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Sleep Hacks & Sleep Aids 💊

Nov 05, 2024

ICYMI 👉

Daylight Savings mixed with election politics could mean a tough week for sleep enthusiasts. So, today I’ll talk about the THREE main ingredients for a good night’s sleep—plus my thoughts on commonly used non-prescription sleep aids.

Everyone knows that sleep is important. From preventing dementia and depression to mitigating high blood pressure and heart disease, sleep is nature’s best medicine. Yet everyone struggles with sleep problems at some point. (Unless you’re my cat.)

During sleep, the fluid that bathes our brain (called cerebrospinal fluid) carries away toxins and metabolic waste that are produced during the day. The enzymes in this fluid are like little sanitation workers who only come out when you’re asleep to take the proverbial trash out.

So, how to get a good sleep?

Step one is to optimize the THREE MAIN AREAS required for a good night’s sleep:

1. Environmental factors

A good sleep environment is dark, quiet, and cool. Too much light in your room? Consider blackout shades. Got noisy teens who stay up late? Try a sound machine or ear plugs. Hot and bothered by menopause or your social media feeds? Set the thermostat to below 65 degrees. Got a bed partner who snores, stays up late reading, or thrashes around? Have a frank conversation about meeting your sleep needs, and consider separate bedrooms if needed—at least for this week!

2. Behavioral factors

We tend to get into bed with our minds still humming from the day, worrying about work, kids, relationships, and politics—everything and nothing at the same time. Which is why sleep hygiene is so important. Here are some behavioral rules of thumb:

Try to get some sort of physical activity every day in order to discharge adrenaline and healthfully fatigue the body.

Don’t eat a large meal three to four hours before bedtime.
Ditch alcohol if possible. Alcohol disrupts the circadian rhythm required for longer blocks of sleep.

Avoid caffeine intake after noon. Our sensitivity to caffeine tends to go up with age. Beware of hidden caffeine in drinks that have black or even green tea!
Set an electronics curfew, ideally shutting off all screens an hour or two before bedtime.

Try doing something relaxing before bed —like taking a shower, listening to calming music, or reading something light.
Keep a journal and jot down your worries before bedtime. Your restless brain can rest assured they’ll be there for you in the morning!

Reserve your bed for activities that are pleasant: sleeping, cuddling, and intimacy.

Download a meditation app like Calm, Headspace, or Insight Timer. The “bedtime stories” on the Calm app are great.

If you’ve been lying in bed for more than 30 minutes and can’t fall asleep, get up and do something else: Make a cup of herbal tea, read in the other room, listen to a relaxing audio story. Try to stay off your phone or other screens, and then try again in another 30 minutes.

Stick to a regular schedule. Our body functions best when we’re on a routine—even on weekends.

3. Biomedical factors

Sometimes sleep issues can be related to a medical condition or medication. Insomnia is associated with conditions such as depression, anxiety, OCD, PTSD, chronic pain, Parkinson's disease, Alzheimer's, restless legs syndrome, acid reflux (GERD), irritable bowel syndrome (IBS); asthma, sleep apnea, hyperthyroidism, perimenopause, and menopause.

Certain medications act as stimulants, such as ADHD medications (Vyvanse, Adderall, etc); Decongestants (Sudafed/pseudoephedrine); Antidepressants (Wellbutrin); Thyroid medications (Levothyroxine, Synthroid); Corticosteroids (Prednisone, Medrol); and Bronchodilators/Inhalers (Albuterol, Salmeterol).

Sleep disturbance is not an inevitable consequence from these medical issues or medications, and periodic bouts of sleeplessness can be normal. However, persistent insomnia can be a symptom of underlying mental or physical health issues. So review your entire health situation with your doctor, making sure to address issues like stress, anxiety, burnout, and depression head-on.

Sleep aids

When we’re keyed up and sleepless, it’s tempting to “just take something” to quiet the noisy brain. The problem is that prescription sleep aids such as Ambien, Clonazepam, and Lunesta produce a state that is closer to sedation and is not actually restorative sleep. They can also be addictive and can cause unpleasant side effects like nighttime eating and fuzzy-headedness upon awakening. They can also negatively affect cognition—which is why I’m super cautious about their use, especially in my older patients.

But there are also common non-prescription sleep aids that patients ask me about:

1. Benadryl

Diphenhydramine, commonly known by the brand name Benadryl, is a sedating antihistamine that people commonly use for sleep. It can be effective for short-term use, such as during periods of acute stress or when traveling. It can be a handy “two-for-one” medicine when you have a cold or allergy symptoms and need to get rest.

However, regular Benadryl use can lead to tolerance, meaning higher doses may be needed over time to achieve the same sedative effects. It can also cause grogginess the following day. Because it has what we call “anticholinergic” properties, Benadryl can cause dry mouth, blurred vision, constipation, and urinary retention. These effects can be more pronounced for older adults, increasing the risk for falls or cognitive impairment.

While Benadryl can be a helpful short-term solution for sleep, it is less suitable for long-term use and should be avoided in older patients and those with cognitive issues.

2. Melatonin

Melatonin is an over-the-counter version of the hormone that our brain naturally makes. Its efficacy is well-documented in medical literature, however, so are its downsides.

Research supports the use of melatonin for reducing symptoms of jet lag, especially when traveling across time zones. Some studies indicate that melatonin may help shift workers adjust to their irregular schedules. Older adults, who may produce less melatonin naturally, might benefit from supplementation to improve sleep.

Common side effects include daytime drowsiness, dizziness, and headaches. Some people may also experience mood changes or vivid dreams. As melatonin is a hormone, there are concerns about its long-term use affecting hormonal balance, particularly in adolescents. Melatonin can interact with various medications, including blood thinners, immunosuppressants, and medications that affect the central nervous system.

3. CBD

CBD (cannabidiol) has gained popularity over the last decade as a potential aid for sleep, and the literature on its efficacy and downsides is growing. Some studies suggest that CBD may help reduce anxiety, which can, in turn, improve sleep quality. Research indicates that CBD might be helpful for insomnia and REM sleep behavior disorder. Some report that it helps them fall asleep faster and enhances overall sleep quality. For those whose sleep is disrupted by muscle tension or chronic pain, CBD's analgesic properties may contribute to improved sleep.

Individual responses to CBD vary widely, however. While some find it effective at low doses, others may require higher doses to experience benefits. Common side effects can include fatigue, diarrhea, and changes in appetite or weight. CBD can interact with certain medications, including blood thinners and drugs that affect liver enzymes. Also note that the CBD market is not uniformly regulated, which can lead to variability in product quality and potency. Some products may not contain the advertised amount of CBD or may contain contaminants, so buyers beware!

4. Ashwagandha

Some studies such as this double-blind, randomized, placebo-controlled study have shown that Ashwagandha significantly improved sleep quality in adults with insomnia (and even those without reported insomnia!) when compared to those who received the placebo.

Ashwagandha seems to lower cortisol levels, which can help mitigate stress-induced insomnia. A study in the Indian Journal of Psychological Medicine (2012) showed a 28% reduction in cortisol levels among participants. A meta-analysis in PLOS One (2021) found that Ashwagandha had a small but significant impact on sleep, especially for people with insomnia, those who took greater than 600 mg per day, and those who took the supplement for over 8 weeks.

The downsides include the potential for gastrointestinal discomfort or diarrhea, and sedation if taken in high doses. Pregnant and nursing women should avoid Ashwagandha due to potential hormonal effects.

5. GABA (Gamma-Aminobutyric Acid)

A review of available data on GABA published in Frontiers in Neuroscience in 2020 essentially said that it’s still unclear as to whether GABA supplementation helps with sleep or stress. GABA promotes relaxation and may help lower anxiety levels, which can aid sleep onset. A study in Sleep Science (2016) reported improved sleep quality in participants who supplemented with GABA before bedtime.

However there is debate about the effectiveness of GABA supplements since they may not effectively cross the blood-brain barrier. Some people report headaches or digestive issues from GABA.

6. Magnesium Glycinate

We know that magnesium helps with muscle relaxation, which can help with tension-related sleep issues. What does the data show about its effect on sleep? A systematic review of the available literature showed that the data are mixed: observational studies show an association between magnesium and sleep, while the randomized controlled trials (which are higher quality studies) fail to show cause and effect.

The downsides of magnesium are that higher doses may cause diarrhea or upset stomach. Over-supplementation can lead to imbalances in other minerals (e.g., calcium).

7. L-Theanine

A systematic review in Sleep Medicine Reviews (2019) suggests that L-theanine can significantly improve sleep quality and reduce sleep onset latency, particularly in individuals with anxiety. L-theanine increases alpha brain wave activity, promoting relaxation without sedation. A study published in Nutritional Neuroscience (2016) indicated that L-theanine supplementation improved sleep quality and reduced anxiety in subjects.

The cons? Some people report headaches or dizziness from L-theanine.

The upshot

Sleep is essential for nearly every aspect of our health. Do your best to get it. Ideally you wouldn’t need pharmacological help. (There are no side effects from meditating or reading Middlemarch before bed!)

That said, sometimes we need a little pharmacological help. That’s generally okay, as long as your expectations are managed, you are aware of the potential downsides, and you are talking with your doctor.

Last, don’t let “perfect” sleep be the enemy of “good enough” sleep. Anxiety around sleep only breeds more sleeplessness and anxiety! Remember that this is a process. For example, putting your phone down for a mere 15 minutes before bedtime is a victory.

During this week of winners and losers, I’ll take any victory I can get.

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Disclaimer: The views expressed here are entirely my own. They do not reflect those of my employer, nor are they a substitute for advice from your personal physician.