Welcome to the another installment of our Ask An Expert series on the Tuck Sleep Blog. If you have a question you’d like us to answer, please email us at [email protected] and we’ll put it in our queue.
As one psychiatrist has said: “All sleep medications have to straddle a very fine line between ‘idiotically dangerous’ and ‘laughably ineffective.’” He’s not kidding. Sleeping pills can place you at risk of oversedation, falls, slowed breathing, confusion, and physiological dependence. The benefits may outweigh the risks, but the decision to take a sleep aid is rarely straightforward.
Now don’t get me wrong, I prescribe medications all the time for all sorts of conditions. And sometimes, a sedative medication is the best treatment for a patient. But for most people with insomnia, the ideal treatment doesn’t involve any medications at all.
So if you’re looking for a medication-free approach to garden-variety insomnia, I completely support your decision.
The best natural treatment
The very best natural treatment for insomnia is a behavioral therapy called cognitive behavioral therapy for insomnia, or CBT-I.
Don’t run away when I say that this is a therapy. CBT-I is usually delivered by a “talk therapist,” but I think of it more like physical therapy than psychoanalysis. In CBT-I, the therapist doesn’t explore your childhood or try to change your relationship with your father. Instead, they provide you with a series of tasks designed to break your body’s tendency to stay awake when you lie in bed.
And no, CBT-I is not just sleep hygiene. It is a rigorous program that will rework all aspects of your sleep. CBT-I works through three main techniques: sleep restriction, stimulus control, and relaxation training. Sleep restriction is the scary-sounding name for an algorithm that will rapidly maximize your sleep efficiency. Stimulus control trains your mind to fall asleep shortly after you get into bed. And relaxation training will help you calm your body when it just wants to sleep. CBT-I builds on these principles with many other valuable skills, and a good CBT-I therapist will help you personalize your bedtime routine until you’re experiencing many more nights of blissful sleep.
Many people find CBT-I daunting, but it’s totally worth doing! The science is clear: CBT-I is safer, longer-lasting, and at least as effective as any pill. For this reason, CBT-I–not medication–is recommended as the first line treatment for chronic insomnia by the American Academy of Sleep Medicine, the American College of Physicians, and the European Sleep Research Council.
Of course, CBT-I doesn’t work for everyone. But it is still the best therapy–natural or otherwise–for most people with insomnia.
If you really want a supplement
Now when you started this article, you may have thought that I would be recommending a specific natural supplement.
Unfortunately, there is little scientific data comparing natural supplements for insomnia to each other. In fact, there is very little data comparing most of these supplements to placebo. That doesn’t necessarily mean they don’t work; it simply means that more research needs to be done. In other words, trial and error is the only way to know if one of these supplements will work for you.
If you want the natural pill with the most scientific support, look no further than melatonin. The data suggest only a modest benefit, but it’s most likely to be effective if you take the right dose, at the right time, and in the right way.
Supplements containing valerian root, magnesium, homeopathic preparations, cannabidiol (CBD), and essential oils have far less data. However, some of my patients swear by them, and I’m grateful they’ve found something that works for them.
If you choose to try a supplement, I strongly recommend that you use it just like any other sleep medication: talk with your doctor about drug-drug interactions, use the supplement only when absolutely necessary, and take the smallest dose possible to help you sleep. Natural supplements for insomnia are often safer than prescription medications, but that doesn’t make them completely risk-free.
Before you start a supplement, make sure you give CBT-I a good faith effort. If that doesn’t work, adding a natural supplement may be appropriate. Science can’t yet tell us which supplements work best, so talk with your doctor to make sure that the supplements you want to try are safe for you.
Jeff Clark, MD is the founder of SlumberCamp.co, and a resident psychiatrist in Seattle, Washington. This column is for educational/entertainment purposes only and should not be taken as personal medical advice. Have a question you’d like answered on the blog? Let us know at [email protected].