It’s three in the morning and you’re still tossing and turning. You’ve counted every sheep in the country and even made yourself some hot cocoa, but your thoughts keep on spinning like a hamster on a wheel, and sleep remains elusive.
Does this sound familiar to you? If it happens once every three months, don’t lose any sleep over it (ha ha!), but if you regularly struggle to fall or stay asleep, the situation should be addressed.
But before you rush to your GP for a prescription for sleeping pills, first consider all the options available to you.
Basically there are three ways to address the problem of insomnia:
- Behavioural or dietary changes
- Herbal or non-prescription sleeping aids
- Prescription medication
Restoring normal sleep patterns may be as simple as making a few minor changes to your lifestyle:
- Avoid stimulants. Beverages like coffee, tea and colas contain caffeine, which is a strong stimulant. Some people are so sensitive to caffeine that a cup of tea after four o’clock in the afternoon is enough to keep them awake. Nicotine found in tobacco products (and in e-cigarettes) is also a stimulant that can interfere with sleeping patterns.
- Avoid alcohol. Alcohol is believed to be a sedative, but it actually has a biphasic effect on the body, which means that it can have both a stimulating and a sedative effect, depending when it is ingested. Researchers at Brown University have found that drinking alcohol in the evening and before going to bed tends to have a stimulating effect.
- Don’t eat or snack late at night. Going to bed with a full stomach can cause discomfort when lying down and may cause acid reflux. A carbohydrate-rich dinner may help you sleep better because carbs stimulate the production of serotonin.
- Go to bed at the same time every night. Having a routine reinforces your body's sleep-wake cycle and promotes better sleep.
- Create conditions that are conducive to sleep. Ideally your room should be cool, dark and quiet. Also make sure your mattress and pillows are comfortable.
- Don’t nap during the day if you find that it interferes with your nighttime sleep.
- Getting sufficient exercise helps to manage stress and relaxes the body, making it easier to fall asleep.
- Find ways to manage your stress levels. Stress and the inability to “switch off” can interfere with your sleep patterns. Yoga and meditation may help.
- Having sex relaxes the body and may be one of nature's best ways to counter insomnia.
Herbal and non-prescription sleeping aids
- Magnesium relaxes the muscles and may help you to fall asleep. Many people are magnesium deficient, but be careful not to take too much as it will cause diarrhoea.
- Many over-the-counter medicines contain antihistamines, which make you feel drowsy and can help you fall asleep. These medicines are however designed to address other problems (e.g. hay fever) and relying on them as a sleep aid is not recommended.
- Valerian has been used for centuries to treat insomnia and anxiety. Some studies suggest that valerian alleviates insomnia and improves quality of sleep. Many over-the-counter remedies contain valerian.
- Hops is not only used for making beer. The extract from this plant is well known for its mild sedative and sleep-inducing properties. Like valerian it is often used in over-the-counter remedies.
- Other herbal remedies that are used to counteract insomnia are: German chamomile, zizyphus, passion flower, lavender oats and ginseng, as well as the homeopathic remedy belladonna.
- A number of over-the-counter remedies contain the amino acid L-theanine which is naturally found in green tea and promotes calmness as well as deeper sleep at night.
- Melatonin is made by the pineal gland which is situated in the brain. When it gets dark, melatonin levels in the blood rise sharply, relaxing the body and preparing it for sleep. Supplements are available, but In South Africa you now need a prescription to obtain melatonin, although some pharmacists will give it to you if you claim to require it for jet lag.
Generally speaking doctors will only prescribe sleeping pills as a last resort and only for a limited period of time.
As the name indicates, this kind of medication can also only be obtained if you have a prescription from a medical doctor or psychiatrist. Not all sleeping pills are the same, and some are definitely more addictive and dangerous than others. Sleeping pills can be fatal if ingested in large doses, particularly if they’re taken with alcohol or any other sedative.
Types of sleeping pills
Sleeping pills can be divided into two categories:
- Benzodiazepines (e.g. Halcion, Normison, Loramet, Dormicum, Dormonoct and Hypnor)
- The new generation of non-benzodiazepines (such as Stilnox, Imovane and Zopiclone)
These sleeping pills relieves anxiety and insomnia and are also used as a sleeping pill before anaesthetic, as a light anaesthetic, in the treatment of alcohol abuse and as a muscle relaxant.
Some benzodiazepines induce sleep almost immediately but their effect lasts just a few hours. Others work for more than 12 hours. The faster they take effect the more addictive they are.
Dormicum, Dormonoct and Halcion work so fast you could fall asleep before you have time to get into bed, and within a few weeks you could become addicted and experience severe withdrawal symptoms when you stop taking them.
Rohypnol and Dormicum cause such severe memory loss that they have been used as date rape drugs. If you’ve been using sleeping tablets for a while, don’t go cold turkey if you want to stop. Gradually wean yourself off the tablets under your doctor’s supervision.
Tablets like Stilnox and Imovane, which are not benzodiazepines, are used just to help you fall asleep. You’re less likely to become dependent on this type of sleeping pill.
A word of caution
Never take sleeping pills given to you by someone else than your doctor! We are not all the same and what is suitable for a friend or family member might not be the right medication for you.