UKH

Hi folks,

Towards keeping my uni course in shape, I'm aware that I need to get more/better quality sleep, which sets me wondering what I could use towards that aim (it could seem to be an element of managing depression that sleep can be patchy, but other than that, my motivation is high and I'm wanting positive things from my life).

Probably, a mixture of sleep aids and other approaches could be optimal, so that I don't end up thinking 'I've run out of sleep aid X, so I won't get to sleep', or so I don't build up a tolerance. What are people's experiences with different kinds of sleep aids, and/or general 'life hacks' towards getting better sleep?

Many thanks.

Tim 

In reply to Timmd:

I use stuff from these guys. Started using them during a period when I was struggling to sleep for no reason.

Don’t need it now really, but still use their pillow spray, and their moisturiser for my hands, when I get into bed. Definitely worth a try. 

https://www.thisworks.com/collections/pillow-sprays?gclid=EAIaIQobChMIo6rX_...

Good luck. 

In reply to Timmd:

One of the most influential books I've read recently is Why we sleep by Matt Walker. I would get everyone to read it if I could.  Give him a google; watch and listen to him on the subject but better, read the book.

It will instill in you the wonder, power, importance, etc. of sleep and provide you with means to improve your sleep without drugs (sorry if that's not what you were getting at, but sleeping pills are very bad!)

youtube.com/watch?v=_lSNEjA-Drk&

youtube.com/watch?v=5MuIMqhT8DM&

In reply to Timmd:

For me, the following work, no coffee after 3 PM, no heavy meals anywhere near bedtime, no screentime (phone, TV, laptop) 30 minutes before sleeping (or in bed), keep a regular time to go to bed, and the best - read a book lying in bed till sleepy (often 10-15 minutes)

Edit, I hate sleeping pills and never take them

In reply to jack89:

Yes, anything which isn't a sleeping pill is definitely what I'm looking into first, anything along the lines of herbs under my pillow, or helpful habits is the priority.

In reply to Timmd:

Routine helps me.  Warm bath or shower, pyjamas on, hot milky drink, and a nice easy "Sunday afternoon" TV show in bed.  Something really quite pleasant and trivial, where nothing bad happens.  

In reply to Timmd:

PS a banana pre-bedtime is worthwhile. It contains tryptophan, which aids relaxation and sleep apparently. 

In reply to Timmd:

Have you tried 5HTP? (I know it sounds like a dance drug, but you can get it in Holland and Barret etc)

It helps with sleep and it's also a precursor to serotonin. Serotonin is (one of) your brains happy chemicals. It has minor benefits in helping you feel good, as well as sleep better.

In reply to Timmd:

Have you tried valerian tea?

In reply to Timmd:

When I can't get to sleep it's usually because I have too many thoughts bouncing round my brain.  A mental task that requires enough effort to stop the thoughts bouncing round, but is simple enough that I don't end up even more stimulated works 90% of the time.

Started off by counting down from 1000 in 3s, but this quickly stopped working.  Current favourite is thinking of a country that begins with A, then one that begins with B all the way through to Z.  Once I've been all the way through the alphabet start again, but no repetition of countries.  Rarely takes me more than a couple of cycles to get to sleep.

In reply to Timmd:

Avoid looking at a screen, computer, kindle or TV in the evening before you go to bed.  Reading from a book is better

Avoid alcohol in the evening before going to bed, and don't eat your evening meal too late.

I find that playing dreamy, not harsh, classical music softly in the bedroom can be very soporific. 

In reply to jack89:

It really is an excellent book isn’t it. 
mom my second read. 
He advises against the use of sleeping pills and favour sleep CBT. 
 

In reply to Timmd:

I've never had any trouble sleeping, but nevertheless I can vouch for a hop pillow. I thought it was bollocks until last year when I grew some and tried it.
 

In reply to Timmd:

Don't know if it works for you, but I find "drowsy" type antihistamines knock me out, and those are intended for daily use during hayfever season at least.  Cetirizine, for example.

In reply to Timmd:

from time to time I use Tranquital which is based on Valerian & Hawthorn, not sure if its available outside France but something with Valerian should be.

In reply to Timmd:

Have you tried 'pink noise'? There are long clips of it on youtube, basically just hissy background noise which (supposedly) is of a specific frequency band so it triggers some kind of brain relaxation response, also tends to mask any other noises which might be keeping you awake. Just setting going on your phone and leave it somewhere near the bed, you don't have to see it just hear it

In reply to Timmd:

I sometimes use Kalms, herbal stuff with valerian extract. Sometimes I just can't turn off my brain, the days work plus up coming jobs spinn round and keep me awake but a Kalms tablet really helps me drift off. Not often though, I may use them for a day or 2 then not for a few weeks. 

In reply to hokkyokusei:

That reminds me, my sister swears by Pukka Night time tea.  Its got Valerian in it and some other herbs and it's fairly easy to find. 

In reply to Timmd:

Looking for 'pills or potions'  to help you sleep can be counterintuitive as they either don't work and you keep on searching and obsessing thus worsening your sleep or find something that becomes a crutch that you rely on...

A good sleep routine combined with winding down before bedtime are the foundations of good sleep....oh and don't lie in bed for ages if you can't sleep. 

In reply to Neil Williams:

Diphenhydramine, the active ingredient of Nytol, is antihistamine that's still used for acute allergies.  Presumably the sleepiness side effect is too bad for treating ailments like hayfever (and being able to market it as a sleep aid was an unexpected bonus for the manufacturers). 

I use Nytol very occasionally when insomnia has driven me to breaking point.  It helps get me to sleep but any night-time visits to the bathroom can be faintly disturbing - like I'm a slightly disembodied third person observer.  I also have to ensure that I have no driving to do early the next morning as there can be a lingering drowsiness.

In reply to Timmd:

Have you ever practiced meditation? It can be good for getting your mind to settle down before bed.

Yoga nidra can be particularly effective - following a guided voice, running through some sort of body scan that takes your mind away from external factors and into concentrating on how different parts of your body feel.

Also, listening to audiobooks/podcasts can give your mind something to focus on, without the visual stimulation of using a TV/laptop/phone.

In reply to Neil Williams:

What are known as "first-generation" antihistamines are good.  Phenergan (promethazine) works well in my experience and is available from the pharmacy counter as a sleep aid. 

Not advisable to use regularly over a long period, obviously take on board other peoples comments/tips on good sleep hygiene.

In reply to Timmd:

After decades I really do find the best "Sleep First Aid" on waking any time between say 2am or 4am is to pick up an enjoyable read and go on with as many chapters as it takes to feel sleepy again. That is in addition to reading at bedtime, something enjoyable enough that you can actually look forward to settling down with it instead of troubling yourself about anything else.

It is a discipline to carry out this as it is all too tempting just to lie there and suffer fruitlessly.

It is important to recognise that you can have good sleep even after 4am if you give your brain some healthy alternative to fussing and worrying.

The reading comforts your worried consciousness and also also quietens down/reprograms your subconscious which otherwise continues to think of reasons why you should be denied sleep

In reply to wercat:

Ah, another member of the 3am club.  

I quite often find I get to sleep ok, but then wake up around that time. 

I usually get up and make a cup of (decaff) tea and read for a bit.  

I found this article reassuring. https://theconversation.com/did-we-used-to-have-two-sleeps-rather-than-one-...

In reply to marsbar:

Fundamentally if you don't feel excessively tired during what is for you "daytime", then what you're doing is working.  Everyone is different.

In reply to Neil Williams:

I've always needed more sleep than some people consider normal and I've always had bouts of insomnia on and off.  

I find the way forward is to just go with the flow. If I need a nap or an early night I go for it. No point in making it worse by worrying.  

I don't wake up at 3am by choice and sometimes it does make me tired, but mostly its occasional and manageable.  

In reply to Timmd:

Melatonin is great for falling asleep. It also doesn't build tolerance and is extremely safe.

In reply to Timmd:

May not be what you're after, but if you find the less pharmaceutical approaches dont work, I've had spells of using zopiclone to be fantastic. I only have the odd night where I cant sleep, I take one of them and I drift off half an hour later. No groginess the next day. And as I only take them infrequently I haven't built up a tolerance nor any addiction feelings. They have been a lifesaver to be honest.

In reply to Timmd:

Ive struggled with sleep all my life, even as a kid I was up all night. I use doxylamine succinate tablets I buy on eBay from the states. I do have some vertigo meds which help also but I only take them when the vertigo is being a pain.

My advice would be is try and improve your sleep naturally - mine is pretty much reliant on taking something, even if I have long since become tolerant. On the rare occasions I do forget and I cant say it makes much difference apart from feeling slightly less groggy the following day.

In reply to Neil Williams:

Piriton from the pharmacy, not the supermarket version, Chlorphenamine maleate. 

In reply to marsbar:

I've always felt sleepy in the afternoon or early evening, since being at school.   I imagine that I'd have been the one in the cave tending the fire during the night to keep the wild things at bay while more normal cavefolk slept

perhaps it's cave-dwellers to cafe-dwellers that's mucked us up

In reply to Trangia:

I'm pretty sure the most usual medical advice these days is that bed should only be used, and thus only associated with, sleep and sex. Certain types of food should be avoided before sleeping eg cheese. 

For myself, I find that reading in bed does work and always makes me drowsy. In fact my problem is not getting to sleep but waking up in the early hours. Its often said that one should get up and do something non-stimulating for a time, perhaps reading, and then go back to bed and try to sleep again. 

In reply to Timmd:

I listen to a couple of podcasts, stories rather than current events etc. I found Knifepoint Horror to be excellent: the narrator has a soothing but engaging voice and I find myself drifting off after about 10 minutes. It can take many nights to get to the end of a story. Sadly I've now listened to most of the tales so have moved onto another podcast called 'Ostium'.

Perhaps I will try re-listening to Knifepoint Horror.

I also use 'Night rain on a Car - 10 Hours Video with Soothing Sounds for Relaxation and Sleep' by Relax Sleep ASMR. 

Also 'Rain on Tent Sound I BLACK SCREEN I Sleep, Study, Mediate I 10 hours' by Relaxing Ambient Sounds

Two of the best and I've tried many. No adds, no appreciable repetition and you know its not going to run out!

In reply to Timmd:

Do you have phone, tv or laptop in your bedroom?

In reply to profitofdoom:

I'm also very caffeine sensitive, (sad as I love good coffee) and recently started having a 1030 cut off time, this with cutting out alcohol had transformed my sleeping 

In reply to Timmd:

I'd also add to the 'no screen time before bed' suggestion. I would often do admin work just before bed for an hour or so and used to struggle with sleep. I make sure I don't do that and now and I sleep better. Might be a mix of suggestions but I'd be looking at chemical solutions as a very last resort.

In reply to olddirtydoggy:

Air and exercise, and ticking things off which have been adding to my stress seem to be helping so far, but there's an interesting mix of suggestions been offered, which I'm sure I'll find helpful in time.

In reply to dread-i:

5htp gives you mental dreams. Not just me that's experienced this, it's the same phenomenon you get from tyrosine in cheese, but far stronger if it's 100mg of 5htp. 

As an antidepressant, I'm pretty certain it's completely ineffective (will have a scan for a cochrane review but I think I checked the research a few years ago and it ineffective).

I've used other precursors to neurotransmitters and they can have very noticeable effects (e.g. DMAE for acetylcholine) but the effects don't last. It seems that when your brain is first flooded with the precursor it thinks "make hay while the sun shines", you get an imbalance with high levels of the neurotransmitter for a week or 2, but then once its obvious you don't need to make any more serotonin (etc) the brain stops converting it and (speculation here) then just reverts the levels to normal. Interesting thing is, once you've done this once, it never seems to work again (I tried DMAE after years since the first profoundly effective go, and it didn't work at all, same with 5htp). 

An SSRI is effective by keeping serotonin in the synapse, but trying to make more serotonin from 5htp isn't effective. Keeps Holland and barret in business though. 

In reply to Timmd:

I think that "non addictive sleeping pill" is an oxymoron. If it puts you to sleep, then when you don't take it, you'll find it hard to sleep, so you'll develop dependency. 

I've used all sorts of sedatives occasionally/recreationally, and none of them I would consider using regularly. Dangerous class of drugs. I also find that if I'm really not sleepy when I go to bed then no amount of meditation, essential oils, or anything non-pharmaceutical has any effect. I just say to myself "I'm only going get a few hours kip tonight" and read a book, and if that's til 3am, it's til 3am. Since I'll be knackered the next day then if I'm getting up for work, the next night will be OK. 

The only thing that really helps me get to sleep is being tired when I go to bed. So, if I've done a full day at work and been climbing or on the fells, no problem. If I've got up late and done f*ck all all day, no chance. So if you can, get up early and do a lot of exercise (I don't think a bit of weights or yoga at home would cut it for me). 

In reply to Jon Stewart:

for me  its not falling asleep but more staying asleep & not getting up the next morning feeling as tired as when I went to bed as I've spent several hours not sleeping.

In reply to oldie:

It is quite nice to know there are others up and about in the night. Me asleep like a brick at 10.30. Then always wake in the night for more or less time. These are my things:

Peanut butter often knocks me right out.

Blindfold for all but the darkest months(t-shirt over the head).

No caffeine. Only decaf coffee and no tea. Some decaf coffee is too strong. 

Next step is earplugs. Even if there is no sound. They seem to stop me subconsciously listening out. 

If still awake, then ibuprofen knocks me out 9 times out of 10.

On the extremely rare occasion that I do sleep through it feels weird. It is like I missed the night. It has become a part of my life. 

In reply to Timmd:

Weed?

In reply to Iamgregp:

I don't think that suggestion is going to go down very well with Tim's previous experience with the drug. 

Doesn't make me relaxed or sleepy either. More likely to have a panic attack. But for some it works a treat - weird stuff! 

In reply to Timmd: Dave MaCLeod has some excellent well presented methods and reasoning. 
like making sure it’s dark, Circadian Rhythm and blue light glasses - which my 10 year old says “make him yawn”  they work! I like reading something I’ve read before and sleeping with a tshirt on. 

In reply to thebigfriendlymoose:

I very very occasionally resort to Nytol (the pharmaceutical one, not the herbal one) if I'm having a really bad patch of poor sleep, but I do find that it knocks out completely and the next morning it leaves me feeling almost as bad as if I hadn't slept much at all anyway.  But at least I do go to sleep, and don't have the interminable lying in bed waiting to go to sleep and failing...

Other antihistamines have variable effects on me.  Piriton doesn't seem to make me drowsy, and most of the one-a-day ones just make me feel weird.  I used to use an off-the-shelf nasal spray containing beclometasone diproprionate occasionally, if my normal oral antihistamines weren't cutting it.  I now have it prescribed for another, related condition and use it daily as prescribed.  That doesn't make me drowsy, but the inhaled version which was prescribed at the same time has me nodding off any time from mid-afternoon (so I'm probably going to stop taking that).

I find the herbal sleep or daytime calmness aids helpful for mild bouts of insomnia.  Also camomile tea at bedtime, to drink while reading that book in bed that also helps you to sleep.

In reply to Timmd:

Like the smoker who says: "Giving up is easy...I've done it dozens of times", I've had sleep problems for many years and have a whole armoury of stuff I use...so feel like an expert...but still have sleep problems (as the time stamp on this post will show. Ho hum)

Anyhoo, I found the "rebound effect" with drugs was too brutal, so knocked them on the head. Trouble was, they showed me what type of life I could have if I could only improve my sleep cos they worked so well. But I wasn't prepared to be dependent on them.

I was selected to take part in some sleep research conducted by a university. They were researching all sorts of non-medicine-based therapies. The sleep hygiene techniques that others have mentioned were all in there. A biggie for me is no screen time (except TV) before bed (blue light's bad, red light's good). Also, a consistent relaxation routine before bed, focussing in particular on trying to get some perspective on past/future anxieties you might find yourself dwelling on when you wake at night. Also no alcohol...that's really tough for me! (Can't drink during the day cos of work...can't drink in the evening cos of sleep...when exactly, the f*ck, can I drink??)

I'll add another three I've found useful I don't think have been mentioned:

1. To stop "dwelling" when you wake during the night, keep a pen and paper next to the bed. Write down the repeating thoughts and tell yourself something like "I'll deal with them in the morning". Even perhaps move the piece of paper out of the bedroom! Sounds naff but works very well in my experience. I now do this exercise as a 'thought experiment' rather than physically writing stuff down and find it works just as well.

2. Combine the above with a fully "immersive" re-run of some mountain exploit, or exploits. I use the plural because I use a "free association" approach, whereby the memory of one adventure triggers the memory of another, and another...I just "go with the flow". Sights, sounds, smells, feelings. I find this very effective - and great fun. A bit like counting sheep for climbers.

3. Sleep restriction: this was one of the core therapies the Uni was researching. It's pretty brutal. It addresses the problem of fragmented sleep. 
Week 1: keep a sleep diary, keeping track of you're nightly sleep/wake cycles. Tot up the total time you're ACTUALLY asleep per night. Let's say you go to bed at 11 and get up at 6, but actually only sleep for 5 hours cos you wake up lots.

Week 2: Set a bed time and getting up time based on the result of your sleep diary. So if you're only actually sleeping for 5 hours, go to bed at 11pm and get up at 4am (told you it was brutal!). No afternoon naps allowed! No dozing off in front of the TV!

Week 3: If (and only if) you manage to sleep the 5 hours without waking in week 2, add half an hour, giving 5h 30m, and reset bed and getting up times accordingly e.g. 11pm to 4.30am

...and so on. 

In reply to Jon Stewart:

Not sure about mental, but certainly they can sometimes be vivid.

I mentioned that it had a minor effect on mood. I'd liken it to a tank of fuel. If your tank is low then there isn't much serotonin to go around. If your tank is full, then there is enough to do the job. Over filing the tank, wont make you happier, but if the tank is low, it might help. TBH, the positive changes in mood, might just be down to getting better sleep. Anecdotally, I've found it useful.

In reply to Jon Stewart:

I think it depends on the ratio of CBD & THC.  

THC gets the user "high" and with that possibly the paranoia and panicy feeling, but most strains also contain CBD which doesn't produce the high, just the drowsy "melt into the sofa" sensation that some users like.

CBD oil might be an option for Tim?  Doesn't get you stoned but does produce the feeling of relaxation that may help him get to sleep.  There's even a few brands out there endorsed by pro climbers, some evidence it aids muscle recovery.

In reply to ian caton:

I know quite a few people who insist on complete darkness when they sleep. One good way is obviously blackout curtains. A local fabric store even has material that doesn't need sewing to prevent fraying. Its something I've been too lazy to do before but you've given me some impetus.

I'll try the peanut butter! Incidentally when I was working I was often a bit drowsy and forgetful and my GP put me on a course of cognitive behavioural therapy to get more sleep, eventually leading to group therapy. It didn't work for me, but then perhaps I wasn't very receptive.

In reply to oldie:

Blackout curtains reduce fresh air flow essential for me to sleep. 

In reply to Timmd:

I don't know of it'll be of any help but I try not to look at screens for an hour or so before bed, I've recently taken to listening to some relaxing music as books also keep me up too late.

In reply to Timmd:

Given how fundamental sleep is, it is weird that it is elusive for so many.

In my case, I got hit by a bunch of symptoms as adverse effects to a common antibiotic. Many have improved over the last year but I simply lost the ability to sleep and that has not returned. I went ten days with no sleep whatsoever back in January before getting some heavy medication. It was certainly no help just being advised to see a psychiatrist!  I have not managed a nap during the day, a couple of glasses of wine make no difference.....it is entirely clear why sleep deprivation is used as torture. I have no desire to stay on medication or be reliant on it but at the moment there seems to be no alternative. The GP actually said that weed may be the answer! I have tried CBD oil but you are meant to leave 4 hours gap between it and certain other medications. 

In reply to Timmd:

I've find the Headspace meditation app really helps. Even though I now know the relaxation exercises I still find it more effective to be taken through them. 

There was decent free content put out back in April time if this is still available it's definitely worth checking out. 

In reply to Timmd:

Another plus we've found is blocking the light from getting through the curtains. We had a lightbulb moment when van camping and noticed we were sleeping better in the van than we were at home. The van has no windows and is completely dark. We noticedat home that as the mornings were getting lighter earlier, we were coming round earlier.

The fix was black out curtains. Plenty of coverage past the window to stop light creeping round the side and the window on night vent to let the air circulate.

In reply to Iamgregp:

From a quick search it looks like the emerging consensus is that CBD isn't intoxicating on its own (which is why it's legal), with but as you say seems it seems to modulate the action of THC. Looks like there's some evidence that CBD on its own can help with anxiety, without getting you stoned.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4604171/

In my case, I don't think that THC agrees with me at all, regardless of how much CBD is present. What's apparently the mellowest squidgy hash ever according to other people (presumably implying high CBD:THC ratio, but it's speculation) makes me feel terrible at a really low dose. I've tried a few times in the last few years with exactly the same results every time.

In reply to dread-i:

There is a bit of evidence for it now:

https://www.cochrane.org/CD003198/DEPRESSN_tryptophan-and-5-hydroxytryptoph...

I've had GP's say to me that "some people don't have enough serotonin and that's why they suffer depression" but I've never believed it - I'm not a neuroscientist but I've studied the brain a bit and know it's more complicated than that, e.g. SSRIs seem to work by causing adaptation of serotonin receptors rather than directly by increasing serotonin availability (why they don't work for a few weeks); low mood following use of MDMA doesn't correlate with serotonin levels (the low mood is reported after serotonin level is restored), etc.

I find it very interesting, but really all anyone is doing (whether trying over the counter supplements, prescribed meds or illegal psychoactive drugs) is taking the drug and seeing what happens to their subjective experience - there is no theory of how brain activity and neurotransmitters work to create different conscious states, only complex correlations.

In reply to Jon Stewart:

Yep sounds like you have a real aversion to THC so best swerve weed entirely.  However CBD on it's own. like you say, has no psychoactive effect so it's good that people such as yourself are able to access this now (should you want to) without having to expose yourself to THC.

In reply to Jon Stewart:

You're absolutely right, it a little more complicated than "not having enough serotonin", for example one theory suggests that it may be a shortage of receptor sites, rather than serotonin itself causes the issue, but increasing the availability of this neurotransmitter at synapses has been shown to have a positive affect. 

As I remember it SSRI's don't work on receptors on the receiving side of the synapse, but on the cells on the transmitting side which reabsorb the serotonin after it has been released and the signal carried across the synapse. 

Normally once the signal has been transmitted across a synapse, these cells reabsorb the serotonin so that it can be used again but an SSRI stops this as happening as much (possibly because their molecules mimic the shape of serotonin molecules in some way) some (but not all, hence selective) of the serotonin stays active in the synapse which can have a positive effect on mood and depression, which can also aid the use of other therapies such as CBT.

This is a really simplistic version of how this all works and I'm sure someone who knows this better (possibly you) can correct me or fill in the details.  It's been 20 years since I studied this so I'm f*cked if I can remember the details!

In reply to ian caton:

Agree. however, we're lucky as just myself and wife so we can leave bedroom door open, have windows in other rooms open, and still get sufficient airflow and darkness.

In reply to Iamgregp:

I think that there's a further stage. It wasn't understood when they were first popular why they took 3 weeks to work. Now it's thought that the post-synaptic serotonin receptors (or some subclass of them) desensitise in response to the elevated serotonin level in the synapse over the course of those weeks, and this is what is correlated with the antidepressant effect. If more serotonin hanging around in the synapse was responsible, the effect would be seen straight away.

Exactly (but not me I'm afraid) - my understanding is the same level, a simplistic version of what's known by the current science.

In reply to Timmd:

1. Don't ask here

2. You will get a load of nonsense anecdotal "I find ketamine really helps' shit.

3. Set an alarm in the morning

4. get up

5. Do stuff

6. Get tired

7. Stay off the caffeine after about 3pm

8. Have a bedtime routine

9. Avoid screens in bed.

10. If that doesn't work have a think

11. Problems getting off to sleep?

12. Problems waking up?

13. Something else?

Mind you I could well be talking utter shit as I am a random person on the internet.

Zopiclone and the other Z drugs are 'clean', don't usually have a hangover effect and are not addictive. I have no idea why people are rabbiting on about SSRIs as they are mostly alerting and if you take them late in the day keep you awake. (I prescribe these drugs on a daily basis and have done for the last 25 years- I also take them).

In reply to Jon Stewart:

Ah interesting! I was wondering what caused the delay in the start of the effect when I wrote that. Thanks for that! 

Not sure if I never knew that or did but forgot. Same as you I fear my knowledge may be a bit out of date.

In reply to Iamgregp:

utter crap.

SSRIs do not have a latency of effect. this is a myth.

Nierenberg AA, Farabaugh AH, Alpert JE, Gordon J, Worthington JJ, Rosenbaum JF, et al. Timing of onset of antidepressant response with fluoxetine treatment. Am J Psychiatry 2000;157:1423-8. [PubMed] [Google Scholar]

Posternak MA, Zimmerman M. Is there a delay in the antidepressant effect? A meta-analysis. J Clin Psychiatry 2005;66:148-58. [PubMed] [Google Scholar]

Taylor MJ, Freemantle N, Geddes JR, Bhagwagar Z. Early onset of selective serotonin reuptake inhibitor antidepressant action: systematic review and meta-analysis. Arch Gen Psychiatry 2006;63:1217-23. [PMC free article] [PubMed] [Google Scholar]

In reply to freeheel47:

I'm off to bed now, but that does not sound right to me. Ambien addiction not a thing? 

Then you didn't follow the thread. 5htp was suggested, and the conversation went on a tangent from there, no one's suggesting them as sleep aids. 

In reply to freeheel47:

That's interesting, I'll read the abstracts. I thought it was a well established thing and people were trying to find the mechanism responsible. 

In reply to freeheel47:

? 

https://www.nhs.uk/conditions/ssri-antidepressants/

Genuine question: why does the NHS tell patients this? The reason I thought it was the case was because 2 GPs told me (and from my brother's experience). 

Who am I to trust if the NHS is so wide of the mark? 

In reply to freeheel47:

But you do prescribe these drugs, right? 

https://www.nhs.uk/medicines/zolpidem/

https://www.nhs.uk/medicines/zopiclone/

What the devil is going on here? 

In reply to Jon Stewart:

Not checked but I thought it was Tricyclic antidepressants that took a couple of weeks before having an antidepressant effect ? (partly based on my memory of being prescribed Amitriptyline many years ago)

 

In reply to Doug:

 NHS advice is that SSRIs take 2-4 weeks to work. 

https://www.nhs.uk/conditions/ssri-antidepressants/

In reply to Jon Stewart:

thanks, my experience is from some 30 years ago, thankfully I've not needed them since.

https://www.nhs.uk/conditions/antidepressants/ suggests 2-4 weeks for all antidepressants before they are fully effective

In reply to freeheel47:

I mean if you'd bothered to read the thread you'd see it's quite obvious that this is a side conversation that a couple of us have arrived at which is unrelated to the OPs sleep issues.

In reply to Doug:

I know that is what the NHS advice and NICE says- it just isn't current.- see the articles / metaanalyses written

In reply to Timmd:

unfortunately it takes ages for evidence to become incorporated into; common knowledge, clinical practice and guidelines

In reply to freeheel47:

So maybe the position is - not inline with latest research and metanalysis than "utter crap"? 

In reply to freeheel47:

What about z drugs being non-addictive?

In reply to Timmd: Don`t share beds or even rooms, its crap.

If you wake up during the night like me, there is a pile of anxiety attached to waking your partner up.

The trouble is there is no other place to go to, we haven't an extra room for me to sleep in. So pink noise is out as wife thinks you are mad or it drives her mad, getting up and chopping wood is out, last time I tried that I woke the whole village up and filled the house with chainsaw exhaust fumes, and forget reading a book because even a head torch can wake your partner up.

Good luck, I am on the strongest sleeping spills to avoid divorce.

Cheers

In reply to Jon Stewart:

they aren't numbers of suspected adverse drug reactions of dependence are miniscule for some in absolute numbers (ie a handful) and for others a tiny fraction given use.

They are also quite freaky for the treatment of catatonia.

In reply to Timmd:

Test for Catatonia with zolpidem Thomas, Pierre et al.The Lancet, (1997) Volume 349, Issue 9053, 702

In reply to freeheel47:

OK. But you can see why I find the statement "z-drugs are not addictive" difficult to reconcile with the NHS advice:

Can I get addicted to zopiclone?

If you just take it for a few weeks, you're unlikely to become addicted to zopiclone.

You may become dependent on it if you take it for longer than 4 weeks.

Ask your doctor or pharmacist for advice about stopping zopiclone.

They can help you come off your medicine gradually if you have been taking it for a long time, or if you're worried about becoming dependent on it

When the OP specifically asked about non-addictive sleeping pills/sleep aids?

And how does this come about for a non-addictive drug?

https://www.uk-rehab.com/treatment-rehab/ambien/

Aye. There was a TV documentary on it in fact. Weird stuff indeed. And the fact that it's fun also counts against it as being a "non-addictive" drug.

In reply to Jon Stewart:

the catalonia stuff isn't 'fun' it is freaky because the treatment of acute catatonia with anything is freaky- it really is like Lazarus.  It is fun to do rather than have it done (fun because you instantly make someone who is really sick and who nobody thinks will get better really better really fast (although this is usually / almost always done with an injection of lorazepam in the UK).

People will offer rehab (for money) for anything. 

In perspective- in England there are about 4-500,000 prescriptions for zopiclone monthly.

Until 2018 across the area served by the European Medicines Agency there had been a total of just over 5-600 reports of (suspected) dependency for the Z drugs as a whole. But often / usually in those taking multiple other psychotropics. Whilst pharmacovigilance does under report (a lot) there are no clinical issues with these- apart from in polysubstance users who want more of everything.

Melatonin is also a non-addictive sleeping tablet- but it is VERY expensive. Don't ask your GP for it - they will be cross.

In reply to freeheel47:

Absolutely amazing and so counter-intuitive. Less dramatic, but still weird, was the stuff on diazepam making the visual cortex plastic so amblyopia could be treated in adults. I've haven't checked to see where that went...

I was a bit unclear there, all I meant to say was that taking ambien (and I'm talking 10mg, not trying to get more peculiar effects) is fun. It's fun in *exactly* the same way that benzos are fun. That's why think I think the potential for addiction to z-drugs is glaring, and I can't dismiss clinics treating people for that addiction as a scam.

And there are no financial motives for down-playing the addictive nature of z-drugs? You're not going to like this, but I found Ben Goldacre's tales compelling.

At the same time point after their introduction, I wonder what the addiction data on benzos looked like? Was everyone delighted with how safe they were (compared to barbiturates) still? I'll be interested to see how many z-drug addicts we have in say 5 years after the covid/recession mental health meltdown...

Haha. Best not post that on a public internet forum!

In reply to Jon Stewart:

Addiction to z drugs isn't really seen in clinical practice in the UK- I'd guess that the rehab patients are addicted to lots of things.  z drugs basically make you sleep - really fast. Rather than wobbly (like temazepam etc).

Yes he is a brilliant author and I really enjoyed Bad Pharma- I haven't seen drug reps for about a decade- and those that have tried to see me have had a flea in their ear- especially the ones representing the companies who have some of the largest corporate fines in history (meaning well north of $1 billion- they then tried to say that because of that they were now 'whiter than white'- utter cock. But I am involved with some research including (publicly funded) psychotropic drug safety and help with the clinical aspects of some biotech research.

I am a very skeptical person by nature and always want proof. Which is why the pharmacolvigilance data is important. They really aren't new drugs- having been used since the mid-1980's.  There is a stark difference with drugs like pregabalin (introduced about 15 years ago)- which has become a huge problem with dependency and diversion- and cost (drop for drop liquid pregabalin is about as expensive  as (for example) a 2010 Château Pichon-Longueville (£150/750ml). (Not a lot of this liquid) is used- but it is. Pfizer made gallillions out of pregabalin and we are now all picking up the pieces both in terms of drug costs and trying to discontinue meds which are being prescribed for no good reason at all. 

All psychotropics (almost) will have problems with diversion- even some of the antipsychotics. Oddly.  In prisons quetiapine is traded ; the tablets are known as 'donkeys' (because taking them is like a kick from a ). Diversion and recreational use is (subtly but distinctly) different from dependency though. 

Well he did ask.

In reply to freeheel47:

I don't find the subjective effects of zolpidem any different to a benzo (thumbs up for both from me), but I'm not claiming to have done any systematic comparison at different doses. Would it be fair to say that the advantage of the z-drugs is mostly just their short duration of action?

Sounds like Interesting work.

I've heard about the absolute horrors of pregabalin withdrawal. My scepticism works in the opposite direction to yours: every GABAergic sedative drug I've ever heard of has a record of having terrible consequences if you take it every day (alcohol at a reasonable dose being an exception, if that counts), so I'm sceptical that the z-drugs are really that different. This is why the ACMD said "treat them like a benzos", and why the NHS patient info says something similar. I appreciate that there are distinct advantages of z-drugs over benzos, but I'm going to follow the NHS guidance and treat them as essentially having the same risks and certainly would not consider using them every day.

In reply to Jon Stewart:

exactly

yes, it  is an unexpected twist to looking after tricky patients who had lots of adverse drug reactions.

there is the rub. On the one hand they can be abused and lots of people have poor sleep, so there is a massive potential for massive cost. On the other they are great if you just want to sleep.  

In the not really that so olden days we used to prescribe "sherry 50mls nocte" or "whisky 25mls" (I think it might have been White Horse) and we'd also go for a pint of two on Friday lunchtimes in white coats outside the pub behind the hospital.  GABAergic drugs are great.

For the OP- I bet he drinks beer which is a very dangerous thing- alcohol being associated with millions of deaths worldwide, most acts of violence and homicide etc.

(It is whole different thing though prescribing hypnotics for older people though- they do fall over).

In reply to freeheel47:

if you've got insomnia bad enough to warrant a prescription, doesn't that mean you struggle to sleep basically every night...so then is it "abusing" the drug to use it every day, if the problem is the same every day?

I don't have a handle on what % of alcohol users are problematic. Seems like although the total harm caused by booze is enormous, since its use is totally normal, the rate of abuse/problems is low? Essentially everyone I know uses alcohol, quite a lot of them myself included are daily users, and I don't know anyone struggling with it at the moment. Isn't booze a fairly safe drug, but when it does go tits up, it's pretty spectacular?

Booze is also absolutely shite as a hypnotic of course.

On the other hand, my intuition is that a much higher proportion of benzo users become dependent and/or have problems; and I suspect it'll turn out, once the cases come out of the woodwork, that the % of problematic z-drug users is somewhere between that of alcohol and benzos.

In reply to Timmd:

Pure cherry juice its full of melatonin first time i drank half lite an hour before bed i was out for 14 hours. Make sure its pure sour cherry not some shite cherry juice drink!