I am a 40-year-old woman. My problem is sleep. I never get enough. I wake up with the pillows in the hallway and the covers on the floor. I am presently on Prozac, 30mg a day, and my doctor has had me try Valium, Remeron, and Doxepin for sleep, to no avail. The Prozac has done wonders for my outlook but hasn't helped the sleep at all. I have tried the natural remedies (melatonin, etc.) and nothing seems to help. Is there anything else I can try? I truly hate taking a lot of medicine.

--Laurie

I'm not sure from your question whether your problem is that you can't get to sleep (or stay asleep), which would be a form of insomnia, or whether you fall -- and stay -- asleep easily but are still tired when you awaken. Such problems can be due to a number of possible psychological and physical factors. The appropriate treatment recommendations would, of course, depend on the nature of your problem.

You may benefit from an evaluation for a possible sleep disorder. There are sleep disorders centers (usually hospital-based) throughout the United States. At such centers, patients check in to sleep a night under observation, usually hooked up to monitoring devices that register what's going on with them physiologically. Such an evaluation could determine (or rule out) whether you suffer from a condition such as sleep apnea, nocturnal myoclonus, restless leg syndrome, or narcolepsy -- all disorders with physical origins.

People with sleep apnea, for instance, repeatedly stop breathing during sleep and may wake up hundreds of times during the night, gasping for air. They're usually unaware of their nocturnal sleep/wake pattern but are understandably exhausted during the day due to lack of refreshing sleep. Nocturnal myoclonus involves intermittent leg twitching and jerking throughout the night, while restless leg syndrome features severe leg aches and jerks that inhibit sleep. Narcolepsy, a rare disorder, is characterized by excessive daytime sleepiness and the tendency to fall asleep in the middle of activities.

Nightmares and posttraumatic stress can also interfere with sleep, as can depression and anxiety. Psychotherapy can help address those factors, if present. Eliminating stimulants such as caffeine and nicotine, getting regular exercise, and refraining from using alcohol for sedation (it just increases wakefulness later in the night) can also increase the likelihood of refreshing sleep. I also recommend that people who have trouble going to sleep or who are bothered by nightmares NOT watch the evening news or other violent or stimulating television fare just before going to bed.

You can read more about psychological and behavioral aids to sleep in the book Getting to Sleep, by Ellen Mohr Catalano, Charles Morin, and Wilse Webb. The book also includes a list of sleep disorders centers in the United States. For more information about sleep disorders, contact the American Sleep Disorders Association, 604 Second Street Southwest, Rochester, MN 55902.