Sleep Aid: Providing rest on a sleepless night

Nothing compares to the frustration of being unable to sleep. Restlessness, poor concentration, and the resulting physical ailments are enough to cause anyone to search for a resolution. Unfortunately, there’s not a magic cure for sleeping woes. But there are a variety of both natural and pharmaceutical sleep aids that may provide some rest on a sleepless night.

Sleep Aid: Providing rest on a sleepless night
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What Is A Sleep Aid?

A sleep aid is a medication, herb, or lifestyle habit that helps induce sleep. Most commonly, sleep aids consist of over-the-counter or prescription drugs. However, many prefer to go the natural route. Consumable herbs, vitamin supplements, and lifestyle adjustments are also considered sleep aids.

Sleep aids affect the body in numerous ways. Some promote relaxation, while others influence the nervous system and alter the circadian rhythm. The circadian rhythm is an internal process that regulates the sleep-wake cycle. It is controlled by an area of the brain called the hypothalamus.

Insomnia: Why Use A Sleep Aid?  

The main reason a person may rely on a sleep aid is to treat disrupted sleep, which is often due to an underlying sleep disorder. According to the National Institutes of Health, 30% of the population complains of insomnia— a sleep disorder characterized by difficulty falling asleep, the inability to remain asleep, and frequent nighttime awakenings. Insomnia can be acute (short-lasting) or chronic (long-lasting) and is associated with medications, anxiety, depression, neurodegenerative diseases, poor lifestyle habits, and chronic medical conditions. A sleep aid targets those symptoms.

Natural Sleep Aid: Herbs and Supplements

Herbs and supplements are derived from plants or naturally occurring vitamins, minerals, and amino acids. They are introduced to the body by ingesting them in pill like form, drinking them in a brewed tea, or applying them topically to the skin as a salve. Many opt for herbs and supplements as sleep aids because they are safer than pharmaceutical drug options. However, even herbs and supplements are not without side effects.  

Melatonin

Melatonin is a hormone produced by the pineal gland in the brain. The hormone is a significant part of the sleep-wake cycle. After the sun goes down, the pineal gland is triggered to produce melatonin and the hormone is released into the blood around 9 PM. Levels linger in the body for 12 hours. Sleep researchers explain that melatonin does not directly cause sleep, but it promotes a state of relaxation that is conducive to sleep.

Melatonin is naturally found in foods and it is offered in supplement form. Taking 1 to 3 milligrams of melatonin two hours before bed may be an effective short term sleep aid for insomnia and jet lag. Long term use is unknown.

Valerian Root

Native to Asia and Europe, valerian root is an herb that’s been used to improve sleep quality since ancient times. While its mechanism is unknown, the theory is that valerian root increases nerve cells in the brain to release the neurotransmitter GABA. GABA slows neural activity to produce a sedating effect similar to the anti-anxiety medication Valium.

Chamomile

Chamomile is a plant with daisy-like flowers popular for its medicinal purposes. When chamomile flowers are brewed into a tea, it treats wounds, chickenpox, bacterial infections, and gastrointestinal ailments. Chamomile contains an antioxidant called apigenin. The antioxidants bind to benzodiazepine receptors in the brain to benefit sleep quality. Cardiac patients in the clinical trials published in Molecular Medicine Reports noted deeper sleep for up to 90 minutes after ingesting chamomile. For best results, drink chamomile tea before bed.

Kava

Kava is a plant in the nightshade family. The roots contain kavalactones that lessen anxiety, protect nerve cells in the brain, and act as an analgesic to minimize sensations of pain. GABA, a neurotransmitter that slows nerve cell activity, is increased which leaves more of the neurotransmitter available in the nervous system. With GABA available in excess, activity in the brain decreases to stimulate a calm mood. The antianxiety qualities of kava make it ideal for stress-related insomnia.

Tryptophan

Tryptophan is an essential amino acid. The body cannot produce tryptophan, so it must be consumed through food. Foods high in protein contain tryptophan. This includes chicken, turkey, beans, whole grains, potatoes, and fruits like bananas. In the body, tryptophan facilitates the production of the 5-HTP (5-hydroxytryptophan) molecule that is later used to produce the neurotransmitter, serotonin, and then the hormone responsible for regulating the sleep-wake cycle, melatonin.

Glycine

Glycine functions both as an amino acid and a neurotransmitter. The body produces glycine on its own, but it is also found in high protein foods such as meat, eggs, spinach, kale, and cabbage. Glycine is a sleep aid because it assists in the production of serotonin—a neurotransmitter involved in producing melatonin to regulate the sleep-wake cycle. Its impact on the nervous system improves blood flow and lowers body temperature. Lower body temperature is a necessary physiological reaction to sleep.

Studies (Kawai, 2015) of supplemental glycine versus a placebo confirm that 3 mg of glycine taken in pill form is an effective sleep aid. Participants fall asleep faster, experience less frequent nighttime awakenings, and have improved sleep efficiency.

Lavender

Lavender is a plant with purple flowers and a pleasant scent. It interacts with GABA to calm nervous system activity, as well as to provide pain relief, reduce inflammation, and stabilize mood. Wesleyan University psychologists studied the effects on sleep from lavender essential oils. Of the 31 participants, brain scans revealed increased slow-wave sleep after sniffing lavender essential oil, but not when sniffing distilled water. For the use of a sleep aid, lavender can be inhaled as an essential oil, consumed orally as a supplement, or absorbed through the skin as a topical cream.

Lemon Balm

Lemon balm is a plant from the mint family. There is little evidence that lemon balm functions as a sleep aid alone, but has demonstrated success when combined with other herbs like valerian root. The sleep aid component of lemon balm is from its antianxiety effect. It increases GABA in the brain, which slows brain activity to promote a calming mood and induce sedation.

Magnesium

Found in foods like leafy greens, nuts, seeds, whole grains, and coffee, magnesium is a mineral essential for many bodily functions because it is involved in over 300 enzyme reactions within the body’s cells. These include cardiac and bone health, metabolism, mood, and sleep. Magnesium promotes relaxation by controlling the release of melatonin which regulates the sleep-wake cycle. It also maintains levels of the neurotransmitter GABA. Whether consumed through food or in supplemental form, magnesium is a powerful sleep aid and has been associated with sleep disorders like insomnia and restless leg syndrome.

Natural Sleep Aid: Therapies and Techniques

Aside from herbs, supplements, and medications, natural therapies and techniques can serve as effective sleep aids. The advantages of these techniques are that they present with fewer unwanted side effects and may be safely combined with other therapies.

Sleep Hygiene

Sleep hygiene is a set of habits that creates an optimal environment for sleep and prepares someone for consistent, quality sleep. The most important step in practicing good sleep hygiene is to ensure sufficient time to receive 8 to 10 hours of sleep per night. Other practices include:

  • Limit naps—Taking naps throughout the day decreases sleep drive. If you must nap, do so earlier in the day and for only 20 to 30 minutes.
  • Avoid heavy foods and stimulants—Heavy foods cause indigestion as the body processes them while sleeping.
  • Keep a routine—Remain consistent with before-bed activities such as showering, reading, light stretching, or brushing your teeth. Establishing a bedtime routine resets the body’s internal clock.
  • Create a comfortable sleep environment—Set a comfortable room temperature, use pillows, shut off the light, and lower the volume of background noise.
  • Use natural light—Natural light is necessary for the body’s circadian rhythm and maintaining a healthy sleep-wake cycle.
  • Remove electronics—Electronics provide synthetic light that distracts the body and mind from rest. Turn off the TV and avoid checking Facebook or Instagram before bed.

Biofeedback

Described by the Cleveland Clinic, “biofeedback is a technique in which a patient is trained to improve his or her health by developing a greater awareness and voluntary control over the physiological processes affected by stress.”

There are different types of biofeedback:

  • EMG biofeedback—measures tension in the muscles
  • Respiratory biofeedback—measures breathing patterns
  • Thermal biofeedback—measures temperature response activated by the sympathetic division of the autonomic nervous system
  • Neurobiofeedback—measures brain activity and is effective in those with high stress and anxiety

Sensors placed on the abdomen, head, fingertips, and other parts of the body measure stress levels in relation to heart rate, blood pressure, and muscle tension. The sensors provide a visual of stress, which allows people to learn relaxation as they control their body’s response. The relaxation stemming from a decreased stress response is a helpful sleep aid.

Relaxation Techniques

Relaxation techniques are techniques that promote relaxation. The most basic relaxation technique applied as a sleep aid is deep breathing. To practice deep breathing, take in deep breaths through the nose. Upon exhalation, contract the abdominal muscle while releasing air from the mouth. Deep breathing can be done laying down before bed to reduce stress, anxiety, and pent up tension that contributes to insomnia. Other common relaxation techniques are self-massage, mindfulness mediation, and guided imagery.

Sleep Restriction

Sleep restriction is a behavioral technique to increase sleep drive. For instance, staying up late and not sleeping leads to excessive drowsiness. As a natural sleep aid, sleep restriction generates less nighttime awakenings to lengthen the time spent in bed sleeping.

Sleep efficiency is the amount of time a person sleeps each night. The sleep efficiency calculation forms the basis of sleep restriction. After logging sleeping habits for a week or more, allot a period equal to the number of hours slept each night to staying in bed. Someone who sleeps 6 hours will allow themselves only 6 hours to remain in bed attempting to sleep. Once sleeping at least 85% of the dedicated sleep time, increase it by 15-minute intervals. The goal is to work up to a healthy 8 to 10 hours of sleep per night with no napping during the day because sleep restriction can normalize the sleep-wake cycle.

Natural Sleep Aid: Exercise

Exercise is a safe, inexpensive sleep aid. Firstly, engaging in physical activity pushes the body and makes one feel tired afterward. Secondly, exercise regulates the sleep-wake cycle when timed appropriately. Activity close to bedtime can stimulate the body into wakefulness. Morning or late afternoon are better hours when applying exercise as a sleep aid. Similar to warm showers in the morning, elevations in body temperature during exercise wake up the body, yet promote sleep as temperatures drop and induce drowsiness 30 to 90 minutes later. Exercise releases endorphins to reduce stress, lessen the amount of time required to fall asleep, and restore deep sleep for the body to heal and grow.

Sleep Aid: Providing rest on a sleepless night
Photo by Nathan Cowley from Pexels

Aerobic Exercise As A Sleep Aid

The benefits of exercise as a potent sleep aid appear with consistent physical activity. Experts at John Hopkins Medical Center suggest at least 30 minutes of exercise daily. Moderate aerobic exercise is a particularly effective sleep aid. Aerobic exercise includes any physical activity that increases heart rate: walking, running, biking, or swimming.

Sleep Aid: Pharmaceutical Options

Pharmaceutical sleep aids are referred to as “sleeping pills” or “sedatives.” They are available over-the-counter at a local pharmacy or prescribed by medical professionals. Which option is likely to be successful? This decision depends on the underlying cause of insomnia, health history, side effect profile, and the length of time the sleep aid will be used. The main classes of pharmaceutical sleep aids are antihistamines, antidepressants, orexin receptor antagonists, benzodiazepines, and hypnotics.

Antihistamines

The majority of over-the-counter sleep aids contain antihistamine properties. Antihistamines are a class of medications that block histamine. Histamine has many roles throughout the body. It is released by mast cells in response to an allergen, which is why antihistamines (i.e. Benadryl) are taken to treat allergies and hay fever. Histamine also controls wakefulness. As a sleep aid, antihistamines alter the nervous system to disrupt the wakefulness cycle and produce drowsiness. They are a go-to sleep aid because they can be purchased over the counter at a pharmacy without a doctor’s prescription. Be cautious of the side effects such as blurry vision, dry mouth, constipation, urinary retention, and daytime drowsiness.

Antidepressants

Insomnia is a side effect of depression. It is also a side effect of antidepressants. Even in known depressed patients, antidepressants are known to improve sleep. Various classes of antidepressants alter levels of neurotransmitters like serotonin, norepinephrine, and dopamine which has a sedating effect. In lower doses than what is prescribed for depression, the drowsiness effect of antidepressants treats sleep disorders.

Orexin Receptor Antagonists

Orexin receptor antagonists are a newer sleep aid that inhibits orexin in the brain. Orexin is a hormone produced by the hypothalamus which regulates sleep and appetite. The impact of orexin receptor antagonists is still being studied; however, blocking orexin activity proves to promote sleep with minimal side effects.

Benzodiazepines

Benzodiazepines are a class of medications that enhance GABA—a neurotransmitter that facilitates communication to neurons (i.e. nerve cells) in the brain. GABA is responsible for lowering or reducing activity in the central nervous system. Benzodiazepines are effective sleep aids. When neural activity in the brain is slowed, benzodiazepines promote relaxation, induce drowsiness, decrease stress, and regulates mood. Confirmed by studies published in the Journal of Clinical Psychiatry, a downfall of benzodiazepines is that they prevent REM deep sleep with long term use. The side effect profile is considerably high, including addiction, low blood pressure, next-day drowsiness, and memory impairments. These drugs are optimal for short term use.

Non-Benzodiazepine Hypnotics

Hypnotics work by binding to receptors in the brain that increase the neurotransmitter GABA and decrease brain activity. The side effects of hypnotics are less than benzodiazepines because they mind to fewer receptors in the brain. Drowsiness the day after taking hypnotics is the most reported side effect.

Are Sleep Aids Safe?

Many are concerned about the safety of sleep aids. Sleep aids, especially pharmaceutical options, do pose risks. While the prescribed and over-the-counter medications come with side effects, so do herbs and supplements. Switching to a natural sleep aid does not eliminate their occurrence. The elderly and those who consume alcohol are most susceptible to the possible side effects of sleep aids.

  • Allergic reaction—Anaphylaxis is a severe allergic reaction affecting three or more body systems. It typically affects the airway.
  • Excessive drowsiness—The next day, sleep aids may result in moderate to severe sleepiness that interferes with daily activities.
  • Memory impairment—Since sleep aids alter the nervous system function, they do influence patterns of cognition and memory is a cognitive skill. Excessive drowsiness also contributes to memory impairments.  
  • Worsened insomnia—Although a sleep aid is meant to help insomnia, on occasion, they cause rebound insomnia. Rebound insomnia is when symptoms worsen from baseline once the sleep aid is discontinued.
  • Behavioral changes—This includes enacting potentially dangerous activities while asleep like sleep-eating, driving, having sex, making phone calls, and starting conversations.
  • Drug interaction—Herbs, vitamin or mineral supplements, and pharmaceutical drugs can interact with other medications and foods. The Food and Drug Administration does not monitor herbal supplements for interactions. Speak with your doctor or pharmacist first.   
  • Dependence—Using sleep aids frequently leads to the body’s dependence on the substance to function.
  • Difficulty breathing—Any existing respiratory issues are exacerbated by certain sleep aids.

Sleep Aids and Pregnancy

Pregnant women can experience significant trouble sleeping. Whether it is from hormonal fluctuations, discomfort, or frequent nighttime urination, sleep aids are not always safe during pregnancy. Medications such as Unisom are prescribed by physicians to combat pregnancy insomnia with close monitoring, but it is best to avoid all prescription and over-the-counter drugs if possible. Herbal supplements can also impact the developing fetus. Safer sleep aids for pregnant women are exercise, consuming a balanced diet, and practicing healthy sleep hygiene.

References

Kawai, N., Sakai, N., Okuro, M., Karakawa, S., Tsuneyoshi, Y., Kawasaki, N., Takeda, T., Bannai, M., & Nishino, S. (2015). The sleep-promoting and hypothermic effects of glycine are mediated by NMDA receptors in the suprachiasmatic nucleus. Neuropsychopharmacology : official publication of the American College of Neuropsychopharmacology, 40(6), 1405–1416. https://doi.org/10.1038/npp.2014.326

Pagel, J. F., & Parnes, B. L. (2001). Medications for the Treatment of Sleep Disorders: An Overview. Primary care companion to the Journal of clinical psychiatry3(3), 118–125. https://doi.org/10.4088/pcc.v03n0303

Srivastava, J. K., Shankar, E., & Gupta, S. (2010). Chamomile: A herbal medicine of the past with bright future. Molecular medicine reports3(6), 895–901. https://doi.org/10.3892/mmr.2010.377

The Cleveland Clinic Guide to Sleep Disorders by Nancy Foldvary-Schaefer, DO