When you can’t sleep due to temporary stress or jet lag, taking sleeping pills for a short time – no more than two weeks – may help you get some rest. But many people, particularly older people, wind up taking sleeping pills for more than just a short time. That may cause significant problems, including progressively poorer sleep and, for users of prescription sleep aids, and escalating risk of physical dependency.

Fortunately, researchers have developed a variety of effective techniques for overcoming insomnia without the hazards and expense of drugs.

A poor prescription for sleep

The most commonly prescribed medications for insomnia are the benzodiazepines. Some of those drugs, such as lorazepam (Ativan), temazepam (Restoril), and triazolam (Halcion), remain active in the body for a relatively short time. Long-acting benzodiazepines include diazepam (Valium), flurazepam (Dalmane), and quazepam (Doral).

While safer and more effective than barbiturates that were once widely prescribed for insomnia, the benzodiazepines still have significant drawbacks. The short-acting benzodiazepines may not keep you asleep throughout the night. And all benzodiazepines may leave you feeling less rested and refreshed that you’d feel after a good night’s sleep without drugs.

Benzodiazepines interfere with deep sleep, and some evidence suggests that deep sleep may help restore mental and physical vigor. More important, benzodiazepines, especially the long-acting ones, can cause an array of lingering side effects, including daytime drowsiness, dizziness, confusion, and reduced coordination.

Such hangover effects are particularly strong and worrisome in older people, who retain drugs in their system longer than younger people do, and who may already be susceptible to confusion and falls. One study of some 30,000 people over age 65 found that those who used long-acting benzodiazepines were 70 percent more likely to fall and fracture a hip than those who didn’t take sleeping pills.

Even more serious problems start to develop in most people who take a benzodiazepine for more than a few weeks. First, they build up tolerance to the drug, so they may need progressively larger doses, which cause progressively shallower sleep. If they abruptly stop taking the medication, particularly if it’s a short acting one, they may experience severe “rebound” insomnia or withdrawal symptoms – such as anxiety, aching muscles, or distorted perceptions – that indicate the development of physical dependency. Although overdose of benzodiazepines is hardly ever fatal, the risk jumps sharply when they’re taken with other sedatives or alcohol.

A better prescription?

The U.S. Food and Drug Administration (FDA) recently approved a new type of short-acting sleep medication zolpidem (Ambien). According to the manufacturer. Ambien causes little or no daytime drowsiness, memory loss, rebound insomnia, or tolerance, and has at most only limited potential for physical dependency.

It’s true the Ambien permits deeper sleep than the benzodiazepines. But there’s not yet enough evidence to confirm the manufacturer’s claims about minimal side effects form the medication. More important, no reliable study has tested whether long-term use of Ambien leads to more serious side effects or to either tolerance or physical dependency. And Ambien costs more than similar benzodiazepines – about $30 for a typical two-week supply, compared with $16 for Restoril and $10 for the generic version. While Ambien may turn out to have significant advantages over the benzodiazepines, it will take a few more years of research and clinical experience to know for sure.

No prescription for sleep

Only two nonprescription ingredients, both antihistamines, are used for treating insomnia: diphenhydramine (Compoz, Nytol, Sominex) and doxylamine (Unisom). Antihistamines do not lead to the development of physical dependency. But they are much less likely to induce sleep than the benzodiazepines, and they have many of the same disadvantages: They cause shallow sleep, and people develop tolerance to the medication. Further, they tend to cause even more side effects than the benzodiazepines, including not only drowsiness, dizziness, and confusion but also difficulty urinating, blurred vision, and increased heart rate.

The nonprescription drug that people take the most often to help them sleep is alcohol. But alcohol induced sleep may be fitful, since alcohol suppresses deep sleep; such sleep also tends to be brief, since the body burns alcohol rapidly.

Treat the cause

Consumers Union’s medical consultants believe that sleep medications should be used only to treat brief episodes of insomnia that are caused by severe emotional distress or long-distance travel. For all other sleep problems, doctors and patients should try to identify and treat the underlying cause rather than merely quelling the symptoms with drugs.

For example, new treatments can help readjust the body’s sleep-wake cycle when it runs ahead of or behind the hours actually allotted for sleeping – common cause of insomnia in older people, night shift workers, and air travelers who cross several time zones. And medical treatment may improve a variety of sleep-disrupting symptoms, such as heartburn, difficulty breathing due to asthma or congestive heart failure, pain form arthritis, or frequent urination due to an enlarged prostate gland.

Insomnia can also be caused by sever common medications, including beta-blockers – particularly propranolol (Inderal) – caffeine, asthma medications such as theophylline (Slo-Hid, Theo-Dur) and the nasal decongestants pseudoephedrine (Sudafed) and phenylpropanolamine (Propagest), (Nonprescription diet aids, such as Acutrim and Dexatrim, also contain phenylpropanolamine.) People with insomina should ask their doctor whether any medications they’re taking may disturb sleep and, if so, whether they can take a smaller dose, stop taking the drug at bedtime, or switch to a different drug.

But one of the most common cause of chronic insomnia is simply poor sleep habits – including the habit of worrying, whenever you climb into bed, that you’re not going to get enough sleep, improving one’s sleep habits can usually help relieve insomnia regardless of the cause.

Indeed, a study conducted by researchers at Harvard Medical School found that a combination of the sleep-enhancing measure described below enabled people with persistent insomnia to fall asleep in about 20 minutes – a 75 percent improvement – and to sleep nearly and hour longer than before, six months later, those gains were still apparent. Other studies suggest that improved sleep habits can help roughly half of people who are hooked on sleeping pills to break that tenacious addiction.

Get in the habit

Here’s how to help yourself sleep better without taking drugs:

· Use the bedroom only for sleeping and sex, not for working, eating, or watching television.

· If you don’t drift off within about 30 minutes, get up and do something else until you feel sleepy. The same advice applies if you wake up in the middle of the night and can’t fall asleep again. Some people may want to try following aggressive, apparently effective extension of that principle: Estimate how much sleep you get each night by subtracting the amount of time you lie awake from the total amount you spend in bed. Then restrict you hours in bed to the amount that you actually sleep. In other words, if you’re getting about six hours of sleep a night and have to get up at seven, don’t go tho bed until one. (If you’re not sure how many hours you sleep, start by spending only five or six hours a night in bed.) Once you’re sleeping roughly 85 percent of those hours, extend your time in bed by about 15 minutes per night.