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Sleep Tracking? No. Now It’s Sleep Training


You can train to run a marathon. You can train yourself to recognize Chopin. But can you train yourself to sleep (or train yourself not to have insomnia)?

Michael Schwartz, creator of the Sleep On Cue iPhone app, says yes.

Sleep training “appears to work via conditioning,” Schwartz said in a recent email exchange. “People ‘learn’ the act of falling asleep. I have found it to be helpful for those who struggle to fall asleep initially and/or struggle to return to sleep during the night.”

But why do insomniacs need to learn to sleep when for most people sleep is effortless?

Intensive Sleep Retraining

The idea of sleep training is based on intensive sleep retraining (ISR), an insomnia treatment originally developed by sleep researchers in Australia. It grew out of sleep studies showing that many insomniacs fall asleep more quickly and sleep longer than we think we do.

Schwartz has observed this phenomenon firsthand in his work as a registered sleep technologist in the United States.

“It seems [that insomniacs] who are taking a traditional hypnotic . . . tend to overestimate sleep time,” he says. “Then if the insomniac begins a tapering of the medication, it swings to an underestimation of sleep time.”

Unlearning and Relearning Sleep

The question of why so many insomniacs tend to underestimate sleep time has not been definitively answered. ISR proponents suggest that insomniacs’ trouble sleeping is conditioned, resulting from poor sleep habits, worry about sleep loss, and negative beliefs about sleep. Eventually we lose touch with what falling asleep actually feels like.

So the goal of treatment is to retrain insomnia sufferers in the experience of falling asleep. Proponents claim that sufficient practice (within the prescribed protocol) will make our perceptions more accurate (i.e., more in sync with objective sleep tests, which indicate we’re sleeping longer) and restore confidence in our ability to sleep.

The Challenge and the Payoff

The ISR treatment as originally prescribed is short but onerous. You spend 25 nearly sleepless hours in a sleep lab. Every 30 minutes, you get a chance to fall asleep (and if you fall asleep, you’re woken up). At the end of the 25-hour period, you’ve had lots of practice falling asleep . . . and you’re very sleep deprived.

But after the initial 25 hours the benefits of ISR are immediate. With loads of sleep pressure built up by the next night and instructions on how to proceed, insomniacs who undergo ISR have experienced improved sleep starting at Day 2. The gains continue, research has shown, for at least 6 months.

A Sleep Training App

An insomnia treatment that involves wiring patients up in a sleep lab and round-the-clock supervision by sleep technicians is very expensive (which may be the reason nobody’s doing ISR in the United States). So when a call came out to get ISR out of the lab and make it available to insomniacs at home, Schwartz went to work.

“After reading the ‘call to action’ article by the notable insomnia researchers, I began thinking about how to detect sleep onset without expensive amplified EEG recording,” Schwartz said. He came up with several ideas before landing on the idea of an iPhone app.

“My ‘ah-ha’ was to realize that a call (tone) and response (slight movement) with a smartphone might be the ticket,” Schwartz said, “and it seems to work well.” Here’s how:

  • You lie down in bed holding your iPhone. Each time the phone emits a tone, you shake it slightly.
  • If the app doesn’t detect a shake, it assumes you’re asleep and vibrates to wake you up.
  • A message then comes on the screen: “Do you think you fell asleep?” You press yes or no.
  • You’re then instructed to leave the bed for a few minutes. The phone vibrates again to indicate when to return to the bed for the next sleep trial.
  • You decide when to end each training session. The screen then displays a graph with information about your sleep ability and your awareness of your sleep.

Modified ISR

The Sleep On Cue protocol is very similar to the ISR protocol, allowing for repeated, short sleep onset opportunities with sleep–wake estimation and confirmation. But Schwartz felt he needed to make ISR more palatable for home users.

“So I decided to reduce each sleep trial time slightly after each successful sleep attempt, as well as to prompt the user to leave the bed for just a couple minutes between sleep trials,” he said. “These two features allow more sleep trials in a shorter amount of time.

“I suggest . . . that sleep training should be done around bedtime for a couple of hours following any poor night of sleep. So maybe 10 sleep trials. Put the phone down and go to sleep when done, review the summary graph in the morning.”

Testimonials on the Sleep On Cue website suggest the app has been helpful for users, including users coming off sleeping pills. According to Schwartz, tests verifying the accuracy and clinical effectiveness of a modified version of the app are under way in Australia right now.

“The best user of my app is someone who is committed to sleep training,” he said, “who can grasp the idea of ISR and how it can help.”

If you try this app, let us know how you fare.

Sleep-Friendly Diet for Long-Term Health, Part I


I’ve always wondered how much of an impact my diet really has on my sleep. Sure, I know from experience that caffeine late in the day gives me insomnia at night. I avoid alcohol within a few hours of going to bed—otherwise, I wake up at 3 in the morning.

As for foods supposed to help with sleep, I’m not so convinced. Evidence for the sleep benefits of kiwi fruit, gelatin, and turkey—to name a few I’ve read about on the web—is slim, and the studies they’re based on are small. It’s a stretch to believe that eating more of these foods would actually improve my sleep.

But I’m intrigued by findings published recently from researchers at the University of Pennsylvania. Those of us plagued by short sleep, and who have trouble falling or staying asleep, consume less of certain nutrients than do good sleepers, their data (based on two huge studies) show. For us, foods high in these nutrients may be golden.

Dietary Nutrients and Sleep Length

Investigators looked at links between dietary nutrients and sleep length. Among the discoveries they made was that compared with normal sleepers, short sleepers—people who reported sleeping 5-6 hours a night—consumed less of three nutrients: vitamin C, lutein and zeaxanthin, and selenium. We’ll consider them one by one:

  • Vitamin C: Antioxidant found abundantly in citrus fruits and vegetables such as broccoli, kale, and sweet peppers. It cuts down on your risk of heart disease, cancer, and other diseases associated with the immune system.
  • Lutein and Zeaxanthin: Two antioxidants often found together in brightly colored vegetables—kale, spinach, broccoli, corn, and orange peppers–and fruits such as tangerines, oranges, and papaya. They’re protective of eye health and decrease your risk of macular degeneration.
  • Selenium: Antioxidant found in fish and seafood, meat, Brazil nuts, and sunflower seeds. It lowers your risk of heart disease and some cancers and has a key role in regulating inflammation and immunity.

Would eating more of these foods actually improve our sleep? The U-Penn study did not explore cause and effect so it doesn’t go as far as answering this question. But here’s why the information about dietary nutrients is important to us: as short sleepers, we’re more vulnerable than normal sleepers to a host of life-threatening illnesses, including hypertension, heart disease, type II diabetes, and, it now looks likely, cancer. If upping our intake of broccoli, kale, nuts, and citrus fruits might protect us from these diseases, what is there to lose by doing it? (And it’s possible that eating more of these foods could reduce our susceptibility to insomnia.)

Sleep Length, Food Variety and Water

Two other significant findings are these:

  • People who slept 7-8 hours a night had a more varied diet than people who slept less.
  • Short sleepers (5-6) drank less tap water than others.

Eating a more a varied diet and drinking more water just might improve our sleep and our long-term health. But take care to steer clear of water and other fluids after dinner to avoid having to get up to go to the bathroom at night.

A second study from this same group shows that people who have trouble falling asleep tend to consume less of certain nutrients while people who have trouble staying asleep tend to consume less of others. Look out for the findings later this month.

What foods seem to improve your sleep?

Insomnia at the Approach of Summer


It happens every year in the spring: someone writes in to The Savvy Insomniac complaining of an inexplicable onset of insomnia. No stress is involved, no abrupt change in circumstances.

Here’s how a reader described the problem this year:

Every year at the same time (between the end of April and the end of June, I don’t know why?), my sleep becomes very capricious. I don’t sleep when I go to bed and, inexorably, I have to start again a new ‘sleep restriction.’ I feel pretty jaded because it’s difficult!

Whenever you’re having trouble sleeping, it helps to tighten up your sleep window and stay out of the bedroom until you’re really sleepy. But if insomnia tends to strike at about this time every year, the problem may have to do with lengthening days. The solution may lie in reducing your exposure to sunlight.

Seasonal Variation in Light Exposure

The further away from the equator you live, the greater are the seasonal differences in your exposure to sunlight. Not many comparative studies have measured how these seasonal variations in day length affect people’s sleep. But one study published in 2012 compared the sleep timing and quality of people living in Norway (far from the equator) and others living in Ghana (close to the equator) in the winter and the summer.

Ghanaians rose and went to sleep at about the same time in both seasons. The Norwegians rose 32 minutes earlier (and went to bed 12 minutes earlier) in the summer than in the winter, suggesting that seasonal variation in day length can affect our internal clocks. When the days are longer and sunrise is earlier, people may tend to get up (and go to bed) a little earlier than they do in the winter.

Seasonal Affective Disorder

However, the Norwegians in this study experienced more insomnia and reported lower moods in the winter when the days were short. This finding aligns with the results of other research—from Norway, for example, and from Finland—showing that in the late fall and winter, insufficient exposure to daylight is associated with seasonal affective disorder, or SAD, and trouble sleeping.

I see anecdotal evidence of this phenomenon every year. Readers write in complaining of insomnia that typically starts in November or December. The solution to this seasonal insomnia is bright light therapy, appropriately timed.

Too Much Light?

Other people report that their insomnia typically occurs in the spring and summer. There’s a dearth of research on this phenomenon, but I suspect that excessive exposure to daylight could trigger insomnia in those who, for whatever reason, are particularly sensitive to light. Light blocks secretion of melatonin, a hormone helpful to sleep, so restricting your exposure to bright light early in the morning and later in the evening may help.

Here are suggestions for how:

  • Install light blocking curtains on bedroom windows so the morning sunlight doesn’t wake you up too early
  • Draw blinds and curtains in your home before the sun sets and keep indoor lighting low in the evening
  • Wear sunglasses if you’re outside in the sunlight very early in the morning or after about 8:30 p.m.
  • Steer clear of devices with screens in the run-up to bedtime.
  • Buy a comfortable eye mask and wear it when you sleep

If you find eye masks uncomfortable, perhaps a towel wrapped around the eyes and head will do the trick. A few years ago a neuroscientist–sleep researcher told me she was super sensitive to light at night, and this was her way of solving the problem. Do whatever works!

Q&A: The Why’s of Winter Insomnia, and What to Do


If there’s a seasonal pattern to your insomnia, reduced light exposure could be the culprit. People in northerly latitudes are exposed to little daylight in the winter, and this can have a negative effect on circadian rhythms and worsen sleep.

Why is it, an insomnia sufferer recently wrote to Ask The Savvy Insomniac, that my insomnia always seems to get worse in the winter? “Erratic” describes my sleep right now. Some mornings I wake up like a bear coming out of hibernation! It’s all I can do to haul myself out of bed. Then when I do get up I’m low on energy and my mind’s in a fog. Some nights I fall asleep early (and wake up as early as 3!), and other nights I can’t fall asleep till 1 or 2.

If there’s a seasonal pattern to your insomnia, reduced light exposure could be the culprit. People in northerly latitudes are exposed to little daylight in the winter, and this can have a negative effect on circadian rhythms and worsen sleep.

Absence of daylight can interfere with the normal rhythm of your body’s secretion of melatonin, a hormone under circadian control. Melatonin secretion typically begins about two hours before you fall asleep and ends at wake-up time. But melatonin is light sensitive. Without the benefit of early morning light, melatonin secretion may be prolonged, making you feel sleepy and less alert.

Absence of light in the evening, on the other hand, can cue melatonin secretion to start soon after dinner. You nod off early and then awaken too early in the morning.

Bright Light Therapy: What and How

The recommended treatment for seasonal sleep disorders involves a light box—bright fluorescent bulbs encased in a box with a diffusing screen. The box is designed to deliver light at the intensity of sunlight—10,000 lux—in a way that’s safe for the eyes, with a minimal amount of ultraviolet (UV) light.

When using a light box, set it on a table or a desktop so the light is aimed at you but you’re not looking directly into it. Use it while doing any stationary activity: reading, eating meals, working at the computer, watching TV.

Timing Is Important to Success

If your main complaint is oversleeping and feeling groggy in the morning, schedule sessions with the light box early in the morning when it’s still dark outside—say, at 6:30 a.m. Thirty minutes a day is sufficient for many users (and is generally sufficient for a majority of people with Seasonal Affective Disorder, or SAD). But people vary greatly in their sensitivity to light. Some may need more exposure to bright light; others, less. Also, the lower the light intensity (some light boxes emit light at 2,500 lux), the longer your daily therapy sessions will need to be. The goal is to enable more efficient sleep and increase your daytime alertness.

If your main complaint is falling asleep too early, schedule your light therapy in the evening between 7 and 9 p.m. Use the light box on a daily basis to keep your circadian rhythms regular and put off sleep until a reasonable hour.

Do you find that your insomnia varies with the season? If so, when is your insomnia worse?

Can’t Sleep in the Summer? Here’s What to Do


Sunshine and warm weather are a boost to the spirit after a long, hard winter. But they may not do much for your sleep. In fact, if you’re sensitive to light and heat, long days and warm nights can be a setup for insomnia.

Here’s how to get more sleep as we move into June and July.

Manage Your Exposure to Light

For people who live in northern latitudes, the daily dose of sunlight at the approach of the summer solstice is nearly double what it is at the winter solstice. Extra bright light in the morning may not be a problem. In fact, it can help synchronize circadian rhythms and give you the same lift as a cup of coffee. (If sunlight wakes you up too early, install light-blocking curtains on your bedroom windows.)

But daylight that extends past 9 and 10 p.m. can delay secretion of the hormone melatonin, postponing the onset of sleep. If you go to bed at your normal bedtime, you can’t sleep. You toss and turn rather than quickly drifting off.

Manage summer insomnia by cutting down on your exposure to bright light in the evening and at night:

  • Wear sunglasses when you’re outside
  • Draw shades and curtains around 8:30 p.m., and lower the lights in your home.
  • Sign off devices with screens an hour or 2 before bedtime, or wear blue light-blocking glasses
  • Put red lightbulbs in nightlights. (While exposure to white light at night may affect your sleep, exposure to red light likely will not.)

Cool Down

Heat can be a factor in summertime insomnia. Research shows that people tend to sleep more readily when their core body temperature is falling, and that extreme ambient heat may interfere with the internal cooling process that normally occurs at night. The ideal room temperature for sleep is a little bit lower than is comfortable with during the daytime, so to get more sleep in the summer,

  • Keep your shades drawn to block out heat from the sun.
  • Use air conditioning and fans to lower the temperature of your bedroom.
  • If air conditioning and fans are unavailable, consider sleeping in a lower level of your home.

There are other ways to facilitate internal heat loss and cool down. Research shows—paradoxically—that engaging in activities that increase skin temperature actually help to cool you down. Warming the skin hastens internal heat loss by dilating blood vessels close to the skin. This allows for the swift release of body heat and a lowering of core body temperature, in turn promoting sleep. So a few hours before you normally go to bed,

At times when you can’t do much of anything in the evening or control the ambient temperature (say you’re driving across country and the air conditioning is broken in the only motel room available at 10 p.m.), take a cool shower before hopping into bed and lie down with a cool washcloth on your forehead.

Belsomra: Weighing Benefits and Risks


Belsomra, Merck’s new sleeping pill, is now the hottest topic on this blog. Insomnia sufferers who write in with comments are wondering about dosage, effectiveness, side effects, and how it compares with other sleeping pills.

Reviews of Belsomra, or suvorexant, have been lukewarm so far. Since I haven’t tried it myself, I can’t weigh in based on personal experience. But my search for information turned up more than I shared in my blog last August. Here’s a bit of context and more details.


There are two ways to induce sleep chemically: by (1) facilitating the action of neurons that promote sleep and (2) deactivating neurons associated with arousal. Z-drugs like zolpidem (Ambien) and eszopiclone (Lunesta) do the former. They enhance the ability of GABA neurons to shut the brain down.

Belsomra, on the other hand, works by disabling the orexin neurons that fire continuously when we’re awake. These orexin neurons—70,000 in all–reside in a part of the brain called the hypothalamus. They’re connected to GABA neurons there, and when the orexin neurons are firing, they hold GABA neurons in check.

Mice that lack orexin neurons are constantly falling asleep. In mice that have orexin neurons, temporarily disabling the neurons also puts the mice to sleep. Blocking the action of the orexins in humans should have a similar effect.


The problem with these drugs is that in some users they have negative side effects: sleep walking, sleep eating, and sleep driving, not to mention interfering with memory formation and possibly increasing mortality. For several years the z-drugs were touted as safe for long-term use, but post-marketing tests have given rise to skepticism among some healthcare providers.

Besides, although sleep scientists are still unclear about the causes of insomnia, the prevailing theory is not that insomnia is the result of a flawed sleep system but rather that it stems from excessive arousal, which is conditioned and/or genetically predisposed. The word often used to describe our predicament is hyperarousal. So it makes sense drug developers are working on insomnia drugs that will tamp the arousal down.


The safety and efficacy of the drug apparently depend on the dose. The FDA approved Belsomra in doses of 5, 10, 15, and 20 mg based on the results of 3 double-blind, placebo-controlled trials that showed it to be better than placebo at putting subjects to sleep and keeping them asleep.

Merck also conducted a one-year safety study in which investigators also looked at the efficacy of 30 and 40 mg of the drug. By the end of the first month, patients taking suvorexant were falling asleep 10 minutes faster than patients taking a placebo and sleeping about 23 minutes longer.

But the main purpose of this study was to assess the drug’s safety. In this respect, suvorexant performed well enough. Subjects who took suvorexant maintained their sleep improvements throughout the year. When they stopped taking the drug at the end of the study, they experienced no more rebound insomnia or withdrawal symptoms than the placebo group. This suggests the drug’s potential to foster the build-up of tolerance and dependency is low.

The one prominent safety issue that did come up was daytime grogginess, unsurprising in a drug whose half-life is about 12 hours. Of the patients on Belsomra, 13 percent experienced next-day sleepiness, sometimes severe, compared to 3 percent on placebo. In studies where patients were taking lower doses of Belsomra—15 and 20 mg—fewer patients experienced next-day sleepiness (7 percent vs. 3 percent on placebo).

The tradeoff, though, was reduced efficacy, especially in doses under 20 mg. Subjects who took a 10-mg dose did not get to sleep significantly sooner than patients on placebo (although they did sleep about 22 minutes longer). So it looks like business as usual here: higher doses are more efficacious but they may also leave you feeling groggy and impair your driving ability the next day.


Merck did not conduct any toe-to-toe comparison studies. The FDA does not require that new drugs be tested against existing drugs. Comparison studies, if they’re done at all, are typically conducted after a new drug comes out.

But results of a Phase-2 study showed that in healthy subjects, suvorexant altered the overall electrical activity in the brain less than 3 other medications—gaboxadol, zolpidem, and trazodone–used for sleep. These findings, say investigators, suggest that drugs like suvorexant “might lead to improvements in sleep without major changes in the patient’s neurophysiology as assessed by electroencephalography.”


Our bodies actually produce 2 different orexin neuropeptides and have 2 different orexin receptors. Belsomra is a “dual orexin receptor antagonist,” or DORA. It promotes sleep by blocking both orexins from binding to their receptors.

In the laboratory, writes Cormac Sheridan in the October 2014 issue of Nature Biotechnology, Belsomra over time shows a greater binding affinity for the orexin-1 receptor. Yet animal knockout studies suggest that of the 2 receptors, the orexin-2 receptor may actually be more important to sleep regulation. So the activity profile of Belsomra may not be ideal.

At least 2 drug companies–GlaxoSmithKline and Minerva Neurosciences—have orexin receptor antagonists in the works. Drugs that more strongly target the orexin-2 receptors may prove to be more effective as hypnotics than Belsomra. The race is o to see.

Ambien Gets Another Black Eye


As if it weren’t bad enough that Ambien, a.k.a. zolpidem, can cause sleepwalking, sleep eating, and sleep driving. Now researchers are saying that America’s favorite sleeping pill increases the retention of negative memories. This is not a good thing.

As if it weren’t bad enough that Ambien, a.k.a. zolpidem, can cause sleepwalking, sleep eating, and sleep driving. Now researchers are saying that America’s favorite sleeping pill increases the retention of negative memories. This is not a good thing.

Sleep generally helps you process negative events. Chances are you’ll never forget the fire that broke out in your kitchen, but sleep will help to diminish its emotional charge. You’ll wake up after a good night’s sleep in a more positive frame of mind.

But Ambien seems to interfere with this process. It does so by increasing sleep spindles—sudden bursts of electrical activity in the brain that may last up to a second. Overall, sleep spindles are beneficial. They play a role in helping to consolidate memories of facts and events. But the team that conducted this new research, led by psychologist Sara C. Mednick of UC Riverside, found that sleep spindles enhance the retention of emotionally charged memories as well—negative memories in particular.


Researchers in this study divided their subjects into three groups. One group was given Ambien; the second, a placebo; and the third, Xyrem, another sedative drug. All subjects then looked at a series of images, some positive and others disturbing. Then they took naps. When they were awakened and asked to recall the images, the subjects that had taken Ambien remembered more images that had negative or highly arousing content. So the drug appears to enhance the recall of negative memories.

I use Ambien from time to time, and frankly I’m not surprised at this result. I love the little yellow pills for their unfailing ability to put me to sleep. But when my wakefulness is due to stress and emotional arousal, malaise is still with me the morning after I take a pill. Whatever good the Ambien does (and I’m still convinced the benefits outweigh the side effects, at least for me) it does not do a good job of helping regulate my mood.

So Ambien looks like a bad drug for people with anxiety disorders and PTSD. “These are people who already have heightened memory for negative and high-arousal memories,” Mednick said, quoted in an online article in Psych Central. “Sleep drugs might be improving their memories for things they don’t want to remember.”

All Ambien users—regardless of other health conditions—should keep this new information in mind.

If you use Ambien, how does taking a pill at night affect your mood the next day?

In Praise of Sleeping on the Couch


It’s a telltale sign of denial, as far as sleep experts are concerned. To sleep anywhere but the bed is to avoid facing up to your real problem with sleep: namely, the fact that your bed has become Enemy Number One. The frustration of going to bed and being unable to sleep has become associated with the bed itself, so that merely setting foot in the bedroom can make you anxious. Just thinking about B-E-D makes your stomach clench.

Hence, the cowardly retreat to sleeping on the couch.

Well, OK. Most of us would rather sleep in our beds, and if the bed triggers negative associations, there are treatments you can undergo to relieve the situation and they’re worth checking out.

But sleeping on the couch isn’t always a sign of denial. Some insomniacs are light sleepers prone to high-frequency brain activity even during the deeper stages of sleep, or so the experts say. We pick up on information in the environment that normal sleepers readily tune out. The problem may be that there are disturbances in the bedroom itself.

  • Snoring husband? Now, which is the more rational approach to sleep, arguing with an unresponsive husband (“Turn over, you’re snoring.” “Was not.” Were too.” “My head’s already under the pillow.” “Is not.” “Is too.”) or tiptoeing out of the bedroom and into the arms of a nice mute couch?
  • Thrashing wife? Same thing. She may be fighting tigers in her dreams, but are you going to stick around to discuss the fact that she may be the one with sleep problem and shouldn’t she finally go in for that sleep study after all? No way. Head for the couch.
  • You wake up roasting in the sheets? It’s time to take a leaf out of Ben Franklin’s book. Franklin knew heat could sabotage sleep and had a second bed to go to when the first got too warm. Why toss and turn amid sweaty sheets when you can stretch out on a nice cool couch?
  • Moonlight awakens you at 2 a.m.? Is it your fault that your partner leaves the blinds open so he can awaken to sunlight and an alarm clock chanting, “’Twas brillig, and the slithy toves Did gyre and gimble in the wabe?” No, señor! The simple way to solve this problem is to head to the couch in the den.

A couch with all the right accouterments can be a godsend for insomniacs in a pinch. Do not underestimate us, sleep experts. Sometimes we’re smarter than you think.

The Low-Down on OTC Sleep Aids


Over-the-counter sleeping pills are readily available at the pharmacy: drugs like ZzzQuil, Benadryl, Unisom and Tylenol PM. All promise sound, refreshing sleep. Just how well do live up to that promise, and are they as harmless as they’re said to be?

These sleep aids work by blocking the secretion of histamine, a neurotransmitter that keeps you awake. Nearly every insomnia sufferer I know has tried them at some time or another, and some are satisfied customers.

“Whatever’s in Unisom, I’ve found it works for me pretty well,” says Dale, a marketing expert I interviewed for my book, whose main problem is getting to sleep at the beginning of the night and who sometimes wakes up in the middle of the night. “It’s 80 to 90 percent reliable.”

Other people with insomnia dismiss over-the-counter sleep aids as worthless. Existing scientific research suggests their efficacy is indeed fairly limited.

The active ingredient in most OTC sleeping pills is diphenhydramine (some formulations of Unisom contain doxylamine, a similar drug). In one study, diphenhydramine moderately increased subjects’ sleep efficiency (i.e., they spent more of their time in bed sleeping rather than lying awake).* In another study, older insomniacs taking the drug woke up a little less frequently at night.** Pretty small gains. Yet what behaves like a sugar pill for one insomniac can apparently work magic for another.


You might think, because these drugs are sold over the counter, that you can use them however you see fit without risk. Some are advertised as “non-habit-forming.” But here it’s better to be cautious. Studies suggest that if you take them every night, you’ll wind up needing to increase the dose to get the same sedative effect.

“Over-the-counter antihistamines may have a role for short-term insomnia treatment in younger adults,” write the authors of a review paper published last year, “but tolerance develops rapidly.”*** So nightly use of OTC sleep aids is not a good idea.

Lingering Effects

The other problem with these antihistamines is that their sedative effects are relatively long lasting and can cause morning drowsiness. Compared to newer prescription sleep meds, they have long elimination half-lives. (Half-life is the time it takes for a dose of a drug in the blood plasma to decrease by half.)

Diphenhydramine has a half-life of 2.4 to 9.3 hours, and its half-life tends to increase with users’ age. It will leave some people—older adults, especially—feeling groggy in the morning. The half-life of doxylamine is about 10 hours, and typically longer in older adults. It, too, may cause morning drowsiness, which increases the risk of falls and driving incidents.

Dale has found a way to cut down on the grogginess. “I use half the recommended dosage,” he says. “That minimizes the hangover in the morning.”

If you’re using OTC sleep aids, keep these caveats in mind.

Menopause, Insomnia and Pycnogenol


When female friends hit their 40s and 50s, they start talking to me about their sleep. “I never had insomnia before in my life.” “I wake up with hot flashes.” “I get these feelings of anxiety and I just can’t sleep!”

Perimenopause and menopause cause an uptick in sleep problems, insomnia, chief among them. Hormonal changes are clearly involved. Starting in perimenopause, our bodies secrete less estrogen, and products containing phytoestrogen—a plant hormone similar to estrogen—are said to help with menopausal symptoms. Soy products are high in phytoestrogen, and supplements containing ginseng, red clover extract, and black cohosh are, too.

But insomnia that occurs in midlife women hasn’t gotten much attention from sleep researchers, nor have these phytoestrogen-containing products. Do they help with insomnia and other menopausal symptoms? All we can do is to try these alternative treatments and see.

French Maritime Pine Bark Extract

Another plant-based supplement shows promise for women looking for relief from insomnia and other menopause-related symptoms. It’s made from the bark of the maritime pine, native to the western Mediterranean, and sold in the US as Pycnogenol.

Pycnogenol contains naturally occurring chemicals called proanthocyanidins, found also in peanut skin, grape seed, and witch hazel bark. Compared to placebo, Pycnogenol supplements taken daily for several weeks have lessened menopausal symptoms in three studies published over the past six years:

  1. In Taiwan, Pycnogenol alleviated menstrual pain and all other menopausal symptoms, favorably altering the LDL/HDL ratio of study subjects as well.
  2. In Italy, Pycnogenol significantly reduced the occurrence of hot flashes, night sweats, mood swings, irregular periods, loss of libido, and vaginal dryness.
  3. In Japan, Pycnogenol was found to be especially effective in alleviating insomnia and vasomotor symptoms such as hot flashes, palpitations, and vaginal dryness.

In none of these studies was Pcynogenol associated with significant side effects.

Other Uses of Pycnogenol

Studies also suggest Pycnogenol may

  • improve exercise capacity in athletes
  • increase elasticity in dry and sun-damaged skin
  • reduce the duration and symptoms of the common cold when combined with zinc and vitamin C.

Pycnogenol sounds too good to be true! But remember, these studies are all preliminary. And, as is the case with many plant-based alternative treatments for insomnia, Pycnogenol may have to be taken for several weeks before it has a noticeable effect. So will it help with sleep problems and other menopausal symptoms? The only way to know is to try it and see.

What plant-based supplements have you tried for insomnia, and have they worked?