Not getting enough sleep seems to be a frequent problem. Many people regularly experience difficulty falling asleep, wake up in the night and can’t fall back to sleep, or wake up too early and lie awake worrying about whether they can snatch another hour.

How do we actually understand sleeping?

Sleep is an essential, biological process that all people and most animals experience, characterised by a reduction of physical activity and a reduction in reactions to physical stimuli.

From a neuroscientific point of view, sleep is a complex process that includes various neurotransmitter systems and areas of the brain, that ensure the transition between wakefulness and sleep, and control the various stages of sleep.

The sleep-wake cycle is regulated by the circadian rhythms (24 hour rhythms), that are managed by the suprachiasmatic core in the hypothalamus – which is like a clock inside our brain. This inner clock reacts to external light signals and regulates the production of melatonin (a hormone that promotes sleep) through our pineal gland.

Non-REM-sleep and REM-sleep

Sleep consists of multiple cycles of non-REM (Rapid Eye Movement) and REM-sleep. Each cycle lasts around 90 minutes and repeats itself multiple times each night.

Non-REM-sleep is further subdivided into three phases, ranging from a light sleep (phase 1) to deep, restorative sleep (phase 3). During these phases the brain activity decreases, with the exception of deep, slow brainwaves; the so called delta-waves, during phase 3.

REM-sleep is characterised by rapid eye movements, increased brain activity that resembles the brain activity when being awake, and vivid dreams. During the REM-sleep there’s an almost complete muscle relaxation, possibly to prevent us from physically carrying out our dreams.

Several neurotransmitters play a part in the sleep-wake cycle, including serotonin, norepinephrine, acetylcholine, GABA (y-Amino butyric acid), and hypo-cretin. These chemicals affect the activity of neurons that are involved in sleep and wakefulness.

The experience of sleeping

The subjective experience of sleeping can vary greatly. During the non-REM-sleep people might feel very relaxed, and their consciousness of the outside world as well as their inner thoughts might be strongly reduced. During the REM-people often experience vivid dreams, though they don’t always remember these when they wake up.

Regenerative aspects of sleep, like the recovery of energy, strengthening of the immune system, consolidating the memory and what we’ve learned, mainly happen during the phases of deep sleep. A good night’s rest is associated with a set of positive health benefits, which include increased cognitive functions, regulation of emotions, and general physical well-being.

Factors that affect our sleep

It isn’t easy to just take control and regulate our sleep, because sleep is so strongly entwined with our entire lives, including the regularity, the life events, the stress levels, and even the structure of our existence.

Nutrition

 Our nutrition is an important aspect in our sleeping pattern. Our sleep can be negatively affected by a diet that is high in fat, salt, and sugar – something that is unfortunately far too common in our society. So common it’s not even seen as a problem any more.

The consumption of alcohol, and other stimulants like coffee, tea, cannabis, MDMA, ritalin, meth, and cocaine can have a negative impact on our sleep. Irregularities in the sleeping pattern, like staying out late, enhance this effect even more.

Psychological suffering

Psychological suffering, associated with thoughts that are emotionally compelling going around in our mind, especially worrying ones, contributes to having trouble sleeping. This can manifest itself in brooding, a gloomy vision of the future, or even hearing voices that disrupt our sleep.

Sleeping pills and (other) medication

Taking psychiatric medication can interfere with our sleep as well, directly or via withdrawal symptoms. Paradoxical reactions or side effects like restlessness can do this too.

Sleeping pills are not actually meant for sleeping

Because of this multitude of factors our sleep is incredibly fragile. To get a good night’s rest, a regulated and maybe even boring life is necessary. But a boring, predictable existence gets harder to achieve each day. That’s why many people resort to sleeping pills as a solution to their sleeping problems, but this is a complex, and often problematic move. Sleeping pills, in the strict sense of the word, don’t actually exist.

Benzodiazepines

There are drugs that cause sedation, which makes sleeping easier. The most commonly used ones are benzodiazepines, like temazepam and lorazepam. These drugs affect the GABA-system in the brain, the same system that is affected by drinking alcohol, and can help us fall asleep. Zolpidem and zoplicone are drugs related to benzodiazepines (so called cyclopyrrolones), and could possibly be addictive.

When benzodiazepines or cyclopyrrolones are used for longer than one or two weeks, a tolerance and habituation is created, which reduces the effect of the drug, en the need of a higher dose increases. Also, people can easily get addicted to the drug – which means they cannot go without it.

Antidepressants, antipsychotics, and alternatives

 This is why some people try antidepressants, antipsychotics, or a different drug with sedative properties as an alternative.

• Trazodone – an antidepressant with sedative properties that is often used to help people fall asleep.
• Quetiapine (Seroquel) – an antipsychotic of which a low dose (25 mg) is often use as sleep medication too.
• Furthermore people sometimes use promethazine (Phenergan), an antihistamine that has sedative substances too and can help people fall asleep.

The problem is that these drugs aren’t officially registered as sleeping pills, can have serious side affects, and are not meant for long-term use as sleep medication.

Lifestyle changes

Instead of putting our trust in medications, it’s often more effective to make some structural lifestyle changes. For example, regular sleeping habits, avoidance of stimuli before bedtime, and creating a restful sleep environment. Meditation can also help calm our minds and promote sleep.

Even though it can be tempting to reach for sleeping pills as a quick fix, it’s important to tackle the underlying causes of our sleeping troubles and to strive for a more sustainable solution. Our sleep is a delicate balance that requires our care and attention.

In practice

But in practice, people often resort to sleeping pills anyway. In which case my advice is: don’t start with benzodiazepines or cyclopyrrolones. Try something like Phenergan, and don’t use it for any longer than a coupe of weeks.

If you do end up taking them for a longer period of time, try to vary the different types and resources, and try to insert longer periods of not using any in between. Make sure you never find yourself in a situation where you can’t go without.

Translated from Dutch by SGM Taplin