Q: A friend of mine has terrible insomnia. Is there anything besides sleeping pills that can help her get more than 4 1/2 hours of sleep a night? A: There are lots of practical ways to ensure a restful night. Try to go to bed and get up at the same time each day; avoid caffeine, nicotine, and alcohol, especially at night; and don't eat or drink too close to bedtime. Creating a restful environment helps, too. Reduce light and noise from your bedroom; make sure your bed, bedding and room temperature are comfortable, and try to keep work and television out of the bedroom. Make it a place for sleep and intimacy only. If you can't fall asleep within 15 to 20 minutes, don't toss and turn. Get up and try a warm bath, reading, or listening to soothing music. Try again after you are sleepy enough. If worrying keeps you awake, keep a journal nearby to write down your concerns in order to release them. I would avoid over the counter and prescription sleep aids, since they can be habit-forming and leave you with a groggy, "hung over" feeling the next day. Natural herbs such as kava and valerian work better; they can induce sleep without any daytime drowsiness. They're especially effective when used together. Some other natural supplements to try are passion flower, California poppy and Corydalis cava (in a 4:1 combination), and the Chinese herb Suanzaorentang. And while I don't suggest prescription drugs very often, there is one, called Xyrem, that I've found to be a highly effective and very safe sleep aid. It also helps relieve anxiety and depression. But Xyrem is expensive (about $200 a month) and somewhat hard to get. Your doctor cannot simply write a prescription for it and have it filled at a local drug store. Instead, you (or your doctor) have to fax the prescription to a "central pharmacy." And you will be required to watch a video warning you about sharing or misusing your prescription by giving it to someone else. It wasn't always this way. Years ago, Xyrem was available in health food stores under its chemical name, gamma-hydroxybutyric acid, or GHB. You may have heard media reports of GHB. It has been branded the "date-rape drug," as it is a sexual disinhibitor, like alcohol. Because of its misuse, the government now puts strict controls on its distribution. Given these hurdles, your physician may be resistant to prescribing it. But if he or she takes the time to research it, he will find that it is much safer than other sleep pills and more effective, too.