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Sleeping without taking Drugs

Sleep is something many people take for granted until their sleeping patterns are disrupted. Most adults sleep for an average of seven hours but the amount of sleep a person needs depends on their individual characteristics and lifestyle. The quality of a person’s sleep is also important—five hours of good quality “deep sleep” may be better than nine hours of poor quality, interrupted sleep.

Disrupted sleep patterns and poor quality sleep can occur because a person:

- has difficulty falling asleep
- wakes frequently during the night
- wakes very early in the morning and cannot fall back to sleep
- is not having enough good quality, restorative, deep sleep.

A good night’s sleep is vital for maintaining good health. A lack of sleep or poor quality sleep can lead to:

- tiredness and lack of energy
- poor concentration
- feeling irritable and moody
- health problems, such as problems with the immune system, which can make a person more susceptible to illness.

Therefore, it is important to develop good sleeping patterns and habits, sometimes referred to as “sleep hygiene”, to have the best chance of getting enough good quality sleep.

There are many different reasons why people may experience sleeping difficulties. It could be due to:

- anxiety, stress or worry
- environmental factors such as noise, an uncomfortable bed or an unfamiliar situation
- circadian rhythms and things like shift work or jet-lag
- bad sleep habits.

Most people’s sleeping patterns return to normal when the problem has been resolved, but in some cases sleep difficulties can last for a longer period of time. People who experience long-term sleep difficulties should seek help from a health professional who can assess whether the person has a sleeping disorder. There are many different types of sleeping disorders, with insomnia being the most common.

There are a number of different methods to help people improve their sleep quality. Most of these techniques are quite simple and aim to change the way a person thinks and behaves. There are also pharmacological treatment (medication) options that may be suitable for some people.

This fact sheet outlines some of the many strategies and techniques that can be used to help people improve their sleep without medication.
Why medication may not be the solution

For most people, the initial treatment for sleep problems is trying to change thought and behaviour patterns rather than using medication.

If medication is required, it should be seen as a short-term option, not a solution. Medication may help with the sleeping problem while it is being taken, but it does not deal with the underlying cause of the sleep disturbance. When a person stops taking medication the sleeping problems may return.

Many of the medications can have serious side effects and other consequences, for example, benzodiazepines can affect a person’s coordination and concentration if the dose is too high. People can also become dependent on (addicted to) benzodiazepines and experience withdrawal symptoms if they suddenly reduce the dose. Other medications can disrupt natural sleeping rhythms so the sleep people do get may not be of a good quality.

Health professionals may prescribe a short course of medication to help a person deal with the sleep disturbance while they use other techniques, such as psychological and behavioural therapies, to help them learn more effective sleep strategies.

If you have any concerns or questions about your medication discuss them with a health professional.

Do not stop taking your medication unless under the supervision of a health professional.
Medication free techniques

The most effective method to help a person improve their sleep depends on their individual situation and may involve a combination of techniques. Having a number of strategies will allow them to choose the most effective strategy, or strategies, to suit their individual needs and situation.

Some of the strategies outlined in this fact sheet are quite simple while others are complex and require the support of a health professional. Health professionals can provide techniques such as cognitive behavioural therapy (CBT), which aims to change the way a person thinks and behaves. It teaches people to identify, challenge and change negative thought and behavioural patterns that may be contributing to sleep disturbances and introduce healthy sleep behaviours. It may include a combination of some of the strategies listed below.

Learning good “sleep hygiene”

This can include learning more about sleep and how health and environmental factors can affect sleep quality.

Research and learn more about sleep; what affects sleep quality and how much an individual needs.

Do some physical activity. It can help you feel more tired at night. Try exercising early morning or late afternoon, but avoid doing any vigorous activity late in the evening.

Spend time outdoors in natural light to help synchronise your body clock. This can be especially helpful in the morning.

Limit caffeine. Try not to drink more than two caffeinated drinks, such as coffee, tea, cola, and energy drinks, each day. Also, try not to drink caffeinated drinks after mid-afternoon.

Do not smoke in the hour or two before going to bed, because tobacco is a stimulant drug.

Do not use alcohol to try to sleep because alcohol affects sleep quality. Alcohol intoxication can cause a person to wake from sleep and become more alert as their blood alcohol level decreases during the night.

Make the bedroom a quiet relaxing space that is a comfortable temperature and free of things such as televisions, clocks and watches. Make sure the bed is comfortable and avoid too many blankets—being too hot can make it harder to fall asleep. Do not share your bed with children or pets.

Set aside time during the day to solve problems so they don’t keep you awake at night. Using techniques such as structured problem solving can help by breaking the problem down into different parts. The technique involves writing down the problem, possible solutions, consequences of the solutions, the best option, and still on paper, planning, implementing and reviewing the outcome.

Cognitive therapy

Cognitive therapy includes psychological techniques that aim to question and change people’s misunderstandings about sleep and sleep problems and replace them with more realistic and positive expectations.

This can help people to not:

- go to bed expecting a bad night’s sleep
- excessively monitor or worry about sleep
- get frustrated and annoyed by sleep difficulties
- exaggerate sleep needs and the consequences of not getting enough sleep.

Negative thoughts about sleep can make it more difficult to fall asleep or go back to sleep, which in turn reinforces the negative thoughts.

Relaxation training

Relaxation training can help reduce tension and stress that may be interfering with a person’s ability to fall asleep.

Practice relaxation breathing to slow your breathing. Breathe in deeply for several counts and then slowly out for several counts. Breathe from the diaphragm and allow your belly to expand as you breathe in. Also, try imagining the stress and tension leaving the body with each exhalation.

Use muscle relaxation techniques to relax the body. Lie in a comfortable position and starting with the toes and working upwards, begin relaxing individual parts of your body. Imagine each body part becoming heavy and sinking down.

Meditate or use visualisation to calm the mind. With your eyes closed, visualise yourself in a peaceful place. Take note of details such as the breeze, the warmth of the sun, the feel of the sand, smell of the garden.

Stimulus control therapy

Stimulus control therapy works to establish a consistent sleep-wake pattern and to associate bed with sleep.

Get up at the same time every morning even if you are still tired, to help establish a routine. Get out of bed when you wake—do not go back to sleep.

Don’t nap; it makes it harder to sleep at night because you will feel less tired.

Go to bed at the same time each night to establish a routine. Listen to your body’s natural clock and do not go to bed too early or too late because this will affect sleep quality.

Develop a bedtime ritual to help remind you it is time to sleep. At least 30 minutes before going to bed try to wind down by relaxing, reading, listening to music, or having a warm bath.

Only use the bed for sleep and sex so you begin to associate the bed with sleep. Do not read or watch television in bed.

Get out of bed if you cannot fall asleep. If you are unable to fall asleep after about 15–20 minutes of being in bed, get up and go to another room. Keep the lights dim and do something boring and non-stimulating until you feel sleepy. Only go back to bed when you feel tired and sleepy.

Sleep restriction therapy

Sleep restriction involves gradually limiting the time spent in bed so it matches the time spent sleeping. This decreases the amount of time a person spends lying awake in bed. This technique is based on the theory that sometimes people increase the amount of time they spend in bed to try to get more sleep, but in reality their sleep becomes broken and of poor quality.

After keeping a sleep diary to monitor sleeping patterns, the person’s bedtime is pushed back until the time they spend in bed matches the time spent sleeping. Then, the time spent in bed is gradually increased until the person reaches their optimum sleep pattern.

This process takes at least a month and time spent in
bed should not be less than five hours. Sleep restriction therapy should be done under the supervision of a
health professional.

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