DOCTOR IS IN: Sleepless in Atlanta

By David Schulman, MD, MPH

Every night, thousands of Atlantans have difficulty falling asleep. In some cases, the problem will be severe enough that they will seek medical advice, though many more will choose not to, believing either that the problem isn’t that big, or that there aren’t any effective therapies available. Others end up using either prescription or over-the-counter sleep aids on a regular basis. That may come with its own set of problems.

When a patient comes to my clinic, I begin the evaluation by looking at three key components of the bedtime process: the environment, evening behaviors and patient attitudes. Are the bed and pillow comfortable? Is the bedroom dark, quiet and cool (People tend to sleep better in cooler weather; making sure the ambient temperature is dropping around bedtime can often improve sleep quality). Are there other noises in the area, coming from outside or the person in bed next to you?  Correction of these factors does not require much work and can often improve symptoms of insomnia.

But, some insomnia patients engage in behaviors before bedtime that make it harder to sleep. A large meal within one-to-two hours, exercise within three hours and caffeine within 12 (!) hours of bedtime can all contribute to difficulty falling asleep.  Another common mistake is to use television or a computer just before going to bed – such activities can make your body more alert and cause insomnia. I am constantly amazed at the number of people who leave the television on to help them fall asleep, in almost all cases, this does more harm than good.

I spend a great deal of time focusing upon the attitudes of patients as they approach bedtime. Depression is very common amongst people with insomnia, and treatment of the underlying mood problem can improve sleep quality. Is my patient nervous or anxious? Often, underlying stress can be the major contributor to poor sleep, even if the affected individual doesn’t feel “stressed out” during the day. Indeed, many patients with chronic insomnia begin to see their bedrooms as a stressful place, and going to bed each night becomes a chore. These attitudes contribute further to anxiety, making insomnia even more likely. Breaking this cycle is a key component of the treatment of insomnia.

Treating insomnia with medication is common. The National Sleep Foundation says that 25 percent of Americans take some type of medication at least once per year to help them sleep. While occasional use of such medications is likely to be safe, the regular need for sleep aids may suggest an underlying sleep or mood disorder that should be evaluated by a specialist. The use of non-prescription sleep aids such as melatonin and valerian is also quite common. It is important to remember that these compounds are not regulated by the Food and Drug Administration, and their effectiveness or safety has not been reliably demonstrated.

Why is all of this important? There is growing evidence that sleeplessness can contribute to illness such as diabetes or heart disease, and many problems can arise when someone has not gotten a good night’s sleep – such as falling asleep while driving or while on the job. We all want to be as healthy as we can – eating right, exercising – and I can tell you that getting a good night’s sleep is just as important to overall health. If you have regular sleep problems, discussing this problem with your doctor may be the first step to finding a solution.

Atlanta, what has been your experience? Share your stories, share your ideas. Post.

(Information provided by Emory on this site is intended solely for general educational purposes and is not intended or implied to be a substitute for professional medical advice. Always seek the advice of your physician or other health provider for any questions you may have regarding your health and medical condition. If you rely on any information available through this website, you do so at your own risk. You understand that you are solely responsible for any damage or loss you may incur that results from your use of or reliance on any material or information provided by Emory through this website.)

8 comments Add your comment


March 11th, 2009
8:40 am

Great Post. A friend just spent me a link for a free sleep report. It has a bunch of great information about getting a great night’s sleep without drugs. Here is link if you are interested

What's sleep?

March 11th, 2009
11:46 am

Falling asleep isn’t my problem. Waking up between 3:30a-4:30a everyday. Now THAT’S a problem.


March 11th, 2009
12:50 pm

My wife and I do not sleep in the same room (or spend much time at all in any room together for most of the past decade for that matter, but that’s another story.) She sleeps with the lights on and the television playing. Apparently, she is warding away the bogey man.


March 11th, 2009
2:07 pm

I’m in my mid-40’s and I’ve found if I get 4 hours of sleep a night that’s great. I can’t sleep during a full moon. I know it’s in my head, but I haven’t been able to for years. Last night I got a lot of work done!


March 11th, 2009
2:40 pm

I’ve had insomnia since I was a little boy. My mom will testify to that. It has gotten worse over the past year. I’ve seen a sleep doctor and he says there is no reason for me not to sleep well. My primary doctor wants to do a narcolepsy study. I’ve done everything – no tv, exercise regularly, don’t drink caffeine, go to bed at the same time every night, etc. Nothing seems to work. I also have a prescription for the highest dose of Ambien. I always wake up after about three or four hours anyway and can’t go back to sleep. I seem to wake up at night no matter how tired I seem. I’ve tried other sleep aids and they don’t work either. I’m getting very tired of being tired all the time. Also, I have Crohn’s Disease but no one has ever said anthything about the two being related or about the medications as all the side effects are drowsiness and so on and so forth. Any alternate ideas?


March 11th, 2009
4:46 pm

I blame not being able to sleep on the time change, as soon as I get used to it, the freakin time changes again. When are the powers that be going to do away with this? My dog whining every morning to go out when the sun comes up doesn’t help either. Also, I have a Tempur Pedic and it’s highly overrated. “Oasis” my a$$! My mom says the same about her sleep number bed also.

Stephen Shapiro

March 11th, 2009
6:20 pm

Dear David, Your dad sent me your Blog…most impressive…
Maybe you or someone you know may be able to HELP ME. I suffer fom chronic pain due to iddypathic periphial neuropthy in both my feet, lehs, hands and arms. Carol and my son , Robbie got my meds whay down, but Im still on 3 50 MGH Fentanyl patches every 2 days; 3 10MG Methidone daily; and now only 1 0r 2 8MG Dilaudid as needed for break through pain. I had also been taking .25MG of Halcion when I really needed it for sleep.
Since we have been down here in Florida for the winter, I don’t think I have had two nights of good sleep in a row. I’m aware of everything..all the twitchig and shooting pain in my legs and arms, pain in my neck and shoulders. The room is usually uit and cool and I generally go to bed a half hour to an hour after Carol, o she can get some needed sleep. Most nights I’m NOT there long….and go back out to atch TV, read, go onto the computer, ec, until I’m ready to fall down with fatigue…and many nights NOT at all.
We eat early, and quite light…I may have a snack and something to drink at about 10P.M.,,,NO Excercise or MEALS.
ANY SUGGESTIONSD or IDEAS? Not only with the insomnia and sleep apnia, but equally important for the Perphial Neurapathy and constant PAIN. Oh yes, I forgot t tell you I also ITCH ALL OVER from the top of my head to the bottom of my feet most days and nights..ALL the time. HELP PLEASE!

Thanks so much… I hope there may be something you might suggest or do for me…I’m at the end of my rope…and Carol is too.

Please give Kim and your beautiful and big children a kiss for me. Our fondest regards to ALL. We’re so proud of YOU!


March 18th, 2009
10:57 am

All my life I have had sleeping problems. Tried prescription medicine as well as over the counter nothing worked so I just got use to sleepless nights. A co-worked suggested I try Melatonin which is over the counter. I take it 30 minutes before I want to fall asleep. Worked for me. I may not sleep more then 4 or 5 hours but I do not have to fight anymore with getting to fall asleep.