The world has gone quiet, everyone is asleep and you are lying awake on your bed with your eyes wide open as you can’t sleep. You are watching the clock go tik-tok. You have a long day ahead, an important meeting with the client, you need to sleep but you can’t. You struggle to sleep but your body refuses to succumb. What went wrong?
It can be as simple as consuming too much caffeine or an active brain because of too much screen time. It may be a psychological problem. Stress caused due to loved one’s death, job loss, change of place, divorce can also be the underlying factors. It may also be just the tip of an iceberg. Some health problems like asthma, arthritis, pain or a bigger picture like cancer.
What Is Insomnia?
The inability to fall asleep or keep asleep for a long duration is termed as insomnia. It results in unrefreshing or non-restorative sleep. It is a very common problem that takes a toll on our energy, mood, and ability to function during the day. Chronic insomnia can lead to serious health problems.
Sleep is a life-sustaining activity just like eating food and a good night’s sleep makes us feel more alert, more energetic, happier, and work efficiently. Sleep is regulated by a powerful internal drive which is very similar to our hunger drive. Scientists have explored the question of why we sleep from many different angles. They have examined what happens when humans or other animals are deprived of sleep.
In other studies, they have looked at sleep patterns in several organisms to see if similarities or differences among species might reveal some facts about sleep’s functions. Different theories have been put forward for the need of sleep, like energy conservation in the night for an active day, repair, rejuvenation, and restoration of the body, etc.
Summary: The inability to fall asleep or keep asleep for a long duration is termed as insomnia. Chronic insomnia can lead to serious health problems.
What Are the Causes of Insomnia?
Stress, depression, anxiety, traumatic experience, medication, health problems, change in the sleep environment, etc can be the cause of insomnia.
Sleeplessness or Insomnia can be categorized into ‘Primary Insomnia’ and ‘Secondary Insomnia’. Primary Insomnia means the underlying cause is not health. Change in sleep schedule, a new shift at work, unfamiliar noise, light or temperature around us, or stress can be the hidden culprit.
The underlying factor of sleeplessness in secondary insomnia includes mental health problems like high blood pressure, asthma, alcohol use, caffeine intake, tobacco use, hyperthyroidism or medications related to cold and allergies. Insomnia affects women more than men and old more than young people.
Summary: Insomnia can be caused by sudden changes in our lives or our environment such as a new shift at work, unfamiliar noise, light or temperature around us. Secondary insomnia can arise from alcohol use, caffeine intake, medications or medical problems such as asthma or high blood pressure.
What Are Sleeping Pills Or Sleep Aids?
Even after practicing all these lifestyle changes, if a good night’s sleep still won’t come, then it’s tempting to turn to a sleeping pill or a sleep aid for relief. Even though the problem may be solved with such sleep aids, it will be temporary in nature. Sleeping pills are like a temporary band-aid or a crutch that can manage the problem at that time but won’t solve it at all. Therefore it is important to weigh the pros and cons of using them.
For short term usage, like traveling across the time zones or recovering from a medical condition, sleeping pills and sleeping aids have been seen to be very effective. Generally, these medications act by working on receptors in the brain to slow down the nervous system. Some medications are used for inducing sleep more while others are used for staying asleep.
Some have a higher risk of becoming habit-forming and some last longer than others in our system (a longer half-life). If you choose to use sleeping pills for a long period, it is best to use them only “as needed” so as to avoid the negative effects.
Summary: Some sleeping pills/sleep aids are medications are used for inducing sleep more while others are used for staying asleep. Some of these have a higher risk of becoming habit-forming.
Sleeping Pills That Are Available In The Market
There are many different brands of sleeping pills available both over the counter and as prescription drugs. Your doctor is the right person who can suggest what is best for you depending on your symptoms. Some commonly used sleeping pills include:
Over-the-counter sleeping pills include antihistamines, melatonin, herbal formulations, and others.
The Risks Associated With Sleeping Pills
Most sleeping pills are described as “sedative hypnotics”. It is a specific class of drugs that are used to induce or maintain sleep. Sedative hypnotics include benzodiazepines, barbiturates, and some hypnotics.
Benzodiazepines such as Xanax, Valium, Ativan, and Librium are anti-anxiety medicines. They increase drowsiness and help people sleep. Halcon is another form of benzodiazepine sedative-hypnotic medicine that has been replaced by newer medicines in the market. While these drugs can be useful for the short-term, all benzodiazepines are potentially addictive and can cause problems with attention and memory. That is why they are not usually recommended for long-term treatment for insomnia.
Barbiturates are another drug in this sedative-hypnotic class. It depresses the central nervous system and can cause sedation. Short or long-acting barbiturates are prescribed as sedatives. But normally, these hypnotic drugs are limited to use as anesthesia. They can be fatal in case of overdose.
New medications help reduce the time it takes to fall asleep. Some of these sleep-inducing drugs, which bind to the same receptors in the brain as do benzodiazepines, include Lunesta, Sonata, and Ambien. They are likely to be habit-forming, but over time can sometimes cause physical dependence. They can work very fast to increase drowsiness and sleep.
Another sleep aid is Rozerem which acts differently from other sleep medicines by affecting the brain hormone melatonin and is not habit-forming. Belsomra is a unique sleep aid that affects a brain chemical called orexin and is not addictive or habit-forming. One more sleep medicine that is not habit-forming, Silenor, is a low-dose form of the tricyclic antidepressant doxepin.
Summary: Sleeping pills with benzodiazepines tend to be addictive and may cause problems with attention and memory. They are not recommended for long-term treatment for insomnia. Barbiturates are another class of drugs that can be fatal in case of overdose.
The Side Effects Of Sleeping Pills
Common side effects of prescription sleeping pills such as Lunesta, Sonata, Ambien, Rozerem, and Halcion are:
- Changes in appetite
- Difficulty keeping balance
- Daytime drowsiness
- Dry mouth or throat
- Reduction in memory retention
- Stomach pain or tenderness
- Uncontrollable shaking of a part of the body
- Burning or tingling in the hands, arms, feet, or legs
Some sleeping pills have potentially harmful side effects, like parasomnias. Parasomnias are movements, behaviors, and actions over which you have no control, like sleepwalking. During a parasomnia, you are asleep and unaware of what is happening.
Parasomnias with sleeping pills are complex sleep behaviors and may include sleep eating, making phone calls, or having sex while in a sleep state. Sleep driving, which is driving while not fully awake, is another serious sleeping pill side effect. Though rare, parasomnias are difficult to detect once the medication takes effect.
Product labels for sedative-hypnotic medicines include the risks of taking a sleeping pill. As complex sleep behaviors are more likely to occur if you increase the dosage of a sleeping pill, take only what your doctor prescribes and nothing more. Other risks of sleeping pills include developing drug tolerance and drug dependence. Withdrawal symptoms may occur if you stop their usage.
Symptoms like nausea, sweating, and shaking can take place. Sleeping pills can also interact with other medications. That can be sometimes dangerous. Sedative hypnotic medications can cause severe allergic reactions in the body. They are memory lapse, hallucination, suicidal thoughts, facial swelling, etc. If you experience any such symptoms, please contact your doctor immediately.
Summary: Many prescription sleeping pills have potentially harmful side effects, like parasomnias, hallucinations, suicidal thoughts, etc. Some of them may cause allergic reactions in the body. You may develop drug tolerance or drug dependence. Withdrawal symptoms may occur when you stop using them.
Herbal And Dietary Sleep Supplements
A lot of dietary and herbal supplements to combat insomnia have been marketed in various forms. Some can be taken as capsules, some as tea, some in powdered form mixed with food.
Even though they promise us a natural solution for insomnia with fewer or no side effects, yet it is important to be aware of these sleeping aids. They may interfere with the other medications or vitamins that you are taking. It is best to consult your doctor or the pharmacist before using them.
While science is still looking for answers about sleeping aids and a lot of studies are going on in this field, some of them have been seen to work very efficiently without any side effects.
1. Melatonin: Melatonin is a hormone that regulates the body’s circadian rhythms. Low melatonin level in the blood is directly associated with insomnia. Research indicates improved sleep when melatonin is taken at an appropriate time for jet lag and shift work. Melatonin is often taken to alleviate characteristic symptoms of insomnia like difficulty falling asleep and staying asleep.
2. Valerian Roots: Valerian root contains valerenic acid, isovaleric acid, and numerous antioxidants such as hesperidin and linarin, which appear to have sedative and sleep-enhancing properties. Research suggests that valerian root may help ease anxious feelings that occur in response to stressful situations. Powdered Valerian root is available in capsule and tablet form. It is also in the form of tea.
3. Lemon Balm: Lemon balm contains chemicals that have a sedative and calming effect. It is used alone or as part of a multi herb sleep aid product. Many studies have been done on the effect of lemon balm in insomniac subjects. 300 mg of a standardized lemon balm extract can be used twice daily for 15 days.
4. Vitex Agnus Castus: The ethanolic extracts from the Vitex have been used for the treatment of premenstrual syndrome, infertility, etc. It has a therapeutic effect on depression and insomnia. Vitex agnus-castus supplements are based on the dry weight of the plant’s fruit. The standard dose is between 150-250mg.
5. Glycine: Glycine is a neurotransmitter with the ability to be both excitatory and inhibitory, which means that it can function both to stimulate the brain and nervous system activity or to quieten it. People use glycine as an oral supplement for a variety of purposes, like improving sleep, enhancing memory, and increasing insulin sensitivity. Glycine lowers the body temperature, increases serotonin and helps the body to smoothly progress towards sleep.
6. Tryptophan: Tryptophan is a precursor to sleep-inducing compounds serotonin and melatonin and is found in small amounts in all protein food. Serotonin affects organs, like the brain and intestines. In the brain specifically, it influences sleep, cognition, and mood. Tryptophan supplements provide extra doses of this sleep-inducing amino acid that help counter sleep disturbances. Doses of up to 5 grams per day have been reported.
7. L-Theanine: L-theanine helps people fall asleep quickly and easily by relaxing the mind and lowering anxiety. It boosts the GABA levels and lowers excitatory brain chemicals. For sleep, stress and other uses, 100 mg to 400 mg is recommended.
8. Other Herbs and Essential Oils: Apart from these above mentioned natural sleep aids, certain herbs like Ginkgo biloba, California poppy, Kava kava, St. John’s Wort, and natural essential oils like lavender oil, some herbal tea like Chamomile tea have been found to be effective in relaxing the mind and inducing good sleep.
9 Tips for Safe Use of Sleeping Pills/Aids
Irrespective of whether you use prescription sleeping pills or natural sleep aids such as herbs or essential oils, keep the following safety guidelines in your mind.
1. Start at the lowest dosage: Whatever sleeping aid you are trying, start at the lowest strength to see how it affects you and whether you experience any side effects.
2. 6- 8 hours timing: Ensure you have 6 to 8 hours of time to sleep before taking a sleeping pill as you will otherwise find yourself extremely drowsy in the morning. For the same reason, it’s best to avoid taking a second dose in the middle of the night if you find yourself awake.
3. Do not mix with alcohol: Before or after taking any kind of drugs that have a sedative effect, do not take alcohol as this can increase the sedation. This is a dangerous combination that may even turn deadly.
4. Reduce frequency of use: Regular usage of sleeping aids can get habit-forming. To prevent addiction, use them as and only when needed.
5. Do not drive a car afterward: Do not operate heavy machinery or drive a car after taking sleep aids as this can get dangerous as you may feel too sleepy to be in control. This is especially important if you are starting on a new sleep aid.
7. Read the instructions carefully: Drug interactions can occur so take care. Some foods such as grapefruit may cause adverse reactions while you are using specific sleep aids, so pay attention to what the insert with the medication warns you about.
8. Do not stop suddenly: Do not attempt to increase the dose of prescription sleeping drugs without asking your doctor. Stopping sleeping pills or sleep aids suddenly after regular use may cause rebound insomnia or other discomforts, so you have to gradually taper it off.
9. Discuss with your doctor: Ensure you tell your doctor about any medical condition you have or any medication you are taking as dangerous drug interactions can occur. Even pain reliever and allergy medications may interfere with the action of sedatives can cause undesirable side effects.
Natural Ways to Overcome Insomnia
Here are some ways to help you sleep better whether it’s about relaxing and falling asleep as you lay awake at night or developing better sleep habits.
1. Relaxation Techniques at Bedtime
Some people who are suffering from insomnia are able to fall asleep but get up in the middle of the night and can’t fall back to sleep. Lying awake on the bed for a long time as the thoughts keep coming makes you totally drained out and tired and unready for the next day.
Under such circumstances, here are a few tips that may be helpful to get back to sleep:
- Don’t let your mind run over any problems of your day, as you lie down to sleep. Postpone the brainstorming and worrying so that your mind is not overactive before sleep.
- A non-stimulating activity like reading a book may help reduce your stress levels and as your eyes and mind tire, it helps you fall asleep faster.
- Closing your eyes and slowly rolling them upwards a few times also helps you to slow down the overactive brain.
- Try rubbing the ShenMen acupressure point at the top of the ear. That relieves stress and anxiety and helps your mind to calm down thus allowing sleep to take over.
- Practicing abdominal breathing is another stress reducer that lulls you to fall asleep as does sitting or lying quietly and focusing on your natural breathing.
- Progressive muscle relaxation is also a good way to destress the tense muscles and relax your body physically.
Other general lifestyle changes you can make to improve your sleep quality are:
2. Have a Bedtime Routine
Have a bedtime routine that signals to your body and mind that its time to wind down and go to bed. This may be simple as getting your bedroom and bed ready, tucking the bedsheets and fluffing up the pillows. Brush your teeth.
A bath using warm water and then applying your nighttime moisturizers or body lotions is a calming routine. You can meditate, pray, listen to music, read a book, write a journal or anything else that helps you relax.
3. Change Your Dinner Timing
You must be attentive to the food that you are consuming at dinner time. You should have a gap of at least 2-3 hours between your dinner time and sleep. It gives the body enough time to digest the food before the body slows down while sleeping.
Stay clear of heavy meals or fatty foods as this can lead to digestive disturbances at bedtime. Avoid late-night snacking, especially on sweet foods as all that sugar can keep you feeling hyper and you may find it difficult to fall asleep.
4. Cut the Caffeine at Bedtime
Coffee is a stimulant and should be avoided before bedtime as it stimulates the mind and makes the brain alert, forbidding it to sleep. Skip that cup of coffee after your dinner and don’t use it as a refresher to help you working into the night. It’ll be tough to fall asleep even if you feel tired and it’s quite late at night.
Caffeine in the coffee enters the bloodstream via the stomach and small intestine and can stimulate the brain within 15 minutes of its consumption. Once it is inside the body, it takes several hours for the caffeine to be eliminated and can show its effect nearly 6 hours after consumption.
5. Cut the Screen Time Before Bed
The smartphone, your tab, laptop stimulates your brain and doesn’t allow it to switch off. The blue light emitting from these screens suppresses melatonin which is responsible for your sleep-wake -cycle.
As the brain gets excited, there is a delay in REM sleep. It is advisable to switch off your screen at least 30 minutes to 1 hour before your bedtime.
6. Avoid Naps During the Day
Even though a good afternoon nap has certain benefits like restoring energy and improving focus, it may cause you to stay awake at night. This is mostly applicable to people who already suffer from insomnia.
A nap of 10-20 minutes seems to have good results but if it is over 30 minutes, then it messes up with the body’s circadian rhythm.
7. Regular Exercise
Studies have shown that regular exercise reduces stress and relieves anxiety. This also reduces the risks of getting sleep disorders like sleep apnea and restless leg syndrome. You can go for a casual stroll after dinner. This raises the body temperature a little and then drops, thereby triggering sleepiness.
Exercising in the morning or late afternoon helps you feel energized in the mornings and you may feel more tired towards the late evenings and this can help in reset your sleep-wake -cycle.
8. Practice Meditation and Yoga
Practicing yoga is one of the best ways to relax your mind and lull it into sleepiness. There is a special kind of yoga with the name yoga Nidra that promotes relaxation through meditation. The term ‘Nidra’ literally means sleep.
Meditation helps to sleep by calming the brain. It reduces blood pressure, anxiety, and depression, thereby inducing sleep in people suffering from insomnia.
The Final Note
Insomnia is defined as the failure to initiate and maintain sleep. At least one-third of the world’s population suffer from occasional insomnia. Insomnia can reach crisis status when prolonged lack of sleep produces severe dysfunction and mental consequences.
Stress, worry and emotional turmoil may produce insomnia. Abnormalities in any of the neurotransmitters may cause sleeplessness. Alcohol or caffeine ingestion can interfere with sleep.
The simple solution may be to develop a healthier lifestyle, practice and develop a calming bedtime routine. Natural sleep aids and relaxation techniques will definitely help overcome most sleeping issues. But if the underlying reason is a more serious medical or psychological problem, you should definitely see a doctor.