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We are a nation struggling to sleep, and it’s only getting worse. 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 and Australia.
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 that 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, however 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 Health Care 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.
Valerian and other herbal remedies
Good for: people who need help relaxing before they go to sleep
Kevin Morgan is 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 2,000 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 Nytol, and other antihistamines
Good for: people with mild, short-term sleeping issues
The main active ingredient of Nytol is diphenhydramine, which is an antihistamine. 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,” says 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, it warns 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: Transatlantic travellers, short-term
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, 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 (your natural body clock that dictates when you wake and fall asleep).
But the supplements – which reached peak popularity in the 1990s as a miracle sleep and jet lag remedy and are available over-the-counter in the US – are now strictly prescription-only in the UK.
Melatonin is currently only available as a short-term treatment for insomnia in the over 55s who have age-related insomnia (the body produces less melatonin as we get older). The NICE guidelines list headaches, weight gain, anxiety and disorientation among its many potential side effects.
Hypnotics (Benzodiazepines and Z drugs)
Good for: people who’ve tried everything – but are not advisable as a long-term solution
The most common sleeping pill prescribed from 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 BMJ (British Medical Journal) stated that users may develop dependency after only a few weeks, while 7.7 per cent of users admitted misusing these drugs.
“Benzodiazepines and Z-drugs are not a long-term solution,” says Professor Morgan. “We know drugs are effective in the short term, but you’d need a Geiger counter to find a short-term insomniac,” says Professor Morgan. “Most insomniacs are by definition chronic.”
Experts now unanimously 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 suffer look at their actions and ingrained thoughts which get in the way of a good night’s sleep.
Therapists can prescribe it; or you can download an app such as Sleepio, which is available for free on the NHS in some areas.