Sleep: 12 tips to get a better night's rest

There are several steps you can take to maximise your chances of getting a good night's sleep. In the final part of Professor Robert Thomas's look at sleep, here is an analysis of the benefits - or not - that each may bring.

Specific dietary strategies

Magnesium supplements are one of the most popular over-the-counter sleeping aids despite the lack of robust clinical evidence. One small randomised trial involving people in a nursing home did show that magnesium pills appeared to reduce insomnia and improve melatonin levels. Unfortunately, a summary of nine other randomised controlled trials (RCTs) reported a poor association between magnesium supplementation and sleep disorders.

Interestingly, in a laboratory study, magnesium deficiency was associated with low levels of melatonin and altered sleep patterns. When magnesium levels were improved with dietary supplements, melatonin and sleep improved but this benefit was not seen if magnesium levels were already normal. This suggests that extra dietary magnesium only helps if a person is deficient but not if their levels are normal in the first place. It would be a good idea to incorporate more magnesium, and other essential minerals in the diet with foods such as pumpkin and chia seeds, nuts, beans and shellfish. If you are someone who does not eat these foods regularly, a multiple mineral supplement would be sensible as there is evidence that many of us have deficiencies in one or more essential minerals including magnesium.

Melatonin-Enhancing Foods

Melatonin is made from serotonin, which, in turn, is made from tryptophan. Melatonin can also be produced from other natural precursor chemicals in plants known as phytomelatonins. Morello cherries, pomegranates, and other citrus fruits are rich in both phytomelatonins and tryptophan, ultimately increasing melatonin levels in the body after consumption.

Seafoods, such as oily fish and shellfish, are also rich in tryptophan and have fewer other amino acids that compete with tryptophan to cross the blood-brain barrier, making them particularly good examples of serotonin and melatonin-boosting foods. Seafood is also high in long-chain omega-3 fats, which have been shown to improve general brain health, mood, and, subsequently, help support the body’s circadian rhythm.

Melatonin tablets

These are available over the counter in some countries and can be prescribed in the UK. They have been evaluated in more than 35 randomised controlled trials worldwide. While there were significant benefits for the short term, benefits for longer-term use were not significant. Many conclude that dietary strategies to naturally improve intrinsic melatonin levels would be better, certainly in the longer term.

Chamomile

Chamomile is rich in a phytochemical called apigenin. Chamomile tea has been traditionally used to enhance sleep for years, and more recent studies are investigating techniques to enhance its sleep-promoting, anti-anxiety, and muscle-relaxing properties. Apigenin is also found in parsley, celery seed, and other fruits, including cherries. The amount of apigenin in a cup of tea is thought to be too small to sufficiently cross into the brain and induce sedation, by blocking gamma-aminobutyric acid GABA receptors. GABA is an inhibitory neurotransmitter that promotes relaxation and reduces neural activity, playing a crucial role in the sleep-wake cycle.

Still, studies using concentrated chamomile have shown more convincing benefits. A study using a capsule containing a high concentration of purified chamomile, combined with other phytochemical-rich foods, significantly improved sleep patterns in people suffering from long Covid. Ginger is also rich in phytomelatonins, so a good nightcap would be some grated ginger added to your chamomile tea with a little lemon.

Valerian plant extracts

These have been marketed for sleep problems in products such as Kalms. Valerian is believed to aid sleep through its interaction with the GABA neurotransmitter system in the brain. Valerian root contains compounds that may enhance GABA's effects, leading to a calming and sedative impact. It's essential to note that individual responses to valerian can vary, and its effectiveness may be influenced by factors such as dosage, duration of use, and an individual's unique physiology.

Several RCTs have been conducted, summarised in two large meta-analyses. About half reported a statistically significant benefit, and the other half did not. However, it's essential to note that individual responses to valerian can vary, and its effectiveness may be influenced by factors such as dosage, duration of use, and an individual's unique physiology.

Ashwagandha, an Indian medicinal plant that has been used for centuries to treat insomnia, affects GABA receptors. Like valerian, it can cause hangover effects in some people.

Phytonightplus+ 

This has some of the most recent scientific evidence for improving sleep and reducing day time fatigue, albeit derived from a study involving participants suffering from long Covid. The intervention gave a combination of lactobacillus probiotics and a blend of concentrated whole foods which are rich in a range of melatonin enhancing phytochemicals.

These included pomegranate, citrus sinensis fruit, turmeric, chamomile and resveratrol. Although some of these foods can influence GABA levels, they don't directly cause sedation so have no hangover or additive effects but work in synergy to prepare the body for sleep. They improve mood and relax the mind and body, stimulate melatonin production and promote a regular circadian rhythm. These colourful aromatic plants also have other health benefits which can aid sleep, independent of melatonin.

They act as prebiotics which help support gut health and have anti-inflammatory properties which can help ease joint discomfort at night. The results published in 2022 showed it was very safe and produced a significant improvement in sleep, day time fatigue and other symptoms.

Antihistamines

Antihistamines such as diphenhydramine in Benadryl and doxylamine in Unisom can be purchased over the counter for hay fever or other allergies and can induce drowsiness, which can aid sleep. Side effects include daytime drowsiness, dry mouth, constipation, and urinary retention. There is evidence that they can help for two to three nights at a time, but tolerance to the sedative effects of antihistamines can develop quickly.

As a result, the longer you take them, the less likely they are to be effective. In older adults, confusion, hallucinations, constipation, nausea, impaired sweating, urinary retention, glaucoma, and tachycardia may occur. In the longer term, recent studies have shown that anticholinergics might increase the risk of cognitive decline.

Weighted blankets

These are one of the most popular sleep hacks on social media, and their sales have surged in the past two years, boosted by stars like Kourtney Kardashian, JoJo Fletcher, Jordan Rodgers, and Vanessa Grimaldi who posted on social media that they find them helpful.

They are supposed to work using a technique called 'pressure therapy' that relaxes the nervous system by mimicking being held or hugged. There are really no reputable scientific studies to back up these claims for most healthy adults, but is good evidence for a benefit in improving melatonin levels and sleep patterns in children and adults with anxiety, depressive and bipolar disorders, or attention deficit hyperactivity disorders (ADHD).

Blue light exposure

One of the best ways to set your circadian clock is to be exposed to bright light, ideally sunlight, during the day. In general, try to get as much natural light as possible during the day. Aim to brighten your environment during the day by keeping curtains open and face a window as much as possible.

...but avoid blue light later on

Just as it's important for your body to get the signal that it's daytime during the day, it's crucial to signal to your body that it's night-time once the sun goes down. This means avoiding blue light and sticking with red and yellow wavelengths, as well as keeping the overall light level much lower.

Send this important "darkness signal" to your circadian clock by keeping indoor lighting as dim as possible in the evenings with dimmer switches or by turning on fewer lights. Set the screen brightness on your computer, phones, or tablets to the lowest setting. Once you go to bed, sleep in a completely dark room, cover up any LED lights on phones, toothbrushes, baby monitors, or other gadgets, and ditch nightlights or switch to ones with red light bulbs. If you need to use the loo at night, either learn to navigate in the dark or use as little light as possible.

Tinted glasses

A good biohack is to wear amber-tinted glasses for the last two to three hours of your day. Several scientific studies show that wearing amber-tinted glasses in the evening improves sleep quality and supports melatonin production. A more sophisticated option is to use programmable light bulbs that allow you to set the colour spectrum and brightness for the time of day.

The Sleepy Girl Mocktail

Last but not least, this recent social media trend claims to be helping thousands of people get to sleep worldwide. In its original form, it's an alcohol-free cocktail (mocktail) that combines tart cherry juice, magnesium powder, and a prebiotic soda. Although there are no medical studies to prove this colourful late-night strategy improves sleep patterns, some scientific data suggests it could help some people.

It targets three factors that could affect sleep regulation: magnesium, melatonin, and prebiotics to improve gut health. The evidence that enhancing these could help improve sleep patterns has been highlighted above. However, it does have some shortcomings that would reduce the chance of it working for most people.

The levels of prebiotics in the soda are relatively small and some people are substituting this with sugary soda. The cherry juice itself has had the fibre from the fruit removed which will negate much of its gut health benefits. Most concerningly, it concentrates the sugar in liquid form hence it is easily and rapidly absorbed cause a peak then dip in sugar levels at night. Studies have shown processed sugar in the evening can disrupt sleep patterns. Sugar also adversely affects gut health by feeding the unhealthy bacterial strains so could counterbalance the benefits of the prebiotics. Finally the levels of magnesium in the powder, using a spoon, would be very variable and result in some people having excessive blood levels. As mentioned above it would be better to general increase magnesium rich food throughout the day or even a specifically designed multimineral supplement.