Smart Ways to Get a Good Night’s Sleep

Sleep aids help millions of Americans get a good night’s sleep, but experts agree they’re not a long-term solution.

About 70 million Americans have a sleep disorder or are sleep deprived, something that can affect their quality of life and pose serious health risks. Many of these people turn to medication at some point to help them get a good night’s sleep. According to the U.S. Centers for Disease Control and Prevention, 4 percent of adults age 20 and older – some 8.5 million people – reported taking a prescription sleep aid within the month.

“Sleep deprivation is a really common problem and medications for it are readily available,” said Michael Howell, MD, a sleep medicine physician at the University of Minnesota Medical Center. “They’re a reasonable solution in the short term, but the only chance to cure insomnia is with behavioral therapy.”

There is no shortage of sleep aids on the market, and not all pills are alike. Some are quick-acting drugs that help you fall asleep. Others last longer to help you stay asleep. Most of them act on neurotrasmitters in the brain to slow down the nervous system. Some antidepressants are also prescribed to treat insomnia.

Howell says these aids are not effective for people with delays in their circadian rhythm who tend to fall asleep and wake up later. He also stresses that they can be dangerous for someone with restless leg syndrome. “People with restless leg syndrome tend to get up in the middle of the night to eat or smoke or take a walk,” said Howell. “So with the medications, they could do these things and not be aware or not remember it later.”

Clete Kushida, MD, a professor of psychiatry and behavior sciences and medical director of the Stanford Sleep Medicine Center, agrees. “Certain medications have been linked to unusual sleepwalking episodes that can cause problems,” he said.

Another concern is that a drug’s effects can linger and impair a person’s ability to handle activities that require alertness, such as driving to work. “The biggest worry is that the medication will carry over into the next day and cause grogginess,” said Kushida.

The U.S. Food and Drug Administration earlier this year said it had received 700 reports of “impaired ability and/or road traffic accidents” linked to certain sleeping pills. The FDA announced it was requiring lower recommended doses for sleep aids containing the sedative-hypnotic drug zolpidem, specifically for women because the drug tends to stay in their systems longer than men’s.

Kushida said all these pills are best for dealing with short bouts of sleeplessness, such as jet lag or stress-induced sleeplessness. But “we typically tell people to not take them more than two to four times a week for about a month,” he added.

Howell added that if a person is on sleep medications for six months and stops taking them, their insomnia will quickly return because their overall sleep behavior hasn’t changed.

Cognitive behavioral therapy can help to reverse a person’s thoughts and habits surrounding sleep.

“A big part of insomnia is when people are lying in bed and they can’t sleep. They keep thinking about how they can’t sleep and how tired they’re going to be in the morning,” said Howell. “You have to separate the bedroom from wakefulness, and get out of bed if you’re not tired. It doesn’t matter what time it is, go do something else and then go back to bed when you’re tired so you’ll fall asleep easier.”

Howell is concerned that many people are not getting the treatment they need, either because “they don’t have insomnia, they have other sleep disorders; or they haven’t tried therapy.” The bottom line, he said, is “we try to recommend therapy first.”

Dr. Sanjay Gupta