*Nothing in this article constitutes medical advice. Seek the guidance of a physician if you have any questions.*
According to the NIH, roughly 30% of Americans complain of sleep disruption. Furthermore, 10% of Americans “have associated symptoms of daytime functional impairment consistent with the diagnosis of insomnia.” About 1 in 3 older Americans take some form of medication to help them fall asleep at night, and some of these individuals take over the counter (OTC) sleep medications. When used properly, these medications can be massively beneficial in correcting sleep patterns and schedules.
Who Needs Sleep Aids?
Ultimately, sleep aids are used to treat insomnia. According to the Mayo Clinic, insomnia is a condition in which it is “hard to fall asleep, hard to stay asleep, or cause you to wake up too early and not be able to get back to sleep.” You should contact your doctor if you think you may have insomnia. Some symptoms include:
- Trouble falling asleep at night
- Waking up too early
- Waking up during the night
- Not feeling properly-rested after a night's sleep
- Fatigue or tiredness during the day
- Irritability, depression, or anxiety
- Ongoing worries about sleep
There are many causes of insomnia. Let’s take a look at just a few:
- Stress: This is one of the most commonly reported causes of insomnia. Whether the stress is related to work, school, family, relationships, or generalized anxiety, stress can be a major detractor from overall sleep quality.
- Poor sleep habits: Many factors that contribute to an irregular sleep pattern constitute “poor sleep habits.” Examples include irregular bedtime, irregular wake time, too much TV or screen time before bed, caffeine or drug use before sleeping, or even eating before bed.
- Sleep-related disorders: It is possible that a secondary disorder or disease could be a contributing factor to an individual’s insomnia. Sleep apnea is a common disorder that affects millions of Americans. Over the course of the night, an individual suffering from sleep apnea may wake up for a brief moment dozens of times. This can lead to severely decreased sleep quality and, eventually, insomnia.
Prescription vs. OTC
Generally, prescription sleep-aids are generally seen as a last resort in order to cure chronic cases of insomnia. All sleep aids are intended to help patients “break out” of a cycle of insomnia as opposed to becoming a routine part of a person’s medical regiment. Prescription sleep aids, doubly so. According to the National Sleep Foundation, “most doctors agree that they should not be used indefinitely.” We will focus on readily available, OTC medications.
Common Sleep Aids
The world of sleep aids is vast and confusing. Here is a list of some of the most common over the counter sleep aids available on the market today.
- Diphenhydramine: This is probably the most common active ingredient in OTC sleep aids in the United States. It is marketed under the names Benadryl, Aleve PM, Wal-Dryl, and Wal-Dryl, and Diphen. Diphenhydramine is simply a sedating antihistamine. This is why most antihistamines carry warnings about causing drowsiness.
- Doxylamine succinate: The main brand name that you will see in the US is Unisom SleepTabs. These work roughly the same way as diphenhydramine and act as sedating antihistamines.
- Melatonin: This drug typically does not carry any branded marketing. Melatonin is a naturally-occuring hormone. According to the Mayo Clinic, “Some research suggests that melatonin supplements might be helpful in treating jet lag or reducing the time it takes to fall asleep — although the effect is typically mild.”
- Valerian: This plant-based compound has been used as a sleep aid for decades. While the research surrounding valerian seems to support a mild sleep-aid effect, it is not considered more effective than traditional remedies.
Side Effects and Precautions
As with most medications, sleep aids should be taken under the advisement of a physician. There are several potential side effects and precautions to pay attention to.
They Are Not a Long Term Cure
The first things your physician may likely tell you is that sleep aids are a temporary fix to insomnia. Ultimately, behavioral and sleep changes will be necessary to reestablish a healthy circadian rhythm that enables you to get a restful night’s sleep. Because most over the counter sleep aids are antihistamine based, tolerance to them can develop quickly. This may cause you to “need” to take larger and larger doses of sleep aids in order to feel their effects. Larger doses are more likely to cause “sleep aid hangovers,” which can be just as bad as poor sleep as a result of insomnia.
NEVER Mix Sleep Aids and Alcohol
This combination is extremely dangerous. Both alcohol and sleep aids depress your central nervous system. The synergistic effect of using them simultaneously can result in overdose and death.
Like many medications, sleep aids can carry a litany of side effects. While the specific profile of side effects will depend on your exact medication, many sleep aids have similarities:
- Gastrointestinal issues
- Allergic reactions
- Prolonged drowsiness
- Memory problems
- Performing daily activities while partially asleep (aka sleepwalking)
Are Sleep Aids Habit-Forming?
One of the most common concerns about sleep aids is whether or not they are habit-forming. Habit-formation is different than addiction, but habit formation is still a concern. Scientists and physicians do believe that there may be cause for concern, as the Federal Drug Administration requires over the counter sleep aids to carry a warning to consumers that they should contact their doctor if the medication is necessary for more than two weeks.
According to the director of the Epilepsy and Sleep Division at Columbia University’s Department of Neurology, Dr. Carl W. Bazil, M.D., Ph.D., “The pills are not ‘addictive’ in the physical sense, but there can certainly be a risk for a psychological dependency.” In practice, this psychological dependency can make it difficult to fall asleep without a given sleep aid. Typically, physicians will strongly recommend against using sleep aids except for short, acute instances of insomnia. If you think you or a loved one may benefit from over the counter sleep aids, contact your physician.
Written by: Patrick O'Hare