When people are having a hard enough time falling asleep that they seek medical help, they are usually looking for an easy answer, and all too often that comes in the form of a pill. Joan Rossman is a classic example of the type – a psychotherapist, Rossman found herself unable to fall asleep, and when she did fall asleep easily she would wake up far earlier than she wanted to and find herself unable to fall back to sleep. “Whether I was preoccupied or excited, it played out in my sleep patterns. I would awaken just exhausted. I knew something was not right,” she said. Rossman sought help from sleep doctor Barry Krakow, who diagnosed her with sleep apnea. Rather than prescribing sleeping pills he gave her a positive air pressure device that provides her with a constant flow of air that keeps her airway open, and she is now sleeping soundly. Rossman was surprised at the diagnosis. She had been anticipating being given a pill to take each night, but Krakow has spent years analyzing data on his patients past and present, and he understands that when patients come to him complaining about insomnia, most of them were already taking sleeping pills. Out of over 1,200 patients 899 were on medication but were still complaining of problems getting a good night’s sleep. In response he took on research into whether those patients were suffering from apnea. His results were recently published in the journal Mayo Clinic Proceedings. What he discovered was that his patients who were taking sleep aids were still complaining of it taking over half an hour for them to fall asleep or of waking up in the middle of the night. He also found that they were spending more than fifteen percent of their time in bed lying awake. All of these facts pointed to the fact that the medications were not doing their job, and he realized that it might have been due to them being inappropriately prescribed. “The average person on these pills has been on them for four, five, ten, twenty years. For all we know, it has some benefits, but did it cure your insomnia? No, it turns out you have another problem,” he says. Krakow says that in most cases the problem si a variety of sleep-disordered breathing, and in many cases the solution is the use of the positive airway pressure device. He determined this by observation of his patients in his sleep lab. Rossman provided a perfect example. Over a series of several sessions she used the device and slept soundly – more soundly than she had in years, despite the fact that she was in an unfamiliar, uncomfortable environment. Krakow’s senior research investigator, Victor Ulibarri, says, “When people are given devices, they cut their sleep problems in half. The only problem with it is that it isn’t comfortable for everyone.” Rossman admits that it took some time to adjust, but that the device has proven invaluable.