Here's Why You Can't Sleep at Night

July 23rd 2015

Kathleen Toohill

One of the most frustrating realities of insomnia is that often, the harder you try to fall asleep, the more elusive sleep becomes. Imagine if other things in life worked this way—the harder you studied, the more likely you were to fail a test, or the more you prepared, the more poorly you performed on a presentation.

There are plenty of distractions that add to sleep deprivation, and it's maddening that many of the tricks we learned as kids just don’t seem to cut it—take counting sheep, for instance. According to Mental Floss, this practice may have originated in medieval Britain. Shepherds needed to keep tabs on their flocks in communal grazing areas and counted their sheep before going to bed each night.

Unfortunately, despite the inexplicable staying power of the “counting sheep” practice, it doesn’t work. According to a study from Oxford University conducted in 2002, counting sheep did not help a group of surveyed insomniacs (though imagining a pleasant scene, such as a waterfall, did help participants to fall asleep).

Sleep deprivation is no joke

Insomnia and sleep deprivation represent a serious public health concern. The Center for Disease Control (CDC) has referred to insufficient sleep as a “public health epidemic.” Sleep deprivation can increase the likelihood of car accidents and industrial disasters, and can make individuals more susceptible to chronic diseases such as obesity and depression.

The CDC estimates that 50 to 70 million adults in the U.S. suffer from sleep or wakefulness disorders, including insomnia, narcolepsy, and disorders related to fragmented sleep (a summary of such disorders is presented in this article published in Current Neuropharmacology in 2008). A study published in the Journal of Psychiatric Research in 2012 reported that almost 20 percent of participants surveyed had experienced moderate to excessive sleepiness during the day. Sleepy individuals were also twice as likely to have been driving during a car accident over the past year.

According to the CDC, adults should aim for seven to eight hours of sleep per night. Children need at least 10 hours, and teens need nine to 10. A 2013 Gallup poll found that 40 percent of Americans reported sleeping less than seven hours a night. Many of the respondents who slept this amount said that they thought they would feel better if they slept more. Two generations earlier, Americans did sleep more. In 1942, only 11 percent of Americans reported sleeping less than seven hours a night.

Many adults suffering from insomnia seek external assistance from prescription sleeping pills, such as Ambien, or homeopathic remedies, including melatonin. Like all medicines, prescription sleeping pills carry the risk of side effects, and the potential risks of Ambien and other prescription sleep aids may include dangerous behaviors such as “sleep driving.” In December 2014, the Food and Drug Administration (FDA) recommended that the manufacturers of Ambien and other drugs containing zolpidem lower suggested doses, hoping to curb sleep behaviors including driving, eating, and talking that have been described as "Ambien blackouts."

“Call your doctor right away if you find out that you have done any of these activities after taking Belsomra,” warns Belsomra's website. Belsorma is a suvorexant drug to treat insomnia approved by the FDA in 2014.

Is it safe to take prescription sleep aids?

Prescription sleeping pills are intended to help patients fall asleep faster and sleep longer, while minimizing grogginess the next morning. The CDC reported in 2013 that nine million Americans used prescription sleeping pills. According to the CDC study, women were more likely to report using sleeping pills than men, and whites were more likely to report using sleeping pills than Hispanics or Blacks.

In December 2013, the New Yorker published a feature by Ian Parker that chronicled the journey of a new class of sleep aid under development by Merck. Parker delved into the history of prescription sleep aids in the U.S., focusing largely on Ambien, a sleeping pill classified as a hypnotic and approved by the FDA in 1992. Ambien (now also sold as a generic, zolpidem), largely replaced the earlier class of popular sleep aids, benzodiazepines (one of which, Halcion, had been tied to addiction and other negative outcomes).

In its December 2014 report, the FDA reported that it had received 700 accounts of individuals driving under the influence of zolpidem. To lower the risk of “next-morning impairment,” the FDA recommends the following:

“It is important for patients to take their insomnia medicine exactly as prescribed. Taking a higher dose than prescribed or using more than one insomnia medicine is dangerous if patients drive or perform activities that require full alertness the next morning, even if the drugs are taken at the beginning of the night. In addition, patients should not take insomnia medicine intended for bedtime use if less than a full night’s sleep (seven to eight hours) remains.“

According to Parker’s New Yorker piece, studies estimate that five percent or fewer users have issues with strange sleep behaviors. Yet even for patients unaffected by sleeping pill blackouts, these medicines may have long-term health consequences.

A 2012 study from Scripps Clinic reported a link between sleeping pills and a higher prevalence of cancer, as well as a death risk 4.6 times higher among individuals taking sleeping pills. The report mentions cognitive therapy as a possible alternative treatment for insomnia. An article published in 2013 in the journal Sleep revealed that sleeping pill use and long sleep (typically 10 to 12 hours for adults) carry greater risks than insomnia and short sleep. Another study found that, while sleeping more than eight hours is safe when accompanied by exercise, sleeping fewer than six hours a night could pose health risks.

Homeopathic remedies offer alternatives

Many people who have sleeping trouble are hesitant to try prescription sleeping pills and are overwhelmed by the multitude of supplements and homeopathic remedies promising a better night’s sleep. To try and help those people, Christopher Null of Wired sampled eight different alternative sleep aids and logged his experiences with each one. As Null explained, each individual may react differently to any given medication or supplement, and it’s always wise to consult with your physician before trying a new supplement.

ATTN: spoke to Dr. James Mattioda, founder of Arcana, a holistic pharmacy in San Diego, about his recommendations for alternative sleep aids. Mattioda said that while melatonin is one of the most popular homeopathic sleep aids, he tends to recommend magnesium instead, specifically magnesium glycinate or chelated magnesium. According to Mattioda, L-tryptophan may help improve sleep as well.

Changing habits for better sleep

Dr. Andrew Weil, best-selling author and pioneer in the field of integrative medicine, recommends evaluating one’s habits when dealing with insomnia. Many experts, Weil included, suggest standardizing bed times, exercising regularly, and avoiding large meals or exercise late at night. Weil recommends eliminating caffeine and alcohol, spending time outdoors, and investing in a white noise machine. Relaxation techniques, such as meditation or breathing exercises, may also be helpful, according to Weil.

In an evaluation of sleeping pills (zolpidem earned the “best buy” designation), Consumer Reports provides a checklist of habits that may be negatively affecting sleep and suggestions for changing them. Consumer Reports advises against watching TV or using the computer in bed, and suggests evaluating sleep conditions—noise, light, temperature of the room, quality of the mattress—in case one of these more mundane culprits is preventing sleep.

The good news is that, between medications, homeopathic supplements, and lifestyle changes, options abound. Whatever you decide to try, at least you’re not stuck with counting sheep.

Related: How Four Successful Millennials Start the Morning