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Do you ever lie awake at night, unable to fall asleep? While it may feel as though you are all alone in that moment, you are far from it.

The Centers for Disease Control and Prevention estimates that 50 million to 70 million Americans suffer from insomnia. And if sales of prescription sleep aids are any indication, it is a growing problem. Some 59 million sleeping pills were prescribed in 2012, with usage significantly increased in those younger than 45.

Women are more likely than men to experience insomnia, thanks to hormonal fluctuations, hot flashes and pregnancy, not to mention stress, depression and anxiety. One common scenario I see in my office is the young working mother who can’t fall asleep because from the moment she crawls into bed, she starts thinking about her to-do list and the things that worry her.

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For insomniacs, the idea of a prescription sleep aid seems like light at the end of the tunnel. However, medications such as zolpidem (Ambien) can have serious side effects such as sleep walking, morning grogginess and even amnesia.

The Federal Drug Administration made a strong recommendation earlier this year for doctors to avoid prescribing more than the 5 milligram (rather than the 10 milligram) dosage to women, who do not metabolize the drug as quickly as men. (The FDA recommendation does extend to men also, but not as strictly as for women). This was based on data revealing impaired alertness and higher-than-expected blood levels of zolpidem in those who took the medication the night before, even when they did not feel groggy the next morning.

If you and your doctor decide that a prescription sleep medication is appropriate, taking the smallest amount for the shortest period of time is preferred.

What can you do to get good shut-eye without medications? Here are some tips:

• Avoid caffeine in the afternoon or evening.

• Don’t be fooled by alcohol’s sedative effects. It can make you feel sleepy, but it tends to disrupt sleep in the second half of the night.

• Be realistic about how much sleep you need. Just because you recall being able to function on five hours of sleep in the past doesn’t mean it’s a good idea now.

• Avoid checking Facebook or your email before bed. Lights from TV, phone and tablets can affect melatonin levels, leading to difficulty sleeping.

• Go to bed and wake up at the same time every day.

• Exercise regularly, but not less than four hours before bedtime.

• Use the bed for sex and sleep only. (What’s not to like here?)

• Make your to-do lists well before bedtime. If you tend to worry at night while in bed, consider scheduling a specific time earlier in the day to mentally go over your concerns.

In short, sleep is complex but often taken for granted. Medications for insomnia have their role but are not without side effects (and can affect alertness more than we previously thought). And though it can take some diligence to get good quality sleep without medications, it is well worth the effort.

Linda Pourmassina, M.D., is an internal medicine physician who practices at The Polyclinic in Seattle. She authors a blog at and can also be found on Facebook and on Twitter (@LindaP_MD).

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