All too often a doctor will prescribe sleeping pills to a patient presenting with insomnia. While sleeping pills can be an appropriate short term solution for some patients, they do nothing to address the underlying cause of the patient’s insomnia.
In the short term, sleeping pills mask the underlying cause. Over the long term, sleeping pills may create more complications through side effects and dependency.
By failing to treat the underlying cause, the patient becomes increasingly reliant on sleeping pills. If the patient tries to quit, he or she may experience a rebound effect for several nights including feelings of anxiety and poor sleep that can be as bad as or worse than before the patient started to take the pills.
Research has shown that strategies for changing a person’s behaviors and thoughts provide more effective long-term improvement of sleep for people with chronic insomnia. Light therapy has also been shown to be an effective treatment option for some people.
Sleeping Pill Use On The Rise In America
Studies report that about 50 to 70 million Americans struggle to fall and stay asleep, with nearly nine million U.S. adults taking prescription sleep aids. This is a worrying trend in modern society as a significant portion of those nine million people are failing to treat the cause of their insomnia, while also adding side effects and potential dependency to their list of woes.
According to an August 2013 study by the Atlanta-based Centers for Disease Control and Prevention, Americans aged 80 and older and those in their 50s were more likely to have taken a sleeping pill or sedative in the previous month. The study also found that pharmaceutical companies reported an increased number of prescriptions filled for sleep medication in the last two decades, and it cited an earlier Thomson Reuters Research Brief that found sleep aid prescriptions tripled from 1998 to 2006 among 18 to 24-year-olds.1
Why Are So Many Sleeping Pills Prescribed?
Sleep is a complex science, seldom understood in any great depth by general practitioners. Standard medical training spends little time educating general practitioners on sleep and how to improve it, without the use of prescription drugs. Further, as a society we have become accustomed to taking oral medication. For many, leaving a doctor’s office without a new medication is unusual and leaves us feeling as though we have not been provided a solution. In many cases, the pressure to prescribe comes from the patient and is felt by the doctor.
There are non-drug alternatives to sleeping better that address the causes of insomnia and provide a safer and more effective long term treatment. The nine million Americans taking drugs would be well served to discuss these options with their doctor.
What Other Solutions Exist?
The body clock has a strong effect on when we feel alert and when we find it easy to sleep. The strength of this effect can be felt in night shift workers who struggle to stay awake in the early morning but then find it difficult to sleep the next day. When we fly across many time zones, the experience of jet lag arises from our body clock still on home time, making it a struggle to sleep and wake at the right times in the new destination.
Two common types of insomnia are caused by the mistiming of our body clock or our circadian (24-hour) rhythms; these are sleep onset insomnia (trouble falling asleep) and early-morning awakening insomnia (waking up too early).
Research has shown that people whose main difficulty is getting to sleep at a conventional night time (sleep onset insomnia) have body clocks that have drifted later in time so their circadian rhythms are not prepared for sleep until 1–3 am. The opposite type of insomnia, early morning waking insomnia, shows no difficulty getting to sleep but difficulty waking too early in the morning (4–5 am) and being unable to get back to sleep. Early morning awakening insomnia is associated with circadian rhythms timed too early.
The good news is extensive research has shown we can retime the body clock with the use of appropriately timed bright light therapy. Bright light presented at our natural wake-up time in the morning will shift our body clock earlier in time and has been shown to effectively treat sleep onset insomnia that is caused by a late timed body clock. Early morning awakening insomnia, caused by a body clock timed too early, can be treated using evening bright light.
To combat sleep onset insomnia, you therefore need to reduce exposure to light before bed and increase exposure to light after awakening in the morning. For example, if you are unable to fall asleep before midnight and you have to wake at 6 am (due to that pesky alarm clock) but you would prefer to fall asleep two hours earlier at 10 pm, then you would do two things:
- Avoid bright light after 9 pm
- Expose your eyes to bright light for at least 30 minutes before 7 am
Early morning sunshine is a good source of morning bright light. If there is a lack of natural sunlight or you do not have time to walk in the morning, using a portable light therapy device is a good alternative. Devices, such as Re-Timer, emitting blue and green wavelengths of light are effective in providing light to regulate your circadian rhythm.2,3
If instead, you fall asleep easily at 10 pm but find you cannot sleep past 4 am and would like to get more sleep by sleeping in until 6 am
- Get bright light stimulation in the evening just before bed for at least 30 minutes.
- Avoid bright light in the morning until after 8 am
In the evening, artificial bright light from a light therapy device such as Re-Timer may be the only option for bright light given that it is likely to be needed after sunset. In addition to being convenient and portable, the blue-green color (wavelength) has been proven to be effective.
Re-Timer is the world’s first wearable green-blue light therapy device designed to re-time the circadian rhythm. Worn like a pair of glasses, the device shines green-blue light into the user’s eyes, altering a person’s circadian rhythm and helping to adjust his or her body clock to a new time. This color of light has been shown by university research to be the most effective color for re-timing the body clock and is UV free. Using the device for 30–50 minutes a day can help people overcome sleep issues based on circadian rhythm mistiming including insomnia, winter blues and jet lag.
The Re-Timer glasses retail for $299 and can be purchased at http://re-timer.com.
- Yinong Chong, PhD, Cheryl D. Fryar, MSPH, Qiuping Gu, MD, PhD. “Prescription Sleep Aid Use Among Adults: United States,” 2005–2010, Centers for Disease Control and Prevention, August 2013.
- Wright, H.R., Lack, L.C., “Effect of light wavelength on suppression and phase delay of the melatonin rhythm,” Chronobiology International, 2001 Sept., 18 (5): 801–8.
- Wright, H.R., Lack, L.C., Kennaway, D.J. (2004). “Differential effects of light wavelength in phase advancing the melatonin rhythm.” Journal of Pineal Research, 36, 140–4.
Leon Lack, Emeritus Professor at Flinders University in Adelaide, Australia, is a Clinical Psychologist at the Adelaide Institute for Sleep Health (AISH). He is acknowledged internationally as one of the world’s leaders in behavioral management of insomnia and has conducted extensive research in sleep, circadian rhythms and insomnia over 30 years. For the last 20 years, he has directed a clinic for the non-drug treatment of insomnia at AISH and has supervised many clinical Masters and PhD students in this area. He was a co-founder of the Australasian Sleep Association and its president from 1989 to 1992. Leon is also the author of 80 peer-reviewed journal articles and has received research grants from bodies including the Australian Research Council and National Health and Medical Research Council. He earned his PhD from The University of Adelaide and received his Bachelor of Arts from Stanford University.