Taking less than just 18 Ambien-class sleeping pills in an entire year may triple the risk of dying prematurely.
How to Get a Good Night’s Sleep Without Sleeping Pills
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Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.
In the Harvard Nurses’ Health Study, women who got five or fewer hours of sleep a night gained about six pounds more over the subsequent 16 years than those getting seven hours a night. Even if that was all due to the difference in sleep, that’s still only six pounds for 10,000+ more hours of sleep. If even a tiny fraction of that time was spent on diet and exercise—biking to the nearest farm stand—more weight could be lost in 16 weeks than in those 16 years. Every little bit helps, though, and getting at least seven hours is healthier for you anyway.
This biggest reason to lose sleep over losing sleep is motor vehicle accident risk. Driving drowsy increases your risk of killing yourself and others. People might think twice about getting behind the wheel after staying awake for 48 hours straight, but even just two weeks of sleeping six hours a night impairs your cognitive performance as much as pulling two all-nighters in a row. So, what’s the best way to sleep better?
Sleeping pills are a nonstarter. Those prescribed even less than 18 pills a year of so-called hypnotics, the class of sleeping pills that includes Ambien, appear to have triple the risk of dying prematurely. Since up to 10 percent of the adult population is prescribed these drugs, if the drugs really are killing people, that could mean a six-figure death toll every year.
Ambien’s manufacturer questioned the study, but that’s just one of dozens of studies that found a significant association between sleeping pills and premature death. When the principal investigator at the Scripps Clinic Sleep Center was criticized for “[r]eporting alarmingly high death risks from these commonly used medications,” he replied: “We cannot hide risks, even if they might frighten patients out of taking hypnotics. Patients have a right to know.”
What’s more, non-pharmacological methods have been found to work as good or better than the drugs. The recommended first-line treatment for insomnia is what’s called “cognitive behavioral therapy,” which combines conditioning techniques to re-associate the bed with sleep and with education surrounding optimal sleep hygiene.
Here are the Four Rules of Sleep Conditioning: #1. Go to bed only when you’re sleepy. #2. Only use the bed for sleep (and sex). No reading, eating, or screen-time. #3. If you can’t fall asleep within about 15–20 minutes, get up, leave the bedroom, and don’t come back until you’re sleepy again. Repeat as necessary. And, #4. Get up at the same time every morning, no matter how little sleep you get. Although avoiding napping is often added, contrary to expectations, the majority of research does not show that daytime naps interfere with nighttime sleep.
If there were four rules of sleep hygiene I’d pick out, it would be:
#1. Exercise regularly. The best time to exercise to improve sleep appears to be four to eight hours before bedtime, though it appears to be a myth that exercising right before bed is somehow disruptive to sleep.
#2. Avoid caffeine, nicotine, and alcohol before bedtime. We used to think as long as you don’t drink caffeine in the evening, it wouldn’t affect sleep, but four cups of coffee’s worth even six hours before bedtime can reduce total sleep time by more than an hour. Even just two cups in the morning, at 7am, can change what your brainwaves look like on EEG that night––though it’s not clear if this has any clinical relevance beyond delaying the onset of sleep by an average of 10 minutes. Late afternoon alcohol consumption (six hours before bedtime) may also impair sleep, even after it’s cleared out of your system. And nicotine, whether from gum, pill, patch, or cigarette, can also have negative sleep effects (though so too can active nicotine withdrawal).
Food-wise, low fiber intake and high saturated fat and sugar intake is associated with lighter, less restorative sleep. Meat intake is associated with napping (suggested as a proxy for sleepiness). This may be one of the reasons insomnia has been reported as a side effect of low carb, ketogenic diets. Supplement-wise, a single megadose of vitamin D was found to improve sleep duration and quality in men and women ages 20 through 50 with sleeping disorders. And, I’ve already talked about melatonin-rich foods and supplements in previous videos.
#3. Make the bedroom quiet, dark, cool, and comfortable. Nocturnal noise can adversely impact sleep even if we’re not consciously aware of it. Within a few days, you can become habituated to noises such that they don’t wake you up, but EEG studies and subjective sleep surveys show the quality of your sleep can still be affected. Thankfully, ear plugs and sound masking (like white noise machines) have been shown to help.
And finally, #4. Establish a relaxing bedtime routine. Relaxation techniques such as massage, mindfulness meditation, and soothing music may also help. So may taking a relaxing hot bath or shower. One of the reasons late-night eating can delay sleep it that it may interfere with the drop in core body temperature that normally occurs about bedtime. That’s thought to be one of the cues that it’s time for bed. So, should you not take a hot bath before bed? No, because as soon as you step out of the bath or shower, the rapid decline in skin temperature can accentuate the natural nighttime drop and improve sleep. Even just a warm footbath may help you fall asleep about 15 minutes faster.
Please consider volunteering to help out on the site.
- Patel SR. Reduced sleep as an obesity risk factor. Obes Rev. 2009;10 Suppl 2:61-68.
- Nielsen LS, Danielsen KV, Sørensen TIA. Short sleep duration as a possible cause of obesity: critical analysis of the epidemiological evidence. Obes Rev. 2011;12(2):78-92.
- Marshall NS, Glozier N, Grunstein RR. Is sleep duration related to obesity? A critical review of the epidemiological evidence. Sleep Med Rev. 2008;12(4):289-298.
- Bioulac S, Micoulaud-Franchi JA, Arnaud M, et al. Risk of motor vehicle accidents related to sleepiness at the wheel: a systematic review and meta-analysis. Sleep. 2017;40(10).
- Van Dongen HPA, Maislin G, Mullington JM, Dinges DF. The cumulative cost of additional wakefulness: dose-response effects on neurobehavioral functions and sleep physiology from chronic sleep restriction and total sleep deprivation. Sleep. 2003;26(2):117-126.
- Kripke DF, Langer RD, Kline LE. Hypnotics’ association with mortality or cancer: a matched cohort study. BMJ Open. 2012;2(1):e000850.
- Pines A. Climacteric commentaries. Better sleep but higher mortality risk. Climacteric. 2012;15(4):401.
- Rabin RC. New worries about sleeping pills. The New York Times. March 12, 2012.
- Kripke DF. Mortality risk of hypnotics: strengths and limits of evidence. Drug Saf. 2016;39(2):93-107.
- Bianchi MT, Thomas RJ, Ellenbogen JM. Hypnotics and mortality risk. J Clin Sleep Med. 2012;8(4):351-352.
- Kripke DF, Langer RD, Kline LE. Do no harm: not even to some degree. J Clin Sleep Med. 2012;8(4):353-354.
- Mitchell MD, Gehrman P, Perlis M, Umscheid CA. Comparative effectiveness of cognitive behavioral therapy for insomnia: a systematic review. BMC Fam Pract. 2012;13:40.
- Qaseem A, Kansagara D, Forciea MA, Cooke M, Denberg TD. Management of chronic insomnia disorder in adults: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2016;165(2):125-133.
- Bjorvatn B, Fiske E, Pallesen S. A self-help book is better than sleep hygiene advice for insomnia: a randomized controlled comparative study. Scand J Psychol. 2011;52(6):580-585.
- Irish LA, Kline CE, Gunn HE, Buysse DJ, Hall MH. The role of sleep hygiene in promoting public health: A review of empirical evidence. Sleep Med Rev. 2015;22:23-36.
- Youngstedt SD, O’Connor PJ, Dishman RK. The effects of acute exercise on sleep: a quantitative synthesis. Sleep. 1997;20(3):203-214.
- Drake C, Roehrs T, Shambroom J, Roth T. Caffeine effects on sleep taken 0, 3, or 6 hours before going to bed. J Clin Sleep Med. 2013;9(11):1195-1200.
- Landolt HP, Werth E, Borbély AA, Dijk DJ. Caffeine intake (200 mg) in the morning affects human sleep and EEG power spectra at night. Brain Res. 1995;675(1-2):67-74.
- Landolt HP, Roth C, Dijk DJ, Borbély AA. Late-afternoon ethanol intake affects nocturnal sleep and the sleep EEG in middle-aged men. J Clin Psychopharmacol. 1996;16(6):428-436.
- Jaehne A, Loessl B, Bárkai Z, Riemann D, Hornyak M. Effects of nicotine on sleep during consumption, withdrawal and replacement therapy. Sleep Med Rev. 2009;13(5):363-377.
- Hayley AC, Downey LA. Quitters never sleep: the effect of nicotine withdrawal upon sleep. Curr Drug Abuse Rev. 2015;8(2):73-74.
- St-Onge MP, Roberts A, Shechter A, Choudhury AR. Fiber and saturated fat are associated with sleep arousals and slow wave sleep. J Clin Sleep Med. 2016;12(1):19-24.
- Grandner MA, Kripke DF, Naidoo N, Langer RD. Relationships among dietary nutrients and subjective sleep, objective sleep, and napping in women. Sleep Med. 2010;11(2):180-184.
- McClernon FJ, Yancy WS, Eberstein JA, Atkins RC, Westman EC. The effects of a low-carbohydrate ketogenic diet and a low-fat diet on mood, hunger, and other self-reported symptoms. Obesity (Silver Spring). 2007;15(1):182-187.
- Majid MS, Ahmad HS, Bizhan H, Hosein HZM, Mohammad A. The effect of vitamin D supplement on the score and quality of sleep in 20-50 year-old people with sleep disorders compared with control group. Nutr Neurosci. 2018;21(7):511-519.
- Xie H, Kang J, Mills GH. Clinical review: The impact of noise on patients’ sleep and the effectiveness of noise reduction strategies in intensive care units. Crit Care. 2009;13(2):208.
- Caldwell JA. Fatigue in the aviation environment: an overview of the causes and effects as well as recommended countermeasures. Aviat Space Environ Med. 1997;68(10):932-938.
- Golem DL, Martin-Biggers JT, Koenings MM, Davis KF, Byrd-Bredbenner C. An integrative review of sleep for nutrition professionals. Adv Nutr. 2014;5(6):742-759.
- Black DS, O’Reilly GA, Olmstead R, Breen EC, Irwin MR. Mindfulness meditation and improvement in sleep quality and daytime impairment among older adults with sleep disturbances: a randomized clinical trial. JAMA Intern Med. 2015;175(4):494-501.
- Feng F, Zhang Y, Hou J, et al. Can music improve sleep quality in adults with primary insomnia? A systematic review and network meta-analysis. Int J Nurs Stud. 2018;77:189-196.
- Brown RF, Thorsteinsson EB, Smithson M, Birmingham CL, Aljarallah H, Nolan C. Can body temperature dysregulation explain the co-occurrence between overweight/obesity, sleep impairment, late-night eating, and a sedentary lifestyle? Eat Weight Disord. 2017;22(4):599-608.
- Sung EJ, Tochihara Y. Effects of bathing and hot footbath on sleep in winter. J Physiol Anthropol Appl Human Sci. 2000;19(1):21-27.
Motion graphics by Avo Media
Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.
In the Harvard Nurses’ Health Study, women who got five or fewer hours of sleep a night gained about six pounds more over the subsequent 16 years than those getting seven hours a night. Even if that was all due to the difference in sleep, that’s still only six pounds for 10,000+ more hours of sleep. If even a tiny fraction of that time was spent on diet and exercise—biking to the nearest farm stand—more weight could be lost in 16 weeks than in those 16 years. Every little bit helps, though, and getting at least seven hours is healthier for you anyway.
This biggest reason to lose sleep over losing sleep is motor vehicle accident risk. Driving drowsy increases your risk of killing yourself and others. People might think twice about getting behind the wheel after staying awake for 48 hours straight, but even just two weeks of sleeping six hours a night impairs your cognitive performance as much as pulling two all-nighters in a row. So, what’s the best way to sleep better?
Sleeping pills are a nonstarter. Those prescribed even less than 18 pills a year of so-called hypnotics, the class of sleeping pills that includes Ambien, appear to have triple the risk of dying prematurely. Since up to 10 percent of the adult population is prescribed these drugs, if the drugs really are killing people, that could mean a six-figure death toll every year.
Ambien’s manufacturer questioned the study, but that’s just one of dozens of studies that found a significant association between sleeping pills and premature death. When the principal investigator at the Scripps Clinic Sleep Center was criticized for “[r]eporting alarmingly high death risks from these commonly used medications,” he replied: “We cannot hide risks, even if they might frighten patients out of taking hypnotics. Patients have a right to know.”
What’s more, non-pharmacological methods have been found to work as good or better than the drugs. The recommended first-line treatment for insomnia is what’s called “cognitive behavioral therapy,” which combines conditioning techniques to re-associate the bed with sleep and with education surrounding optimal sleep hygiene.
Here are the Four Rules of Sleep Conditioning: #1. Go to bed only when you’re sleepy. #2. Only use the bed for sleep (and sex). No reading, eating, or screen-time. #3. If you can’t fall asleep within about 15–20 minutes, get up, leave the bedroom, and don’t come back until you’re sleepy again. Repeat as necessary. And, #4. Get up at the same time every morning, no matter how little sleep you get. Although avoiding napping is often added, contrary to expectations, the majority of research does not show that daytime naps interfere with nighttime sleep.
If there were four rules of sleep hygiene I’d pick out, it would be:
#1. Exercise regularly. The best time to exercise to improve sleep appears to be four to eight hours before bedtime, though it appears to be a myth that exercising right before bed is somehow disruptive to sleep.
#2. Avoid caffeine, nicotine, and alcohol before bedtime. We used to think as long as you don’t drink caffeine in the evening, it wouldn’t affect sleep, but four cups of coffee’s worth even six hours before bedtime can reduce total sleep time by more than an hour. Even just two cups in the morning, at 7am, can change what your brainwaves look like on EEG that night––though it’s not clear if this has any clinical relevance beyond delaying the onset of sleep by an average of 10 minutes. Late afternoon alcohol consumption (six hours before bedtime) may also impair sleep, even after it’s cleared out of your system. And nicotine, whether from gum, pill, patch, or cigarette, can also have negative sleep effects (though so too can active nicotine withdrawal).
Food-wise, low fiber intake and high saturated fat and sugar intake is associated with lighter, less restorative sleep. Meat intake is associated with napping (suggested as a proxy for sleepiness). This may be one of the reasons insomnia has been reported as a side effect of low carb, ketogenic diets. Supplement-wise, a single megadose of vitamin D was found to improve sleep duration and quality in men and women ages 20 through 50 with sleeping disorders. And, I’ve already talked about melatonin-rich foods and supplements in previous videos.
#3. Make the bedroom quiet, dark, cool, and comfortable. Nocturnal noise can adversely impact sleep even if we’re not consciously aware of it. Within a few days, you can become habituated to noises such that they don’t wake you up, but EEG studies and subjective sleep surveys show the quality of your sleep can still be affected. Thankfully, ear plugs and sound masking (like white noise machines) have been shown to help.
And finally, #4. Establish a relaxing bedtime routine. Relaxation techniques such as massage, mindfulness meditation, and soothing music may also help. So may taking a relaxing hot bath or shower. One of the reasons late-night eating can delay sleep it that it may interfere with the drop in core body temperature that normally occurs about bedtime. That’s thought to be one of the cues that it’s time for bed. So, should you not take a hot bath before bed? No, because as soon as you step out of the bath or shower, the rapid decline in skin temperature can accentuate the natural nighttime drop and improve sleep. Even just a warm footbath may help you fall asleep about 15 minutes faster.
Please consider volunteering to help out on the site.
- Patel SR. Reduced sleep as an obesity risk factor. Obes Rev. 2009;10 Suppl 2:61-68.
- Nielsen LS, Danielsen KV, Sørensen TIA. Short sleep duration as a possible cause of obesity: critical analysis of the epidemiological evidence. Obes Rev. 2011;12(2):78-92.
- Marshall NS, Glozier N, Grunstein RR. Is sleep duration related to obesity? A critical review of the epidemiological evidence. Sleep Med Rev. 2008;12(4):289-298.
- Bioulac S, Micoulaud-Franchi JA, Arnaud M, et al. Risk of motor vehicle accidents related to sleepiness at the wheel: a systematic review and meta-analysis. Sleep. 2017;40(10).
- Van Dongen HPA, Maislin G, Mullington JM, Dinges DF. The cumulative cost of additional wakefulness: dose-response effects on neurobehavioral functions and sleep physiology from chronic sleep restriction and total sleep deprivation. Sleep. 2003;26(2):117-126.
- Kripke DF, Langer RD, Kline LE. Hypnotics’ association with mortality or cancer: a matched cohort study. BMJ Open. 2012;2(1):e000850.
- Pines A. Climacteric commentaries. Better sleep but higher mortality risk. Climacteric. 2012;15(4):401.
- Rabin RC. New worries about sleeping pills. The New York Times. March 12, 2012.
- Kripke DF. Mortality risk of hypnotics: strengths and limits of evidence. Drug Saf. 2016;39(2):93-107.
- Bianchi MT, Thomas RJ, Ellenbogen JM. Hypnotics and mortality risk. J Clin Sleep Med. 2012;8(4):351-352.
- Kripke DF, Langer RD, Kline LE. Do no harm: not even to some degree. J Clin Sleep Med. 2012;8(4):353-354.
- Mitchell MD, Gehrman P, Perlis M, Umscheid CA. Comparative effectiveness of cognitive behavioral therapy for insomnia: a systematic review. BMC Fam Pract. 2012;13:40.
- Qaseem A, Kansagara D, Forciea MA, Cooke M, Denberg TD. Management of chronic insomnia disorder in adults: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2016;165(2):125-133.
- Bjorvatn B, Fiske E, Pallesen S. A self-help book is better than sleep hygiene advice for insomnia: a randomized controlled comparative study. Scand J Psychol. 2011;52(6):580-585.
- Irish LA, Kline CE, Gunn HE, Buysse DJ, Hall MH. The role of sleep hygiene in promoting public health: A review of empirical evidence. Sleep Med Rev. 2015;22:23-36.
- Youngstedt SD, O’Connor PJ, Dishman RK. The effects of acute exercise on sleep: a quantitative synthesis. Sleep. 1997;20(3):203-214.
- Drake C, Roehrs T, Shambroom J, Roth T. Caffeine effects on sleep taken 0, 3, or 6 hours before going to bed. J Clin Sleep Med. 2013;9(11):1195-1200.
- Landolt HP, Werth E, Borbély AA, Dijk DJ. Caffeine intake (200 mg) in the morning affects human sleep and EEG power spectra at night. Brain Res. 1995;675(1-2):67-74.
- Landolt HP, Roth C, Dijk DJ, Borbély AA. Late-afternoon ethanol intake affects nocturnal sleep and the sleep EEG in middle-aged men. J Clin Psychopharmacol. 1996;16(6):428-436.
- Jaehne A, Loessl B, Bárkai Z, Riemann D, Hornyak M. Effects of nicotine on sleep during consumption, withdrawal and replacement therapy. Sleep Med Rev. 2009;13(5):363-377.
- Hayley AC, Downey LA. Quitters never sleep: the effect of nicotine withdrawal upon sleep. Curr Drug Abuse Rev. 2015;8(2):73-74.
- St-Onge MP, Roberts A, Shechter A, Choudhury AR. Fiber and saturated fat are associated with sleep arousals and slow wave sleep. J Clin Sleep Med. 2016;12(1):19-24.
- Grandner MA, Kripke DF, Naidoo N, Langer RD. Relationships among dietary nutrients and subjective sleep, objective sleep, and napping in women. Sleep Med. 2010;11(2):180-184.
- McClernon FJ, Yancy WS, Eberstein JA, Atkins RC, Westman EC. The effects of a low-carbohydrate ketogenic diet and a low-fat diet on mood, hunger, and other self-reported symptoms. Obesity (Silver Spring). 2007;15(1):182-187.
- Majid MS, Ahmad HS, Bizhan H, Hosein HZM, Mohammad A. The effect of vitamin D supplement on the score and quality of sleep in 20-50 year-old people with sleep disorders compared with control group. Nutr Neurosci. 2018;21(7):511-519.
- Xie H, Kang J, Mills GH. Clinical review: The impact of noise on patients’ sleep and the effectiveness of noise reduction strategies in intensive care units. Crit Care. 2009;13(2):208.
- Caldwell JA. Fatigue in the aviation environment: an overview of the causes and effects as well as recommended countermeasures. Aviat Space Environ Med. 1997;68(10):932-938.
- Golem DL, Martin-Biggers JT, Koenings MM, Davis KF, Byrd-Bredbenner C. An integrative review of sleep for nutrition professionals. Adv Nutr. 2014;5(6):742-759.
- Black DS, O’Reilly GA, Olmstead R, Breen EC, Irwin MR. Mindfulness meditation and improvement in sleep quality and daytime impairment among older adults with sleep disturbances: a randomized clinical trial. JAMA Intern Med. 2015;175(4):494-501.
- Feng F, Zhang Y, Hou J, et al. Can music improve sleep quality in adults with primary insomnia? A systematic review and network meta-analysis. Int J Nurs Stud. 2018;77:189-196.
- Brown RF, Thorsteinsson EB, Smithson M, Birmingham CL, Aljarallah H, Nolan C. Can body temperature dysregulation explain the co-occurrence between overweight/obesity, sleep impairment, late-night eating, and a sedentary lifestyle? Eat Weight Disord. 2017;22(4):599-608.
- Sung EJ, Tochihara Y. Effects of bathing and hot footbath on sleep in winter. J Physiol Anthropol Appl Human Sci. 2000;19(1):21-27.
Motion graphics by Avo Media
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How to Get a Good Night’s Sleep Without Sleeping Pills
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Is Six Hours of Sleep Enough? See the video to find out.
My videos on melatonin are How to Treat Jet Lag with Melatonin-Rich Food and Are Melatonin Supplements Safe?.
You may also be interested in How Much Sleep Is Needed for Glymphatic Flow (Brain Cleaning)? and The Best Sleeping Position for Glymphatic Flow in the Brain.
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