"It's a very strict program," Remmes says, "and nobody likes to do it," but results usually last forever, as long as patients maintain good sleep hygiene. The program works, she says, because most insomniacs underestimate the amount of time they sleep. The woman who reports getting only five hours probably gets six, or has a weekly catch-up night when she passes out for eight or ten hours. Limiting herself to five hours and then gradually extending the time is going to boost her sleep drive, and her nocturnal self-esteem. As little as two weeks of decent sleep can make a dramatic change in her state of mind, according to Bains. "Confidence is a powerful thing," he says, when it comes to falling asleep.

Sometimess the best solution is medication. Gynecologist Judith Reichman, MD, author of the book Slow Your Clock Down: The Complete Guide to a Healthy, Younger You , may prescribe hormone replacement therapy for newly menopausal patients who are suffering from significant sleep problems; she reevaluates the women after three and five years, when, she says, about 80 percent of troublesome symptoms go away. If endorsing HTR is a controversial position these days, Reichman points out that much of medicine involves choosing the lesser of two evils. A woman how hasn't slept well in three years is probably going to have health problems, including impaired immunity and depression.

In many cases, insomnia experts prefer the strategic use of short-acting prescription sleep drugs (see "Snooze Control" ) in conjuction with behavioral changes. Sonata, which lasts about three hours, and Ambien, which lasts about six hours, can be especially helpful for women who have trouble falling or staying asleep, because they won't feel groggy in the morning. But Bains points out that both drugs are for short-term use only, generally no more than a couple of weeks. For ongoing sleep troubles, he suggests addressing behavioral factors rather than continuing to take medication.

In the meantime, happy insomniacs suggest trying a little imagination before reaching for drugs. Some nocturnal habits may not need to be cured. And for anyone who can manage to keep her eyes open and her demons at bay, those wakeful hours are precious—"the gift," says Robin, "of extra time."

Snooze Control
Sleeping pills do not have a great rep. But when all else fails, isn't there some dreamy little thing you can pop for a good night of slumber? Here's how the nocturnal drugs and natural remedies stack up, along with their risks and side effects.


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