An investigation conducted by the University of Arizona spanning 40 years found a close relationship between persistent insomnia and increased mortality rates. The study showed that people with intermittent insomnia faced a 54 percent greater risk of death during the follow-up period compared to those without insomnia. In contrast, those suffering from chronic insomnia, lasting more than six years, were observed to be 98 percent more likely to die within the same timeframe.

Insomnia is not only related to poor sleep but also profoundly affects health and life expectancy.

How to get a good night’s sleep? In NTDTV’s “She Health” program, Liu Zongxian, director of the Department of Community Psychiatry at Taipei United Hospital, shared the underlying causes of insomnia, and the risks of sleeping pills, and recommended seven ways to improve insomnia effectively.

Insomnia: Tip of the Health Iceberg

Insomnia is not just a problem of being unable to fall asleep or waking up multiple times during the night. It can be a symptom of a variety of health issues.

Liu pointed out that insomnia is the tip of the iceberg of physical health problems. It may originate from physical illness, pain, endocrine disorders, or even mental problems such as depression or bipolar disorder. If left untreated, insomnia can lead to serious, sometimes irreversible, health consequences.

Improving sleep quality can often start with simple changes in sleep habits during the early stages of insomnia, according to Liu. If this works, you do not need immediate medical attention. On the other hand, if you do not see improvement over time, you may need to seek professional medical help.

Many people mistakenly believe that sleeping pills can easily solve the problem of insomnia, but this is not the case at all, Liu noted. He cautions that casual use of sleeping pills may lead to addiction and even increase the risk of dementia. Additionally, sleeping pills only relieve the symptoms rather than address their root causes. 

Risks Associated with Sleeping Pills

New research suggests your nightly sleep aid could be doing more harm than good in the long run.

Increase dementia risk

Liu said that if you have been taking medication over a long period or take a sizeable dose each time, you should discuss in earnest with your doctor the likelihood of a medication reduction plan. Studies have shown that long-term or frequent use of sleeping pills can increase the risk of dementia.

A new study from the University of California has found that frequent use of sleeping pills is associated with an increased risk of dementia among white older adults. The study was published in the January 2023 issue of the Journal of Alzheimer’s Disease.

Research published in the BMJ analyzed the medication records of 1,800 Alzheimer’s patients from 6 to 10 years before the disease was diagnosed and compared them with the medication records of 7,200 control subjects. Results showed that the use of benzodiazepine sleeping pills, commonly prescribed for short-term treatment of insomnia,  was closely associated with the risk of developing Alzheimer’s disease.

The study found that while short-term use of sleeping pills (less than three months) did not appear to affect Alzheimer’s risk, usage beyond six months saw an alarming 84 percent increase in risk compared to non-users.

Highly addictive

Liu said that initially, some insomniacs find success in falling asleep using a single sleeping pill. However, after taking it for a while, they may find themselves needing to increase the dosage to achieve the same results, leading to dependency. Liu notes that this escalating behavior is highly variable among individuals based on their physical body shape. 

Psychological dependence and unhealthy lifestyles can further exacerbate the problem. If an insomniac does not exercise at all, does not give up coffee, and does not quit smoking, they may take more and more sleeping pills. But if they adopt a healthy sleep regime, the dosage they need can be reduced.

Liu added that there is a range of sleeping pills available, categorized into fast-acting, medium-acting, and long-acting forms. The fast-acting type is suitable for those who have difficulty falling asleep, while the medium- and long-acting type is suitable for people who wake up easily at night or who cannot fall asleep again after waking up in the early morning.

Therefore, sleeping pills need to be selected according to the type of insomnia and used under the guidance of a physician. Moreover, alternatives such as antihistamines, antiepileptic drugs, or certain antidepressants may also assist with sleep and pose a lower risk of addiction.

7 Practical Tips to Combat Insomnia

Sleeping pills are known to have numerous side effects. Based on his own clinical experience, Liu provides the following seven methods to help improve insomnia and improve sleep quality:

Fixed Wake Up Time

Liu pointed out that a fixed wake-up time is the key to improving insomnia. Since the time it takes to fall asleep can be unpredictable, insomniacs may find themselves taking a long time to settle down after going to bed. Even if sleep quality was poor the previous night, it is important to rise at a consistent time to avoid daytime naps, which can disrupt the biological clock.

This approach is part of the “Stimulus Control” strategy within the “Cognitive Behavioral Therapy for Insomnia (CBTI)” framework, pioneered by Richard Bootzin, a renowned psychiatrist. Research published in The Lancet in September 2022 confirmed that this therapy is considered the most effective as a non-drug treatment for chronic insomnia.

Morning Exercise

Research shows that both acute aerobic exercise and regular exercise have a positive impact on sleep. This is attributed to the production of dopamine and serotonin during exercise—hormones that help stabilize mood and enhance sleep. However, it is not advisable to do strenuous exercise before going to bed.  The best time for exercising is in the morning.

Liu notes that exercising in the morning is beneficial in part due to the presence of mild sunlight, which aids in regulating melatonin secretion. Melatonin is a neurohormone that regulates sleep cycles and helps stabilize sleep patterns.

Get More Sunlight During the Day

Liu explained that exposure to light does not have to come solely from direct sunlight. He suggested that curtains should be opened during the day to keep the room bright. This is because the body’s sleep-wake cycle is determined by the biological clock (circadian rhythm). Receiving more sunlight during the day helps maintain the body’s circadian rhythm.

Conversely, insufficient daylight coupled with excessive artificial light from electronic devices can disrupt this rhythm, negatively affecting melatonin secretion and leading to insomnia at night.

Circadian rhythm is the human body’s internal clock, which operates on a roughly 24-hour cycle and influences various physiological functions, including sleep and wakefulness. Daylight inhibits melatonin production, keeping us awake as light diminishes in the evening, the pineal gland secretes melatonin, signaling the body to prepare for sleep.

Go to Bed Only When Sleepy

CBTI also requires insomniacs to go to bed only when they feel sleepy. Liu highlights that many people experience distress from tossing and turning in bed, leading to a negative association between the bed and anxiety or stress.  If things go on like this, turning off the lights and looking at the bed while sleeping may cause anxiety and psychological stress, and further aggravating insomnia.

Liu suggested that people still unable to sleep after taking sleeping pills should engage in relaxing activities, such as reading or listening to soothing music until they feel drowsy before returning to bed.

Drink Hot Milk

A 2023 research review in Advances in Nutrition showed that dairy products are beneficial to sleep quality.

Research indicated that dairy is rich in tryptophan, which is essential for producing serotonin and melatonin, key components in initiating and maintaining sleep. In addition, dairy products provide various micronutrients such as magnesium, zinc, and vitamins B6 and B12, which support the synthesis of melatonin from tryptophan.

Take a Hot Bath

Studies have shown that taking a hot bath (or shower) one to two hours before going to bed and maintaining the water temperature between 40°C and 42.8°C (104°F and 109°F), can help people enter deep sleep easier.  The average time lapse for falling asleep can be reduced by as much as 10 minutes.

Body temperature regulation is integral to the sleep-wake cycle; a hot bath helps dissipate body heat, effectively lowering the body temperature as it prepares for sleep. The body temperature in the evening is 2-3 degrees Fahrenheit higher than the body temperature during sleep. Therefore, taking a hot bath or shower to lower your body temperature up to a couple of hours before going to bed can help you fall asleep quicker. The study was published in the August 2019 issue of Sleep Medicine Reviews.

Create a Deep Sleep Space

External factors such as noise, light, and temperature may interrupt the sleep cycle and hinder one’s ability to achieve deep sleep, contributing to insomnia or poor sleep quality.

Liu recommends creating an optimal sleeping environment in cases where these external factors play a role. This might include installing soundproof windows to reduce noise, using blackout curtains to block excessive light, and adjusting the bedroom temperature to suit personal comfort needs.

Conclusion

Insomnia is not a trivial matter, and it may signal many hidden health problems. If you have tried various methods to improve sleep but without success, Liu recommends seeking medical attention as soon as possible.

Doctors can help insomnia patients understand deep-seated problems in the body and provide professional analysis and diagnosis of the causes of insomnia. Only by solving the root causes can we gradually reduce our dependence on sleeping pills and restore healthy sleep.