OTC medicines, sleeping pills and supplements
There’s no simple cure for insomnia – and it definitely can’t be found in a sleeping pill. Despite that, a National Sleep Foundation survey of 1,003 women found that 29 percent used some kind of sleep aid, either prescription or over the counter, at least a few nights a week. Yvette Taylor, 60, an editor in Boca Raton, Fla., says she relied on Tylenol PM for years for her pain and sleep problems until her fibromyalgia was diagnosed in the late 1990s. “I couldn’t sleep without taking it,” she says.
Still, sleep experts are lukewarm, at best, about the safety and efficacy of over-the-counter (OTC) sleep aids. Most contain antihistamines, which can cause blurred vision, constipation and urinary retention. And antihistamines can leave you feeling sluggish the next day. Tylenol PM and other products contain acetaminophen, which could result in too high a dose, as well as subsequent liver problems, if you’re already taking it for arthritis.
Two of the most popular supplements for sleep, melatonin and valerian, both taken at night, are also not recommended for long-term use. Melatonin is a hormone made by the body that helps regulate its internal clock, telling you when to go to bed and when to wake up, and melatonin supplements have been proposed as a sleep aid. But a comprehensive analysis of research studies, published in 2004, determined that short-term use doesn’t help with most sleep disorders. As for valerian, some studies show it may help halt insomnia with fewer side effects than most drugs, but more research is needed to determine long-term safety and effectiveness.
Two newer classes of prescription medications have come on the market in recent years. One class, called nonbenzodiazepines, includes medications such as eszopiclone (Lunesta), zaleplon (Sonata) and zolpidem (Ambien). They induce drowsiness by working on a particular receptor in the brain, called GABA, believed to be influential in sleep. Two years ago, the FDA approved ramelteon (Rozerem). It works differently than other prescription sleep medications, affecting the melatonin receptors in the brain, so it may work best for people who have trouble falling asleep. Rozerem is not believed to have the same potential for abuse and dependence as other sleep drugs and is approved for long-term use.
Although the newer medications may be somewhat safer, they aren’t risk-free. The FDA recently required all manufacturers of prescription sleeping pills to strengthen the warnings on their labels about potential risks, including severe allergic reactions, angioedema (severe facial swelling) and odd behaviors such as sleep-driving, making phone calls, and preparing and eating food (while asleep).
In addition to physical side effects, sleeping pills also can reap a psychological price. Users sometimes feel as though they’ve lost control over their sleep, says Smith. “You basically lose the belief that your body can function normally,” he says. “Then people end up taking it longer than they need it.”
