Finally, what about the fourth component? As I have already noted, this fourth component contains some of the most controversial pathways, ranging from over-the-counter sleep aides to drugs requiring physician prescriptions (because they are potentially addictive). As we turn to this fourth component, I will be introducing several important issues. Are the effects of these drugs a result of actual biochemical changes or a result of psychological changes (specifically the “placebo” effect)? Does this drug accelerate the onset of sleep or does it instead extend the duration of uninterrupted sleep? Does this drug have an impact beyond just enhancing sleep—for instance does this drug influence our dreams, our processing of memories, or even our “activities” while supposedly asleep (such as sleep walking)? These are all interesting and important questions to be addressed in the consideration of benefits and costs associated with specific sleep aides.
The Four Criteria for Evaluating the Sleep Pathways
I will be identifying more than 70 pathways and this list is likely to grow as I prepare future editions of these Pathways to Sleep essays. How does one make decisions, given all of these optional pathways? It’s like the challenge of choosing toothpaste. There are at least ten different product lines, and each product line offers at least five different versions. Do I choose a whitening toothpaste or one that is geared particularly to prevention of tooth decay? And are my teeth sensitive? Do I need to worry about bad breath or restoring my enamel? There is a similar challenge facing us when we choose among pathways to sleep. Some of you might wish that I would make some choices for you or at least be more discriminating in choosing the pathways to include in these essays. Unfortunately (for those of you who want me to be more definitive), I am inclined to leave these choices up to you. I am asking you, once again, to become sleep researchers on behalf of your own personal achievement of sleep quality.
Fortunately, there is more to it than just offering you many choices. I am helping you make your personal choices (or at least narrowing the list of potential choices) by offering four sources of information (and criteria). First, I am providing you with the best expert advice I have received (or reviewed) from experts in the field of sleep. These experts might not always agree. I will let you know when there isn’t agreement and even suggest how the experts might be biased in their research strategy and/or their interpretation and reporting of results. Second, I am offering you user-based judgments made by folks like you and me who are trying to get a good night sleep. I have sent the inventory to many people and asked for their personal rating of each pathway (or at least ones that they have personally tested). I will be inviting you to participate in this ongoing review and will be providing you with instructions at the end of this essay (and each of the following essays) as to how to get the full inventory from me and where to send your results (as a way of contributing to ongoing improvement of the results I am reporting).
