Q. I have trouble sleeping. What about trying a newer sleeping pill I saw on TV?

A. Yes, older sleeping pills may have more adverse effects, especially long-lasting ones such as diazepam, temazepam, alprazolam, lorazepam and flurazepam. But both older pills and newer ones such as Sonata, zolpidem (Ambien) and Lunesta can cause you to walk, prepare food or drive while asleep, or trigger bad allergic reactions like anaphylaxis.

Q. A study in the June 28, 2006, Journal of the American Medical Association measured sleep level and night awakenings to see whether sleeping pills or behavior therapy worked better after six weeks. Those on behavior therapy increased time spent in deep sleep by 34 percent, but those on Lunesta pills not only spent more of the night awake, but actually spent 23 percent less time in deep sleep. So taking sleeping pills more than 4 to 6 weeks may worsen sleep quality.

A. Two types of behavior therapy work the best. Try each alone or both together. The easiest, stimulus-control therapy, has five parts:

1. Go to bed only when sleepy.

2. Get out of bed if unable to sleep after 20 minutes; go to another room, do something relaxing — no stimulating activities or thoughts — and return to bed when sleepy.

3. Use the bedroom only for sleeping — don't problem-solve or watch TV.

4. Wake up the same time every day, regardless of the amount of sleep the night before.

5. No daytime napping.

But sleep-restriction therapy may work the best. Try to keep a sleep diary one to two weeks before and during therapy. Estimate total time actually asleep and add one hour to this. Spend this amount of time in bed the first week. If you're in bed at 9, asleep at 10, awaken three times for an hour each, and are up at 7, total sleep time is six hours. For week one, you could go to bed at 11 but awaken at 6, no matter how little sleep you get. Bright light for half an hour on awakening will help reset your cycle.

Divide time actually slept by total time in bed for your sleep efficiency, or SE. If you sleep six hours between 11 and 6, your SE is 86 percent. After each week, increase time in bed by 20 minutes for the next week if SE is above 85 percent, decrease it 20 minutes if it's below 80 percent, and keep it the same if it's 80 percent to 85 percent, but don't reduce time in bed to less than five hours. You'll be drowsy at first (careful with driving!), but you'll go to sleep faster and awaken less. Be patient — behavior therapy takes four to six weeks to work.

Dr. Landis Lum is a family-practice physician for Kaiser Permanente and an associate clinical professor at the University of Hawai'i John A. Burns School of Medicine. Send questions to: Prescriptions, Island Life, The Advertiser, P.O. Box 3110, Honolulu, HI 96802; islandlife@honoluluadvertiser.com; or fax 535-8170. This column is not intended to provide medical advice.

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