Our recommendation: go to a really good doctor who is well versed in the latest research.

Here is why.

First off, sleeping pills do not really work!

• On average sleeping pills reduce the time taken to fall asleep by less than 13 minutes!
• You only sleep 11 minutes longer than you would have without taking them.
• For many people the quality of sleep obtained using sleeping pills is not satisfactory.

Source: 2007 NIH Study, quoted in New York Times “Sleep drugs found only mildly effective, but wildly popular”

Next up: there are side-effects

• There are side-effects, which include memory loss, dizziness, reduced cognitive capacity, being dozy the day after use, and rebound insomnia.
• There are potentially dangerous interactions with other drugs, or alcohol.
• Traveller’s amnesia.  Some passengers who have taken sleeping pills to cope with jet lag have got lost or forgotten where they were!

Finally, they may kill you, even when used for only a short period

• Sleeping pill users have 3.6 times the risk of early death, even with fewer than 18 pills prescribed per year.  This also applies to new generation short-acting drugs like Eszopiclone, Zaleplon and Zolpidem.
• Up to 35% greater risk of cancer.

Source: Kripke DF, Langer RD, Kline LE. Hypnotics’ association with mortality or cancer: a matched cohort study. BMJ Open 2012;2:e000850. doi

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This advice is intended for longhaul flights.  For shorter flights you are pretty much on your own and sleep is unlikely because your fellow travellers are probably not going to be sleeping and that means that the environment will be noisier, brighter and you are not going to be able to recline your seat.

Sleep factors

The following factors affect sleep wherever you are, on terra firma, or up in the sky:

• Clothing
• Temperature/drafts
• Light
• Motion
• Noise
• Being horizontal
• Movement
• Time-table

Each of these has an acceptable range and unless you are utterly exhausted, they need to be within your personal preferences for you to be able to sleep.

Clothing

Few sober people regularly sleep in the sort of clothing that they will wear on the plane and if you normally sleep au naturel then you have lost entirely.

Pyjamas are NOT acceptable wear unless you have your own private room/cabin (but let’s face it: if you have your own private room/cabin you will have few, if any, of the problems documented here).  However, a tracksuit offers many of the advantages of pyjamas and it is acceptable, so that is a real option.  There is an additional advantage of a tracksuit – they usually have a drawstring, so you will be spared the awkwardness of having to hold up your pants with one hand when you pass through the security-check.

Whatever your choice, you want clothing that is not too tight.

Temperature/drafts

Here you start to lose control.  If you need a cool room for sleeping then you can only hope that the temperature is acceptable.  You can warm up by using blankets, which the cabin crew will provide.

One traveller known to us always takes “my oldest pale pink pashmina, which doubles as a blanket; and cashmere flight socks” in order to ensure that she is warm enough.

You have some ability to control the flow of fresh air, if the overhead controls are working.  But if you need absolutely still air you lose – the aircraft circulates the air and you are going to get a steady downdraft of air throughout the flight.

Light

Your only reliable recourse is to wear a sleep mask, which are usually provided by the airline.  The good thing is that they really work, so this is one sleep factor that you really can succeed with.

Motion

You have no control over this factor at all.  Air is a fickle medium and there will always be some bouncing around in the sky.  For the most part many people find that this is not bad for sleep, unless the movement gets jerky, or you hit significant turbulence.

If you have unruly brats or a boor behind you then you may suffer the misfortune of being kicked from behind.  Your best option is to complain to the cabin crew, who can speak to the miscreant, or possibly move you to an empty seat.

Noise

No matter where you sit on the aircraft there will be a problem with noise, even in business class.  The difference in noise levels between different places in the aircraft is minimal.

You can block some of it out with headphones or ear plugs.  Some people find it useful to play music.  It cannot drown out the engine sounds, but it at leasts gives the brain something to focus on.

More expensive headphones have active noise cancellation, which uses out-of-phase sound to cancel incoming noise.  (It listens to the ambient sounds through a little microphone.)  This does not make it completely quiet but makes an immediate difference to the amount of disturbing low-frequency sounds.

Being horizontal

If you are travelling in coach, you lose.  Seats in front of emergency rows, and the back row of seats in front of a bulkhead, cannot even recline.  Some people manage to fall asleep in front of the television at home.  That skill will come in useful on board.  Unfortunately, while the cheapest livingroom chair is comfortable, for some reason aerospace engineers lack the wit to design comfortable seats.

If you cannot sleep in the seated position then you lose again.  One of my travellers who is over six feet tall complained that on a recent longhaul flight the only posture he could find to nap in was leaning forward, with his face pushed into the back of the seat in front of him.  It must surely only be a matter of time before large men bring class-action lawsuits against the aircraft manufacturers and operators.

If you are short and there is an empty row of seats then you may be permitted to stretch out across them.  You win!  (You may have to pinch a few extra pillows to place over the seat buckles.)

Movement

It is a very basic observation of sleep-science that people turn over, spread out and move during their sleep.  This is entirely ignored by the airlines and you are strapped into your seat, immobile.  The more active you are when asleep or the more you tend to spread out, the worse this factor will be for you.

Some people also fall over sideways when they sleep.  If that affects you, you can try out a window seat, then direct your slump towards the window so you do not inconvenience the person next to you.

If your head flops about then you can use one of those inflatable horse-shoe-shaped pillows.

Time-table

On a long-haul flight you cannot sensibly decide your own bed-time.  When you are on a plane the time-table is controlled by the staff and your fellow passengers.  Irrespective of your plans to acclimatise yourself to the time zone of your destination, you will find it easer to go with the flow in terms of what happens when.

Don’t try to fight the time-table.  You will just get grumpy and be a nuisance to your neighbours.  And that will make sleep even harder than ever.

Consolation – Naps

If you are able to sleep then by all means sleep.  If you cannot sleep, nap.  If you cannot nap, rest.  If you cannot rest, move around a bit and get some mild exercise.  Your aim is not to torment yourself with trying to force yourself to sleep when your circumstances are such that you are not able to do so.

A number of people who claim that they “did not sleep a wink” none-the-less manage to have a number of short naps.  While they may not have managed deep sleep, successful naps may be all that they needed to be fully functional the next day.