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November 28, 2014
by David Porter, MA

Getting a Good Night's Sleep without Using Sleep Medication

November 28, 2014 02:55 by David Porter, MA

Sleep is a basic requirement for survival, as essential as air, food, and water. It is a period of time where the activity of our body and brain are on standby, so both can not only reduce the amount of energy used, but recharge vital functions. It is something we must all do about every 16 hours.

The Four Stages of Sleep

Sleep is divided into four stages, which we move through each night. Stage One is very light sleep, in which we are very easy to awaken, we will have no recall of having been asleep if awakened, and we may experience hypnogogic hallucinations, or myoclonic jerks. Hypnogogic hallucinations are hallucinations that occur can occur as we fall asleep- they can be visual, auditory, tactile or olfactory. We may see hear, feel, or smell things which are not there. A myoclonic jerk is the full body muscle spasm which jolts you out of sleep, and makes you feel like you have fallen out of bed. Stage Two sleep is deeper, and we are more difficult to awaken. Stage Three is the deepest sleep. It is more difficult to rouse a person out of Stage three sleep, and we tend to be and we tend to be irritated if awoke. During Stage Three sleep, blood pressure and heart rate are down, giving our cardiovascular system a rest. Body temperature is down, as we are moving less, so there are fewer muscle contractions to generate body heat. Gh (Growth hormone) is released by our pituitary gland, repairing any damaged tissues, promoting muscle growth from weight training or physical labor, and allowing children and adolescents to experience normal growth and development. Our immune system is restored as our bone marrow produces Killer B-cells, our thymus gland makes Killer T-cells, two different types of white blood cells that are critical components of our immune system, and neurotransmitters are replenished. Stage Three sleep is also called Deep Sleep, or restorative sleep (American Academy of Sleep Medicine, 2010).

Next is REM (Rapid Eye Movements) Sleep. This is dream sleep. We experience partial voluntary muscle paralysis- or we would leap out of bed and act out our dreams. Our heart rate, blood pressure, and respiration increase, and we may sweat. This stage of sleep is also called paradoxical sleep, because this is the deepest stage of sleep, yet our brain and body are very active (American Academy of Sleep Medicine, 2010). We go up and down through the four stages throughout the night, and by morning, we awake, refreshed and restored, ready for the day.

Insomnia is lack of sufficient sleep. Sufficient sleep is going to be defined differently for everyone. Some people need 10 hours of sleep, and others require half as much. This is partly dependent on how efficiently one sleeps. Some people are asleep within five minutes or less of resting their head on the pillow. They shoot through Stage One and Two sleep quickly, right into Stage Three, deep, restorative sleep, dream, rebound back into Stage One very briefly, and then right into Stage Three again. They do not need to be in bed very long, because they get the restoration they need in less time. Other people are restless and don't sleep well. It takes them 30 minutes or more to fall asleep, they spend a lot of time in Stage One, waking, then going back to Stage One, and eventually drift into Stage Two and Three, briefly stay in Stage Three, go into REM for a quick dream, and bounce right back up to Stage One again- they need eight or more hours to get the restoration they need.

Insomnia can be further defined as: Late Onset of sleep, in which it takes too long to fall asleep, Early Awakening, in which you awaken at 3:00 or 4:00 AM and can't fall back to sleep, or Poor Maintenance of sleep, in which you wake up frequently during the night. A more useful definition of insomnia is you are not restored the next day. You wake up feeling worse than when you went to bed, you take an hour or three to feel fully awake, then are tired again by mid-afternoon, and could easily fall asleep if you sat still. Being sleep deprived means you will not be functioning to your fullest potential.

Sleep deprivation can cause:

  • Daytime fatigue

  • Lowered alertness

  • Difficulty concentrating

  • Irritability

  • Loss of inhibition

  • Tunnel vision

  • Euphoria

  • False confidence

  • Impaired judgment

  • Lack of coordination and balance.

  • Slowed reflexes

  • Overall Increased likelihood of mistakes

  • Auditory and visual hallucinations ( if sleep deprived for about 72 hours or more).

All of these factors can be very dangerous if you are working in an environment where you have little or no room for error. A common thread with some of the worst industrial accidents in history has been sleep-deprived key personnel:

  • 1979 TMI (Three Mile Island) nuclear plant, Harrisburg, PA, USA.

  • 1984 Bhopal, Madhya Pradesh, India, Union Carbide plant pesticide leak. 3800 fatalities.

  • 1986 Chernobyl Nuclear power plant, 76 fatalities.

  • 1986 Space Shuttle Challenger explosion- seven fatalities.

  • 1989 Exxon Valdez spilling more than 11 million gallons of crude oil. The spill was the largest in U.S. history (WebMD, 2014).

Many circumstances can affect our sleep, such as shift work where you are working against your body's natural rhythms and expectations: Light = awake, Dark = sleep. Anxiety and depression, short term stress, and preoccupation with major life changes can prevent restorative sleep. Sometimes physical discomfort from an injury can wake you up every time you move in your sleep. Sometimes bad habits have been developed that are incompatible with sleep. Insomnia is better thought of as a symptom rather than a disorder. Insomnia is a sign that there is something else wrong. An occasional missed night's sleep is of less concern than a pattern of insomnia. At this point many people will turn to medication to help them sleep.

Concerns about sleep meds 

OTC (Over The Counter) sleeping medications are typically antihistamines. For many people, antihistamines produce drowsiness. This side effect is focused on and they are marketed sleep medications (Mayo Clinic, 2014). Prescription sleep medications are in three different categories: 1) benzodiazepines, 2) atypical GABA (Gamma Amino Butyric Acid) agonists, and 3) RAS (Reticular Activating System) modulators. Benzodiazepines produce relaxation and drowsiness. They are highly physiologically addictive, and should only be used short term, and are contraindicated in persons with a history of chemical dependency. Atypical GABA agonists work on the same part of the brain as benzodiazepines, but have less addictive potential. There is only one RAS modulator on the market- Rozerem ( Ramelteon). It is unique in that it works directly on the Brain's sleep/wake system, which is called the RAS (Rx List, 2014)

Before trying medication to help you sleep, your physician may inquire about your sleep practices, which are referred to as sleep hygiene- how clean, or efficient, is your sleeping routine? Attention to your sleep hygiene should be the first step in management of insomnia.

Sleep hygiene is a series of procedure to help you sleep.

  • Maintain a regular time to go to bed and to wake up. Our bodies run on a 24 hour cycle, largely in response to availability of light. We sleep best when we work in coordination with this cycle. Going to bed and rising within 30 minutes of the same time every night and morning can give you a reset, and enable regular, restorative sleep.

  • Avoid alcohol before going to bed. Alcohol is sedating, and a nightcap- a small amount- can help you relax and induce sleep. However, alcohol is very short acting. When it wears off in an hour to 90 minutes, your nervous system will rebound, or compensate, and you may wake up again, and find it difficult to fall back to sleep. Alcohol is also a REM sleep suppressant. Once it wears off, you may tumble into REM sleep harder than usual, and have nightmares, or bad dreams, as your brain compensates for delayed REM sleep. Another consideration is that alcohol is addictive. You may need more and more to fall asleep if you use it regularly, and this can become a very costly ( in every sense of the word) habit.

  • Avoid caffeine before bed. Caffeine is a mild stimulant drug, which lasts for about three to six hours. There are plenty of people who can drink coffee before bed and sleep fine. This is typically due to high tolerance. Other people are very sensitive to the effects of caffeine, and their sleep at midnight may be delayed by the espresso they had at 6:00 PM.

  • Avoid a heavy meal before you go to sleep, but try a light snack. It takes energy to digest food. A lot of blood has to be shunted to your digestive system, stomach acid production increases, and intestinal churning increases. This can disrupt your sleep. A few bites of something easily digested- e.g., two slices of toast with jam- can help you feel satisfied and is a soothing bedtime ritual that can help prepare you for sleep.

  • Try to resolve conflicts or put them aside before you go to sleep. This is much easier said than done, but whatever problems you have will only get worse if you are sleep deprived and your ability to cope is further impaired.

  • No eating, drinking, reading, or tapping on an electronic device in bed- these are behaviors incompatible with sleep. Your bed should only be used for two things: sleeping and sex.

  • Make sure your sleeping environment is comfortable, however you define comfort: A pillow and mattress that is firm or soft enough for your individual preference, enough blankets or quilts, comfortable pajamas, sweats, or nightwear.

  • Your sleep environment is best kept dark and quiet, so shut out all the light and noise you can. Other people need a nightlight, or a white noise machine, or need to fall asleep listening to music. It is a matter of preference. Of course, the comfort of your sleep environment may be compromised if you have a sleeping partner.

  • If you still can't sleep after about 20 or 30 minutes, don't lie in bed tossing and turning, get up and do some quiet activity such as reading or watching TV, then go back to bed and try to sleep. Repeat as often as necessary. You do not want to associate your bed with not sleeping (National Sleep Foundation, 2014).

If sleep hygiene does not provide relief, the next step will be either addressing the underlying issues, or use of sleep medication. A sleep study may also be indicated. Your physician can make a referral to a Sleep Laboratory, where you spend the night monitored by Polysomnographers, or sleep technicians. They will be able to determine how long it takes you to reach each stage of sleep, how long you are in each stage, and if you have a sleep disorder, such as Sleep Apnea, which is disturbing your sleep. 


American Academy of Sleep Medicine. (2010). The Science of Sleep. American Academy of Sleep Medicine. Retrieved August 16, 2014, from: 

Mayo Clinic. (2014). Sleep Aids- understanding Over the Counter Options. Mayo Clinic. Retrieved August 14, 2014, from:

National Sleep Foundation. (2014). Sleep Hygiene. National Sleep Foundation. Retrieved August 16, 2014, from: 

Rx List. (2014) . Rozerem. Rx List. Retrieved August 14, 2014, from:

WebMD. (2014). 10 Things to hate about sleep loss. WebMD. Retrieved August 14, 2014, from:


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