This chapter provides information on some substances that are not exactly “pills” but they are often marketed as sleep aids. They include over-the-counter products, natural health products including herbal remedies, and cannabis. Over-the-counter sleep aids do not require a prescription and they are quite widely available through pharmacies. If a person has seasonal allergies, these medications may help them sleep on those nights when their allergy symptoms would otherwise disturb their sleep. Natural health products may help induce sleepiness and help some people who have mild difficulty falling asleep, and who are otherwise healthy (having no medical or mental health problems). There are several downsides of using recreational cannabis for sleep. Regular use of any form of cannabis can lead to dependence and difficult withdrawal symptoms including irritability, insomnia, depression and anxiety. Importantly, it can impair brain function, especially in people under age 21, whose brains are still developing.

Often people who are starting to improve their sleep worry that their progress is only temporary and that poor sleep will return. If a person had insomnia for several years, he/she may be especially prone to this fear of relapse. Maintenance starts with reminding oneself that they have acquired new knowledge about their sleep and mastered the strategies that improve it. This is very important to remember; it means that one will never be back at square one. This chapter provides some very practical steps to anticipate what could happen. Once a person knows the strategies for improving sleep he/she can use them as needed.

Surveys from all over the world show that people who have medical conditions are especially likely to have sleep problems. A medical condition can lead to a sleep problem, and a sleep problem can lead to a medical condition. Each can exacerbate the other. There is a particularly strong link between chronic pain and sleep difficulty. Most people with chronic pain have insomnia. Research shows that cognitive behavioral therapy for insomnia improves the sleep of people who have heart disease and insomnia. People with lung cancer and women with breast cancer are especially likely to experience sleep difficulty. People who experience seasonal allergies are more likely than other people to have insomnia, to snore and to have sleep related breathing problems. The chapter also summarizes some of the findings about sleep when a person has Alzheimer’s disease, Parkinson’s disease, or multiple sclerosis.

This chapter comes up with two numbers that are essential for Sleep Therapy. Sleep Therapy combines the most effective components of Cognitive Behavioral Therapy for Insomnia (CBT-I); it involves tailoring bedtime and rise time for sleep needs, and associating bed with great sleep. Knowing the numbers will allow one to tailor their sleep improvement procedures. The first number is one’s “total sleep time”, which is how much sleep they are getting now. The second number is “sleep efficiency”, which is how solid their sleep is. One can use their baseline sleep diary to estimate fairly accurately their baseline values for total sleep time and sleep efficiency. The chapter shows how to estimate one’s baseline sleep duration, based on a night from their sleep diary.

Sleep is increasingly being recognized as the third pillar of health, along with nutrition and exercise. All three health behaviors (yes, sleep can be considered a behavior) interact with one another. If our sleep is good, we are more likely to eat well, to exercise and to be healthy. This chapter shares some fascinating new research findings about these interrelationships. Sex has rarely been discussed in relationship to sleep. The chapter examines what we know, or don’t know, about this relationship. Men with these sleep disorders have high rates of erectile dysfunction. A recent online survey revealed that worse sexual functioning was linked with worse sleep. Looking from a positive perspective, this also means that those with better sexual functioning experienced better sleep. Just as with nutrition and exercise, sexual functioning is related to sleep bidirectionally: each influences the other.

This chapter summarizes the strategies of sleep therapy in 6 specific steps. The steps of sleep therapy appear to be simple, but they require some time and effort. The most important factor that determines whether their sleep will improve is the consistency with which one follows the steps. The chapter discusses fifth and sixth steps. Fifth step is if sleepiness is overwhelming, one may take a short nap (set aside no longer than 45 minutes) in the afternoon, between 1:00 and 4:00 p.m. Many programs recommend that one avoid daytime naps entirely because naps may make it harder to sleep at night. While this is partially true, one also knows that humans are biologically predisposed to have a nap in the afternoon if circumstances permit. Sixth step is maintaining a sleep diary. Keeping a sleep diary will show how one’s sleep improves as a result of their actions.

This chapter discusses the advantages and disadvantages of the current medications that are used for sleep. If a doctor prescribes a medication to help one sleep, it is most likely to be a benzodiazepine receptor agonist (BzRA). If one needs sleep immediately, BzRAs will most likely help. Sometimes, instead of prescribing a BzRA for sleep, physicians prescribe a low dose of an antidepressant or antipsychotic medication. For people who are depressed, the sedating antidepressants can improve sleep, more so than some other classes of antidepressants. Standard (immediate-release) melatonin can sometimes be useful for prevention of east-bound jet lag and for certain shift work schedules, and it may be helpful in the short term (up to 1–2 weeks) for sleep difficulty. Orexin is a neuropeptide that is involved in the regulation of wakefulness and sleep as well as other functions such as appetite regulation.

Years of research have revealed that certain techniques reliably lead to improved quality and quantity of sleep and increased satisfaction with sleep. Together these techniques can be called “cognitive behavioral therapy for insomnia” (CBT-I). In the mid-1990s two important reports were published on these techniques. These reports were based on meta-analyses. In a meta-analysis, the research data from many studies of a given treatment are carefully combined to provide the overall story on the treatment’s usefulness. In these particular meta-analyses, the authors reviewed studies that had compared CBT-I techniques with no treatment or with a placebo treatment. Research shows that CBT-I is useful even if one have some mild to moderate symptoms of anxiety or depression, or some long-lasting medical problem like chronic pain or cancer. This book shows how to deal with and overcome insomnia if one has insomnia that has lasted longer than 4 weeks.

This chapter explains two essential elements form Sleep Therapy, which are based on sleep science and psychology principles. Many people find this background intriguing. What’s more, it is always easier to carry out techniques when one understands how they work. The elements of Sleep Therapy are: uncovering one’s natural sleep processes and associating one’s bed with sleep. By understanding how sleep comes and goes in the natural state one can see more clearly how to restore healthy sleep. Good sleep comes when our biological sleep processes can operate without interference. Associating one’s bed with sleep element of Sleep Therapy is based on something called “conditioning” or “learned associations”. These are connections one make in their mind (automatically) between two things that occur together on several occasions.