How to Sleep Better Without Pills: Doctors’ Advice

Before resorting to sleeping pills, try these sleep improvement techniques.
It’s a different world at 3 a.m. when you’re lying in bed staring at the ceiling or worse, at the clock. All you do is worry: How will I manage tomorrow if I haven’t slept at all?
If you often have trouble falling asleep or staying asleep, as is the case for over 60% of older women, you may have considered trying sleeping pills. While these medications can help you fall asleep, they can also have side effects, including an increased risk of falling and morning grogginess, making driving that day dangerous. Therefore, since January 2013, the FDA has begun requiring drug manufacturers to reduce the recommended dose of hypnotics containing zolpidem.
Before starting a treatment with sleeping pills, it is important to identify whether you actually have a sleep problem. Some people are disturbed by waking up during the night but get up, go to the bathroom, and return to sleep. There is nothing wrong with that, explains Dr. Hadine Joffe, an assistant professor of psychiatry at Harvard Medical School. If it takes you 20 minutes to fall asleep, it doesn’t necessarily mean you have a sleep problem, the doctor adds.
If you regularly cannot fall asleep or stay awake and it affects you during the day, you may be suffering from insomnia. But before taking medications to help you sleep, Dr. Joffe recommends trying to change something in your lifestyle, such as eliminating caffeine and maintaining a regular sleep schedule. It may also be helpful to consult a doctor to find out if your sleep disorder is caused by a medical issue.
Why Can’t I Sleep?
There are several reasons why sleep problems are so common among women, says Dr. Julia Schlam Edelman, a clinical instructor in obstetrics and reproductive biology at Harvard Medical School and author of Successful Sleep Strategies for Women. One reason is the obesity rate. Sixty-five percent of women are overweight. Overweight women are more likely to suffer from sleep-related breathing disorders, says Dr. Edelman.
Sleep-related breathing disorders often refer to obstructive sleep apnea, a condition in which the airways become periodically blocked during the night. This blockage temporarily interrupts airflow, leading to snoring and frequent sleep interruptions.
Health issues such as thyroid problems, anemia, menopause-related hot flashes, heartburn, urinary incontinence, and depression can also affect sleep both qualitatively and quantitatively. And medications you take to treat health issues—including beta-blockers for high blood pressure, cold medications containing alcohol, and migraine remedies containing caffeine—can all disrupt sleep.
Common Sleep Problems and Their Solutions
Here are some common sleep problems and how to address them.
Problem: I’m tired, but I just can’t sleep.
Solution: Try changing your lifestyle by avoiding factors that might keep you awake. Limit caffeine and alcohol (especially before bedtime); ensure your bedroom is cool, dark, and comfortable; and turn off all electronic devices (including the book you’re reading on your tablet) at least an hour before bed.

Problem: I sleep seven or eight hours a night, but I wake up exhausted in the morning. My partner also says I snore.
Solution: Consult a pulmonologist, who may recommend a test for sleep apnea.
Problem: My joints hurt so much that I can’t fall asleep.
Solution: Ask your rheumatologist for pain relievers for arthritis, such as nonsteroidal anti-inflammatory drugs (NSAIDs) and corticosteroids.
Problem: I’m too stressed and can’t sleep.
Solution: Try stress relief techniques such as meditation, hot baths, or listening to music. Dr. Joffe suggests making a worry list before bed with everything that’s on your mind. Once you’ve put your worries on paper, it may be easier to set them aside. It’s such a simple thing, but very effective, says Dr. Joffe.
Problem: My legs twitch, shake, and itch so uncontrollably that I can’t fall asleep, and after I do fall asleep, I keep waking up.
Solution: You may have restless legs syndrome. Your doctor might recommend stretching exercises or massaging your legs before bed. You can also try a warm bath. If lifestyle changes don’t work, there are medications that treat this condition.
Problem: I keep waking up in the middle of the night to go to the bathroom.
Solution: Reduce caffeine and alcohol, which can increase the need to urinate. Don’t drink fluids a few hours before bed. And go to the bathroom right before you get into bed. If you take diuretics, talk to your doctor, as they may be a cause of your problem.
Problem: Heartburn keeps me awake.
Solution: Try elevating the head of your bed by 10 to 15 cm. Have dinner at least two to preferably three hours before going to bed and avoid heavy meals. Avoid foods that can cause heartburn, such as chocolate, coffee, caffeinated drinks, spicy foods, and fatty foods.
When You Need Sleeping Pills
Sometimes insomnia is so severe that you are willing to take sleeping pills to be able to sleep. Before grabbing a box of sleeping medication from the pharmacy, try following the steps outlined below in your Daily Guide to Good Sleep. If these steps don’t work, see a doctor who can determine the medical causes of your sleep problems.
You can start by trying a natural sleep aid like melatonin, a hormone that helps regulate the body’s sleep-wake cycle. Melatonin tends to be effective in women over