Improving Sleep by Harvard Health Publishing

Author:Harvard Health Publishing [Publishing, Harvard Health]
Language: eng
Format: epub
Publisher: Harvard Health Publishing
Published: 2019-01-15T05:00:00+00:00

© PonyWang | Getty Images

Over-the-counter sleep aids

Drugstores carry a bewildering variety of over-the-counter sleep products. But do these products work? And if you try them, should you choose a sleeping pill, an herbal remedy, or a dietary supplement?

Nonprescription sleeping pills

There is a riot of competing brands, but otherwise these products are remarkably similar. Each one — whether a tablet, capsule, or gelcap — contains an antihistamine as its primary active ingredient. Most over-the-counter sleep aids — including Nytol, Sominex, and others — contain 25 to 50 milligrams (mg) of the antihistamine diphenhydramine. A few, such as Unisom SleepTabs, contain 25 mg of doxylamine, another antihistamine. (Note that antihistamines are also found in pain relievers like Tylenol PM, Excedrin PM, Aleve PM, and Advil PM, which are typically marketed for “occasional sleeplessness associated with minor aches and pains.”)

The antihistamines found in these products have a sedating effect and are generally safe when taken as directed for brief time periods. But they can cause nausea and, more rarely, fast or irregular heartbeat, blurred vision, or heightened sensitivity to sunlight. Complications are generally more common in children and in people over age 60. Diphenhydramine blocks the brain chemical acetylcholine, which is essential for normal brain function, and elderly people who take these drugs face a higher risk of cognitive problems, including delirium. Alcohol heightens the effect of these medications, which can also interact adversely with some drugs. Sleep experts generally advise against using these medications for more than brief periods because they are often ineffective and because of the possibility of these side effects.

Dietary supplements

As with multivitamins and other supplements, the FDA does not regulate these products, so they aren’t tested for safety, effectiveness, quality, or accuracy of labeling. One problem with supplements in general is that they often do not contain the amount of the active ingredient stated on the label and may contain other substances not listed.

There are other potential problems. Although marketed as “natural,” these products may contain biologically active substances that can have side effects or interact with other medications or supplements. For example, scientists have identified more than 100 compounds in valerian root. Researchers don’t know precisely which of these account for the herb’s effect, nor can they say exactly how these or other compounds in valerian might interact with other medications. If you’re thinking about using such products (or already do so), be sure to tell your doctor.

Finally, what we know generally comes from small, short-term studies. Thus, most doctors discourage the use of herbal medicines as sleep aids.

Readily available alternative sleep remedies typically include one or more of the following substances.

Valerian (Valeriana officinalis). A few studies suggest that valerian is mildly sedating and can help people fall asleep and improve their sleep quality. But a review in the Journal of Clinical Sleep Medicine pointed out that most of the studies were small and flawed, and that even the positive studies showed only a mild effect. The most common reported side effects are headaches, dizziness, itching, and gastrointestinal disturbances.

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