Insomnia and your thinking

When you live with insomnia, it is very easy for your thoughts about sleep to become worried and negative.

Common examples are: “If I don’t sleep 8 hours, tomorrow will be a disaster” or “It’s 2am again, I’ll never fix this.”

Watching the clock and checking the time over and over usually makes these thoughts louder and keeps your brain more alert.

Over time, your bed can start to feel like a place of stress rather than rest, which then makes it even harder to drift off.

Part of improving sleep is gently noticing these unhelpful thoughts, stepping out of the clock‑watching habit, and rebuilding a calm, predictable sleep routine.

Practical sleep hygiene steps

These habits are a good first step before thinking about sleeping tablets, and they work best when you stick with them most days.

1. Go to bed and get up at about the same time every day, including weekends.

2. Only go to bed when you feel sleepy, rather than lying awake for long periods.

3. If you are awake for around 20 minutes, get up, sit somewhere quiet and dim, do something boring or calming, and go back to bed when sleepy.

4. Keep the bed just for sleep and sex – avoid TV, phones, laptops, eating or paying bills in bed.

5. Avoid caffeine (coffee, strong tea, energy drinks, cola, chocolate) and nicotine for 4–6 hours before bed.

6. Avoid alcohol in the evening; it may help you nod off but it disrupts sleep later in the night.

7. Try not to nap; if you must, keep it under 30–45 minutes and before 3pm.

8. Create a wind-down routine for the last 30–60 minutes before bed – gentle stretches, breathing exercises, or a warm caffeine‑free drink.

9. Consider a warm bath or shower 1–2 hours before bedtime to help your body wind down as your temperature drops again.

10. Turn the clock away from you and avoid checking the time overnight.

11. Keep the bedroom dark, quiet, a little cool, and comfortable; use curtains, an eye mask or earplugs if needed.

12. Be active during the day, but avoid vigorous exercise in the last 3–4 hours before bed.

13. Eat a balanced diet, avoid large late‑night meals, and if needed have a light snack before bed so you are not too hungry.

14. Try to keep your daytime routine as normal as possible, even after a bad night, so you do not strengthen the “sick role” around sleep.

15. For a week or two, you can use a simple sleep diary to track patterns and see what helps, then put the diary away so you are not clock‑watching long‑term.

Medications for insomnia

Before we talk about medication, I always remind my patients that sleeping tablets are rarely the first‑line treatment for insomnia. Building strong sleep hygiene, practicing meditation and trying structured programs like Cognitive Behavioural Therapy for Insomnia (CBT-i) are almost always safer, more effective, and provide much better long-term results.

Medications generally don't fix the underlying cause of poor sleep, but there are times when a short course might be appropriate to help you break a bad cycle. If we do decide to explore this route together, here is a general guide to the options we might discuss, from the mildest to the strongest:

1. Simple supplements (e.g., Magnesium, Valerian): These are gentle, natural options that help relax the nervous system. They are generally very safe, though occasionally people report mild stomach upset or vivid dreams.

2. Behind-the-counter antihistamines (e.g., Doxylamine): Available at the pharmacy, these work by causing drowsiness. While they can help you nod off, they often cause a "hangover" effect, leaving you feeling groggy the next day, and can also cause a dry mouth or mild dizziness.

3. Melatonin: This is a synthetic version of the sleep hormone your brain naturally produces. It is particularly good for resetting your body clock or helping you fall asleep. Side effects are usually mild but can include daytime sleepiness, headaches, or unusual dreams. In Australia, there're currently two forms registered under the TGA: Slow release (Circadin), and Immediate release (Voquily) which also now comes in a liquid form.

4. Sedating antidepressants (e.g., Amitriptyline, Mirtazapine, Agomelatin): We sometimes use very low doses of these medications because they have a strong sedating effect. They can be quite helpful, especially if your sleep issues are tied to low mood, anxiety or chronic pain. Common side effects include morning grogginess, dry mouth, and sometimes an increased appetite or weight gain.

5. Benzodiazepines (e.g., Temazepam, Serepax): These are traditional, strong sleeping pills. They are generally only prescribed these for a short-term use (usually just a few days-weeks) during times of acute stress. While they put you to sleep quickly, they carry a high risk of tolerance—meaning your body quickly gets used to them and needs a higher dose—as well as risks of dependence, daytime drowsiness, memory issues, and a higher risk of falls.

Newer sleep medications (e.g., Belsomra / Dayvigo): These newer drugs work in a completely different way; instead of sedating your brain, they block the specific chemical pathway that keeps you awake (called Orexin). They can be effective, but possible side effects include next-day sleepiness, vivid dreams, and in rare cases, sleepwalking or sleep paralysis.

Resources:

- Sleephealthfoundation.org.au

- cci.health.wa.gov.au --> Resources --> looking after yourself --> Sleep (worksheet)

- ThisWayUp.org.au - look for insomnia online modules

- blackdoginstitute.org.au --> Sleep Ninja app

- medication apps: Smiling Mind, Headspace, Medito, Calm