A good night's sleep enhances energy, mood, motivation, vitality, and reduces the risk for chronic medical conditions. People who have a tough time getting a good night's sleep are more likely to become dissatisfied with their lives.
   One of the most important sleep tips is to take a walk in the morning to expose yourself to early morning light. This will help your circadian clock readjust so that when night comes your body will naturally be ready to slow down. If you can't walk outside, try to be near a window in the morning or throughout the day with natural light coming in.

Causes of disturbed sleep
Sleep problems can be caused by lack of exercise, overheated body or high temperature in the bedroom, noise, too much alcohol, certain medications, and a number of medical disorders including asthma, breathing problems, COPD or other types of lung disease, chronic pain, enlarged prostate gland leading to frequent nighttime bathroom visits, gastroesophageal reflux, heart failure, restless leg syndrome. Psychological conditions include depression and anxiety. Obstructive sleep apnea causes daytime fatigue. A cause of sleep disturbance in women who are in their 40s or early 50s is perimenopause. Lack of adequate sleep can increase the risk for chronic medical conditions such as high blood pressure, cancer, heart disease, and diabetes and can reduce sex drive partly due to lower testosterone levels.
 

Good Night Rx natural sleeping aid, developed by Dr. Ray Sahelian, M.D.

Suggested Use: Take one capsule of Good Night Rx two to four hours before sleep, on an empty stomach, you can eat a half hour later. It does not work as well when taken with a meal. This natural sleeping pill was formulated for those with occasional sleep problems but may help some individuals who have chronic insomnia and are dependent on pharmaceutical sleeping pills. The benefits of Good Night Rx take longer in those with chronic insomnia or those dependent on prescription sleeping pills. A good option is to take a capsule of Good Night Rx about 3 hours before bed followed by a carbohydrate meal a half hour later. Later, an hour or so before bed, take a capsule of graviola along with a capsule of hops. This combination works quite well.
 

Purchase Good Night Rx or see the list of ingredients

Practical sleep tips

Exposure to sunlight
Early morning exposure to sunlight is ideal but any time of day is also good. The more a person is exposed to light during the day  -- does not necessarily mean being in direct sunlight, it could be being outdoors yet in shade -- the better they will sleep at night. The more activity a person does during the day that makes them tired, the better they will sleep at night. Artificial light exposure is helpful but the effects are minimal compared to being outdoors.

If you have chronic insomnia and nothing seems to work and you are habituated to taking prescription sleep medications, consider, as a last resort, if you can afford to, and are physically able, to take a several day vacation where you go to a sunny area and are physically active all day, whether hiking, swimming, or biking. All day light exposure and fatigue through physical activity are bound to give you a good night's sleep and readjust your sleep / awake cycle. If you are not able to be very active physically, just taking long drives in the countryside and visiting tourist spots with short walks will expose you to enough light to make your sleep deeper.
   
Eating before bedtime
Eat a light or medium sized snack or meal about 1 to 4 hours before sleep. If you drink too much liquid before sleep, you'll wake up repeatedly in the night for trips to the bathroom. A meal consisting of carbohydrates will make you fall asleep quicker but can cause weight gain if done regularly. It's a delicate balance between deeper sleep and weight gain.
   Foods for sleep: If you get the munchies, eat something that triggers serotonin, which makes you sleepy. Carbohydrates (whole grain bread, pasta with tomato sauce, potatoes, lentils, barley, fruits, or cereal) with small amount of foods containing the amino acid L-tryptophan (milk, tuna, or turkey) will do the trick. A fruit salad or smoothie (with mangoes, bananas) and vegetable soup are good options. Another idea is whole grain bread with tomatoes (or salsa) and melted cheese. A meal that really works to help you sleep is spaghetti with tomato sauce and cheese about two to four hours before bedtime. Dietary carbohydrate intake has been shown to increase the plasma concentration of tryptophan, a precursor of serotonin and sleep-inducing agent. A carbohydrate-based high-GI meal results in a significant shortening of onset to sleep compared with a low-GI meal.

Make your bed comfortable

• If you share your bed, make sure there is enough room for two.
• Use your bed only for sleep and sex.
• Go to bed when you are tired and turn out the lights. If you don't fall asleep in 15 minutes, get up and do something else. Go back to bed when you are tired.
• Do not agonize about falling asleep. The stress will only prevent sleep.

• Use the lowest dosage and never mix alcohol and sleeping pills. The occasional use of prescription sleep pills should not be harmful. Regular use can lead to dependence on these sleeping pills and you could have rebound insomnia (not sleeping well) the night you stop take them.
• If you feel sleepy or dizzy during the day, talk to your doctor about changing the dosage or discontinuing the sleeping pills.
• Melatonin at a dose of 0.5 to 2 mg one to three hours before bed can help induce sleep. Limit melatonin use to once or twice a week. Sometimes a lower dose such as 0.3 mg taken earlier in the evening, about 6 or 7 PM works better than a higher dose taken later.
• The herb hops in tea or pill can also help with sleep, so can passionflower herb. Hops is taken about an hour or two before bed. The herb graviola can help together with hops. A Valerian root / Hops combination 500mg / 100mg may also work well. I have not found chamomile tea to be helpful. In fact, chamomile tea sometimes makes me more alert.
• Kava taken a few hours before bed can also be helpful, so can the occasional use of 5-HTP at a dose of 50 mg an hour to three hours before bed on an empty stomach or half an hour before dinner. Another option is tryptophan.
• Another option for occasional sleepless night is Good Night Rx which has a combination of many sleep herbs and sleep nutrients including Lemon Balm herb and taurine. You may also consider the mineral magnesium.

Use sleep relaxation techniques
Try one or more relaxation techniques. When you are in bed lying on your back, shake and loosen a leg and foot. Take a few, slow, deep breaths by expanding your belly. Proceed to shake and loosen the other leg and foot and then return to your abdomen for a few more relaxed breaths. Proceed with this relaxation to your arms, shoulders, and neck. Now relax your facial muscles--especially the muscles around the eyes and mouth. Remember to return to your breath after relaxing each muscle group. Before you know it you'll be drifting into your adventure-filled unconscious. Also helpful is mentally focusing on a serene and inviting place -- like the waves on a beach or a quiet lake surrounded by tall trees -- and slowly deep breathing.

Being woken up and exposed to bright light at night can throw off a person's biological clock for the next few days. What's more, the researchers found that being woken up at night at all--even in a dark room--also disrupts the body's timing, although to a lesser degree.

Aromatherapy may work for some people
The smell of jasmine in the bedroom has been found to help improve sleep in those who are sensitive to aromatherapy. Lavender may also help slightly.

Soft music
In a paper published in the February issue of the Journal of Advanced Nursing, a team from Taiwan’s Tzu Chi University said they studied the sleep patterns of 60 people aged between 60 and 83 who had difficulty sleeping. Half were given relaxing music to listen to for 45 minutes at bedtime and half were given no help to sleep. The team found that those who listened to a selection of soft, slow music experienced physical changes that aided restful sleep, such as lower heart and respiratory rates.

An hour or two before bedtime
Avoid doing any kind of work that takes alert thinking. If your mind is racing (you’re planning a trip, a move; you’re worried about a medical diagnosis), write down what’s on your mind.

A low-carbohydrate diet leads to modest improvements in daytime sleepiness in patients with narcolepsy.

The deep baby sleep.
Nothing seems to improve memory, mood, and overall mental health as well as regular, deep sleep. Sleep aids include natural supplements, sleeping pills, ear plugs, eye shades or sleep masks, and others.
 

In my experience as a family physician I recommend eating carbohydrate foods an hour or two before bedtime in order to induce sleep. Some of the suggestions that I tell my patients are to eat a fruit salad with maple syrup, whole grain cereal, potato, cheese and tomato sandwich, or pasta with tomato sauce. Carbohydrates stimulate insulin release which in turn helps the amino acid tryptophan more easily cross the blood brain barrier and in the brain tryptophan gets converted into serotonin and on to melatonin.

Sleep apnea treatment
There is currently no proven drug therapy for sleep apnea. However, there are 4 basic approaches. Try to change the circumstances which may be causing sleep apnea or making it worse. This would include weight loss, avoidance of alcohol and sedative drugs, trying to sleep only on your side and stopping smoking. Losing weight makes a significant improvement. Use Continuous Positive Airway Pressure (CPAP) in the upper airway to support and hold the airway open. One of the reasons for the upper airway to become narrowed at night is because the tongue falls backwards, especially in the supine position. Since the tongue is attached to mandible this can be a significant problem in people with retrognathia and/or a very large tongue. It is possible to use a dental splint at night that effectively prevents the jaw and tongue from moving back when someone lies down and goes to sleep. A surgical operation on the back of the throat to remove redundant soft tissue in an attempt to increase the size of the upper airway can be performed to reduce sleep apnea.
   Mouth devices that aid breathing during sleep can be used as the first-line treatment for people with chronic snoring or milder cases of obstructive sleep apnea. Oral appliances - similar to mouth guards used in sports - should be offered as an initial treatment to people with mild to moderate OSA. People with more severe cases, however, are advised to first try continuous positive airway pressure (CPAP), which has been shown to be more effective than oral devices.

Length of sleep
The amount of sleep that a person needs to function normally depends on several factors (e.g., age). Infants sleep most of the day (about 16 hours); teenagers usually need about 9 hours a day; and adults need an average of 7 to 8 hours a day. Although elderly adults require about as much sleep as young adults, they usually sleep for shorter periods and spend less time in deep stages of sleep. About 50% of adults over the age of 65 have some type of sleep disorder, although it is not clear whether this is a normal part of aging or a result of medications that older people commonly use, or a deficiency of melatonin, or lack of adequate exercise and exposure to sunshine.

Sleep disorder
There are a few dozen different sleep disorders that are generally classified into one of three categories:
Lack of sleep (e.g., insomnia, this is the most common and occurs more often in women and the elderly)
Disturbed sleep (e.g., obstructive sleep apnea, sleepwalking, night terrors, sleep walking, sleep talking, bed-wetting, restless legs syndrome), and
Excessive sleep (e.g., narcolepsy).

Types of sleep medications
There are several prescription options available, and I believe they are effective and safe when used infrequently. Some may cause bedwetting but this is not a frequent occurrence.
Ambien prescription medication
Lunesta has been approved for long term use, but I am always cautious about taking drugs for long periods of time.

I have been taking 25 mg. of Valium for over 20 years - about 2 hours before bedtime. Since I have insomnia, I have been also taking 1.5 mg. of Lunesta for over a year. I have so many nights of sleeplessness that I am desperate to try something that will work. I have tried getting off the Lunesta and have spent many nights just lying awake and then having to get up and go to work the next morning. It is a vicious circle. Valerian and melatonin seem to have the opposite effect on me - they wire me. I am wondering about Good Night Rx. Do you think these will natural sleep product will work for me?
    Those with chronic insomnia who are habituated to pharmaceutical sleeping pills are not likely to benefit right away from natural supplements. A comprehensive approach to sleep and lifestyle changes must accompany the use of the herbal pills. The most important is daytime sun exposure and outdoor physical activity.

Over the counter sleep medication or medicine
You can find over-the-counter sleep medications such as diphenhydramine and dimenhydrinate. I don't think they work well to give a better sleep, and these sleep medications can leave you drowsy the next day, but they do not appear to be addictive. Side effects of these sleep medications include dizziness, blurred vision, and dry mouth. Other commonly used over-the-counter sleep medications include Nytol, Sleep-Eez, and Sominex. When sleeplessness is caused by minor pain, over-the-counter pain relievers such as acetaminophen (Tylenol) or a nonsteroidal anti-inflammatory drug (Advil, Motrin) can sometimes be helpful. Antihistamines have a sedating effect and may be used as mild sleep inducers. They include chlorpheniramine (Chlor-Trimeton) and diphenhydramine (Benadryl). I personally prefer the natural sleep aids.

REM sleep
REM sleep is a stage of sleep characterized by a number of features including rapid, low-voltage brain waves detectable on the electroencephalographic (EEG) recording, irregular breathing and heart rate and involuntary muscle jerks. Dreams occur during REM sleep. We typically have 3 to 5 periods of REM sleep per night. They occur at intervals of 1-2 hours and are quite variable in length. An episode of REM sleep may last 5 minutes or over an hour. About 20% of sleep is REM sleep. If you sleep 7-8 hours a night, perhaps an hour and half of that time, 90 minutes, is REM sleep. By contrast, NREM (non-REM) sleep is dreamless sleep. During NREM, the brain waves on the EEG are typically slow and of high voltage, the breathing and heart rate are slow and regular, the blood pressure is low, and the sleeper is relatively still. NREM sleep is divided into 4 stages of increasing depth of sleep leading to REM sleep. About 80% of sleep is NREM sleep. If you sleep 7-8 hours a night, all but maybe an hour and a half is spent in dreamless NREM sleep.

Sleep and Memory
Skimping on sleep can slow certain types of learning, and the difficulty seems to arise from a lack of new brain neurons. Rodents that got half their normal amount of shut-eye had a harder time remembering how to navigate a maze than well-rested rats.

Sleep on it before you make a major decision
When faced with a major decision, such as buying a car or a house, it's best to do your homework, and then forget about it for a while and let your unconscious churn through the options. Unconscious deliberation may lead to a more satisfying choice than mere conscious deliberation alone, at least for major decisions. The human subconscious has a higher capacity to integrate more information, which can lead to better choices.

Delayed Sleep Phase Syndrome
Many teens and adults have delayed sleep phase syndrome. Some people have a lot of trouble getting to sleep until 2 or 3 in the morning and they could have a condition known as delayed sleep phase syndrome. This is a disorder where people may think they have insomnia, but can actually sleep well as long as they sleep hours after others have gone to bed.  Delayed sleep phase syndrome affects between 7 percent and 16 percent of adolescents and young adults. It is less common among older adults. Among those affected by the disorder, the body's circadian rhythm allows them to stay awake long past what may be considered a normal bedtime. There is no cure for delayed sleep phase syndrome, but it can be treated by behavioral modification, such as restricting the consumption of caffeinated beverages, not exercising during or near bedtime hours and limiting light exposure from computer screens and television screens at night. Exposure to sunlight during the day and doing lots of exercise that leads to exhaustion can be helpful. The occasional use of melatonin or kava in the evening may provide temporary benefit.

Sleep natural treatment with herbs, vitamins and supplements emails
Right now I am taking 1000 mg of Valerian and 150 mg of Hops for insomnia. I had been taking a sleeping pill called Ambien and did not like the hung over feeling I had in the morning so I weaned myself off of Ambien - slowly; and then I slowly started to introduce Valerian and Hops. So far so good - but here are some nights that I simply do not sleep well. Can "tolerance" develop with these herbs? And, Dr Sahelian, thank you so much for your hard work, dedication, and pioneering spirit in nutritional medicine! I am indeed a fan.
   I appreciate the positive feedback. There are several herbs and nutrients that can help with insomnia, such as hops, valerian, kava, melatonin, 5-HTP, etc., unfortunately, tolerance can develop with most of them, and they are not as consistent as pharmaceutical medicines. I recommend to my patients to alternate various nutrients and herbs, and sometimes I will prescribe the occasional use of a prescription sleeping pill. It's also a good idea to take breaks and not use any pills for sleep for at least a couple of nights.

I have problems sleeping at night and staying awake in the day and I'm looking for natural a solution. For energy I found Acetyl-L-Cartinine and R-Alpha lipoic Acid, which are recomended to be taken together. For sleep I found Tryptophan and 5-HTP. Which of the 2 sleep aids would be most effective and safest to take long-term? Would it make sense to take a sleep aid and the energy boosters listed above? Would these products work against each other in some way?
   Both acetylcarnitine and lipoic acid, in a high dose, can cause sleep problems even if they are used in the morning. So, dosages should stay low enough to not interfere with sleep. It's difficult to predict which of the two serotonin precursors, 5-HTP or tryptophan, would be a better sleep aid. Different people respond differently.

I just saw an ad in a magazine for an all natural product called LipoRid PM for better sleep. I have had such a hard time with sleep since I lost my son six years ago, and since entering menopause. I would really like to know if you could tell me if I should consider taking LipoRid PM. It lists the ingredients as Gymnema sylvestre, Guggulipid, and N-Acetyl L-Carnitine, Sleep enhancers combined with Fat metabolizers and Amino Acids. 5-HTP, banaba Leaf and GABA. I take a generic prescription drug for low thyroid. Could I take LipoRid PM or should I just keep looking. I have taken melatonin and also valerian root, but nothing really works. Sometimes I lay in bed for hours before falling asleep.
   We have not heard of LipoRid PM, and do not know if it works or not for better sleep. Acetyl-l-carnitine actually causes alertness and we are not sure why this nutrient has been included in LipoRid PM sleep product.

I am a 64 year old woman who until the age of 55 never had a sleep problem, as soon as i started menopause i start having major difficulties, my doctor prescribe me 0.5mg Ativan and i have been taking it every night for about 2 years, then the 0.5mg stop working my doctor doubled the dose, after a while that also stop working. Should one stop Ativan while i am taking the melatonin, I decided to take a low dose 2 times a week.
   Natural sleep pills such as melatonin are not recommended to be taken the same night as a pharmaceutical sleep pill. It is best to take melatonin on a night that a person is not taking prescription sleep meds. However, there is sometimes a rebound effect when a drug is stopped. The rebound effect means that it is difficult to fall asleep since the brain is used to getting the drug. Thus, when a natural sleep pill is taken, it may appear that it is not working since it has to overcome the rebound effect. It is best to follow all suggestions for a deeper sleep as mentioned on this page.

I am 6 years into the perimenopause change right now, and the most common symptom I find amongst all the women I meet is sleep problems. I find this sleep disturbance is rarely discussed anywhere, so I wonder if it is a newer phenomenon that sleep problems or wakefulness are so common in women going through the change. Given the tremendous lack of info on peri-menopause to begin with, and most doctors lack of understanding of it, it would be very helpful if this were mentioned there. Most women I meet have this problem, and many say their doctors say it’s from “stress” and either tell them to relax more or prescribe ant-depressants! So many women are relieved when I tell them this is a common problem, and that as they balance their hormones, it is reduced. Unfortunately for me and most of my friends, when we get overtired or at all out of balance (every so many months my body shifts and I have to readjust my supplements), we cannot get back until we have gotten enough rest. This usually requires a couple nights of sleeping pills, natural or prescription. I’m hoping Good Night Rx product will be a good alternative.

Do you have any idea why some people wake up in the middle of the night for no apparent reason?
    There are many reasons why people can wake up in the middle of the night, including nightmares, anxiety disorder, depression, use of medications or supplements and stimulants that cause alertness, certain medical conditions, noises in the house or outside, etc.