A Restful Night’s Sleep Without Medications and Their Side Effects

Is taking prescription medication always the answer? Throughout my career, I’ve had many patients request medication to help with falling asleep. Insomnia is a very real and common problem. Restful sleep is an extremely important part of our health. Without it, we fall short of good lifestyle management and enhancement. Instead we are left sluggish, depressed, anxious, and with a decreased attention span. Poor sleep can lead to a multitude of other health problems including:

  • Heart Disease
  • Kidney Disease
  • High Blood Pressure
  • Diabetes
  • Stroke
  • Obesity
  • Increased Risk of Cancer

Poor sleep can be a result of the demands of our day, our current mental health, or chronic conditions that need to be addressed.

Are Prescriptions Drugs Always The Answer?

Are long term medication use with Ambien or antidepressant medications like Trazodone the key? Do they really address the underlying issue or are they quick fixes – ignoring the underlying problem at hand? These medications can lead to side effects that can be harmful and sometimes irreversible. They are meant for short term use, not life long use and are known to lead to complex sleep related behavior in addition to:

  • Impaired mental alertness
  • Depression
  • Hallucinations
  • Aggressive behavior
  • Headaches
  • Dependency and abuse

Medications can prove to be effective in the short term, but to truly address the disorder, try these first-line recommendations: Avoid the following sleep disrupters:  

  • Too much food or drink close to sleep time
  • Blue light from phone/computer/television screen
  • Caffeine and alcohol use
  • Stress/anxiety/worry
  • Certain noises/sounds
  • Temperature (too hot or too cold)
  • Lack of daytime sunlight exposure
  • Medications and medical conditions
  • Bed partner and/or pets For Better Sleep

Strategies that you can implement for better sleep:

  • Use bed for sleep only (keep tv’s off, iPads, and phones away at least an hour before sleep)
  • Establish a regular sleep schedule (same sleep and wake times)
  • Minimize/eliminate bedroom noise and lights
  • Increase daytime exposure to sunlight
  • Move at least every hour during the day
  • Eliminate nighttime caffeine and limit daytime caffeine
  • Avoid alcohol within 3 hours of bedtime
  • Avoid high-sodium foods close to bedtime
  • Eliminate/limit after-dinner and late-night snacking
  • Maintain a healthy BMI
  • Stay hydrated during the day
  • Cognitive Behavioral Therapy for Insomnia
  • Exercise
  • Meditation

Patients often cite racing thoughts as an impediment to sleep. They report being tired, ready to go to bed, looking forward to sleeping and then lying in the bed feeling restless and unable to go to sleep. While this happens to almost all of us from time to time, it is a regular occurrence for some people. There is both an explanation and a solution for the problem.
Bluma Wulfovna Zeigamik was a Russian psychiatrist who made an interesting discovery in the 1920’s. Waiters in a restaurant were able to keep very good track of many orders and unpaid bills for restaurant patrons, but were unable to recall almost any details for those orders that had been filled and paid for. She was curious and started conducting research to identify an explanation for this in her lab.

In one study, children were asked to complete simple tasks, puzzles, and math problems. The children were interrupted after half of the tasks were completed. After an hour, almost all of the children had better memory of the unfinished tasks than those that they completed. In similar experiments with adults, she found that they had 90% better recall of unfinished than finished tasks. This became known as the Zeigamik Effect, and it has been confirmed by other researchers.[1]

Some studies have shown that the Zeigamik Effect can interfere with sleep. For example, a study of 59 employees over a 12-week period of time showed that unfinished tasks at work led to rumination, which in turn interfered with sleep, even on the weekends.[2]

So how can this information be used to help an individual sleep better? Some people will sleep better if they take the time before going to bed each night to evaluate their day, look at the calendar, make a to-do list, and prepare notes for the next day’s activities, including those related to unfinished tasks. Taking the time to write in a diary about ongoing family issues and proposed plans of actions is a good idea too.

Actions like closing the appointment book, closing out of screens on the computer, putting lists in a prominent place where they will be easily noticed in the morning, and placing a paper and pen at the bedside in case a great idea comes to mind in the middle of the night can also be helpful.

The message these activities sends to the brain is “I’m prepared for tomorrow. I have a plan. I’ve thought through my options and now can process this information while I sleep and will wake up tomorrow with even better ideas.”

[1] https://www.psychologistworld.com/memory/zeigarnik-effect-interruptions-memory#references
[2] Syrek C, Weigelt O, Peifer C, Antoni C. “Zeigarnik’s sleepless nights: How unfinished tasks at the end of the week impair employee sleep on the weekend through rumination.” J Occup Health Psych 2017 Apr 22(2):225-238
(3) Wellness Forum,Racing Thoughts and Sleep, Pamela A. Popper, Ph.D., N.D
(4) American College of Lifestyle Medicine, lifestylemedicine.org. Lifestyle Sleep Health