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Sensible Use of Sleep Aids

From time to time, almost everyone has a bad night when sleep is elusive.  Short-term insomnia lasts only a few days and usually isn't a cause for concern. But if you can't sleep on most nights for two to three weeks, talk with your health care provider. Insomnia that lasts this long usually continues until the cause is treated. For short-term problems getting to sleep or staying asleep, taking an over-the-counter (OTC) sleep aid can be a safe and effective way to get a good night's sleep.

A good night's sleep for most adults is about eight hours long, although some people may need as few as six hours or as many as 10. How do you know how much sleep you need? Think of how you feel in the morning. If you feel refreshed on awakening, you've had enough sleep.

What's in a sleeping pill?

Most OTC sleep aids contain antihistamines. Some common antihistamines found in OTC sleep aids are benadryl (diphenhydramine) and doxylamine. The primary use of antihistamines is to block the effect of histamine on the nasal passages, reducing congestion, sneezing, and coughing. A side effect of antihistamines is drowsiness, so they are sometimes used to treat insomnia. They may give people a groggy feeling the next morning. Antihistamines should also be avoided in people with heart disease and by older people. Older people may become confused with antihistamines, and older men can develop problems urinating.

Prescription sleeping pills are different. They act in areas of the brain to help promote sleep. Since the 1970s, the most commonly prescribed are benzodiazepines, such as valium. They work on a molecular level with the brain chemical known as GABA. GABA opens chloride channels, quieting brain activity and allowing sleep. Benzodiazepines work with GABA to help sleep. Some benzodiazepines used as sleep aids are Halcion (triazolam) and Restoril (temazepam).

Newer sleep medications aren't related to benzodiazepines, but they block the same receptors and therefore mimic benzodiazepines. Ambien (zolpidem), Sonata (zaleplon), and Lunesta (eszopiclone) are newer, nonbenzodiazepine medications used to treat insomnia. These drugs have fewer side effects and are being prescribed more commonly than the benzodiazepines. Other prescription drugs are in the “pipeline” to treat insomnia.

In 2005, the FDA approved Rozerem (ramelteon) to treat insomnia marked by difficulty falling asleep. It acts on melatonin receptors in the brain.

If you are taking a prescription or OTC sleep aid, don't ever take more than the recommended dose, don't drink alcohol while taking it, and don't combine different kinds. If you're pregnant, you should avoid sleeping pills altogether.

Two dietary supplements – valerian root and melatonin – have recently been touted as "natural" sleep aids, but few studies have been done to find out how effective they are, how they work, or what side effects they may have. Valerian root may cause liver damage. Melatonin, the most widely used supplement, is secreted by the brain's pineal gland in response to darkness. This lowers body temperature and brings on drowsiness. Initial reports say the supplement is best used to regulate the body's internal clock when adjusting to jet lag of about an hour or to shift work.

Coping with sleeplessness

If you are having trouble sleeping, try a warm bath or glass of warm milk before bedtime. Consider that you may have an underlying medical or psychological problem that's causing your sleep difficulties. You may be drinking too much caffeine, not getting enough exercise, or not unwinding before you go to bed.

Taking a sleeping pill is appropriate when used according to directions during those rare occasions when sleeping is difficult. Examples are adjusting to jet lag; changes in your shift-rotation; a personal crisis, such as the loss of a loved one; or stress related to a specific event, such as giving a presentation.

There are two major drawbacks to taking sleep aids on a long-term basis:

  • The pills start to lose their effectiveness.

  • When you stop taking a sleeping pill, it becomes even harder to sleep.

Remember that you may even have unrealistic assumptions or expectations about how much sleep you need. Most people don't need much more than 7½ hours of sleep a night.