Q&A: Honey for allergies?

I’ve read that eating local honey helps fight seasonal allergies. Is there any evidence to support this? —R.D.K., Jersey City, N.J.

None that we could find. Numerous books and Web sites tout the idea that pollen consumed by bees remains in the honey they make, providing a natural "vaccination" that boosts your body’s immunity. But the one clinical trial we could find showed that honey didn’t protect against allergies any better than a placebo. The only herbal remedy with documented effectiveness against the seasonal sniffles is butterbur, which may reduce levels of chemicals that can set off the body's allergic response. But its long-term safety is unknown, and some preparations contain certain substances that can harm the liver and lungs. Avoid butterbur if you’re allergic to ragweed. For proven relief, consider the over-the-counter drugs cetirizine (Zyrtec and generic) or loratadine (Claritin and generic), or a prescription pill or nasal spray.

This article first appeared in the September 2008 issue of Consumer Reports On Health.

Read more about herbal remedies for hay fever (free), and read our Natural Medicine Ratings for butterbur (subscribers only).

Do infant seats leave too little "tummy time" for tots?

For the first six months of my daughter's life, there were three items I couldn't do without: a nursing pillow, a front carrier pack, and the all-important bouncy chair. Although I carried Maddy much of the time, I relied on the chair for a safe place to put her when my back needed a break, a meal needed cooking or my preschool son needed extra attention.

For many parents like me, chairs, swings and other strap-in seats are undeniably convenient. But they could be costing our babies developmentally important "tummy time," according to the American Physical Therapy Association (APTA).

The APTA says that many babies are spending too much of their waking time on their backs and not enough time on their stomachs. And a lack of tummy time can delay infants' muscle development and mobility. The APTA cites a recent survey of 400 physical and occupational therapists in which two-thirds had seen an increase in early motor delays among infants over the past six years. An early motor delay happens when a child isn't able to meet important physical milestones in the first months and years of life. More than 80 percent of therapists listed a lack of tummy time as the No. 1 reason for this increase.

Hospitals will have to pay for their mistakes

In 2004, the very hospitals where Dorothy Etheridge picked up infections and a bedsore were reimbursed by Medicare for the extra care she needed to recover from them. Etheridge, 73, a retired mental-health-care worker from New Hampshire, had a diagnosis of treatable lung cancer. The bed sore and infections added to her suffering and required significant hospital care in the last year of her life.

Consumers Union estimates that more than 2.4 million Americans suffer each year from an error or infection that occurs while they’re in the hospital for something else. Medicare, private insurers, or the patients are typically billed for the additional care they need to recover from hospital mistakes.

That's about to change for the more than 40 million Medicare enrollees. Congress passed a law requiring the Centers for Medicare & Medicaid Services to start identifying preventable "hospital-acquired conditions" for which Medicare would no longer pay. The idea is to push hospitals to improve care by making them foot the bill when they err.

Medicare has listed eight preventable conditions (above) for which it will not reimburse hospitals after Oct. 1, 2008, and is proposing nine more conditions to be added in 2009. The effects could widen as private insurers and state-funded health insurance programs begin to follow Medicare's lead.

Men, age and fatherhood

Women are used to hearing about their "biological clock" and how their fertility declines as they get older. But new research suggests that men's chances of fatherhood are also affected by how old they are.

The research, presented at a meeting of the European Society of Human Reproduction and Embryology, was carried out in a group of people having treatment for fertility problems. So the results may not apply to everyone. But they made interesting reading, nonetheless.

We already know that sperm, like eggs, are more likely to have DNA damage as men get older. This damage can make it harder for the sperm to fertilize an egg. And if a damaged sperm does fertilize an egg, there's a higher risk of the pregnancy ending in miscarriage. Miscarriage can be very distressing, especially if you've been trying for a baby for a long time.

Cover America: Denied insurance because of a medical coding error

With all manner of high costs, limited protections, and confusing fine print, it’s tough going it alone in the health-insurance market. It’s all the more intimidating for those whose health history is being quietly tracked by a little-known insurance-industry group called MIB.

Few people realize MIB, formerly known as the Medical Information Bureau, has a file on them. Like a credit-reporting agency, MIB monitors virtually every aspect of a person’s health care. When someone applies for individual health-care coverage, the application is routinely run through MIB's huge database of health and medical information. Insurers effectively use the MIB data for health-insurance applicants like they use motor-vehicle administration records for auto-insurance applicants, adjusting premiums or even denying coverage based wholly or in part on what is in a person's MIB file.

Consumer Reports Health's Cover America Tour realized the impact of MIB when we visited Sheila (above) in Gulfport, Miss., the day after her 50th birthday. She and her granddaughters welcomed us in and shared some leftover lemon cake from the previous day's celebration.

Sheila was surprised when she was rejected for an individual health-insurance policy by three different companies. She was even more shocked when she learned why: Her record with MIB listed her as having a history of Chronic Obstructive Pulmonary Disease (COPD). Sheila does suffer from asthma, but COPD is supposed to be used to indicate more severe diseases of the lungs, such as emphysema or severe bronchitis. No company would insure her with this damaging mark on her record.

Q&A: How do I find a therapist?

You have reported on the benefits of cognitive behavioral therapy. How do I find a therapist who uses this approach? —M.H., Chadds Ford , Pa.

Cognitive behavioral therapy (CBT) seeks to change the way you cope with difficult situations or conditions by training you to think about them in a positive, constructive manner. Studies have shown the therapy to be helpful for a number of physical and emotional problems, including chronic pain, depression, insomnia, obsessive-compulsive disorder, and phobias. To find a therapist who uses CBT, ask your doctor for a referral, or consider the therapist locators at the Web sites of the Association for Behavioral and Cognitive Therapies or the National Association of Cognitive-Behavioral Therapists.

This article first appeared in the August 2008 issue of Consumer Reports On Health.

Read more about cognitive behavioral therapy in our Treatment Ratings (subscribers only) for mental health, and find out what to looking for when choosing a doctor (free).

Drug "breakthrough" for Alzheimer's?

Today, hundreds of doctors, researchers and reporters will be heading home from Chicago to recover from a week of networking at the International Conference on Alzheimer's Disease. Scientists often use conferences to show off early results from their research, which is why so many stories about new Alzheimer's drugs have been in the press this week.

There are good reasons for all the new research. Alzheimer's disease affects more than 4 million Americans, but there's still no cure. Current treatments can help with some of the symptoms of Alzheimer's, but the benefits are limited.

It's always tempting to be optimistic when a new drug is hyped by the media as a "breakthrough." But there's often a big gap between hope and reality.

Two Alzheimer's drugs presented at the conference are methylthioninium chloride (its brand name is Rember) and PBT2. Both of these drugs have shown some promise, but they're still in phase II trials. Phase II trials look at how well a treatment works for a couple of hundred people. If a drug is successful at this stage, and there are no major side effects, it can progress to large-scale tests. If the drug is shown to work, its manufacturer can then apply to the FDA to get it approved for sale.

When health insurance won’t cover your pregnancy

A few weeks after my first prenatal exam, I got a letter from my health-insurance company. It informed me that my pregnancy would not be covered because I wasn’t insured at the time of conception. The fact that I did not know that I was pregnant at the time of conception was irrelevant. I had a complicated pregnancy with preeclampsia, which raised my blood pressure and caused my kidneys to function poorly. Because I required a month of hospitalization and numerous tests, the costs were exorbitant. But I was fortunate. My baby was healthy and my previous insurance company paid the initial bills through the waiting period.

For Tina (right), in Pittsburgh, the solution was not so easy. She, too, developed preeclampsia, as well as gestational diabetes, another high-risk condition. About five months into her pregnancy, she began receiving doctors’ bills and was informed that her individual insurance policy did not cover maternity care. In addition to the mounting financial stress, her mother was diagnosed with cancer, and she had a death in the family. The emotional toll did not help her medical condition. But a newspaper reporter took on her story, and, in the end, the insurance company agreed to cover her bills.

But what about all the women who are not as lucky as Tina and I am?

Annual buzz about West Nile

As it seems to every summer, the buzzing of mosquitoes has turned to media buzz about West Nile virus. The Boston Globe recently reported that West Nile has been "established in Massachusetts for the summer." Last week a newspaper headline in Illinois read "West Nile cases now official in Illinois" announcing the first human case in the state for the year. And we could go on about other regions as well, but the fact is if you live in the continental United States, you should consider your mosquito season to be West Nile virus season. Every state except Alaska and Hawaii has had incidents of the virus reported in humans, or in birds, mosquitoes, or other animals over the past three years.

Take a look at this map of incidents to date this year from the Centers for Disease Control and Prevention (CDC). All but 10 states in the continental United States have already had either human, or avian, mosquito, or other animal cases reported. And mosquito season lasts until the first hard frost. On last year’s CDC map of the 48 contiguous states, only Maine remained free of the virus.

To understand the West Nile threat: The virus, which appeared in North America in 1999, is spread by mosquitoes. The CDC has estimated that there were approximately 175,000 West Nile virus infections last year, but fortunately most of them don’t cause any significant illnesses. About 20 percent of infections lead to West Nile fever, and fewer still cause more serious conditions including meningitis and encephalitis. The CDC reported that there were 124 fatalities from West Nile in 2007.

Epilepsy, drugs and pregnancy

If you're a woman with epilepsy, one of the challenges you may face is managing your condition if you want to get pregnant (subscribers only). It's important to avoid seizures during your pregnancy.

Happily, more than 9 in 10 women with epilepsy go on to have a healthy baby. But epilepsy drugs are linked to a higher chance of having a baby with birth defects.

Researchers are trying to find out which drugs, or combination of drugs, are safest for women and their babies. Older drugs like valproate (subscribers only) have a higher risk of certain birth defects. But there's been less research about newer drugs.

The latest research looked at a drug called topiramate (brand name: Topamax). The research found links between topiramate and some birth defects, but overall, topiramate didn't seem to be worse than other epilepsy drugs.

Makers of Airborne cough up $30M for false advertising claims

As part of a whopping $30 million settlement with the Federal Trade Commission, the makers of Airborne may have to grant refunds to millions of consumers who purchased their highly popular cold remedies. The settlement charges that Airborne did not have adequate evidence to support its advertising claims. "There is no credible evidence that Airborne products, taken as directed, will reduce the severity or duration of colds, or provide any tangible benefit for people who are exposed to germs in crowded places," said Lydia Parnes, Director of the FTC’s Bureau of Consumer Protection.

We've been skeptical of Airborne's claims since 2006. In a more recent blog about misleading packages, we advise consumers to leave over-the-counter products that are labeled homeopathic on the shelf.

Read more on what we say about homeopathic drugs, and to apply for a refund for Airborne product purchases, visit www.airbornehealthsettlement.com.

Multivitamins more essential for certain groups

The National Institutes of Health says there's no reason to recommend multivitamins in general but notes a few combinations that might help some people, such as beta-carotene, vitamins C and E, and zinc for those with age-related macular degeneration.

But multis can make sense for certain groups:

• Dieters or picky eaters, to prevent major nutritional deficiencies.
• Strict vegetarians, mainly for the vitamin B12.
• People older than 50, mainly for the B12 and vitamins.
• Women who are pregnant, likely to become pregnant, or breast-feeding.
• People who have a chronic gastrointestinal disorder, such as colitis or pancreatitis, that impairs absorption or digestion.
• People with a chronic illness. Diabetes, cancer, and other conditions can deplete nutrients.

So-called women's multis often pack extra calcium, which can be fine for both genders, but if you need more than 200 mg you'll have to take a separate calcium supplement. Stick with the basic nutrients: the herbs and phytochemicals sometimes included have dubious value and are often present in such small quantities that they have little effect. Finally, avoid supplements that contain more than 9 mg of iron unless advised by your doctor, since excess iron can lead to organ damage in people with hemochromatosis, a common genetic disorder.

This article first appeared in the September 2008 issue of Consumer Reports On Health.

Read more on special precautions (free) you should follow when taking a multivitamin, find out which vitamins fill your nutritional gaps and which you should avoid (free), and if you're taking a multivitamin or supplement, visit our Natural Medicine Ratings (subscribers only) section to check the effectiveness and interactions.

Q&A: X-rays and cancer risks?

In search of a diagnosis for my persistent low-back pain, my doctor recently ordered several X-rays of my spine. Do multiple X-rays increase my risk of developing cancer? —P.B., Clemson, S.C.

Yes. While nearly all X-rays expose you to radiation that increases your cancer risk, a low-back X-ray can expose you to relatively high doses. Moreover, those tests are often unnecessary, since nearly all low-back pain stems from muscles, ligaments, and nerves, which don't appear on X-rays. And most low-back pain eventually resolves on its own with simple self-help measures, including mild painkillers and cold packs.

In general, agree to imaging tests only if the pain doesn't respond to self-help methods or physical therapy and lasts for more than a month, or if you also have any of the following: leg weakness; pain radiating from the buttock to the thigh, knee, or lower leg; a history of osteoporosis, or a recent fall or accident; fever, night sweats, or unexplained weight loss; or a history of cancer or incontinence.

This article first appeared in the August 2008 issue of Consumer Reports on Health.

Find out when you should consider an X-ray for pain (free), see our whole-body guide on imaging tests (free), and take a look at our Treatment Ratings for back pain (subscribers only).

The terrors of texting

Driving while texting is nothing to LOL about. From New York to England there have been reports of teens getting into serious car accidents because they keep their hands and eyes on their cell phone keys, rather than the steering wheel. And the results are too often tragic.

The practice is widespread. According to a survey by AAA and Seventeen magazine, 61 percent of 16- and 17-year-olds admit to risky driving habits and of those, 46 percent say they text while driving. Fifty-one percent of those teens say they drive while talking on their cell phones.

Some states have banned driving while texting, talking on cell phones without a hands-free device, or both, and others have banned all cell phone practices for young drivers, but the laws are often ignored by teens and appear to be loosely enforced by law enforcement officials.

Studies have shown that a person using a cell phone while driving, hands-free or not, is four times more likely to crash and, as a result, land in the hospital, and that using a cell phone while driving is as risky as driving drunk. Furthermore, inexperienced drivers are much more accident-prone when distracted, and many inexperienced teens don’t recognize the dangers cell phones pose.

Be aware of Lyme disease this summer

Millions of Americans spend time working or playing in the great outdoors. If you're one of them, you need to be aware of a tick-borne illness called Lyme disease.

Ticks are tiny, spider-like creatures that live on deer, sheep and horses. If a tick bites you, the bacteria they carry can get into your blood and cause Lyme disease.

In 2006, nearly 20,000 people in the were diagnosed with Lyme disease. It's more common in northeastern and north-central states, particularly in Connecticut and Delaware. In fact, Lyme disease was named for Old Lyme, Connecticut, after a spate of cases happened there in the 1970s.

The best way to prevent Lyme disease is to avoid tick bites. If you're spending time in grassy or wooded areas, wear clothes that cover your skin, and tuck your pants into your socks. When you can, check your body for ticks. You can also use a repellent. Look for ones containing DEET or permethrin, and make sure you follow the instructions. (Subscribers to ConsumerReportsHealth.org can read more about how to prevent tick bites.)

The whole (grain) truth

Don't get faked out by healthy-sounding grain claims! Supermarket shelves are loaded with breads, crackers, and cereals labeled "bran," "multigrain," "7-grain," "stone-ground," and "wheat flour." But none is necessarily whole grain. A true whole-grain food should list one of the following as its first ingredient: barley, brown rice, bulgur, graham flour, kamut, oatmeal, whole-grain corn, whole or rolled oats, whole rye, whole wheat, or wild rice.

So why should you care? Unlike white rice and flour, which are stripped of many nutrients because of the way they're processed, whole-grain foods are loaded with good stuff. They contain cancer-fighting antioxidants, heart-healthy fiber, and a variety of essential vitamins and minerals, including magnesium and B vitamins.

Studies show that whole grains also help regulate blood sugar. The government recommends that adults eat about 6 ounces of grains per day, half of which should be whole grains (1 ounce equals about a slice of bread or a half-cup of rice or pasta). For more info, visit the USDA's grain pyramid.

This article first appeared in the August/September 2008 issue of ShopSmart.

Read more on the health benefits of whole grains (free), and learn how whole grains can help keep diabetes under control (subscribers only).

Can you do anything to prepare for jet lag?

I wish I had. Having recently stepped off a plane from New York to London, I know exactly what it feels like to have jet lag. Finally falling asleep at 5 a.m. the day before I was due back to work was not conducive to a productive day in the office. And I couldn't resist the temptation to nap as soon as I got home from work, which didn't help with sleep that night either. Only days after returning from vacation, I felt like I needed another one.

I did follow some advice about how to reduce the impact of long-haul air travel and reset my body clock. I set my watch to London time before I boarded the plane, for example. And I drank nothing but water and fruit juice during the flight. Doctors often advise against alcohol and caffeine-laden beverages to minimise jet lag, because the former can dehydrate and the latter can interfere with sleep, adding to the classic jet lag symptoms: tiredness, poor concentration, irritability, upset digestion and generally feeling unwell.

But there were other tips. I should have got some sleep during my overnight flight back to London (and resisted the urge to watch that second film). And on my way out to the United States, (which resulted in mild jet lag, not nearly as bad as that from travelling eastwards), I should have made sure I got some light exercise and sunshine on my first day, to give my body the right cues about the new time. Eating small meals at the right time for my destination might have also helped.

Back pain: Get a bed that’s just right

Many people think that firmer mattresses offer more back support than soft ones. But a new industry-financed study found that at least some people with chronic back pain sleep better on a waterbed or body-conforming foam mattress.

Other research suggests that medium-firm surfaces are often best. A mattress that’s too hard might not provide even support and cause achy hips and shoulders, but if it’s too soft you could sink in, which can be equally uncomfortable. Consumer Reports’ research has found that there is no "best" mattress for everyone. So lie on a mattress for at least 15 minutes before buying it.

This article first appeared in the July 2008 issue of Consumer Reports On Health.

Find out everything you need to know about choosing a mattress (subscribers only), and if the mattress is not your problem, read our new survey on America's sleeping habits (free).

Q&A: Cinnamon to control diabetes?

I use cinnamon to help control my diabetes. But I just read that a new study found that cinnamon doesn’t help after all. Should I stop using it? —M.G., Bronx, N.Y.

No, especially if you enjoy the taste. The research you heard about combined the findings from previous studies and reanalyzed them, a process known as meta-analysis. While that study did conclude that cinnamon had no beneficial effect on blood sugar it's hardly the last word, since such analysis can distort the findings of the underlying data. And some of the best of those earlier studies suggested that as little as a half-teaspoon of cinnamon a day may help control type 2 diabetes, possibly by increasing cells' sensitivity to insulin. So it's fine to keep using cinnamon or cinnamon pills, though as an adjunct—not a replacement—for more-proven treatments (subscribers only).

This article first appeared in the August 2008 issue of Consumer Reports On Health.

Check out our Natural Medicine Ratings on cinnamon for diabetes (subscribers only), and if you're on prescription drugs for your diabetes, read up on how to save money (free).

Number of new HIV infections top earlier estimates

The big news out of the International AIDS Conference in Mexico City this week is troubling. The Centers for Disease Control and Prevention (CDC) released its updated estimates of new HIV infections in the U.S. for 2006, revealing a total 40 percent higher than previously thought. For a study published in the August 6th edition of the Journal of the American Medical Association, researchers utilized new and more precise methods to find that about 56,300 adults and adolescents were newly infected with HIV in 2006. Their previous estimate was close to 40,000.

The CDC also used the new methods to back-calculate historical trends in HIV infections. They found that HIV infections increased sharply after 1977, the first year of data, peaking at about 130,000 per year in 1984 and 1985. Infections then began to decline, bottoming out at about 49,000 infections per year in the early 1990s. Incidents jumped again to about 58,000 in the late 1990s and have remained steady at around 55,000 each year since.

When interviewed at the conference, Dr. Kevin Fenton, M.D., Ph.D., director of the CDC's National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, called these numbers a "wake-up call" and indicated that Americans need to step-up prevention measures.

Green tea and broccoli: Unpicking the puzzle

Two research papers made interesting reading this week, for a number of reasons. They looked at how two dietary items, green tea and broccoli, might impact on heart disease and prostate cancer respectively.

Both heart disease and prostate cancer are mammoth diseases. Heart disease kills more men and women in the United States than any other illness, and, after skin cancer, prostate cancer is the most common cancer in American men. It's little wonder that scientists and public health doctors are anxious to find out whether altering what we eat or drink can protect against these diseases.

Unfortunately, there are no clear take-home messages from either of these papers. We can't say yet whether drinking two cups of green tea a day or eating three portions of broccoli a week can help keep these diseases at bay. That's because neither study was of the type to be able to give us definite answers.

The study on green tea was carried out in healthy volunteers. It found that half an hour after having a cup of tea, the blood vessels become slightly more elastic. Ninety minutes later, the blood vessels had returned to their normal state.

For the broccoli study, researchers found that men at risk of prostate cancer who ate about 14 ounces of broccoli a week for a year had more changes in gene activity than those who didn't. The researchers think that the changes they saw could help to protect against prostate cancer.

Got poor sleep habits?

What's keeping you up at night? Could be some obvious nighttime activities (TV watching, errrr …blogging, etc.)—and some less obvious ones. Take a look at some do's and don't's from our latest Best Buy Drugs report on insomnia drugs—and then, turn off the computer and get some sleep.

• Watching TV in bed. Don't. TV viewing is not conducive to calming down.
• Computer work in bed. Don't work on a computer at all for at least an hour before going to bed.
• Drinking alcoholic or caffeinated drinks at night. Don't drink either for at least 3 hours before going to bed.
• Taking medicines late at night. Many prescription and nonprescription medicines can delay or disrupt sleep. If you take any on a regular basis, check with your doctor about this.
• Big meals late at night. Not ideal especially if you are prone to indigestion or heartburn. Allow at least 3 hours between dinner and going to bed.
• Smoking at night. Don't smoke for at least 3 hours before going to bed. (Better yet: Quit!)
• Lack of exercise. Just do it! Regular exercise promotes healthy sleep.
• Exercise late at night. A no-no. Allow at least 4 hours between exercise and going to bed. It revs up your metabolism, making falling asleep harder.
• Busy or stressful activities late at night. Another no-no. Stop working or doing strenuous house work at least 2 hours before going to bed. The best preparation for a good night’s rest is unwinding and relaxing.
• Varying bedtimes.Going to sleep at widely varying bed times—10:00 p.m. one night and 1:00 a.m. the next—disrupts optimal sleep. The best practice is to go to sleep at around the same time every night, even on the weekends.
• Varying wake-up times. Likewise, the best practice is to wake up around the same time every day (with not more than an hour’s difference on the weekends).
• Spending too much time in bed, tossing and turning. Solving insomnia by spending too much time in bed is usually counter-productive; you’ll become only more frustrated. Don’t stay in bed if you are awake, tossing and turning. Get up and do something else until you are ready to go to sleep.
• Late day napping. Naps can be wonderful but should not be taken after 3:00 pm. This can disrupt your ability to get to sleep at night.
• Poor sleep environment. Noisy, too hot, uncomfortable bed, not dark enough, not the right covers or pillow—all these can prevent a good night’s sleep. Solve these problems if you have them.

Read our latest Best Buy Drugs insomnia report, find out more on why you can't sleep, and take our interactive sleep quiz to see how your sleep habits compare to those of survey respondents.

Frankincense extract: A wise treatment for osteoarthritis?

When two popular treatments for osteoarthritis (Vioxx and Bextra) were withdrawn from the market a few years ago due to safety concerns, you could almost hear the collective cry of dismay from the thousands of people who relied on these drugs to control their joint pain (my father being one of them). Many people were put on different kinds of the same general type of medication, called nonsteroidal anti-inflammatory drugs. But this didn't sit easy with some (my dad included), who worried about the risks of these drugs as well.

If you fall into this group, you may be interested in a new study that looked at a novel treatment for osteoarthritis: frankincense. This plant resin is associated more with the holidays than with healing in Western culture, but it has been used in traditional Indian and Chinese medicine for centuries.

The study looked at using a concentrated extract of the Indian frankincense plant, Boswellia serrate, for osteoarthritis in the knee. After 90 days, people who took this treatment, called 5-Loxin, had around half as much pain and stiffness in their knees as they had at the beginning of the study, and their knee movement was about twice as good. Symptoms of those taking a pretend treatment for comparison (a placebo) also improved, but only by a little. People taking the treatment had no more side effects than those on the placebo.

Q&A: Mixing sleep meds?

I took eszopiclone (Lunesta), then zolpidem (Ambien and generic), for my chronic insomnia, but each stopped working after awhile. Now my doctor is recommending I take both pills together. Is that safe? —B.F., via e-mail

Probably not. While combining those drugs increases the likelihood of falling asleep, it also increases your risk of side effects, including daytime sleepiness, dependency, dizziness, memory problems, rebound insomnia, sleepwalking, and even sleep-driving. And we could find no studies documenting the safety of that regimen. Instead, make sure your doctor has evaluated you for an underlying condition that could hinder sleep, including anxiety, arthritis, depression, heart disease, or sleep apnea. In addition to treating any underlying problems, consider non-drug measures to improve sleep, such as cognitive behavioral therapy, which research has shown to be at least as effective as drugs. For more information, go to www.ConsumerReportsHealth.org and search for "insomnia."

This article first appeared in the May 2008 issue of Consumer Reports On Health.

Read the latest Best Buy Drugs report on insomnia drugs, and check out our new report and survey on America's sleeping habits.

Sleeping pills: You don’t need to spend big bucks

Americans spent more than $3 billion on prescription sleep aids in 2007, no doubt urged on by the ubiquitous TV ads, such as the Rozerem commercial, promoting those drugs (you know the ones: luna moths, soft music, Abe Lincoln, a beaver). But for many poor sleepers, a safer, less-expensive solution—a sound machine—may be just as helpful.

That's a finding from a recent sleep survey of 1,466 nationally representative respondents and a parallel survey of 1,093 Americans suffering from chronic sleep loss conducted by the Consumer Reports National Research Center and published in the September issue of Consumer Reports. Our analysis of what techniques worked best focused on the experiences of 2,021 problem sleepers and confirmed insomniacs, drawn from both surveys.

We asked respondents who had used some kind of insomnia treatment on at least eight nights in the previous month about what they’d tried, and how often it helped. Among the 12 percent who’d used prescription drugs, 75 percent of them said the pills helped most nights. (That included not just drugs marketed exclusively for sleep, like Ambien CR, Lunesta, Rozerem, and Sonata, but other drugs with sleep-inducing properties, including the antianxiety drug alprazolam and the antidepressant trazodone.) But nearly the same percentage—70 percent—of people who used a sound machine (above) in the bedroom reported getting relief. For the most severe cases, however, they were not as effective. We bought three such machines and asked a staff panel to try them out. Their favorite: the Brookstone Tranquil Moments Sound Therapy System, $129, which offers white noise and 11 other sounds.

Cover America Tour: Keeping a job just for the health insurance

Nearly a quarter of Americans are making major life decisions based solely on the ability to get or keep their health insurance, according a recent report from the Kaiser Family Foundation.

Think about that for minute.

People are taking jobs they don’t want, staying in jobs they don’t like—even getting married—just for the insurance benefits. Eight weeks and 28 states into the Cover America Tour, we've met many of the people behind the statistic.

John, 23, from Pelham, AL wrote to Consumers Union with his health care story: His insurance company determined that an emergency helicopter airlift was from an out-of-network provider and left it up to him to pay the $9,000 bill. You can see John talk about his struggles paying down the debt, and his outrage that the emergency transportation wasn’t covered in our video (right).

But there's a lot more to John's story. He recently received a job offer with a hefty pay raise that he was ready to take—especially with that $9000 helicopter bill hanging over the family budget. But unlike his current job, the new one wouldn't include health insurance benefits. He checked out the insurance options he could get for his family, including his pregnant wife and their two-year-old daughter. None would include maternity coverage for the first year—if at all.

John had to pass on the new job simply because he couldn't find affordable health insurance that would cover the pregnancy. Maybe after the baby's born, he says. Then maybe he'll be able to pursue other job options. For now he'll stay where he is for the health insurance.

Buzzword: Formulary

What does it mean? A formulary is a list of approved or preferred prescription drugs compiled by insurance plans that–in theory, at least–are supposed to drive down overall costs for the insurer while still providing adequate treatment for patients. "Closed" formularies generally cover only drugs approved by that particular insurer. "Open" formularies generally provide coverage for both listed and unlisted drugs, although medical providers are usually encouraged to prescribe drugs on the formulary. Many formularies fall somewhere between "open" and "closed," with substantially higher co-payments used to steer patients toward listed drugs and away from non-listed ones.

Why the buzz? Formularies are constantly changing, with drugs being added, dropped, upgraded or downgraded (in pricing) periodically. Specific medications a patient may have used for years may suddenly be dropped from a formulary or cost substantially more than before. For example, Cathleen Otto of Spring, Texas, recently found out just how much a formulary change can cost. In January she saw her out-of-pocket costs for the rheumatoid arthritis medication she has been using for years jump from about $6.25 per injection to $72 after her insurer changed its formulary. She says she has tried just about everything and nothing else relieves her symptoms adequately. On top of that, her health-care insurance premiums jumped almost $200 a month at the same time.

"I have decided–without my doctor's permission–to reduce the frequency of my shots to every other week," says Otto, who is a retired school teacher. "I am sorer and more tired, but I cannot afford this increase."