Desperate for a good night’s sleep? Before you take a pill, read this

The science around sleeping pills is somewhat contradictory. Photo / 123RF

According to the NHS, one in three people in the UK will have episodes of insomnia at some point – up from one in four 10 years ago. Little wonder that in February, NHS data showed a record one million people in the UK are now prescribed insomnia medication each year.

The science around sleeping pills is somewhat contradictory. In April, a small study from the Washington University School of Medicine in St Louis revealed that taking a certain sleeping medication can help stave off Alzheimer’s by reducing the build up of harmful proteins in the brain.

Suvorexant, the drug used in the research, isn’t approved for use in the UK but is in the US, Japan, Australia and New Zealand.

Tiny though the study was – 38 people aged between 45 and 65 – the findings seemed at odds with previous research, which has linked sleep medication with a raised risk of dementia.

At the end of January, a paper published in the Journal of Alzheimer’s Disease found certain groups who “often” or “almost always” took sleep medications had a 79 per cent higher risk of developing dementia compared to those who “never” or “rarely” used them. (As ever with medical studies, it’s important to understand the nuances of these statistics. They don’t mean that 79 per cent of people taking sleeping pills will develop dementia, but that there will be that percentage increase from their original risk.)

What adds to the difficulty is that lack of sleep can also lead to issues with brain health. “There is an association between sleep disturbance and Alzheimer’s which may work in either direction,” explains Niro Siriwardena, professor of primary and prehospital healthcare at the University of Lincoln. “For example, sleep disturbance may be a symptom of Alzheimer’s, but poor sleep may also lead to dementia.”

If your sleep-frazzled brain needs some pointers, here’s our guide to sleep aids, from herbal remedies to full-on pharmaceuticals.

Herbal sleeping aids have been used for centuries, but scientists say there's no evidence they actually work. Photo / 123RF

Valerian and other herbal remedies

Good for: People who need help relaxing before they go to sleep

Kevin Morgan is a professor of psychology at Loughborough University. “There are two kinds of pharmaceutical products that claim to address sleeping problems, those with good evidence and those with poor or no evidence,” he says. “Herbal remedies fall into the latter category.”

Morgan acknowledges some people swear they can’t drop off without a herbal tea before bed, but does not consider these anecdotes to be proper evidence.

“Herbal sleeping aids like valerian have been used for over 2000 years,” says Dr Neil Stanley, former director of sleep research at the University of Surrey and author of How To Sleep Well.

“Do their natural ingredients help you get to sleep? Probably not. Do they help with anxiety? Probably. Is that going to help you sleep? Maybe. The evidence they can help you sleep isn’t there, however, whatever relaxes you or calms you down does help you sleep.”

Over-the-counter sleep aids, such as antihistamines

Good for: People with mild, short-term sleeping issues

Antihistamines aren’t generally thought of as sleeping pills – rather, as treatments for hay fever – but because drowsiness can be one of their main side effects, people often use them routinely as sleep aids.

“Antihistamines can be bought from a pharmacist without a prescription to help sleep, but always take advice from your pharmacist on this,” advises Professor Morgan.

“Current UK guidelines do not recommend they’re taken purely for sleep because if taken for a long time they can cause something called ‘rebound insomnia’, where your insomnia returns often worse than before, when you stop taking them. Other side effects can include feeling drowsy the next day.”

The NHS website says while antihistamines are largely safe, they can cause dependency if taken for a period of time, and to speak to your GP if you need to take them for more than two weeks.

Antihistamines can also affect your coordination and concentration: children and older people are more likely to feel their effects and side effects.

Melatonin

Good for: Travellers, short-term sleeping issues

Melatonin is a naturally occurring hormone that helps regulate sleep/wake cycles. As melatonin levels rise in the evening, they promote sleepiness. However, levels decline with age and not everybody produces enough melatonin. Jet lag or shift work can also upset the balance.

According to a paper written by Alexander Nesbitt, a consultant neurologist at Guy’s and St Thomas’ Hospital, taking melatonin supplements can gently nudge the body back into a good day/night routine. Several other studies have found that taking melatonin helps those with circadian rhythm disruptions (your natural body clock that dictates when you wake and fall asleep).

UK health guidelines list headaches, weight gain, anxiety and disorientation among melatonin’s many potential side effects.

Hypnotics (Benzodiazepines and Z drugs)

Good for: People who’ve tried everything – but not advisable as a long-term solution

The most common sleeping pill prescribed by your doctor is likely to be a “Z-drug” such as zopiclone – or a benzodiazepine, such as temazepam (but the latter drugs have largely fallen out of favour).

“By and large these are safe and effective in the short term,” says Professor Morgan. “If used intelligently and intermittently, they can be a life-saving, first-line treatment.” But, used repeatedly, both types of drugs can lead to tolerance (you need more of them to get the same result) or dependency (they are really hard to come off, without distressing withdrawal symptoms).

A 2018 report in the British Medical Journal stated that users may develop dependency after only a few weeks, while 7.7 per cent of users admitted misusing the drugs.

“Benzodiazepines and Z-drugs are not a long-term solution,” Morgan says. “We know drugs are effective in the short term, but you’d need a Geiger counter to find a short-term insomniac. Most insomniacs are, by definition, chronic.”

Experts now agree that the internationally agreed treatment for insomnia is no longer a pill, but rather Cognitive Behavioural Therapy for Insomnia (CBTi) – a talking therapy which helps the sufferer look at the actions and ingrained thoughts that get in the way of a good night’s sleep.

Therapists can prescribe it, or you can download an app such as Sleepio.