A good night's sleep enhances energy, mood, vitality, sex drive, and reduces the risk for chronic medical conditions. Deep sleep also has anti-aging benefits. This page will provide you with sleep aid ideas.

Causes of disturbed sleep
Sleep problems can be caused by a number of medical disorders including asthma, COPD, heart failure, enlarged prostate, gastroesophageal reflux, chronic pain, restless leg syndrome, depression, and anxiety. Obstructive sleep apnea causes daytime fatigue. A cause of sleep disturbance in women in the 40s or early 50s is perimenopause.

Good Night Rx -  for occasional sleep disturbance

Developed by Ray Sahelian, M.D.

Good Night Rx Supplement Facts:

Suggested Use: Take one capsule of Good Night Rx one to three hours before sleep, on an empty stomach. Good Night Rx does not work as well when taken with a meal. Good Night Rx was not formulated for those who have chronic insomnia and are already dependent on pharmaceutical sleeping pills.

For more information, ingredients, or to purchase Good Night Rx

Sign up to a FREE Supplement Research Update newsletter. Once or twice a month you will receive an email with a review of several studies on various supplements and natural medicine topics - including sleep disturbance treatment and how to have better sleep - and their practical interpretation by Ray Sahelian, M.D.

Practical Sleep Tips
1. Try to stick to a schedule, and don't sleep late on weekends. If you sleep late on Saturday and Sunday mornings, you'll get Sunday night insomnia. Instead, go to sleep and get up at about the same time every day. You may not need to rely on an alarm clock to wake up when you get enough sleep.

• Don't eat too many spicy or fatty foods. They may cause heartburn and interfere with proper 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 (with mangoes) and vegetable soup are good options. Another idea is whole grain bread with tomatoes (or salsa) and melted cheese.
• Don't drink more than one or two ounces of alcohol before sleep. It may cause you to wake up repeatedly, snore and possibly develop sleep apnea.

8. 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 1 to 2 mg an hour or two before bed can help induce sleep. Limit use to once 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. Hops is taken about an hour or two before bed. A Valerian/Hops combination 500mg/100mg may also work well.
• 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 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 herbs.

11. Use ear plugs and eye shades to block noise and light. You may be amazed on how much better you'll sleep and feel in the morning when you use ear plugs since you will be able to get a deeper sleep without frequent overnight interruptions from traffic noise, airplanes, dogs barking, roommates snoring, etc.

12. Use sleep relaxation techniques.
Once you are in bed, take a deep breath and gradually let it out. Do this a few times. Then, lightly shake one of your feet, and go back to taking a couple of deep breaths. Lightly shake the other foot and then take a couple of deep breaths. Move up to your legs, hips, arms, neck, muscle around the mouth, eye muscles, etc., while going back to the breath after shaking each body part. Soon you'll be in la la land. 

Being woken up and exposed to bright light at night can throw off a person's biological clock for the next few days, a new study shows. 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.

13. Aromatherapy
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.

14. 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.

15. Avoid regular use of pharmaceutical sleep medication. Frequent use of sleep medication can lead to reliance, tolerance, and loss of memory.

Sleep Research Update
Sleep problems affects 20% of the adult population in western countries and its prevalence increases with age. There is a controversy regarding the origin of sleep disorders in elderly. Are they only due to a senile process of sleep functioning or due to other associated comorbidities? Considering the objective assessment of sleep in elderly (by polysomnography), it has been shown an increasing sleep latency, decreasing total sleep time and sleep efficiency, a lower percentage of slow wave sleep. The circadian clock is also modified by age with phase advance and a decreased amplitude of the circadian rhythms. The most relevant comorbidities found in older people are: sleep apneas, restless leg syndrome, psychiatric disorders (anxiety and depression) and the use of drugs.

Researchers found that among more than a thousand third-graders, obesity, "mouth breathing" during the day, frequent sore throats and parents' smoking were all associated with a higher risk of habitual snoring.

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

Sleep related to disease
Sleep deprivation affected hormonal levels. Men and women had a 40% to 60% average increase in the inflammatory marker interleukin-6 (IL-6), while men alone showed a 20% to 30% increase in another marker for inflammation, tumor necrosis factor (TNF). Both IL-6 and TNF are cytokines, which are proteins the body releases in response to injury. The findings indicate that getting a full night's rest of eight hours is not a nice bonus, but necessary. In addition, the finding that lack of sleep may stimulate an increase in chronic, low-level inflammatory response is worrisome, because that state has been linked to conditions such as high blood pressure, heart disease and most recently, diabetes.

The Deep baby sleep.
Nothing seems to improve memory, mood, and overall mental health as well as regular, deep sleep.

There are many tips on how to have good sleep patterns. I recommend that patients expose themselves to morning light for at least ten to twenty minutes by either taking a walk or driving to work. Morning light exposure helps reset our daily clock. Mental activity should be stopped at least one hour before bed and the mind allowed to switch to fun reading, watching a comedy film or TV show. You could tape your favorite prime time sitcom and then watch it before bed.

Use earplugs to muffle noises. You may be surprised how many noises can potentially disturb your sleep. These could be such interruptions as a dog barking, traffic, airplanes flying overhead, birds chirping outside your room in the early morning, or a loud bed partner.

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.

In my experience as a family physician, I recommend eating carbohydrate foods an hour ot 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 (not sleep apnia)
People with sleep apnea stop breathing for 10 to 30 seconds at a time during sleep. These short stops in breathing can happen several hundred times every night. If you have sleep apnea, the periods of not breathing may make you wake up from deep sleep. People with obstructive sleep apnea (OSA) may find nighttime treatment with a pressurized breathing machine cumbersome, but it pays off: continuous positive airway pressure therapy -- CPAP, as it's called -- does lower the rate of heart-related deaths in such patients.
     When an elderly person dies in his or her sleep, cessation of breathing related to the loss of neurons in a particular area of the brain could be a possible cause of death. A brain region called the ventrolateral medulla is critical for generating regular, rhythmic breathing, and neurons in this area show high levels of a receptor termed NK1R. A lack of NK1R-carrying neurons could underlie central sleep apnea. The most common form of sleep apnea is obstructive sleep apnea, when airway passages collapse and block breathing, but it can also arise when respiration signals from the brain are interrupted -- known as central sleep apnea. Researchers studied rats after the animals were injected with a toxin that selectively kills off neurons carrying NK1R. After 4 days, respiratory disturbances had increased from 4 to 66 episodes per hour during sleep, and the rate worsened even more over the next two days. From day 7 on, the animals developed a highly fragmented sleep pattern and reduced total sleep time. While awake, breathing became increasingly irregular. By 10 days, the rats stopped breathing immediately upon falling asleep, starting again only after they awakened. Central sleep apnea becomes more prevalent as people get older. Since these neurons slowly deteriorate, and because older individuals' heart and lungs are weaker, they become more susceptible to respiratory failure during sleep.
     Mayo Clinic researchers have identified a new type of sleep apnea called "complex sleep apnea" that may be resistant to standard treatment such as continuous positive airway pressure (CPAP).

Sleep apnea symptom
If you are waking up all night long, you aren't getting enough rest from your sleep and you are likely to be exhausted the next day. A sleep apnea symptom your partner may notice is periods of not breathing which can last over half a minute. Next day sleepiness is another sleep apnea symptom. If you feel the need to drink a lot of coffee to keep you awake during the day, you may be covering up a sleep apnea symptom. In fact, drinking coffee could make you sleep worse at night.
   People who suffer from sleep apnea may develop high levels of carbon dioxide in the blood during the daytime -- a condition known as hypercapnia.

Sleep apnea treatment
Sleep apnea treatment is not always effective but worth a try. There are four approaches one can take. There is currently no proven drug therapy for sleep apnea. However, there are 4 basic approaches 1. 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. 2. Use Continuous Positive Airway Pressure (CPAP) in the upper airway to support and hold the airway open. 3. 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. 4. 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.

Sleep Apnea, Snoring, and Didgeridoo
Researchers in Switzerland examined 25 patients who suffered from snoring and moderate obstructive sleep apnea syndrome, both common sleep disorders. Half the group were given daily lessons in playing the didgeridoo, a wind instrument about 1.5 meters (yards) long that originated in northern Australia and is traditionally made from the trunk of a tree hollowed out by termites. The study, published in the British Medical Journal's January 2006 edition, found that those who played the unusual instrument over a four-month trial period saw a significant improvement in their daytime sleepiness and apnea. Their partners also reported less disturbance from snoring. The researchers said training the upper airways through the breathing techniques required to play the didgeridoo was behind the improvement.

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 aid
Sleep aids include natural supplements, sleeping pills, ear plugs, eye shades or sleep masks, and others.

Effects of Sleep deprivation
Sleep deprivation can lead to fatigue, low mood, low motivation, and disturbed immune system leading to more colds and flu. Over the long run, chronic disturbed sleep can cause many illnesses including increasing the risk for cancer.

Sleep study
Sleep studies, or polysomnographic (PSG) studies, are a series of tests that help evaluate what happens to the body during sleep and are used if people have a sleep problem. A sleep study is done to diagnose sleep disorders.

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)
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.
     In most cases, sleep disorders can be easily managed once they are properly diagnosed. Insomnia is the most common sleep disorder. It occurs more often in women and in the elderly. If you have a serious sleep disorder, make an appointment with a sleep expert doctor, sleep disorder center, or a sleep clinic. 

Sleep medication or sleep 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.

Sleep Medication and the Elderly - risks outweigh benefits
While sedative hypnotics may improve sleep in older people with insomnia, the risks of such therapy may outweigh the benefits. The findings are based on a meta-analysis of 24 randomized, controlled trials that included 2417 subjects aged 60 or older who were treated with sedative hypnotics or placebo for insomnia. The subjects received the assigned agent for at least five consecutive nights. Compared with placebo, sedative use was associated with statistical significant improvements in sleep quality, total sleep time, and the number of nighttime awakenings. However, the effect size was small. Several adverse effects were more common with sedative hypnotics than with placebo. Sedative use was associated with  a several fold increased risks of adverse cognitive events, adverse psychomotor events, and daytime fatigue. The likelihood of an untoward event was even greater in subjects who were at high risk for falls or cognitive impairment.

Types of Sleep Medication
There are several sleep medication options available, and I believe they are effective and safe when used infrequently.
Ambien
Lunesta has been approved for long term use, but I am always cautious about taking drugs for long periods of time.

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 - Sleep for Major Decisions
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. According to the results of a novel study published today in the journal Science, 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 a sleep disorder known as 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 and bed wetting: see bedwetting

Sleep Emails
Q. The purpose of this email is to ask a question about Valerian and Hops for sleep. 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.
     A. 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.

Q. Does Benadryl help a baby sleep?
     A. Studies have found that the antihistamine Benadryl is not effective in helping babies sleep.

Q. 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?
     A. 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.

Q. 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.
     A. 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.

Q. 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 sleep 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 it takes hours to fall asleep, i read an article about melatonin and i said to myself it's worth the try. My question is shall i stop the Ativan while i am taking the melatonin, I decided to take a low dose 2 times a week.
   A. 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 on sleep when a drug is stopped. The rebound effect means that it is difficult to sleep since the brain is used to getting the sleep 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.

Q. One thing I noticed about your Sleep info page is that, when you discuss Causes of disturbed Sleep there is no mention of peri-menopause and the hormone changes as a possible cause. I am no doctor, but I have studied natural healing for 20 years. I am 6 years into the 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.
   A. We have added perimenopause as a cause of sleep disturbance. Thank you.

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