Monthly Archives: June 2011

Study confirms mammography reduces risk of breast cancer death

Reproductive Health

Study confirms mammography reduces risk of breast cancer death

2011-06-30

A new study of more than 133,000 women confirms that regular mammography screenings reduce a woman’s risk of dying from breast cancer.

The Swedish Two-County Trial study began in the late 1970s. In its first phase, researchers divided the study participants in to two groups: Women who were given regular mammograms, and women who were treated with “usual care,” or treatment that did not include mammograms. That screening period lasted for seven years, after which the study’s second phase began and the women were followed for an additional 29 years. Continue reading Study confirms mammography reduces risk of breast cancer death →

Obesity caused by more than sitting on couch

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Obesity caused by more than sitting on couch

2011-06-28

Obesity experts have been saying for years that children who sit in front of the TV screen day in and day out tend to be heavier. It’s the sedentary lifestyle. But now experts are finding it’s not only the couch potato effect, but the television ads children are watching, along with other factors that can add inches to their waistlines.

According to a new policy statement from the American Academy of Pediatrics, titled, “Children, Adolescents, Obesity and the Media,” junk food and fast food ads increase a child’s desire to eat those types of foods. Studies also show that snacking while watching the tube increases. And if kids stay up late at night while watching the tube or playing video games, their lack of sleep can be a major factor in raising their risk for obesity. Continue reading Obesity caused by more than sitting on couch →

How to win over stubborn children

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How to win over stubborn children

2011-06-16

The battles with the older of my two girls began when she was a toddler. I’ve got photos of the tiny thing standing a good distance away from me at the park, arms folded defiantly, eyes glaring as if to say “No way am I doing what you want, lady!” I even have a videotape of her saying indignantly into the camera, “I’m a mommy, too — of my dollies! I’m in charge now!”

Some kids are just built to butt heads with their parents. Call it stubborn or strong-willed or whatever you like. If you’re living with one of these guys, you know that straightforward methods of getting them to follow directions or behave often don’t work. They want to be in charge. But, of course, so do you!

Instead of resorting to the usual verbal combat (aka yelling or pleading), try my so-called sneaky or judo parenting strategies instead.

Being sneaky doesn’t have to mean being underhanded or manipulative with your children. Rather, “‘sneaky parenting’ is actually ‘smart parenting,'” explains parenting educator Sharon Silver of Proactive Parenting, in Tucson, AZ, and author of “Stop Reacting and Start Responding”. “It means approaching your kids sideways instead of straight on, and using calmness, respect, and creativity to get what you want accomplished.”

Rachel Rudman, a mom of two and a pediatric occupational therapist in Cedarhurst, NY, supports this approach. “In my private practice, I constantly recommend what could be referred to as ‘sneaky parenting’ strategies, and they work for me at home, too,” she says.

Her take: It’s simply human nature for everyone — children, too — to want to be included in decisions about their daily habits. “With many kids who need just a little more control, asking their opinion sometimes and giving them choices often are easy answers to getting them to do what ‘we’ want,” she notes.

Try the following tricks and your child will probably even think it was all her idea!

Chore wars

The power struggle: Your toddler spends half the day pulling toys off the shelf and out of the box, then flits off to another activity when it’s time to clean up.

Sneaky strategies

Beat the clock. For the younger set, the best bet is almost always to turn picking up toys into a beat-the-timer game, suggests Malibu, CA, psychotherapist Susan Stiffelman, author of “Parenting Without Power Struggles: Raising Joyful, Resilient Kids While Staying Cool, Calm and Connected”.

Stubborn kids are often intrigued by games and challenges, so see how many toys your child can put away in, say, five minutes. You can push the idea further by keeping a chart and encouraging your child to “beat his best effort,” perhaps rewarding him with a sticker or privilege when he does.

Play the “helper” card. Ask him, “Would you like to be my special helper today? You are so good at setting the dinner table, gathering laundry, cleaning the mirror…” so your child feels like pitching in is actually a privilege.

Think positive. Use encouraging, supportive words, rather than threats, to help take the “fight” out of obstinate kids, emphasizes Stiffelman. Instead of saying “We can’t go to the park until your toys are put away!” try “As soon as your toys are put away, we get to go to the park!”

If your child replies “But I really wanna go play with Brandon,” instead of nagging him about what he has to do to earn that privilege, smile brightly and say “Why yes, you certainly can do that…as soon as all your toys are picked up.”

Bath and bedtime battles

The power struggle: Your child knows that getting out of the bathtub means bedtime is close, so no way is she leaving the water willingly! As for bedtime, she fights it every pajama-clad step of the way. It’s becoming a nightly sparring period for your family.

Sneaky strategies

Tune in. Steal a method that stores and movie producers employ all the time — using music to influence people’s moods. Calming tunes subliminally puts Kellie Pease’s three children into bedtime mode without her ever saying a word.

Each child has a favorite disc that the Derby, CT, mom pops into a CD player during bath- and storytime to help them wind down. This works especially well with strong-willed kids, who may have a hard time relaxing enough on their own to be ready to go to sleep.

Play the “yes” game. Try this clever strategy from Stiffelman: Ask your child questions that will prompt her to answer “yes” at least three times in a row, such as “Wow, you’re having a great time playing with those bath toys, aren’t you?” (Yep!) “What about bringing your swimming goggles into the bath with you next time? Would that be fun?” (Hey, yeah, that’s a good idea!)

“Does that dinosaur float? Can you show me?” (Sure I can! Just watch this!) The “three yeses” help break down your child’s resistance, and she also feels like she’s been heard and understood.

Offer options. Gently guide her toward the next step with two choices, such as “Do you want to dry yourself off with the towel or should I help you?” Don’t announce that bathtime is over; simply start the process.

Move seamlessly through the getting-ready-for-bed routine, offering two options at a time along the way, such as “Which book should we read before bed — X or Y?” If your child balks at the choices — “Neither! I’m not going to bed!” — respond calmly, “That wasn’t one of the choices. Did you want this book or that one?” Repeat calmly as needed.

Stiffelman says stubborn kids hate hearing parents sound like broken records, and they usually give in. If they don’t, simply say “Okay, I guess you’ve chosen not to have a book tonight. Good night, sweetie! We’ll try again tomorrow night!” Lights-out. And don’t give in, even if your kid puts up a fuss. Sticking to your word practically guarantees you won’t have a repeat episode tomorrow night.

Establish a connection. Before actually moving your kids toward the bedroom, use a technique psychotherapist Susan Stiffelman, of Malibu, CA, calls “Connect Before You Direct.” Take a few minutes to sit beside your child and show interest in the game he’s playing or TV show he’s watching.

Ask a few well-placed questions or say something supportive like “I can see why you like this show — it’s really funny!” When kids feel connected to you, they’re much more likely to do what you ask next, says Stiffelman, the author of “Parenting Without Power Struggles: Raising Joyful, Resilient Kids While Staying Cool, Calm, and Connected”.

Negotiate a new bedtime. Bigger kids’ sleep habits are starting to change as they head toward tweendom. If you prefer your child be in bed with the lights out at 8:30 p.m., but he swears he’s not tired until 9 p.m., strike a deal that he must be in his room and quiet — not coming out repeatedly to bug you — at 8:30.

Then he can stay up and read or play quietly, and you’ll trust him to put himself into bed when 9 p.m. rolls around. Strong-willed kids see this kind of deal as a “win” on their part because it gives them an added measure of independence.

But be clear that if your child breaks the deal — by being loud, coming out of his room, or ignoring the new curfew — you’ll go back to the earlier lights-out time.

Dinnertime dynamics

The power struggle: Your child refuses all veggies, eats only white foods, or insists he isn’t hungry at all. You fear he’ll starve, and you resent his attitude after you’ve worked so hard to prepare the meal.

Sneaky strategies

Start small. Give picky eaters very small portions of everything you’re serving, then let them choose what they want to eat, if anything, recommends child-development and behavior specialist Betsy Brown Braun, the Pacific Palisades, CA, author of “You’re Not the Boss of Me: Brat-Proofing Your 4- to 12-Year-Old Child”.

The critical key to your sneakiness: Don’t say a word about the food. No pushing your child to try just a bite. “Talk about your day, the weather, anything other than food, since that’s what picky eaters are waiting for — a chance to fight with you,” says Brown Braun.

Dish up a dessert. If you know your child is just biding his time until he gets his end-of-the-meal treat, don’t deny him, but do make sure it’s super small, like one chocolate kiss or a vanilla-wafer cookie, Brown Braun says. You can even put it on the plate with dinner so your child knows that’s all he’s going to get.

That way, there’s no more bargaining with your child to eat “real food” in return for sweets. He gets dessert no matter what, and you won’t feel like you’re caving in, because the treat is so small and unexciting. Plus, there’s no way that little dessert will fill your child up.

If he’s still hungry — and he will be — he’ll have to go back to his entrée and the accompanying veggies!

Keep your cool. Have one unchanging food alternative your child can make himself if he doesn’t want what you’re serving. It should be easy, nutritious, something you always have on hand, and not require cooking.

Think beans, yogurt, hummus, or even the good old PB&J sandwich, suggests child and family therapist (and mom of three kids) Wendy Young of Newberry, MI. “Even three-year-olds can smear peanut butter on bread, and it’s important for stubborn kids to be in charge of the alternate food,” she says.

After a few meals of this, most kids will weary of preparing (and eating) their alternate food and give in to what you’re serving. If your child decides to eat nothing at all, Young suggests supporting his decision and calmly acknowledging, “No problem. You can have a big breakfast tomorrow.”

Really headstrong kids can carry on this act for a long time, however, so be prepared. The most important thing here is to keep calm and not have an emotional reaction. Encouraging, but never forcing, your child to eat a variety of foods should be the main objective.

Keep in mind, too, that tastes change over time, so what a child refuses to eat today may actually be well-liked in several months.

Wardrobe willfulness

The power struggle: Your little fashionista pushes to wear clothes that you think look silly or are inappropriate for the weather, not to mention continually changing outfits in the time-pressed morning.

Sneaky strategies

Clean out the closet. First off, having too many clothes adds fuel to the fire here. If your child’s closet is bulging, parenting educator Sharon Silver suggests rotating an assortment of clothes every few weeks (move the extras into bins out of sight) or simply putting away out-of-season items.

If there’s anything in your child’s closet that you consider inappropriate (too-tight pants, ripped or stained shirts, fuzzy boots in summer), you’re the parent: Remove them. Argument over.

Pick your battles. Every evening before bed, narrow down your child’s clothing options to two or three ensembles from which she can choose for the next day. But remember: Allowing your kid to make the final decision is still important. “Like adults, kids feel more comfortable all day long if they are wearing clothes that feel and fit them right for that particular day,” says Silver.

Another sneaky secret: laying out the complete outfit the night before, to head off manic morning battles.

Ignore the weather. As for the coat conundrum, “Just let it go,” says Silver. If your child doesn’t want to wear a jacket, “Stay quiet, then listen for the chattering teeth in the backseat or while you’re walking,” she says.

You could also let your kid either carry it or put it in her backpack just in case (again, two choices you’re fine with). Sneaky parents let strong-willed kids learn the value of outerwear on their own, because that’s usually how they learn best.

Homework hassles

The power struggle: Your child constantly whines for your help when you know she’s capable of doing homework herself, or is still finishing up assignments when it’s bedtime.

Sneaky strategies

Break it down. First, consider that your child’s stubbornness or whining may actually be a sign that she’s overwhelmed by her schoolwork or has trouble focusing. If that’s the case, try breaking down her tasks into smaller increments (two math problems, three spelling words written out, etc.) and letting her jump up and down or run laps around the room as a break before she goes back for more work.

Use the timer approach for tough cases: Your child works for ten minutes, takes a one- to two-minute break, then works for another ten minutes. Most kids can do almost anything for just ten minutes at a stretch!

Make it fun. Could your son do his required reading in a tent you make with a table and a sheet? By flashlight in a dark room? Could your child practice her spelling while bouncing a ball or jumping rope (as the main character did in the movie “Akeelah and the Bee”)? Give it a shot.

Do a disappearing act. If you’re confident your child really can handle things on her own, purposely move to a different part of the house while she does her homework, suggests Brown Braun. Make it a rule that she must come to you if she has any questions, not vice versa.

Of course, you’ll want to check in with her about halfway through and at the end to be sure she’s on track. But if your student has to climb a flight of stairs to ask for help or lug a heavy textbook to you, she may learn to take a minute to think on her own before she seeks you out.

Good in Bed: Getting back in sexual sync

featured, Sexual Health

Good in Bed: Getting back in sexual sync

With an estimated 40 million Americans stuck in sexless marriages, mismatched libidos could be the No. 1 sex-related issue facing couples in long-term relationships.

Generally, at the start of a relationship, the thrill of infatuation keeps us sexually motivated – the whole “can’t keep your hands off of each other” phase – but once we settle into a sense of routine, gaps in libido that may have previously been masked become revealed. Sex drive is very individual, and no two people can reasonably expect to always be in sync over the course of a long-term relationship, regardless of their love for each other.

Mismatched libidos are so common partly because our individual sex drives interconnect with so many other aspects of our lives, and numerous factors can lead one or both partners to experience diminished desire at one point or another. If you stay in a relationship long enough, it’s almost guaranteed that at some point you’ll be dealing with one or more of these issues and that your libido or your partner’s will change:

– Stress, depression, and anxiety
– Age, health, and medical treatment
– Lifestyle issues such as sleep, exercise, nutrition, and tobacco and alcohol consumption
– Relationship boredom
– Diminishing sexual attraction to one’s partner
– Relationship issues and anger
– Lack of sexual enjoyment during partner sex
– Milestones such as having kids that often test a relationship
– Lack of prioritization of sex

Unlike a general sex rut, in which both partners experience diminished desire, libidos that are starkly mismatched can present a whole new array of problems. When you want sex but your partner doesn’t, the rejection can sting – and highjack your relationship emotionally: Your self-esteem can plummet and an inner rage can seethe.

The ego is extremely frail when it comes to sex, and even being rejected once or twice can lead you to give up altogether. On the other hand, if you’re not feeling in the mood, even a hug or a kiss can feel like a sexual overture and create a sense of sexual pressure. Mismatched libidos can be complex, so it’s worth seeking out a therapist or counselor to help cope with them, especially if the problem has been going on for a while. In the meantime you can visit one of our experts in our forum at Good in Bed and here are some tips to help you get in sync:

– If you’re in a relationship in which non-sexual physical intimacy has dried up to the point where any gesture of intimacy comes off as an overture to have sex, it’s probably a sign that you need to cultivate more non-physical intimacy in your relationship. Recent research shows that kissing is paramount to men’s sexual satisfaction, according to researcher Debby Herbenick, Ph.D. Men who report engaging in more kissing, cuddling, and touching with their partners tend to be more sexually satisfied in their marriages. If sex is like a plant and easily prone to withering, then non-physical intimacy is a vital nutrient, like the sun. Create a zone in your relationship where you can be physical and affectionate without the pressure of those activities leading to sex.

– Don’t give up on sex, especially if you’re the partner with a higher libido. I offer this advice a lot to new parents, especially dads who often find themselves feeling like a third wheel or who are frustrated that their wives are so disinterested in sex. It’s easy to turn off and tune out, and many new parents have gone months, even a year or more, without having sex. But a couple has to restore intimacy, which often requires the patience and loving persistence of the higher-desire partner. Life is full of ebbs and flows, and common milestones—like having kids—can transform a relationship and often one’s sex life.

– Communicate about the issue, figure out what’s going on, and come up with a plan. Usually the issue just goes unacknowledged too long, leading to a sense of silent desperation. But relationships come with lots of difficult conversations – about money, kids, in-laws – and talking about sex shouldn’t be swept under the rug, either. When sex drive disappears (from an individual or a relationship), it’s generally a sign that something else is going on. Sex is a clue and a motivation to get to the bottom of the problem.

– Make the conversation sexy. It takes more than just constructive communication to get in the mood. That’s why so many sex therapists and counselors give their patients homework. The brain is the biggest sex organ, so find something sexy to say about your partner, share a fantasy, do something that is simultaneously sexy and boosts your partner’s self-esteem.

– Enjoy your sexuality on your own. Masturbation isn’t a substitute for the thrill and sensuality of skin-on-skin partner sex, but if you’re the higher-desire partner it can help take the edge off and fill natural gaps in libido. For lower-desire partners, just because you have less interest in sex with your partner that doesn’t mean you can’t or shouldn’t enjoy your own sexuality. Sometimes masturbation can provide a sexual jumpstart.

– Pay attention to how you handle the issue. When a little dry spell starts to become a permanent rut, we usually deal with it in one of two ways: lashing out and being mean, or holding a grudge and acting like everything’s fine. Neither option is healthy. Left unattended, mismatched libidos can create issues that spiral out of control and lead to unfortunate consequences, such as infidelity.

– Last of all, have sex. Try it – you’ll like it (we hope). This is especially true if you’re the type of person that wants to want sex, but just doesn’t. Sometimes you have to put your body through the motions and wait for your mind to follow.

If, despite these tips, you really feel like your libidos are irreconcilably mismatched, see a professional. Visit the website for the American Association of Sexuality Educators, Counselors, and Therapists at aasect.org to find a therapist. With the right care and feeding, your sex life can thrive.

Should Kids Under 13 Be on Facebook?

featured, Uncategorized

Should Kids Under 13 Be on Facebook?

2011-06-14

In a perfect, law-abiding world, no child under 13 has a Facebook account. But this world is pretty far from ideal, if the 7.5 million tweens — and younger kids — trolling the social-media behemoth are any gauge. Now, if Facebook founder Mark Zuckerberg gets his way, that already impressive number will explode.

Last week, Zuckerberg told the NewSchools Venture Fund’s Summit in Burlingame, Calif., that he’d like younger children to be permitted to patronize his site. Technically, the Children’s Online Privacy Protection Act (COPPA) prohibits websites that gather data about users from allowing access to anyone younger than 13. In reality, though, COPPA is pretty ineffectual.

Consumer Reports (CR) recently announced results of an annual survey that found that “more than one-third of the 20 million minors who actively used Facebook in the past year” were under 13.

In fact CR found that over 5 million of Facebook’s 7.5 million-plus underage were as young as “10 and under.” … That’s not the worst of it. CR also found that underage kids using Facebook were unsupervised by parents. The site claims — not wrongly — that this exposes them to “malware or serious threats such as predators or bullies.”

Consider other points raised in the report like: 15% of all Facebook users post “their current location or travel plans,” 34% post their birth date in full, and 21% with children post their children’s names and pictures.

What about Facebook’s privacy controls, your bastion against all things nefarious? CR found “roughly one in five” weren’t using them.

Still Zuckerberg insists that connecting on Facebook — for educational purposes, natch — is a must for young kids. “That will be a fight we take on at some point,” CNNMoney quoted him as saying. “My philosophy is that for education you need to start at a really, really young age.”

(More on Time.com: Pediatricians Should Discuss ‘Facebook Depression’ with Kids)

Zuckerberg, not so far removed from the gawky age of 13 himself, says that Facebook has not begun researching how to open up the site to young kids and protect them at the same time. “Because of the restrictions we haven’t even begun this learning process,” he said. “If they’re lifted, then we’d start to learn what works. We’d take a lot of precautions to make sure that they [younger kids] are safe.”

Whew. That’s reassuring.

Still, it’s undeniable that kids simply don’t have the same powers of judgment as adults. Consider, for example, the New Hampshire teen who mourned on Facebook that Osama bin Laden hadn’t first offed her math teacher before he was killed. “In hindsight, she’s mortified that she said that, but she’s a 13-year-old kid,” the girl’s mother, Kimberly Dell’isola, told a local television station.

That’s exactly why the publisher of Consumer Reports isn’t quite as cavalier as Zuckerberg about little ones friending and tagging to their hearts’ content. On Friday, the nonprofit Consumers Union worried that kids and teens don’t really get why it’s so important to self-censor what they share with the online world. “We urge Facebook to strengthen its efforts to identify and terminate the accounts of users under 13 years of age, and also to implement more effective age-verification methods for users signing up for new accounts,” Ioana Rusu, the regulatory counsel for Consumers Union, wrote in a letter to Zuckerberg.

According to the Los Angeles Times, Rusu’s letter came on the heels of a congressional hearing questioning the security of underage Facebook users:

Senate Commerce Committee Chairman John D. Rockefeller (D-W.Va.) said it was “indefensible” that Facebook had only 100 employees monitoring the activities of its 600 million users.

At the hearing, Facebook Chief Technology Officer Bret Taylor said Facebook shuts down the accounts of people found to be lying about their age. But he acknowledged that Facebook depended on other users to report underage users.

The Consumers Union urged Facebook to be more “diligent and effective” at safeguarding the millions of minors who frequent the site. It suggested a few ways to do that: make minors’ default privacy setting one that facilitates sharing with “friends only” instead of “friends of friends;” for the average user, that amounts to nearly 17,000 people. And institute an “eraser button” that users can click to delete embarrassing information posted on the site when they were underage.

An eraser button? Should it actually be created, many adults will likely lobby to use it too.

Go ahead – ‘sext’ your spouse

featured, Sexual Health

Go ahead – ‘sext’ your spouse

2011-06-10

Is “sexting” really cheating? Well, if, like Congressman Anthony Wiener, you’re married and sexting someone other than your spouse (and without your partner’s knowledge or approval), of course it is!

In an earlier post for The Chart, I talked about Internet infidelity and how it’s accelerating at a record pace. With its easy accessibility and novelty, the Internet enables us to easily tune out and turn off to our partners, when we should be making an effort to tune in and turn on.

The instant gratification of these technologies stimulates reward centers in the brain, and soon we find ourselves craving the quick hit of an instant connection or lamenting its absence.

Real relationships take time and patience, whereas sexting a stranger or engaging in a flirtatious Facebook friendship brings us a quick thrill and requires a lot less work. And the more technology becomes a personal accessory that renders us always on, the more likely we are to become novelty seekers in search of the next ping.

We live in an era when many consider sexual infidelity to be the ultimate personal betrayal. But there are those who believe that if infidelity doesn’t involve a physical component, it’s not really cheating—and that’s just not true.

The accessibility of the Internet means that we need to be more vigilant of emotional infidelity, and seemingly benign activities that nonetheless have a sexual and secretive component.

In her seminal book on emotional infidelity, “Not Just Friends,” the late psychotherapist Shirley Glass implores readers to “maintain appropriate walls and windows. Keep the windows open at home. Put up privacy walls with others who could threaten your marriage.” She contends than an emotional affair is marked by three distinguishing qualities:

– Close friendship and emotional intimacy. An emotional affair often begins as friendship and gradually drifts into something more. While friendship alone isn’t enough to qualify as cheating, a feeling of shared closeness and understanding is the starting point for an emotional affair.

– Sexual attraction. An emotional affair is fueled by feelings of attraction between two people.

– Secrecy. Here’s where friendship and attraction cross the line into emotional cheating. In an emotional affair, each person stops sharing certain aspects of the friendship with his or her partner, and starts confiding more in the “friend” and less in his or her partner.

We’re all living, breathing sexual beings. Attraction doesn’t end once we’re in a relationship. Even the most happily coupled people are going to feel the familiar buzz of attraction when someone catches their eye or laughs at one of their jokes. And as I discussed in another column for The Chart on negotiated monogamy, some couples are even willing to expand the boundaries of flirtation and accepted behavior within their relationship.

Relationships often start out in the “fast lane,” but eventually we find a comfortable cruising speed in the middle lane, and sometimes switch over to the slow lane.

Some relationships run out of fuel altogether, and every couple needs a jump-start every now and then. Instead of seeking that jolt of excitement from outside your relationship, make more of an effort to seek it within.

Beware the sleeping pill hangover

Psycological Health

Beware the sleeping pill hangover

2011-06-08

Henry was 80 years old and “tired all the time.” His primary care doc had done a thorough work up. I tested for every sleep disorder known to man and god and found no underlying problem with his sleep quality.

At our initial visit, I had expressed my concern that his hypnotic medication, Clonazepam, could be part of the problem, especially because his dose of 2 mg was rather high for a man his age. He had been reluctant to make any changes to a medication that, from his point of view, had worked so well for him over the years. Now, with all other explanations ruled out, he was ready to try to get off it in order to feel less groggy in the morning.

I tapered him slowly and he had no withdrawal symptoms nor any rebound insomnia. He feels more energetic and less sleepy in the daytime and he only occasionally uses a sleeping aid when he has trouble falling asleep.

This is a scenario that is played out every day in my sleep clinic: the medications that we doctors give to help patients sleep end up making them feel tired and groggy the next day.

Clonazepam (Klonopin) is a common culprit. It belongs to a class of drugs called benzodiazepines. They have been used as sleeping agents for decades. They have many other uses including the treatment of anxiety, seizure and muscle spasm.

In general, these drugs can be very useful sleep aids, but must be used cautiously because they will often cause dependence, tolerance, withdrawal and rebound insomnia if used long enough on a nightly basis. Dependence is fairly self-explanatory and means that a person cannot sleep without the drug. Tolerance means that that the dosage has to be repeatedly increased to achieve the same affect. It is not the same as addiction but is often confused with it.

They can also cause withdrawal which means the emergence of a new set of symptoms that were not present before using the medication. Common withdrawal symptoms include agitation, nausea, sweating and palpitations.

The benzodiazepines can cause rebound insomnia. Rebound insomnia means insomnia that is worse than it was before a patient started the drug. Typically, it lasts only one or two nights.

The problem with Clonazepam in particular is that it has a very long half life. Therefore, it takes a long time to clear the system and its hypnotic and sedating effects can last well into the next day. There can be withdrawal if stopped abruptly, but it is less likely to cause rebound insomnia when compared to shorter-acting benzos.

Besides daytime sedation, any of the benzodiazepines can cause amnesia, sleepwalking and sleep eating. There are studies showing increased fall risk in the elderly, but there is also research showing that untreated insomnia increases falls. There is definite concern that these medications can have multiple deleterious effects in the elderly including memory and cognition problems. As with most medications, the doses should be lower when patients are elderly or have liver or kidney impairment.

For insomnia treatment, it is better to use benzodiazepines that have a medium half life such as lorazepam or temazepam. They will usually help someone get to sleep and stay asleep most of the night without too much hangover effect the next morning.

As with most prescription sleep aids, I recommend intermittent use so that tolerance and withdrawal might be avoided.

Medications such as zolpidem (Ambien) are called non-benzodiazepines but that is misleading because they act on the same GABA benzodiazepine receptors in the brain. They just don’t bind to as many subunits as the traditional benzos which has good and bad effects. One bad effect is that drugs like Ambien have no anti-anxiety properties and most people with insomnia have anxiety either that is fueling the insomnia or as a consequence of the insomnia.

Therefore, if someone has chronic, nightly difficulty falling asleep or staying asleep, I recommend CBT-I (cognitive behavioral therapy for insomnia). As I have discussed in previous posts, it is the safest treatment and actually the most effective one in the long term.