How to Get Sleep

Drink milk.

Sleep is one of the commonest problems people see their doctor with. One study identified as many as a third of general practitioner attendees had concerns with chronic insomnia. It is a universal experience, but one which is as mysterious regarding its purpose as to how to treat it. It certainly is a difficulty for parents with young children, and there have been concerns regarding its overuse in Australia for children.

There are two major issues with sleep. One of them, is that it is a common endpoint for almost every mental illness. Depression, mania, anxiety, even psychosis – these are all classically described as being associated with sleep difficulties. Given that the odds are that you may have sleep problems, I might point out that a sleep issue does not mean a mental illness per se, only that if it is difficult to treat there is a higher likelihood – i.e., see your doctor if symptoms persist (sorry).

The second issue is the high risk of addiction with almost any prescribed – and many over the counter – hypnotic agents. I’m aware of at least three commonly prescribed agents, all of which were promoted initially with a marketing spiel describing it as the “first non-addictive sleep agent”. I’m still waiting on that promise.

Which brings me to milk.

I work as an old age and general adult psychiatrist – meaning I see a lot of people with long term difficulties with sleep (for my older patients, this can be decades). Back when I was a training registrar, I had the good fortune of working in a small rural acute inpatient unit, that had some of the most unwell patients around. These were huge blokes with more tattoos than teeth, and were veterans of pretty much any prescribed – and nonprescribed – substance you could name. Nothing we gave them would work at night time short of the most powerful (and dangerous) sedatives, but what I saw work with regularity, was hot milk with cinnamon. There is very little that compares to the sight of a giant biker who could snap you in half peacefully sleeping off a prescription of dairy.

The literature seems to support this. A recent systematic review of 14 studies identified milk being associated with improving sleep quality. Researchers are divided as to how it works – there is tryptophan and melatonin in the average glass of milk, but it’s questionable as to how relevant the dosing is. There is anecodotal support for the temperature, with some suggesting that the warmth of the milk may increase internal body temperature, leading to a cascade of operations (https://www.livescience.com/does-warm-milk-help-sleep) that helps relax the body.

In my practice, I ask my patients to plan for sleep with a night time ritual, warming up half a cup of milk in the microwave and experimenting with timing so that it’s hot but not undrinkable. Some prefer nutmeg, but I suggest a minor dash primarily for flavour. Lactose-free alternatives seem to work, but I recommend against soy milk, because I can’t stand the stuff. The cup should be drunk immediately before they go to bed, and then other sleep hygiene elements come in (quiet room, no blue lights or devices, slightly lower temperature, etc.) Invariably my newer patients blink at me, wondering why they’re paying my gap.

I have about a 30% success rate with milk as a sleep aid, and I’ve had patients addicted to benzodiazepines for years who successfully weaned off them via milk. It’s probably not the most cutting edge thing I can prescribe, but if it worked for those giant bikies, there’s a good chance it’ll work for you.