As many of you know when I work with patients one of the things I try to do is meet them where they are in the process of getting to sleep (or not). That could mean:
- Working with their doctor to determine a taper schedule to get them off sleep meds
- Starting cognitive behavioral therapy for insomnia to begin to replace sleep medication they are currently taking,
- Trying to help them find the lowest effective dose so that they can still get the benefits of the medication without having too much of it in their system
- Finally, I am always on the lookout for potential addictions or abuse of the sleep medication as well.
It turns out that sleep medications can have a complicated relationship with the end user. I read an amazing article in Sleep Review magazine by Kristin Daley, PhD CBSM ( a behavioral sleep medicine specialist) this week, that I wanted to add a few ideas too, and explain the information in more detail to everyone, so here goes…
We all know the data that sleep medications are both quick and effective. So, short term I can completely understand why doctors are quick to prescribe them, they work. There is very little out there that can help you “turn off your brain” better than some of the available sleep medications. That said, looking at medication as a long-term solution, is not the right pathway for everyone, and we know that over time CBT-I (Cognitive Behavior Therapy for Insomnia) will not only be more effective, and but last longer and be more helpful.
But what if I told you there are several behaviors you can initiate, right now, if you are currently taking sleep aids, that can help increase the effectiveness of these medications? I am sure you would be interested.
- Get Educated. Reduce any anxiety by getting all of your questions answered. Many people get a prescription from their doctor and are not 100% sure they want to take it. They have concerns, fears, questions, and in many cases the doctor may not have the time to explain it all, or the web may give you all kinds of mis-information. This causes anxiety, which is the opposite of sleep. If you are not 100% comfortable with taking a med, it will not work.
Take away Tip: When your doctor prescribes you a sleep aid ask these questions and get your answers:
- What is both the trade and generic name of the medication? (so you can look it up later), and do they have any information you can read about the medication? (FYI, many pharmacies will give you this as well).
- How long does the doctor expect you to be on this medication?
- How often should you take this medication?
- Does it interact with any other medications? OR supplements you are currently taking?
- Weekly Consistency. Take your pill at an agreed upon regular weekly schedule. Many people think that they should only take a pill “When they think they need it” which can be problematic with sleeping pills. First of all, you may or may not “know” prior to bed, but more importantly once you “realize” you need the sleeping pill, in many cases it is a bit too late. Literally. It’s often 1:00 am, it will still take 30 min for the pill to work, so you are not going to get any rest until at least 2:00 am, and that provokes anxiety, which does not help with sleep.
Take away Tip: If your meds are prescribed on an “as needed basis (aka PRN)” on Sunday, determine which nights each week you simply MUST get good rest, for example Sunday nights before the work week starts, or the night before a big meeting, trip, or presentation, maybe avoid weekends since you will be out late and may have alcohol. This can help by reducing anxiety when you have a bad night but it is too late for meds, and knowing that you will get good sleep can also help reduce anxiety.
- Nightly Consistency. Take you pill each night at the same time. There is some data to suggest that many people, even if prescribed medication to be taken in the beginning of the night, are taking it in the middle of the night.
This can be a problem for several reasons.
First these pills have what is called a half-life, meaning it takes a certain amount of time to get ½ out of your system. If the drug was built to be in a person’s body for a total time of 6-7 hours, and you decide to take it in the middle of the night, it will make it very difficult to wake up, and you will worry about it when falling asleep, which also decreases effectiveness.
Take away Tip: Set an alarm on your phone to remind you when to take your sleep meds, make sure to set the alarm for same time each time so you take your meds at the appropriate time. Don’t take meds in the middle of the night.
- Set yourself up for a good experience. Use the Power Down Hour. We know that the effectiveness of these types of medications can be INCREASED based on the mood or state of mind you are in when taking them. Thus, doing some type of meditation or relaxation, prior to bed, after taking your pill (or before if it helps reduce any residual anxiety you may have) will increase its likelihood of working.
Take away Tip: I personally like doing deep breathing ( look at the 4-7-8 method here).
- Stay sober. Alcohol and sleeping pills DO NOT MIX. While alcohol is the most popular sleep aid in the world, and marijuana is probably not too far behind, these substances should NEVER be mixed together with sleeping pills. They do not seem to have an additive effect but rather it multiplies the effects of alcohol and marijuana. This is where we see many of the weird behaviors reported on sleeping pills is when they are mixed with alcohol. It is dangerous and should always be avoided.
Take away Tip: Hydrate with water, 1 hour before taking a sleep aid.
- Be aware of your time zone. Don’t let jet lag effect your sleep. Many patients will use sleeping pills when traveling or on vacation, especially if they are trying to avoid jet lag. While this can be very effective, you should definitely speak with your doctor about the timing of sleeping pills while in a different time zone.
Take away Tip: Download Timeshifter this is a GREAT app which will give you a few free jet lag plans (subscriptions after the free ones), and it really works to eliminate jet lag.
- Keep Cool. Sleep follows your core body temp, the cooler you are the deeper you sleep. We all know that sleep environment plays a key role in sleeping better, one of the best things you can do is to keep it cool for you. This might mean that you and your bedpartner have different temperature needs. Don’t compromise thinking that your sleeping pill will override your need for a cool temp.
Take away tip: I use the Chilipad. This helps keep each person at their preferred temperature, and is one less thing to worry about.
- Avoid caffeine at night. Even if you think it does not bother you. Some people think that by using caffeine it will deliver the sleeping ingredients more quickly. This is simply not true, in addition caffeine in particular will do the opposite of a sleeping pill, and it tends to increase anxiety, which we know works against using sleep medication.
Take away tip: Stop caffeine by 2pm, it’s better for your sleep in general, and also better if you take sleep meds.
- Let someone know what you are doing. You never know how your body may react. While for the vast majority sleeping pills are perfectly safe. There are some people who can have side effects. It is best NOT to experience these alone. I am not saying have your mom move in, but for the first 1-3 nights, it is never a bad idea to have someone close by. It will also help reduce your anxiety, and you will know quickly if you have an issue, and there will be someone there to help.
Take away tip: Have a slumber party for at least the first night you try your sleeping medication.
- Avoid a full stomach when taking your meds. Less food equals more sleep. In some cases, a full belly could slow down the effectiveness of sleeping medication. Your metabolism does not know the difference between food and medication so all of it gets digested based on when it enters the stomach (basically). That said, if you have a full belly of pasta, it will take longer for your medication to be effective, increase anxiety, which goes against the function of falling asleep.
I hope you find this article useful and helps with the discussions you will have with your doctor about your sleep aids.
My most popular Facebook post this week: 9 Things to Do When You Can’t Shut Off Your Brain
My most popular Twitter post this week: This Is the Reason Why You Feel Like You’re Falling When Going to Sleep
Dr. Michael Breus