You have been lying awake for hours, or at least it feels like it. You are desperate for sleep, but it just won't come. In the medicine cabinet are some sleeping tablets your doctor gave you, but the media has been full of warnings that they aren't safe. A paper published last week in the journal BMJ Open looked at 10,500 people who had taken sleeping tablets and compared them to similar people who had not taken medication. It found that people who took pills twice a month or more are nearly four times as likely to die early as those who don't. So should you bin the sleeping pills or take a couple to break the cycle of insomnia? After all, being sleep deprived makes you miserable, knackered and liable to crash the car.

The solution

The research paper showed an association with an increased risk of dying early even for people taking small numbers of sleeping tablets (fewer than 18 pills a year). Taking more than 132 pills a year was associated with increased risks of lymphoma, lung, colon and prostate cancer. However, an association only means that there may be a link – the paper doesn't prove that sleeping tablets are the cause of people dying earlier. But sleeping pills do have side-effects, such as causing day-time sleepiness and affecting short-term memory.

Even so, some doctors will suggest that you try these medicines to help you break a cycle of insomnia. Taking them for three to five days is usually enough to get back into a habit of sleeping normally. You should not use them routinely because of the risk of addiction. There is also evidence that melatonin (a hormone that controls your body clock) helps you get to sleep and sleep longer, but you will need a prescription for it.

It is easy to get worked up about not sleeping, but often your body will sort it out over a few days. It can be normal to take up to 20 minutes to doze off, so you should be realistic and not get anxious if you don't drop off immediately. Practice what doctors call "sleep hygiene", which means avoiding stimulants such as caffeine, nicotine or alcohol in the late evening, or looking at a computer screen before you go to sleep. You should start winding down in the hour before bed and make sure your bedroom is quiet, dark and comfortable.

There is some evidence that cognitive behavioural therapy (CBT), which involves thinking positively instead of fretting about not going to sleep, is effective. There is no good evidence that herbal remedies such as valerian work. Although acupuncture may improve the quality of sleep, it doesn't help you to nod off.