To Eat, Perchance to Sleep Indeed, a number of studies suggests that drinking warm milk before retiring for the night can not only shorten the time it takes to fall asleep but also can make the sleep more restful. Admittedly, a glass of warm milk isn't going to solve the sleep problem all by itself. But paying attention to what you consume – and when – can benefit your slumber. Here are several other food-related "sleep hygiene" steps to consider: Try chamomile tea. Reportedly the number-one consumed tea in Germany, where herbs are taken more seriously for their purported health benefits, chamomile is considered to have a mild sedative effect. As with milk, though, "most people know that just the act of sitting down, taking five minutes, boiling the water and having the tea is relaxing in itself," says Roy Upton, executive director of the American Herbal Pharmacopoeia. Don't have a nightcap. Alcohol may help some people fall asleep, but it interferes with substances in the brain that allow for continuous sleep. The result is repeated waking (or partial waking) through the night, leading to fewer hours of truly deep, restful sleep. (A drink at dinner is okay, but avoid drinking between dinner and bedtime.) Don't eat a large meal too close to bedtime. Typically, it takes about four hours after eating for the stomach to empty its contents. But the acid secreted to break down those contents can last an estimated seven hours. That's a particular problem for those with acid reflux and the ensuing heartburn and other gastric distress it causes; such discomfort can keep people awake. Some individuals, says neurologist Sassower, "may not have overt symptoms of reflux during the day," such as an acid or burning feeling. But at night they may suffer from reflux symptoms that are not obvious, like intermittent coughing. Eating too close to bedtime could also cause spontaneous arousal, or lightening of sleep, for reasons that don't appear to have anything to do with reflux. But don't go to bed too hungry, either. Going many hours without food causes the release of a hormone called glucagon, which sends a signal to let more sugar into the bloodstream. But glucagon has side effects that are thought to be similar to those of adrenaline, the fight-or-flight hormone that creates a state of agitation. People with anxiety disorders might be especially sensitive to that effect and thus might want to be conscientious about not going to bed with a rumbling stomach. (Maybe that's the reason a glass of warm milk induces sleepiness in some people – it staves off hunger.) Take medications judiciously. Some over-the-counter pain medications, if taken several times a day, contribute as much caffeine as several cups of coffee. A two-tablet dose of Extra Strength Excedrin, for example, contains 130 milligrams of caffeine, while Anacin contains 64 milligrams. The "active ingredients" part of any over-the-counter drug label will tell you the number of milligrams of caffeine per dose. Ingredients in cold medicines such as ephedrine, pseudoephedrine and phenylpropanolamine also act as stimulants.CAUTION! Several of these are banned substances! Prescription drugs can take a toll on sleep, too. Bronchodilators used by asthma patients contain some of the same ingredients as cold preparations, and diuretics swallowed too close to bedtime can keep you running to the bathroom into the night. Several of these are also BANNED! Antidepressants such as Prozac as well as over-medication with thyroid drugs could cause sleeplessness, as can migraine drugs like Cafergot and Wigraine. If you are taking a drug on a regular basis and have difficulty sleeping, ask your physician about whether the drug could be at least partially responsible – and whether the dosage and timing of the drug taking could be modified. If you have restless leg syndrome, talk to your doctor about taking supplements of iron or vitamin E. Up to 5 percent of the population has restless leg syndrome, which Sassower says people often describe as a "creepy, crawly sensation" that worsens when the body is inactive and thereby causes a very strong urge to move the legs – and interrupt sleep. Within that group there is "a subset of individuals," he explains, who have an iron deficiency and see their symptoms diminish with iron supplementation. It doesn't have to be a large deficiency; even people with iron levels in the low/normal range can be affected. As far as vitamin E, comments Sassower, "I find that in my clinical practice about one in five individuals are helped by vitamin E therapy either for restless legs or period limb movements" – a related condition that also keeps people up at night. The "typical dosage is 400 units two times a day," he notes. Try valerian root. Valerian, purported to reduce the time it takes to get to sleep, has been approved as a sedative in Canada, England, France, Switzerland and several other countries. But "there's not much hard data" on it, says Sassower. Still, he points out, "some people swear by it. Who would want to interfere with that? But clearly it's not a panacea. They're still coming to the clinic." Heiner Berthold, a physician at the University of Bonn in Germany, takes a similar view. "I'm not really sure if it works since hard scientific evidence is hard to obtain," he comments. But he's not against people trying it. Note that if you do want to try valerian, reported side effects include headaches, nausea, blurred vision and, paradoxically, restlessness. Valerian should not be taken with other sleep aids or with alcohol. And the U.S. Pharmacopeial Convention, which sets standards for drugs, does not recommend using the herb for more than two weeks because of the absence of long-term safety studies. Amounts considered safe: in capsule form, up to three grams, three times a day; as a tincture, one-half to one teaspoon several times a day; as a tea, one teaspoon steeped in one cup of hot water for 10 to 15 minutes, two to three times a day and before bedtime. A final warning: Valerian stinks, and that's putting it mildly. The American Herbal Pharmacopeia's Upton says it has a "godawful taste," while Donald Bliwise, director of the Sleep Disorders Center at Emory University, refers to its "godawful smell." If you've ever been up close to a pair of dirty socks, you'll get the drift. Richard T Herrick,MD herrickclinic@mindspring.com www.herrickclinic.com