Desperate for sleep

Safe when taken as directed.

But Xanax, Valium, Lunesta, Restoril and Ambien, the various and assorted sleeping and anti-anxiety medications found near the corpse of Heath Ledger in his Manhattan apartment last week might have conspired to kill the troubled 28-year-old actor.

In combination, in the wrong person, they may not have been safe at all.

The Australian heartthrob, famous for his portrayal of a gay cowboy in the movie Brokeback Mountain, was both an insomniac and dogged with anxiety and depression.

Ledger knew the frustration of chronic sleep loss, and was forthcoming in an interview last November while promoting the Bob Dylan biopic I'm Not There.

"Last week I probably slept an average of two hours a night," Ledger told The New York Times. "I couldn't stop thinking. My body was exhausted and my mind was still going." He said two Ambien pills worked for only an hour.

"Insomnia is an enormous problem in North America," says Dr. Gilles Lavigne, president of the Canadian Sleep Society, who estimates 30 per cent of Canadians suffer from intermittent bouts of insomnia, trouble falling or staying asleep, or waking up too early. Worse, 10 per cent of Canadians suffer from chronic insomnia, he says. The line is drawn when lack of sleep starts to persistently interfere with daytime functioning and mood.

Dr. Charles Morin, of Laval University in Quebec City, is a world leader in insomnia research. Author of Insomnia: Psychological Assessment and Management, Morin estimates, "four in 10 chronic insomnia sufferers also experience concurrent psychological problems such as anxiety, depression and substance abuse."

Much of Morin's research centres on cognitive/behavioural treatments, such as distraction therapies. Medications, he says, should only be considered as short-term solutions.

Some sleep disorder researchers have drawn connections between insomnia and creativity – a well-documented Ledger trait.

Wende Wood is a psychiatric pharmacist at the Centre for Addiction and Mental Health in Toronto. She says insomnia is a symptom of an underlying disorder that can include pain, depression and stress, "just like nausea is a symptom of food poisoning."

"It takes a while to find the underlying cause and sometimes in the rush, prescriptions are written as a Band-Aid," she says. For example, a patient who complains of anxiety or depression will be prescribed Effexor or Prozac. But according to Wood, because those drugs can take four to six weeks to kick in, a sleeping pill like Lunesta or Restoril is prescribed to help in the interim. "All along, sleeping pills have been used for short-term symptomatic use," she says, "perhaps one to two weeks, long enough to establish a sleeping pattern."

Although it's ultimately a doctor's discretion about the quantity and length of prescriptions, which are sometimes checked by wary pharmacists, sleep-inducing drugs dispensed to most patients should only be for up to a month's supply, particularly at the onset of treatment, Wood explains. Drug therapies to treat patients with anxiety and depression usually involve longer-term treatments.