Sleeping pills aren’t a dream solution for chronic insomnia.

Sleeping pill next to bed

More than half a million prescriptions are handed out each year for the sleeping pill zopiclone, making the tablets one of the country’s most-prescribed medications. But reaching for a pill to save you from another sleepless night isn’t without downsides.

Sleeping pill use carries long-term health risks and you might be better off giving drug-free options a go instead.

Issues with sleeping pills

Staring at the ceiling while it seems the rest of the world sleeps soundly? You’re not alone. Up to 30% of adults have trouble going to or staying asleep at some point.

Some find the struggle with sleepless nights goes on for years, even if they’ve tried medication (from hypnotics and sedating antidepressants to melatonin). One Consumer member who preferred not to be named described his 3 years of insomnia as “crippling”.

“I would have periods where it would be unbearable, where I would have to take sick days,” he says.

He was prescribed sleeping medication, but was concerned about dependency. “While it was effective, I found that on nights I didn’t use it, it was twice as hard to get to sleep … It was getting to the point where I was beginning to lose it,” he says.

As he found, treating insomnia solely with sleeping pills can swap one issue for another.

Studies show sleeping pills only help people fall asleep about 8 to 20 minutes faster, adding less than 35 minutes to an overall night’s sleep compared with those who don’t take the medicine.

The pills can help you through stressful times. However, regular use comes with the risk of side effects such as daytime drowsiness, dizziness, hallucinations, sleepwalking and sleep-eating.

People who use sleeping pills regularly can also struggle with rebound effects when they stop taking the medication, University of Auckland Professor Bruce Arroll says.

These patients may need their doctor’s help at this point, he says. “People can experience excessive dreaming and wake up feeling completely wrecked. Because of this, some people end up on sleeping pills the rest of their lives. GPs are pretty careful about giving them.”

What else can be done?

Sleeping pills should be a last resort, but that doesn’t mean your doctor has nothing else to offer. Insomniacs shouldn’t feel like they need to simply soldier on, Dr Arroll says. “There’s an acceptance in the community that insomnia is normal. But there’s a lot that can be done.”

Dr Arroll says if insomnia is interfering with your ability to function, contact your GP. The first step is determining whether your insomnia is a symptom of another condition, such as sleep apnoea or iron deficiency.

Many cases of insomnia are linked to depression and anxiety, he says.

To understand the likely cause of your restless nights, your GP will ask about the frequency of your sleeping troubles and how long they’ve lasted. It may be worth keeping a sleep diary for a week or two before your appointment.

You’ll also be asked about your general health and mental wellbeing, sleeping environment, work schedule, daytime and evening habits – from naps and device use to intensive exercise and alcohol consumption.

Other clues to the cause may come from how you feel the day after a bout of insomnia or your tendency to snore. You may want to ask your partner if they’ve noticed any interruptions to your breathing during the night (as this indicates sleep apnoea) or other behaviours, such as unconscious leg movements.

If related conditions are ruled out, your doctor will likely diagnose you with chronic insomnia. They may recommend a form of cognitive behavioural therapy (CBT) tailored for insomnia. The therapy may also be used alongside treatments for anxiety or chronic pain.

Cognitive behavioural therapy

A drug-free therapy that can even help insomniacs who suffered for decades may sound too good to be true. But the science for CBT stacks up, says Massey University Sleep/Wake Research Centre clinician Dr Bronwyn Sweeney.

Four out of 5 chronic insomniacs experience improved sleep following treatment, she says.

CBT uses a set of well-researched techniques and is the Australasian Sleep Association’s recommended initial treatment for insomnia.

Typically, a specialist will tailor CBT techniques to a patient in individual or group therapy sessions. The techniques aim to rebalance your sleeping and waking cycle, and may involve relaxation exercises and visualisations before you hit the sack alongside stress-reduction techniques during the day. CBT clinics charge between $100 and $200 a session.

Dr Sweeney says the therapy, which is applied over 3 to 8 sessions, can require discipline and commitment. “People usually get worse before they get better. Some people can’t handle that.”

One of the tougher exercises requires insomniacs to go to bed later than they would normally, while still getting up at the usual time. Although this seems counter-intuitive, the technique (known as time-in-bed restriction) trains the person to sleep in a continuous block.

Spending 9 hours in bed but only getting 6 hours of broken sleep leaves you worse off than spending 6 hours sleeping continuously – even if the block is shorter than the recommended amount (7 to 9 hours each night).

The technique should be introduced with the help of a GP or CBT specialist, who will discuss the safest and most appropriate ways to implement it (they’ll never recommend fewer than 5 hours and may advise you to try it when you’re on leave from work). Once unbroken sleep is achieved, the insomniac can then gradually increase the hours they spend in bed.

Unlike with medication, patients undergoing CBT typically keep improving after they finish, Dr Sweeney says. Patients who complete the course then have techniques to tackle insomnia in case it returns.

Digital CBT programmes that use algorithms to suggest techniques for improving your sleep are also available. Some you’ll have to pay for, such as SHUTi. The Health Navigator website suggests the free CBT-i Coach app, developed by the US Department of Veterans Affairs and Stanford University.

Although Dr Sweeney recommends an in-person approach, she says scientifically validated courses such as SHUTi are great resources for those who don’t have access to a cognitive behavioural therapist.

Alternative remedies

Ask Dr Google for help with your insomnia, and you’ll find recommendations for natural remedies peppered alongside clinically proven therapies.

  • One of the natural remedies de jour is tart cherry. The juices and extracts haven’t been as well studied – and don’t look to be as effective – as CBT techniques. Early trials (such as this one and this one) found tart cherries can improve symptoms of insomnia compared with a placebo, but these studies generally included only a handful of participants and were often industry funded, so aren’t very reliable.

  • Valerian plant extracts have been studied in more detail than cherry juice, but a review of trials showed almost no difference between the herbal remedy and a placebo in the time research participants took to fall asleep.

Sleeping tips

If you’re troubled by a bout of short-term sleeplessness, small changes in your behaviour can make a big difference. Dr Arroll says if you’ve spent the past few nights tossing and turning, try these 7 tips.

  • Wait until you’re drowsy before going to bed
  • Limit screen time and switch off your TV, computer and phone (or at least put it down) an hour before your intended bedtime. Reading, listening to music, making a warm milk drink or taking a bath can put you in the right frame of mind to sleep
  • Avoid caffeine, alcohol and nicotine consumption at night
  • Exercise can improve sleep, but limit vigorous exercise during the evening
  • Ensure your bedroom is comfortable, dark and quiet and limit the things that will disturb you (this includes your partner and pets)
  • Avoid napping during the day or limit naps to no more than 30 minutes and before 3pm
  • If you’re not asleep within 20 minutes, get out of bed and return only when drowsy. Reading or listening to gentle music in a dimly lit room are more likely to help you feel sleepy than tossing and turning, which often builds anxiety.

However, these tips may not help if you have chronic insomnia, which is defined as sleeping problems occurring more than 3 nights a week for at least 3 months. In this case, it’s best to contact a professional such as your GP.

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Member comments

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Neil B.
28 Jul 2018
Something to consider...

I had chronic insomnia after a medical issue. Once the issue was resolved, I still could not get to sleep very easily and could not stay asleep for very long. A good night was 2 or 3 hours.

I tried a variety of things including Cognitive Behavourial Therapy for Insomnia (CBT-i) and supplements, but nothing was working. In fact, CBT-i made my insomnia much worse.

With my doctor I subsequently discovered I had low serotonin, but I did not have the depression or anxiety that often comes together with low serotonin.

I am now using a variety of non-aggressive methods for increasing my serotonin and sleep has been slowly improving over the last 2 weeks.

If you have chronic insomnia it is worth considering if you do have a physical issue. Insomnia is not always just 'in the mind'. Even if it starts in the mind, it can cause real physical issues such as low serotonin which can be a difficult cycle to break out of.

Kevin M.
05 Feb 2018
have a cuppa (Herbal)

If I can't sleep I get up make a cuppa, maybe watch TV or read a book for 30 mins and bingo, problem solved. It beats sitting in bed for hours whilst your head spins....

Margaret D.
03 Feb 2018
Understanding Insomnia

May I recommend the book 'Why We Sleep' by Prof Matthew Walker? It describes sleep and its astonishing effects but also insomnia and factors that contribute to keeping us awake. Published in late 2017 it is based on the latest discoveries. There are comprehensive reviews and videos online. MMD.

Previous member
22 Jan 2018
re: insomnia. Why haven't you mentioned Melatonin?

Melatonin seems to work for many people.
Particularly in slow release form (Circadin).(via prescription from GP in NZ but OTC in USA), This naturally occurring hormone assists some people to fall asleep without forcing you to stay asleep as sleeping pills do,
often that can make the difference to finding deep sleep.
Some generic - often less reliable products are available too. Kids with ASD often find melatonin helpful it seems.

Previous member
23 Jan 2018
Re: re: insomnia. Why haven't you mentioned Melatonin?

Hi Regan,

Thanks for your feedback. There are different kinds of medications prescribed for insomnia: hypnotic drugs such as zopiclone, sedating antidepressants, sedating antipsychotics, as well as melatonin.

Melatonin is a bodily hormone and can help with secondary insomnia, for example the sleep issues of shift workers. However, there’s not a lot of evidence that melatonin is effective for primary insomnia (beyond the placebo effect). On top of this, scientists believe the hormone does more in the body than simply regulate sleep and the effects of long-term use aren’t well known (

Because of this, melatonin is like other types of sleeping pill – experts recommend a patient should try a non-pill approach like cognitive behavioural therapy (CBT) first. Therefore, adults using melatonin may want to try a course of CBT or discuss this avenue with their doctor. I hope this has helped.

Kind regards,
Olivia - Consumer NZ writer

David H.
03 Mar 2018
Melatonin works for me

Melatonin has been working well for me. Thanks for the link to research. I guess I will have to discuss it with my doctor at some point.

Neil B.
28 Jul 2018
Melatonin didn't work for me

I tried melatonin (Circadin) and whilst initially it helped a little bit (not a lot), subsequently I found it made my insomnia worse because it actively kept me awake due to strange feelings in my sinus area.

Whilst melatonin works for some people, it is possibly better used for realigning circadian rhythm rather than insomnia.