Q&A

Francis M. Gengo, associate professor of

pharmacy practice and neurology, is research director of the Sleep Disorder Center of Western New York and director of the Neuropharmacology Division of the Dent Neurological Institute at Millard Fillmore Hospitals.

What attracted you to the study of sleep disorders?

I do not study sleep disorders, per se. More specifically, I study the capacities for various drugs to affect sleep. This includes the obvious, such as whether a "sleeping pill" produces real sleep or another form of unconsciousness and whether the physiology of normal sleep is preserved or affected by the drug, and the impact that this can have on the patient's ability to cognitively function the next day. Less obvious aspects include the potential for medications taken during the daytime to produce sleepiness and/or mental impairment. This includes agents ranging from recreational drugs, to prescription medications taken for systemic illness, and also includes over-the-counter medications.

Everyone's complaining about sleep deprivation. Why is it so hard for us to get a good night's sleep?

The events of the day can produce any number of compromises of a good night's sleep. The most important to identify are frank sleep disorders, such as obstructive sleep apnea, Nocturnal Myoclonus and Restless Legs Syndrome, to name just a few. Secondly, it is important to identify other medical/psychiatric conditions that can secondarily interfere with sleep. This identification requires a careful examination by a neurologist with training in sleep medicine.

Additionally, in response to some of life's stresses, we can take on behaviors that can exacerbate poor sleep. Some examples are:

- Excessive caffeine, especially if consumed after 3 p.m.

- Nighttime alcohol consumption. Ethanol hastens a decreased level of consciousness, but produces an abnormal sleep, a shortened sleep and sleep that is disrupted by multiple nighttime arousals and awakenings.

- Irregular bedtime and sleeptime habits. Sleeping into the afternoon on weekends can make getting to sleep on Sunday night very difficult, renewing the sleep debt.

The tenets of good "sleep hygiene" include: Establish regular bedtime and waketime, eliminate daytime naps, get regular aerobic exercise, have a light bedtime snack and avoid ethanol and tobacco in the evening hours.

Are OTC sleeping aids as effective as prescription sleeping aids?

No. Most over-the-counter agents are older antihistamines that tend to make people drowsy. Feeling drowsy in the daytime is very different from producing nighttime sleep in patients with insomnia. There is little data for OTC agents in patients with insomnia. Those data that do exist show that over-the-counter agents produce an effect that is only slightly greater than placebo and only for the first night or two.

What's the biggest drawback to OTC sleeping aids?

The effect they produce is a very small and transient decrease in time to get to sleep, with no real change in the total sleeptime. These drugs are, however, not without side effects. Many can produce a next-morning hangover. Especially in the elderly, they can produce orthostatic hypertension and urinary retention.

You've also done quite a bit of work on OTC antihistamines. What's the most important thing people should know about these drugs?

These are not benign agents. They can significantly impair cognitive skill; for example, driving. They can produce symptoms in the elderly that can be mistaken for early dementia. The list goes on and on, as can be seen from their respective labels.

What question do you wish I had asked, and how would you have answered it?

How is my son's hockey team doing this season? They have done well enough to qualify for the New York State championship finals, which will be held March 20-22, and if they win those, will compete in the national finals