Do OTC Sleep Aids Work?

Need something to get your sleep schedule back on track?
Tried one OTC sleep aid that didn’t quite work?

We all have different reasons for trying out those over the counter sleep aids. And because they’re not the “heavy duty” prescription sleeping pills, we wonder if there’s enough firepower in OTC sleep aids to do the trick. Or we would have heard about their infamous hangover and other side effects that might just take us back to square one.

Basically, people generally refer to the 2 types of OTC sleep aids: antihistamines and herbal supplements.

ANTIHISTAMINE OTC SLEEP AIDS

1. THE BASIC FACTS

They are the same drugs you take for allergy and cough and cold. You are basically using their side effect of prolonged drowsiness to get you to sleep.

Popular brands are from 2 types of antihistamines

i. Sominex, Nytol, Tylenol PM, Benadryl -Diphenhydramine compound

ii. Unisom, Equate
- Doxylamine compound

Side effects:
-Prolonged drowsiness or hangover effect that impairs driving, etc
-Dizziness
-Fatigue
-Headaches
-Reduced alertness
-Vomiting

Note: racing heartbeat and constipation are frequent complaints

2. DO THEY WORK?

(i.) The antihistamines only work short term. The fact is tolerance to the drug easily develops, sometimes in as little time as three to four days. That means you can’t use it for days on end to get the same result. It also explains why for some people, it may have worked well the first time but get different results when they use it again say, 2 months later.

"It worked only for a while. And then it does not work and when I tried to get off it, I got a nightmarish Rebound Insomnia which is worse than any insomnia that I had before," a 33 year old male recounted

“I have been taking benadryl nightly for 15 years to help me get to sleep. My tolerance has increased to the point that I take 150 mg (6 pills) to sleep and, often, sleep doesn't come for hours. I occasionally take two more after several hours of wakefulness.” 42 year old female patient said

(ii.) The other tricky part about antihistamine sleep aids is that the degree of sedation varies from person to person. The general rule of thumb used is to take it before 9pm i.e. you allocate more time in bed by starting early so that the sedation wears off by the time you’re supposed to wake up around 7am next morning. Even so, the prolonged drowsiness can be severe in some people although the medication is taken the prior day or night.

“It's (Unisom) so strong that I have to buy it in the oval tablet form and break them in half. If I took a whole one, I'd still be in a fog for over half of the next day. As it is, even with the half tablet, I'm still too groggy in the morning which is why I don't use it more.” a 51 year old male explained

“I've used Benadryl for years off and on. This is a great allergy pill, and it does help me sleep. However, after about three nights of taking it, I begin to have really bad hangover effects the next day. I can't seem to wake up. I put my shirt on backwards and didn't realize it one time. I have trouble driving. I can't focus and have trouble remembering things I want to say. And I feel anxious and irritable. I would take it only when you absolutely have to. The side effects are too much and can be dangerous.” a 34 years old female said

(iii.) There have also been cases where these OTC sleep aids had little effect at all. It appears that the “patient variability” factor is very pronounced in this group of drugs. So, if you want to make it work for you, you have to be prepared to do much trial and error; and bear with the resulting side effects in the meantime. May be too much trouble, too much pain.

“Benadryl gets me to sleep, but only for about 5 hours, which I have learned to live with. I wake up very tired, but after about twenty minutes I feel fine. Sometimes a nightly dose of 50 mg gets me to sleep in an hour, other times it takes three hours.” a 35 year old male said

“…first tried taking 50 mg. My heartbeat actually increased and I had mild trouble falling asleep. However, after that I slept well for a good 7 hours. However I woke up singing to myself in my head. Took 38mg (as Tylenol PM) the next night. It had a gentle narcotic effect. Slept about 6 hours but again woke up hearing music in my head. Last night, I tried 50 mg again and am fully unable to sleep.” a 44 year old male described

(iv.) The Medical Letter, which reviews drugs, recommends against using antihistamines for sleep. Some doctors say users of Tylenol PM, a combination of antihistamine and painkiller, may be taking acetaminophen they don’t need. Acetaminophen overdoses can cause liver failure.

Overall, the unpredictability of these OTC sleep aids’ efficacy just goes to show why they’re better off used as they were originally intended for i.e. allergy. That’s why drug companies continue to make improved versions of antihistamines to treat allergy minus the sedation side effect.

HERBAL OTC SLEEP AIDS

The 2 most popular are melatonin and valerian.

1. THE BASIC FACTS

Melatonin
- a hormone secreted from our the pineal gland in our brain; thought to help our bodies’ internal clock i.e when it's time to go to sleep and when it's time to wake up.
- the synthetic form is available in many brands; AVOID natural forms that are basically melatonin derived from animal’s pineal glands due to possible contamination
-side effects: daytime drowsiness headaches, dizziness, a "heavy-head" feeling, stomach discomfort

Valerian
- a plant; its active ingredient is still unclear therefore how it works is unclear too. Generally thought to help reduce the time to get to sleep
- available in many brands but hard to compare as the potencies of various ingredients vary from preparation to preparation.
- side effects: headache, excitability or uneasiness, heart disturbances

2. DO THEY WORK?

Melatonin is recognized to be generally good for jet lag or effects of shift work. Much has been studied about the hormone itself, over 14,000 clinical publications (mostly in test tubes and rats). Valerian, on the other hand, is touted to reduce your time to get to sleep as well as improve your sleep.

However, the main hindrance to using herbal OTC sleep aids is that there’s so much that is unknown about 2 things: their side effects and interaction with other drugs.” The implications can be serious. For example, the FDA has issued a consumer advisory in 2002 that herbal supplements containing kava may be associated with severe liver damage while a significant drug interaction between St. John’s wort and certain prescription drugs was found in 2000.

It’s also even harder to compare their efficacy and benefits than antihistamines. As it is, the optimal dose can’t be established without human trials. FDA also does not routinely analyze the content of herbal supplements: the quantity of a supplement’s ingredients may vary by manufacturer and the actual content may greatly differ from what is listed on the product label. For example, one study found that most ginseng products contain less than half the amount of ginseng that is listed on the label.

THE VERDICT?

Everyone deserves a good night's sleep. Over-the-counter sleep aids or supplements may help when stress, travel or other disruptions keep you awake. However, you would need to weigh the risks or problems against the short-term benefits.

A better approach is to remove the cause - most often, by understanding how you’re wired mentally to mould your body’s ability to fall asleep. Today, the American Academy of Sleep Medicine holds that cognitive behavioral therapy (CBT) is the other primary form of treatment for insomnia apart from prescription sleep medications. It involves techniques to change your negative thoughts about sleep (cognition) so you will stop sabotaging good shut-eye (behavior).

Just remember one final point: whatever sleep aid you decide on (OTC, prescription sleep aids or natural sleep aids), you always need to work on your thoughts and sleep habits for lasting success. There is absolutely not one magic treatment for all.