Need To Catch Some Shut-Eye? Tips on Getting the Sleep You Need
Medically reviewed by Leigh Ann Anderson, PharmD. Last updated on March 3, 2021.
Is Trouble With Sleeping a Common Problem?
If you had trouble getting to sleep last night, you are not the only one.
Insomnia, which is defined as difficulty falling asleep, staying asleep, or both, is one of the most common health conditions - roughly 40% to 50% of people have trouble sleeping.
Sometimes insomnia can just be a short-term problem - maybe your internal clock is off from air travel, or maybe your lack of sleep is due to a more chronic problem - like undiagnosed depression, acid reflux or pain.
The first step is to examine your lifestyle habits to see if your insomnia is preventable. Think about your habits, and how you can change them, if you think they may be contributing to your sleep problems.
Who Is Most At Risk For Insomnia?
Losing a night or two of sleep can happen to anyone, but certain risk factors can increase the chances for chronic insomnia.
- As we get older, especially past 60 or 65 years of age, insomnia may be more prevalent.
- Women, sometimes due to menopause or other hormonal changes, may have a greater risk of insomnia.
- Life stresses or mental health conditions can aggravate sleep patterns, as can financial woes.
- Jet lag or working night shifts can alter our internal clock.
- Mourning the loss of a loved or worries about health can also affect how we rest.
- Medical conditions, like sleep apnea, can lead to a restless night and daytime sleepiness.
Caffeine: It May Be In Places You Wouldn't Expect
Monster-sized energy drinks? Triple Venti Latte? Cold brew at 2?
We all know that caffeine keeps us awake -- but how much do we really consume?
Caffeine can be found in coffee, tea, soft drinks, chocolate, energy drinks, some OTC medications, and in other hidden places.
Guarana, which contains some of the highest concentrations of caffeine in any plant, is often found in energy drinks.
If you are tossing and turning at bedtime, it may be best to avoid caffeinated products after lunch if you want a good night's rest.
I Avoid Caffeine, and I'm Still Having Trouble Sleeping
Caffeine may not always be to blame. Certain behavioral habits, also called "sleep hygiene", might need adjustment.
Try these tips to promote a more restful night of sleep:
- Going to bed and getting up at the same time -- even on weekends.
- Exercising regularly most days -- but NOT before bed if it distrupts your sleep.
- Not watching TV or other electronics in the bedroom.
- Avoiding alcohol and cigarettes in the evening.
- Turning off electronics at least 30 minutes before bed.
- For some people, a warm bath or a good book is relaxing, too.
When Should I See A Doctor?
Medical conditions may interfere with normal sleep patterns. Insomnia can occur when a person is under stress, in pain or has another medical condition.
Conditions that can cause insomnia or cause people to wake up in the middle of the night:
- Frequent urination
- Restless leg syndrome
- Frequent nightmares
- Depression can cause people to wake up in the middle of the night.
Medical treatment of the underlying condition can often improve nighttime rest.
If you have tried to adjust bedtime routines and cut back on caffeine, and you are still having trouble getting a good night's sleep, it may be time to contact your doctor.
What Other Options Are Available to Help Me Get to Sleep?
Cognitive behavioral therapy (CBT) can teach you new sleep habits and can be very effective for insomnia. CBT is a common type of talk therapy, known as psychotherapy. You will see a therapist and follow a structured plan, attending a limited number of sessions. Your doctor may recommend this as a first line of treatment.
Behavioral therapies may include:
- Education about good sleep habits.
- Learning methods to relax, focused breathing, and methods to replace negative worries.
- Readjusting use of the bedroom for sleep and sex only.
- Phototherapy and chronotherapy, techniques to reset your "sleep clock".
- In some circumstances, your doctor might prescribe a short trial of sleep medicine.
Guided Meditation Taking You To A Restful State
Meditation can be an excellent non-drug way to induce sleep. Countless sleep-promoting podcasts are available that guide people new to meditation through the process.
Several are aimed specifically at children and feature calming imagery such as hot-air balloons and enchanted forests.
Meditation helps you to relax your muscles, slow-down and deepen your breathing, and replace stressful or worrying thoughts with dream-like images.
Guided meditation can be used each evening, and most podcasts feature people with soothing voices who walk you through each step one at a time -- all you have to do is listen and follow their advice.
I'm Worried About Using Sleeping Pills - Are They Safe?
Sleeping pills known as "sedative-hypnotics" are usually for short-term use.
Sleep medicines can be useful while you try to adjust your sleep habits; however, many of these medications can be addicting, so it is important to limit their use.
Any sleep drug can cause next-morning drowsiness for activities that require mental alertness, including driving. Sleep medications are also known for a wide range of drug interactions, so it is important that your pharmacist complete a drug interaction review with all of your prescription, over-the-counter, and herbal medicines.
When possible, always try non-drug remedies (such as guided meditation or cognitive behavioral therapy) first.
Short-Term Use: Benzodiazepine Sedative-Hypnotics
Benzodiazepines (BZDs) are a class of drugs that work on specific receptors in the brain to promote sleep.
BZDs have many different uses, for example they can be used as sedatives to help with sleep, to reduce anxiety or panic, to help treat and prevent seizures, and as muscle relaxants. BZDs are generally only recommended for short-term use for sleep, as they can be highly addicting.
Examples of BZDs that are used to help with sleep include:
Unless specifically okayed by your doctor, DO NOT use benzodiazepines with pain medications known as opioids (narcotic analgesics), as this may result in profound sedation, respiratory depression, coma, and death
Medicines for Sleep: Nonbenzodiazepine Sedative-Hypnotics
Nonbenzodiazepines are similar to benzodiazepines but they work on the more focused sleep centers of the brain.
They are shorter-acting but can still cause next-day drowsiness, impairment of alertness and driving, and complex sleep behaviors that some people may forget, like eating or driving in the middle of the night.
Examples of these drugs include:
Some sleep agents are available in the lower-cost generic form; be sure to ask your pharmacist.
The use of nonbenzodiazepine agents with other other CNS depressants, such as benzodiazepines, opioids, tricyclic antidepressants, can add to the depressant effects of these drugs and should be avoided unless specifically recommended by your doctor.
Do NOT drink alcohol with benzodiazepines or nonbenzodiazepines.
Take Note: Precautions for Use of Sedative-Hypnotics
The drowsy effect with sleep medications may last into the next day which could impair driving safety, work function and decision-making; it is important to use only the dose prescribed by your doctor.
You should not drink alcoholic beverages while you are taking any of these medications; it could slow your breathing and cause extreme drowsiness or confusion.
If you are:
- pregnant or planning a pregnancy
- use alcohol
- have kidney, liver or lung problems
- have sleep apnea
- need to work or care for people at night (for example - you're on-call or have small children), or drive, be sure to tell your doctor.
Side Effects with Sedative-Hypnotics Can Be Serious
Sedative-hypnotics are strong medications. Side effects can be serious, and you should pay attention and follow the warnings for these drugs.
Common side effects and warnings may include:
- Unusual behaviors like driving or eating in the middle of the night after using one of these medications.
- "Amnesia" or loss of memory of events that occur while under the influence of the medication.
- Driving can be more dangerous in the morning, as the effect of the medication may not have worn off.
- Avoid taking other sedative-type drugs, or any pain medication that contains a narcotic.
- And definitely don't take these drugs with alcohol as your breathing could be dangerously slowed or stop.
Ramelteon (Rozerem): Another Option
Ramelteon works by attaching to the melatonin receptors in the brain and helps to signal to the body that it's time for sleep.
It should be taken within 30 minutes of bedtime, but avoid taking this drug with a meal that has a high fat content.
Ramelteon is unlikely to cause next-day drowsiness or to be addicting; however, it can have side effects like headache, dizziness and nausea.
Antidepressants: Beware of Side Effects
- Dry mouth, blurred vision, dizziness and urine retention may occur as side effects with Silenor.
- Unusual sleep behaviors, such as walking, driving, eating or engaging in other activities while asleep is also a risk.
Melatonin: An OTC Used for Sleep
Melatonin is a hormone produced in the brain. The release of melatonin is stimulated by darkness and suppressed by light, which suggests it may be involved in our normal wake-sleep patterns.
Melatonin supplements might be helpful in treating jet lag or insomnia, but research suggests the effect is mild. Melatonin is not approved by the FDA for insomnia because it is classified as an OTC dietary supplement.
Melatonin is available over-the-counter (OTC) in tablet form as a dietary supplement. It's found at pharmacies, grocery stores and even online. As alway, be vigilant with online purchases of any medication as there is always the potential for fraud.
Learn More: Melatonin: Worth Losing Sleep Over?
Antihistamines: Also Used for Sleep
Antihistamines, such as diphenhydramine (Nytol, Sominex, Simply Sleep), are available over-the-counter without a prescription and are used for sleep.
When antihistamines are used for sleep, side effects may occur, such as:
- next-day drowsiness
- dry mouth
- urine retention
- blurred vision
First generation antihistamines such as diphenhydramine can be linked with anticholinergic side effects, which can be especially dangerous in the elderly population. Learn more here: Anticholinergic Drugs to Avoid in the Elderly
Many products contain an antihistamine combined with an OTC pain reliever (such as Tylenol PM, Advil PM). Avoid these products for sleep if you do not have pain.
In any age group, adjusting lifestyle and sleep habits, getting regular exercise, and avoiding too much caffeine and blue light from electronics should be your first step to improve sleep patterns.
New Drugs for Insomia: Orexin Antagonists
Dual orexin 1 and 2 receptor antagonists (DORA) are a new class of sleep medications. DORA drugs block orexin, which is a brain chemical involved in wakefulness and arousal.
Belsomra and Dayvigo are oral drugs used for the treatment of insomnia characterized by difficulties with sleep onset and sleep maintenance (falling asleep and/or staying asleep). Do not take more than prescribed, and do not drink alcohol with these medications. Use the lowest dose possible, and if you are prescribed a higher dose, use caution if driving the next day and with other activities requiring complete mental alertness.
- Belsomra is usually prescribed as a 10 mg oral dose, taken no more than once per night and within 30 minutes of going to bed. You also must have at least 7 hours remaining before the planned time of awakening when taking Belsomra.
- Dayvigo is typically prescribed as a 5 mg dose at bedtime (no more than once per night) with at least 7 hours before the planned time of awakening.
Talk to your doctor about the side effects of these drugs before you use them. Serious side effects may include: complex sleep behaviors, worsening depression and suicidal thoughts, sleep paralysis, or leg weakness. Common side effects include: a decreased ability to drive safely and think clearly and sleepiness during the day.
Finished: Need To Catch Some Shut-Eye? Tips on Getting the Sleep You Need
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- Dayvigo Product Information. Eisai Inc. Accessed March 3, 2021 at https://www.accessdata.fda.gov/drugsatfda_docs/label/2019/212028s000lbl.pdf
- Belsomra Product Information. Merck and Co. Accessed March 3, 2021 at https://www.accessdata.fda.gov/drugsatfda_docs/label/2020/204569s006lbl.pdf
- Insomnia. Harvard Health Guide. Accessed March 2, 2020 at https://www.drugs.com/health-guide/insomnia.html.
- Wickwire EM, Collop NA. Insomnia and sleep-related breathing disorders. Chest. 2010;137:1449-1463.
- Schutte-Rodin S, Broch L, Buysse D, at al. Clinical guideline for the evaluation and management of chronic insomnia in adults. J Clin Sleep Med 2008;4:487-504.
- Up to Date. Patient eduation: Insomnia (Beyond the Basics). Available at http://www.uptodate.com/contents/insomnia-beyond-the-basics
- Insomnia treatment: Cognitive behavioral therapy instead of sleeping pills. Mayo Clinic. Accessed March 3, 2021 at https://www.drugs.com/mca/insomnia-treatment-cognitive-behavioral-therapy-instead-of-sleeping-pills