Ashwin Lewis
Sleep is an important part of staying healthy, and a lack of sleep can cause a range of problems beyond fatigue, including reduced concentration and higher risks for hypertension, diabetes, heart disease and dementia. Sleep aids are commonly used to treat insomnia and occasional sleeplessness, and can be a helpful way of drifting off on nights when sleep is difficult. However, sleep aids may have side effects, risks and possible drug dependencies, so it is important to consider your options carefully and consult a doctor before taking any medication.
| Characteristics | Values |
|---|---|
| Who should consider sleep aids? | People who have recurring problems falling asleep, and whose sleep issues impact their daytime routine. |
| Who is affected by sleep issues? | 14.5% of American adults, with women experiencing more sleeplessness than men. |
| What are the consequences of poor sleep? | Poor sleep can cause fatigue, reduced concentration, shorter reaction times, and a higher risk for hypertension, diabetes, heart disease, and dementia. |
| What are some non-medicated methods to improve sleep? | Practicing good sleep habits, also known as sleep hygiene, such as maintaining a consistent bedtime, avoiding caffeine after noon, and refraining from exercise an hour before bed. |
| What are some natural remedies for sleep? | Soothing teas, melatonin, valerian, and other supplements and vitamins. |
| When should you consult a doctor about sleep issues? | If you have consistent trouble falling asleep and staying asleep, or if you experience side effects or risks associated with over-the-counter sleep aids. |
| What are some prescription sleep aids? | Zolpidem, zolpidem extended release, antidepressants with a sedating effect, and benzodiazepines. |
| What are the potential side effects of prescription sleep aids? | Dizziness, lightheadedness, prolonged drowsiness, severe allergic reaction, dangerous sleep-related behaviors, hallucinations, agitation, memory issues, and suicidal thoughts. |
| What precautions should be taken when using sleep medications? | Consult a doctor, follow recommended dosage and timing, avoid mixing with alcohol or opioids, and be aware of potential side effects and interactions with other medications. |
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What You'll Learn
Natural sleep aids
- Melatonin supplements: Melatonin is a hormone that is naturally released in the brain four hours before we feel sleepy. It is triggered by the body's response to reduced light exposure, which should naturally happen at night. However, exposure to unnatural light from phones, laptops, or TVs can prevent its release, making it difficult to fall asleep. Melatonin supplements are available over the counter and can help regulate your sleep cycle.
- Warm milk, chamomile tea, and tart cherry juice: Warm milk is believed to contain chemicals that simulate the effects of tryptophan in the brain, which is involved in the sleep-wake transition. Similarly, chamomile tea is thought to contain flavonoids that interact with receptors in the brain involved in the sleep-wake transition. Finally, tart cherry juice may support melatonin production and promote a healthy sleep cycle.
- Exercise: Physical activity can improve sleep quality, particularly moderate aerobic exercise, which increases the amount of nourishing slow-wave (deep) sleep. However, it is important to time your workouts right, as aerobic exercise releases endorphins and raises core body temperature, which can interfere with sleep. Try to avoid exercising within two hours of bedtime.
- Maintain a cool temperature: Keeping your bedroom cool can help you sleep better. The ideal temperature for your thermostat is between 65 and 72 degrees Fahrenheit. If you are going through menopause and experiencing hot flashes, keep the room as cool as possible and wear cotton or breathable fabrics to bed.
- Limit screen time and light exposure: The light from smartphones, laptops, and TVs can interfere with sleep. Try to avoid screens before bed and use a flashlight instead of turning on the lights if you need to get up during the night.
- Magnesium: Magnesium is a mineral that plays a crucial role in many bodily processes, including brain function and heart health. It can help quiet the mind and body, making it easier to fall asleep. Magnesium supplements are available in various forms, including those that combine magnesium with other sleep-promoting ingredients like glycine or melatonin.
- Valerian root: Valerian is an herb native to Asia and Europe, and its root is commonly used to treat anxiety, depression, and menopause symptoms. It is also one of the most popular sleep-promoting supplements in the US and Europe. While study results are inconsistent, some research suggests that valerian root can improve sleep quality and reduce insomnia symptoms.
- Lavender aromatherapy: The soothing fragrance of lavender is believed to enhance sleep. Several studies suggest that inhaling lavender oil before bed can improve sleep quality, even in those with insomnia. However, oral ingestion of lavender oil is not recommended due to potential side effects.
- Passionflower: Passionflower, or Passiflora incarnata, is a popular herbal remedy for insomnia. While its effects in humans vary depending on the form consumed, some studies suggest that passionflower tea or extract may slightly improve sleep quality.
- Cannabidiol (CBD): CBD is a compound derived from hemp and is often featured in oils and capsules. It contains low amounts of THC, the psychoactive compound in cannabis, so it doesn't cause the same high. Some studies suggest that CBD can act as a natural sleep aid and reduce anxiety. However, more research is needed to confirm its effectiveness and long-term safety.
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Over-the-counter sleep aids
Natural sleep aids are another option for those seeking over-the-counter remedies. Melatonin is a popular choice, as it is a hormone that is naturally released in the brain before we feel sleepy. It can be purchased as an over-the-counter supplement to help with occasional insomnia or jet lag. However, it may cause side effects such as nausea, headaches, and daytime sleepiness. Valerian is another natural sleep aid that has been used as a herbal remedy for hundreds of years. While its benefits are unclear, it is generally considered safe and may cause mild side effects such as headaches and weakness.
In addition to over-the-counter medications, there are also many non-medicated methods to improve sleep. Good sleep habits, also known as sleep hygiene, can make a significant difference in your sleep quality. This includes maintaining a consistent bedtime, avoiding caffeine after noon, and keeping your bedroom temperature cool. Additionally, it is important to avoid screens and exercise for at least an hour before bed, as these can interfere with your sleep schedule.
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Prescription sleep aids
There are several types of prescription sleep aids available. One common type is benzodiazepines, which include temazepam (Restoril), triazolam (Halcion), estazolam (Prosom), and zolpidem (Ambien, Intermezzo, Zolpimist). These work by stimulating a chemical in the brain called GABA, leading to sedation, muscle relaxation, and reduced anxiety. However, they have the potential for dependency and misuse, so they are typically prescribed for short-term use only.
Another type of prescription sleep aid is Z-drugs, which include zolpidem (Ambien, Intermezzo, Zolpimist), eszopiclone (Lunesta), and zaleplon (Sonata). These work by slowing down brain activity and are also typically prescribed for short-term use due to the risk of dependency and misuse.
Other prescription sleep aids include doxepin (Silenor) and Ramelteon (Rozerem). Doxepin may be prescribed for up to 3 months to help with insomnia. It is available in 3 and 6 mg doses, and it is important to consult a doctor to determine the appropriate dose. Ramelteon, on the other hand, is a melatonin antagonist that affects melatonin receptors to promote sleep and positively impact circadian rhythms. It is often prescribed for longer-term use due to its low likelihood of misuse or dependency.
While prescription sleep aids can be effective in treating sleep disorders, they also come with potential side effects and risks. Some common side effects include central nervous system (CNS) depression, unusual thinking patterns, behavioural changes, worsening depression, and suicidal thoughts. It is important to carefully weigh the benefits against the risks when considering the use of prescription sleep aids.
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Cognitive behavioural therapy
CBT-I involves stimulus control, sleep restriction, and relaxation training. It focuses on restructuring thoughts, feelings, and behaviours that contribute to insomnia. During treatment, a trained CBT-I provider helps to identify thoughts, feelings, and behaviours that are contributing to the symptoms of insomnia. Thoughts and feelings about sleep are examined and tested to see if they are accurate, while behaviours are examined to determine if they promote sleep. The provider then clarifies or reframes misconceptions and challenges in a way that is more conducive to restful sleep.
CBT-I includes cognitive, behavioural, and educational components. Cognitive interventions involve cognitive restructuring, which attempts to change inaccurate or unhelpful thoughts about sleep. Behavioural interventions include stimulus control before bed, sleep restriction and compression, and incorporating relaxation techniques to establish healthy pre-sleep habits. Psychoeducational interventions involve providing information about the connection between thoughts, feelings, behaviours, and sleep.
The core components of CBT-I are Sleep Restriction Therapy (SRT) and Stimulus Control Therapy (SCT). SRT is based on the notion that the most important perpetuating factor for chronic insomnia is sleep extension. It aims to address the mismatch between sleep ability and sleep opportunity by limiting the time spent in bed to the person's average sleep ability. SCT is based on behavioural principles and the idea that one stimulus may lead to a variety of responses depending on the conditioning history. It aims to manage nocturnal wakefulness via behavioural modification.
Cognitive Therapy (CT) is another important component of CBT-I. It helps patients develop realistic sleep expectations by identifying and modifying dysfunctional thoughts about sleep that perpetuate insomnia or contribute to pre-sleep arousal. CT follows the traditional cognitive therapy approach by using thought records to identify maladaptive sleep-related cognitions and the resulting emotional reactions. The patient is then instructed to apply revised thoughts to the situation and note the change in emotion.
CBT-I is considered a safe and effective treatment for insomnia, with no side effects and fewer episodes of relapse compared to sleep medication. It is recommended as the first-line treatment for chronic insomnia. However, there is currently a shortage of trained CBT-I practitioners, and patients are often more likely to turn to medication as a treatment for insomnia.
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Sleep hygiene
Optimise Your Sleep Schedule
- Maintain a fixed wake-up time: Keep the same wake-up time every day, even on weekends. A consistent wake-up time helps establish a rhythm of consistent sleep.
- Prioritise sleep: Avoid sacrificing sleep for other activities like work, studying, socialising, or exercise. Calculate your target bedtime based on your wake-up time and prepare for bed around that time each night.
- Make gradual adjustments: If you need to change your sleep times, do it gradually. Making sudden drastic changes to your sleep schedule can disrupt your body's rhythm. Instead, adjust your sleep times in small steps of up to an hour or two at a time.
- Limit naps: Naps can be energising during the day, but they can interfere with your nighttime sleep. Keep naps short and in the early afternoon to minimise their impact on your nighttime sleep.
Establish a Nightly Routine
- Keep your routine consistent: Follow the same pre-sleep steps each night, such as putting on pajamas and brushing your teeth. Consistency reinforces the mental association between your routine and bedtime.
- Wind down for 30 minutes: Engage in calming activities like soft music, light stretching, reading, or relaxation exercises before bed.
- Dim the lights: Bright lights can hinder melatonin production, which is crucial for sleep. Reduce your exposure to bright lights as part of your pre-sleep routine.
- Unplug from electronics: Take a break from cell phones, tablets, and laptops for 30 to 60 minutes before bed. These devices provide mental stimulation that can be hard to turn off, and they emit blue light, which interferes with melatonin production.
- Practise relaxation techniques: Instead of solely focusing on falling asleep, try meditation, mindfulness, paced breathing, or other relaxation techniques to prepare your mind and body for sleep.
- Avoid tossing and turning: If you can't fall asleep after 20 minutes, get up and engage in a calming activity in low light. This helps reinforce the mental association between being in bed and sleeping.
Cultivate Healthy Daily Habits
- Get daylight exposure: Sunlight is a key regulator of circadian rhythms, which influence the quality of your sleep.
- Exercise regularly: Physical activity improves sleep quality and provides other health benefits. However, avoid exercising within two hours of bedtime, as it can temporarily increase alertness.
- Avoid nicotine and reduce alcohol consumption: Nicotine disrupts sleep, and while alcohol may make it easier to fall asleep, it can cause disruptions later in the night.
- Limit caffeine intake: Caffeine is a stimulant that can keep you wired when you want to rest. Avoid consuming caffeine in the afternoon and evening.
- Eat dinner early: A late, heavy, or spicy meal can disrupt sleep because your body is still digesting when it's time for bed. Opt for lighter meals or snacks before bed.
- Restrict in-bed activities: To strengthen the mental association between your bed and sleep, use your bed only for sleeping (with sex being the one exception).
Optimise Your Bedroom Environment
- Invest in a comfortable mattress and pillow: Your sleeping surface is crucial for comfort and pain-free sleep. Choose a mattress and pillow that meet your needs and preferences.
- Use comfortable bedding: Ensure your sheets and blankets are comfortable and match your preferences.
- Maintain a cool temperature: Set your bedroom temperature to a comfortable level, slightly on the cooler side (around 65°F or 18.3°C).
- Block out light: Use heavy curtains or an eye mask to prevent light from interrupting your sleep.
- Reduce noise: Use earplugs or a white noise machine to minimise disruptive sounds.
- Try calming scents: Light scents like lavender may promote relaxation and create a positive sleep environment.
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