Better Than Ambien

A new book argues sleeping pills aren’t the answer to chronic insomnia. Instead, a simple, natural trick works better.

A teddy bear on a bed surrounded by pillows
Phil Noble / Reuters

There was a time not long ago when this reporter was, shall we say, stretched a bit thin. At night, she lay in her bed, which was covered with laundered and not-yet-folded yoga pants, attempting to gain respite. Yet none would come. Instead, she would play mental chess with various cost-benefit analyses, or she would arrange and rearrange her mental to-do list, as though, like so much broccoli under a pile of mashed potatoes, moving it around a bit would make it disappear.

Then, this reporter remembered that there was probably some old Ambien in the Khazan Khouse somewhere. She fished it out from that one nightstand drawer, and popped one.

And, she slept ... or something. She definitely had her eyes closed for seven hours, which was not like what had been happening any of the other nights that week. But the sleep was also not what one would typically call sleep, per se. The next day, she was not filled with the same vim and vigor that normally course through her as she pursues the Truth in the halls of power. Instead, she was kind of out of it.

At last comes an explanation: According to the new book Why We Sleep, by Matthew Walker, the director of the Sleep and Neuroimaging Lab at the University of California, Berkeley, the sleep people get on sleeping pills like Ambien is not true sleep. Drugs like these simply “switch off the top of your cortex, the top of your brain,” he explained to New York Magazine, “and put you into a state of unconsciousness.” That’s not sleep; that’s cryogenics. According to Walker, sleeping-pill sleep doesn’t have the same restorative powers—and there are lots, from an immune boost to emotional resilience—as good, old-fashioned zzzzs.

Sleeping pills don’t even seem to work all that well. It’s true that some people say they fall asleep faster and sleep better on pills. But, as Walker writes, there’s little difference between the amount of time it takes someone to fall asleep with the help of a pill, compared to a placebo. Even a newer drug, suvorexant, only helps people fall asleep four to eight minutes faster, according to one study he describes.

In addition to causing daytime grogginess, Walker argues, Ambien impairs memory and increases the risk of cancer and death. “Do you feel differently about using or continuing to use sleeping pills having learned about this evidence?” he asks the reader. This reporter does.

Luckily, there is a better way. Walker recommends something known as CBT-I, or cognitive behavioral therapy for insomnia. A major part of it is proper “sleep hygiene”—well-known advice like keeping the bedroom dark and cold, using your frigid cave-bed only for sleep and sex, and turning off anything that emits light a few hours before bed. But another element, paradoxically, involves purposefully getting less sleep than you might want to—at least at first.

This process, called sleep restriction, involves setting a wake-up time and hitting it at the same time every day (no snoozing—snoozing is also bad). Then, you only go to bed when you’re very sleepy—say six hours before the wake-up time. If you successfully sleep through the night, you gradually allow yourself to go to bed a few minutes earlier, until you’re sleeping the amount you want to.

“By keeping patients awake for longer, we build up a strong sleep pressure,” Walker writes. That means adenosine, a chemical that builds up in our brains throughout the day and gradually makes us sleepy, has more time to accrue and lull the body naturally to slumberland.

Some meta-analyses have found that behavioral therapies like these actually work better than pills, and now, CBT-I is considered the first-line treatment for chronic insomniacs.

There are other psychological hacks to curing insomnia, most of which are targeted at easing the oh-god-I’m-going-to-be-so-wrecked-at-the-meeting-tomorrow dread that comes with lying awake at night. For example, the Mayo Clinic also recommends remaining “passively awake,” or “avoiding any effort to fall asleep,” so you can finally stop worrying and, you know, go to sleep. Your mind, it seems, can be a toddler, so sometimes you have to tell it that sleep is yucky and there’s nothing more fun than staying awake all night.

Of course, some of these hacks work better if you can practice them with a sleep therapist, which the low-income people who are likeliest to be sleep-deprived are less likely to have access to. For this population and others, sleeping pills might actually work faster and be easier to come by. But according to Walker, just like sleep deprivation, their side effects catch up with you in the long run.