Sleep medication: Mother's new little helper

The indiscriminate worries and ruminations that churn through the mind of Cheryl Downs McCoy are matters most working mothers have rifled through at some point: “I need to call that guy about fixing the car. I think I’ve run out my daughter’s favorite snack. Should I change the batteries in the smoke alarm?”

These are entirely acceptable matters to ponder. But not at 3 in the morning. Yet that is when Ms. McCoy, a 45-year-old museum exhibit writer in Oakland, Calif., lies awake, debating and categorizing the details of working motherhood.

“Most of the time I get stuck mulling over the logistics of how everything’s going to get done â€" my brain really digs down the minutiae,” said Ms. McCoy, who has consulted a sleep therapist and has tried every prescription and over-the-counter soporific, from Ambien to low-dose anti-depressants, to assuage her maternal unrest.

For some women, the drug of choice is Lunesta; for others, melatonin. Ms. McCoy knows a mother of two who takes Xanax a few times a week, “but she worries about addiction so some nights she just doesn’t sleep at all rather than take it,” she said. “I think she saw the irony in not sleeping because she was anxious about taking an anti-anxiety medicine in order to sleep.”

Mother’s little helper of the new millennium may in fact be the sleeping pill â€" a prescription not likely to inspire a jaunty pop song anytime soon. Nearly 3 in 10 American women fess up to using some kind of sleep aid at least a few nights a week, according to “Women and Sleep,” a 2007 study by the National Sleep Foundation, a nonprofit research group.

Take, for example, Chris Baldwin, a 43-year-old mother of two. Ms. Baldwin goes through extended jags of Tylenol PM only to cut herself off after a fortnight to avert dependency. “The mornings after I stop, I get a hangover,” she said ruefully.

One of the cruel jokes of motherhood is that the sleeplessness of pregnancy, followed by the sleeplessness generated by an infant (a period in which a staggering â€" truly â€" 84 percent of women experience insomnia), is not followed by a makeup period of rest. It is merely the setup for what can become a permanent modus operandi.

Sleep-medicine practices are overwhelmingly dominated by female patients. Dr. Nancy Collop, director of the Emory Sleep Center in Atlanta, said three out of four insomnia patients at the clinic are women.

Why all the angst over bedtime, the one part of the day that, barring nightmares, ought to bring deeply needed peace? Many believe that sleep deprivation among women has worsened. In the “Women and Sleep” study, 80 percent of women reported being just too stressed or worried to turn out the proverbial lights.

Dr. Collop points to the persistent creep of technology into the after-hours, a time once reserved for physical and psychological winding down.

“There’s always the worry another e-mail has come in,” she said. “Just the light from the electronic book or the iPad screen is stimulating.”

It is hard to stop yourself from taking one last just-before-bedtime peek at the screen before calling it a day. For many, that makes falling asleep in the first place a problem.

“My brain is just going, going, going,” said Erica Zidel, a mother and a founder of a baby-sitting company in Boston, who takes melatonin to fall asleep. “It’s so active that I can’t slow it down.”

While women with infants are loath to take something that might conk them into an oblivion the sleep monitor cannot penetrate, mothers with older children seem to have fewer misgivings.

According to IMS Health, a health care consulting firm in Danbury, Conn., the use of prescription sleep aids among women peaks from 40 to 59. Last year, the firm said, 15,473,000 American women between those ages got a prescription (overwhelmingly for Zolpidem, the generic form of Ambien) to help them sleep, nearly twice the number of men in that age group.

Those figures do not include those who are prescribed anti-anxiety or anti-depressant medications, frequently used off-label for insomnia. Nor do they include women who zone out with a glass of wine.

They also do not take into account the many women who have no trouble passing out at 10 p.m. â€" but zing wide awake at 3:30 a.m. with thoughts like those of Anne Kimball, 46, a mother in Oxford, Pa., as she runs “down the menu, from kid to kid”: “Did I send in the permission slip by deadline? Should I chaperone the field trip? Am I green enough?”

Or those of Susan Stoga, a mother of two in Barrington, Ill.: “Did I send that e-mail to my client? Is the permission slip for pictures due today? Do Carrie’s dance shoes still fit? Is Girl Scouts on this week?”

“Stupid stuff, when it comes down to it,” said Ms. Stoga, 46.

Meg Wolitzer, 52, a novelist who half-jokingly named her blog “Written on Ambien,” said: “Waking up in the middle of the night is the problem of every woman I know. The minute I had children I was like the mother listening in the woods for the bear. I don’t know if men are less vigilant, but my husband doesn’t wake up in the middle of the night. He could sleep in a dunking booth.”

Many mothers “never back off the vigilance,” said Dr. Katherine M. Sharkey, a sleep-medicine expert at the Sleep for Science Research Lab at Brown University. A female patient will come in complaining of insomnia, Dr. Sharkey said, and when asked how long she’s had it, the patient will say, “Fifteen years â€" ever since my baby was born.”

ONE of the great untruths of modern parenthood is that children â€" with their runny noses, lost teddies, nightmares real and faux â€" are largely to blame for mothers’ lack of sleep; that women are all like Christina Applegate in the sitcom “Up All Night,” cutely wan from their infant’s 2 a.m. feedings. But here is the reality: it is the mothers who keep themselves awake.

“There’s no release valve to let things fall by the wayside during the day, and that’s creeping into women’s nights,” Dr. Sharkey said. “So they’re waking up in the middle of the night with a million things running through their heads: things that may not be earth shattering, but it’s real stuff and it causes serious sleep deprivation.”

Dr. Meir Kryger, director of sleep medicine research and education at Gaylord Hospital in Wallingford, Conn., said women “are really paying the price in sleep for their current role in society.” Given their often-dueling roles as both a breadwinner and primary caregiver, “they have way more problems with insomnia.”

Some women blame their own perfectionism.

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