Do you struggle to sleep? If so, you’re far from alone. According to the latest NHS data, a record one million Britons are now prescribed insomnia medication each year.
And this is despite studies that have linked some types of the pills to increased dementia rates, addiction and withdrawal symptoms, as well as a host of other side effects when taken long-term.
Stress, the lasting reverberations of the chaos that lockdown caused and the rise of other conditions that make sleeplessness more likely – such as chronic pain, type 1 diabetes, asthma and digestive issues – are all to blame for the burgeoning problem.
And even children seem to be caught up in this silent epidemic.
An investigation last year revealed almost 60,000 under-17s were being prescribed the sleeping pill melatonin, up from 20,000 in 2015.
According to the latest NHS data, a record one million Britons are now prescribed insomnia medication each year
Stress, the lasting reverberations of the chaos that lockdown caused and the rise of other conditions that make sleeplessness are all to blame for the burgeoning problem
Doctors are warned not to offer the drug to youngsters for more than a few weeks, and experts are concerned the pills are being handed out too freely.
In some children and adults, however, the benefits of sleeping pills do outweigh the considerable risks, as insomnia is well-known to wreck lives and health.
And it means that GPs and desperate patients are often stuck between a rock and a hard place.
Meanwhile, supplement firms have found a fertile market – chemist shelves heave with remedies that they claim will help provide much-needed shut-eye. Do any of them really work? Read on to find out…
BACTERIA WHICH CAN CALM YOUR WORRIES
A 2020 meta-analysis of clinical trials concluded that probiotics could significantly improve symptoms in patients suffering from depression and stress
Holland & Barrett Gut Powered Night
£12.99 for 30 capsules, hollandandbarrett.com
WHAT’S IN IT?
Probiotic bacteria – including Lactobacillus acidophilus, Bifidobacterium lactis and Bifidobacterium bifidum – along with Vitamin D, magnesium and 5-hydroxytryptophan (5-HTP).
DOES IT WORK?
Endless claims are made about the benefits of the ‘friendly bacteria’ in probiotic supplements, but many of them are unfounded.
Yes, there is good evidence they ease symptoms of irritable bowel syndrome and can help the gut recover after a bout of food poisoning or antibiotics, but could they really help aid sleep? Perhaps – if it’s worry that’s keeping you awake.
A 2020 meta-analysis of clinical trials, published in the journal Frontiers In Neurology, concluded that probiotics could significantly improve symptoms in patients suffering from depression and stress.
Another review, published the same year in BMJ Nutrition, Prevention & Health, concluded that probiotic supplements may be linked to reductions in depression and anxiety – although the authors pointed out that the studies looked at were small and didn’t last long.
Aside from the name of the product, Holland & Barrett make no specific claim about probiotics and sleep. However, dietician Dr Frankie Phillips says: ‘Research shows that our gut bacteria send signals to our brain and this affects the regulation of hormones involved with mood. Theoretically, changing the combination of gut flora could improve mental wellbeing and aid sleep.’
A 2022 review concluded there is ‘some evidence’ that specifically Lactobacillus and Bifidobacterium can help insomnia. Some research suggests Vitamin D supplements might help with depression but only in very high doses, which aren’t provided here. Studies show magnesium may help improve improve sleep in a different way, according to studies – more on this later
SHAKY PROOF FOR AMINO ACID CAPSULES
Glycine is an amino acid, which are molecules the body uses for growth and repair and to create hormones and brain chemicals called neurotransmitters
Life Extension Glycine
£13.62 for 100 capsules, lifeextensioneurope.co.uk
WHAT’S IN IT?
Amino acid glycine (1,000mg).
DOES IT WORK?
Ever heard of glycine? We hadn’t either – but for the past few decades, researchers have been looking at whether taking it as a supplement might improve sleep quality. According to Carmine Pariante, professor of biological psychiatry at King’s College London, trial results are best described as ‘preliminary’.
Glycine is an amino acid, which are molecules the body uses for growth and repair and to create hormones and brain chemicals called neurotransmitters.
Some amino acids have to be consumed via the diet, but the body makes its own glycine by breaking down other nutrients. It does various things, such as helping to process sensory information in the brain, permitting movement and pain perception.
So, what about supplements? In one recent trial, seven participants either drank 3g of glycine before bed, or a placebo that contained none. Those who drank the glycine reported feeling more alert and less fatigued than the other group – even when restricted to less sleep than normal.
But Prof Pariante says the small size of this study and others like it meant ‘no firm conclusions’ could be drawn, adding: ‘We know glycine is active in the brain, interacting with receptors which are involved in memory, emotion and cognition.
‘Promising new drugs for depression also target these receptors. In theory, glycine could affect depression [which is known to cause insomnia] but trials have been disappointing, so we can’t if say it has any effect on sleep.’
ANTI-STRESS FORMULA THAT AIUDS RELAXATION
A 2019 study published in journal Nutrients found that participants taking 200mg of theanine before bed fell asleep faster and woke up less frequently through the night
Vitl Sweet Sleep
£9.99 for 30 capsules, hollandandbarrett.com
WHAT’S IN IT?
Key ingredients are L-theanine, Montmorency cherry extract, lemon balm extract and zinc.
DOES IT WORK?
Theanine is an amino acid found naturally in tea. The average cup provides about 25mg, and in this supplement there’s 100mg.
A 2019 study published in journal Nutrients found that participants taking 200mg of theanine before bed fell asleep faster and woke up less frequently through the night than a placebo group. Other research also suggests it has an effect on stress and depression.
Theanine is thought to work by affecting the brain’s response to stress and helping calm the heart rate, according to some studies.
Tests that measure electrical activity in the brain have shown that taking theanine brings a state of relaxation, rather than causing drowsiness like sleeping pills.
But Prof Pariante cautions: ‘There is some evidence of an anti-stress effect – and if it’s stress and worry causing sleeplessness, this could theoretically help. But the quality of these studies is not anything like you’d find with a medication.
‘Theanine has been tested only on healthy subjects or those with mild mental health problems – not those with severe insomnia.’
Montmorency cherry extract also features in many other sleep supplements. ‘Montmorency cherries are sour cherries that contain small amounts of melatonin [a chemical produced in the brain that readies the body for sleep] but the amount here is unlikely to have any impact,’ says sleep expert Dr Neil Stanley.
NO EVIDENCE FOR FAVOURITE REMEDY
Valerian herbal tea might be worth a go, however, says Neil Stanley – but not because of any sedative effect
Kalms Night One-A-Night Valerian Root Extract
£5.25 for 2 capsules, boots.com
WHAT IS IT?
A dry extract from the roots of the Valarian plant – a herb with white flowers, native to Europe and parts of Asia.
DOES IT WORK?
Valarian is many a natural-health-devotees go-to sleep aid – so there’s actually been a lot of scientific research into it. One of the best designed studies, dating back to 1996, found 600 mg valerian root extract before bed wasn’t effective in the first two weeks but did do much better than placebo after 28 days, which suggests you need to take the supplement daily, for a few weeks before it begins to work.
One theory is that the active ingredient, valerianic acid, may cause sedation by mimicking the activity of the neurotransmitter gamma-aminobutyric acid (GABA) in the brain.
GABA is responsible for dampening nerve transmissions and bringing about feelings of calm and sleepiness.
However, other research has produced conflicting results and numerous reviews – which look at several studies in order to draw an overall picture – concluded that valerian did not aid sleep or benefit other mental health concerns such as depression or stress.
Valerian herbal tea might be worth a go, however, says Neil Stanley – but not because of any sedative effect:
‘The amount of Valarian in tea will be tiny. But you might still benefit from the ritual of a warm calming drink at bedtime, which happens regardless of the drink.’
MAKING SURE YOU GET ENOUGH MAGNESIUM
Magnesium is a mineral that’s integral in myriad bodily functions – found in grains, dark green leafy vegetables, beans and pulses
Better You Magnesium Sleep Spray
£13.95 for 100ml, hollandandbarrett.com
WHAT’S IN IT?
The mineral magnesium, in an oil form, which is absorbed when applied to the skin.
DOES IT WORK?
Once again, whether this works might depend on what’s stopping you sleeping. Magnesium is a mineral that’s integral in myriad bodily functions – found in grains, dark green leafy vegetables, beans and pulses.
We need about 300mg a day, but research suggests up to two-thirds of us don’t hit this target. Deficiency – having low enough levels of magnesium to cause symptoms – is uncommon but is seen in people with conditions that stop them absorbing nutrients, such as diabetes and coeliac disease.
Checking magnesium levels is tricky as much of it is stored in the bones, so blood tests aren’t always useful. But even mild deficiency is known to cause anxiety and irritability, as well as muscle pain, cramps and twitching. This is because magnesium is essential for regulating signals sent between the body’s nerves and the brain.
Dietician Dr Duane Mellor says: ‘This is why it can work well for restless leg syndrome, where the legs won’t stop twitching.’
A 2018 Australian study of 1,400 adults found that those with the least magnesium in their diet were most likely to struggle to drift off.
So, if you’re vulnerable to deficiency and your sleepless nights are related to muscle cramps or feeling physically restless – magnesium may help, says Dr Mellor.
ALLERGY PILL WORKS FOR JUST A FEW DAYS
Research suggests patients quickly build up tolerance, which the sedating effect ending after just four days
£7.30 for 20 tablets, boots.com
WHAT’S IN IT?
The active ingredient is an antihistamine called diphenhydramine.
DOES IT WORK?
Drowsiness is a side effect of diphenhydramine – also given to reduce allergic reactions, such as hay fever, hives and to reduce discomfort from insect bites and stings.
But studies that have looked at this and other antihistamines as an insomnia treatment have produced inconsistent results.
In one of the largest, volunteers taking a 50mg dose of diphenhydramine before bed – the same amount in Nytol One-A-Night tablets – reported significant improvements in their sleep difficulties. However, when scientists measured how long it took participants to fall asleep, and total sleep time, no differences were seen.
Research also suggests patients quickly build up tolerance, which the sedating effect ending after just four days.
A large review, published in 2015, concluded that diphenhydramine caused a ‘hangover’: sleepiness and grogginess the next day. This effect can be particularly acute in adults over the age of 65, and there is a danger that it can trigger dizziness and falls.
‘Also, patients who suffer restless leg syndrome [in which the legs twitch and spasm uncontrollably at night] report that these medicines make their symptoms worse, and this keeps them awake,’ says Professor Guy Leschziner, a consultant neurologist and sleep disorders specialist at Guy’s and St Thomas’ Hospitals, London.
100-YEAR-OLD CURE IS JUST A PLACEBO
The remedy, which has been around for about 100 years, has dedicated followers who believe it works
Bach Rescue Peaceful Night Capsules
£14.99 for 30 capsules, hollandandbarrett.com
WHAT’S IN IT?
Flower essences, ashwagandha, lemon balm extract, chamomile and magnesium.
DOES IT WORK?
This product promises a ‘peaceful night’ and that you’ll ‘wake refreshed’, but there’s no evidence that Bach remedies work as a sleep aid.
Studies on Bach’s best-known Rescue treatment have shown it is no more (or less) effective than a placebo treatment in tackling anxiety and stress.
Despite this, the remedy, which has been around for about 100 years, has dedicated followers who believe it works – and this may be enough to mean that these capsules help.
‘Given that insomnia has strong psychological contributors, it is likely that the placebo response has an important role when it comes to some of the sleep supplements,’ says Prof Leschziner.
INDIAN ROOT THAT DOES EASE ANXIETY
A review in The World Journal of Biological Psychiatry concluded that neither had a therapeutic effect on mental health, and there’s little evidence they aid sleep
Sleep Alpha Deep Sleep
£42.99 for 60 capsules, sleepalpha.co.uk
WHAT’S IN IT?
A cocktail of ingredients, including 5-HTP, valerian root, lemon balm, zinc, L-tryptophan, magnesium and ashwagandha.
DOES IT WORK?
Early studies into 5-HTP – a compound made by the body which then gets converted to the mood-boosting chemical serotonin – suggested it might be a useful natural depression remedy. L-tryptophan, an amino acid found in foods such as fish and eggs, is also needed to make 5-HTP.
But last year a review in The World Journal of Biological Psychiatry concluded that neither had a therapeutic effect on mental health, and there’s little evidence they aid sleep. There is also scant proof behind the other ingredients – bar ashwagandha.
The review said the root extract, used in traditional Indian medicine, showed promise in treating anxiety and may improve symptoms of fatigue and insomnia.
A 2021 review suggested 600mg for at least eight weeks before sleep benefits were seen. Each of these capsules has 200mg.
Don’t abuse Night Nurse, experts warn
The medicine contains concerning ingredients, including dextromethorphan, a cough suppressant which experts say has similar properties to opium
To help with sleep problems, many have turned to cold and flu medicines such as the over-the-counter Night Nurse.
Pharmacists are warned that the syrup is addictive and to look out for people who buy it too often.
The medicine contains concerning ingredients, including dextromethorphan, a cough suppressant which experts say has similar properties to opium.
Professor Penny Ward, a pharmaceutical expert at King’s College London, says: ‘It activates some of the same receptors in the brain as opium and, when taken often enough, can result in physical dependence and withdrawal symptoms.’
It also contains a large amount of paracetamol.
One dose of Night Nurse contains 1,000mg of the painkiller. The maximum daily dose is 4,000mg, which means that anyone taking any other medication containing paracetamol needs to be very cautious they do not overdose by accident.
However, it’s the sedating ingredient, antihistamine promethazine, that leads to overuse of Night Nurse.
‘If someone is sleep-deprived and they find something they think is working, the chances are they’ll continue to use it,’ says Nuno Albuquerque, head of treatment for the UK Addiction Treatment Group.
‘This creates dependence as they believe they can’t sleep without it.’
And what about those ‘risky’ prescription pills?
NHS watchdog the National Institute for Health and Care Excellence (NICE) recommends three medications to treat insomnia: zopiclone and zolpidem – collectively known as Z-drugs – and melatonin.
Z-drugs work by increasing the activity of the brain chemical gamma-aminobutyric acid, which induces feelings of relaxation and sleepiness.
They were first marketed in the early 1990s as a safer option than addictive benzodiazepine tranquillisers such as temazepam.
In the short term, Z-drugs cause few problems and can be a lifeline to those battling a debilitating bout of insomnia.
However, it is now well recognised that they carry similar risks to the older drugs, such as dependence and withdrawal, as well as the return of sleep problems. They can also trigger side effects, including daytime drowsiness, which can lead to traffic accidents, falls and fractures. They can also cause sleepwalking.
The National Institute for Health and Care Excellence (NICE) recommends three medications to treat insomnia: zopiclone and zolpidem – collectively known as Z-drugs – and melatonin
NICE say patients should be on the lowest dose for the shortest time possible
There’s even some evidence that, if taken long-term, they could increase the risk of dementia.
Therefore, NICE say patients should be on the lowest dose for the shortest time possible.
Professor Guy Leschziner, a London-based neurologist, says: ‘Z-drugs should be used for a maximum of two weeks – when people can’t sleep due to extreme stress, for example.’
But NHS data suggests up to 300,000 adults have been taking the tablets for a year or more.
Melatonin – a synthetic version of the hormone naturally produced by the body to trigger sleep – is similarly tricky.
NICE say the drug can be prescribed for up to 13 weeks in patients aged 55 or over (there isn’t good evidence they work in younger patients).
However, Prof Leschziner says: ‘Melatonin doesn’t work for everyone, and its effects can wear off. Patients don’t become dependent on it but there are questions as to whether taking it might then suppress your own normal production.
‘If you have issues with your sleep, using effective non-drug-based therapies is the way to go.’
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