OTC Sleep Aids

Insomnia Treatments Without Side Effects

Sat, 09 Aug 2008 15:24:49 +0000

On a daily basis, we are bombarded by commercials that tout the virtues of sleeping pills. We are constantly reassured that sleeping pills are getting better: Lunesta, Ambien and Sonata cause fewer side effects than their predecessors.

But the fact remains that sleeping pills continue to have side effects. Just take a look at the prescribing information in any sleeping pill box. There is always the inadvertent portion on common side effects. Worse still, things like sleep-eating and sleep-driving are not listed there. Rosemary Eckley, a graphic artist in New London, Wis., said she thought she was sleeping well on Ambien but woke to find her wrist broken, apparently in a fall while sleepwalking, she wrote in an e-mail exchange.

Also, they don’t greatly improve sleep for the average person. The National Institutes of Health found that viewed as a group, these sleeping pills reduced the average time to go to sleep 12.8 minutes, and increased total sleep time 11.4 minutes compared with fake pills.

So what then are the existing insomnia treatments without side effects? Overall, they are called non-pharmacologic insomnia treatments. These include hypnotherapy, cognitive behavioral therapy, relaxation therapy and brainwave entrainment.

1. Hypnotherapy

Hypnotherapy has been well documented for its effective use with conditions such as depression and pain. As for insomnia, a meta-analysis showed that when combined with psychotherapy, 70% of patients have shown greater improvement compared with those on psychotherapy alone.

The plus point with hypnotherapy is you can eventually be taught to self-treat and so gain a sense of control. This would give you the ability to stay insomnia free. However, just be mindful that not everyone can be hypnotized i.e. some people have persistently low hypnotizability as measured by the Hypnotic Induction Profile.

2. Cognitive Behavioral Therapy (CBT)

It is based on the idea that how you think affects the way you feel and behave. It involves techniques to change your negative thoughts about sleep (cognition) so you will stop sabotaging good shut-eye (behavior).

A recent study conducted by Harvard Medical School’s Gregg Jacobs found that CBT worked better than sleeping pills both in the short term and the long term. Volunteers only received four half-hour sessions of CBT, plus a follow-up phone call that led to sleep improvements that persisted even after treatment was stopped.

As few as two sessions have been shown to produce results. Unfortunately, there are very few CBT practitioners specializing in sleep. However, nurses and psychology grad students can be easily trained to provide CBT. And there is a growing lay literature designed to help people try it for themselves.

3. Relaxation Therapy

This includes muscle relaxation, biofeedback, imagery training through meditation and thought stopping. Professionals, who specialize in instructing these techniques, can be found in some healthcare centers, support communities and even cancer centers. The best part is you can accomplish some of these techniques on your own. You may find deep breathing, stretching, meditation or prayer to be relaxing. A warm bath, warm glass of milk or cup of chamomile tea at bedtime can help to induce a restful state. Avoid alcohol although it may cause initial tiredness, it usually leads to fragmented sleep.

4. Brainwave Entrainment

Many professionals in psychology and neurology have used this technology to train, empower and treat people for a wide variety of issues including insomnia. Research has shown that brainwaves can be stimulated to actually change a person’s current state. Hence, this is achieved through sound pulses that gently guide your brain to produce more of the brainwave frequencies associated with sleep.

Your brain is re-trained to sleep deeply and naturally eventually foregoing the soundtracks. So, coupled with sleep hygiene or basic CBT, all you need to do is listen to some soundtracks. However, this isn’t for everyone as it involves brainwave stimulation. People who are epileptic, prone to seizures, pregnant or wearing a pacemaker would have to give this a pass.

In summary, the good news is that studies have reported about 70 to 80% of the patients treated benefited from these insomnia treatments. Just remember one thing: best results are obtained when you combine any of them. There is absolutely not one magic treatment for all.

Do OTC Sleep Aids Work?

Sat, 09 Aug 2008 08:31:02 +0000

Insomnia Handbook, Vol.2, Issue 2, Abstract (May 2008)

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?
- Having trouble falling asleep lately and thinking you need to start doing something about it?

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.

Allow me to first swiftly summarize what these OTC sleep aids are. Basically most people are referring to the 2 types of OTC sleep aids: antihistamines and herbal supplements.

ANTIHISTAMINES HERBAL

HOW THEY WORK
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
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.

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

POPULAR BRANDS are from 2 types of antihistamines

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

2. Unisom, Equate
- Doxylamine compound
Melatonin- 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

Valerian – available in many brands but hard to compare as the potencies of various ingredients vary from preparation to preparation

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
Melatonin
-daytime drowsiness headaches, dizziness, a “heavy-head” feeling, stomach discomfort

Valerian
-headache, excitability or uneasiness, heart disturbances

WARNING:

Not for pregnant or nursing women

Not for you if you have:
• Heart problems
• Glaucoma
• Enlarged prostate

Not to be taken with alcohol or with a sleeping pill, sedative, tranquilizer, or another antihistamine

Especially for Unisom, you can’t even take them if you’ve got asthma or bronchitis.
Not for pregnant or nursing women

Melatonin
-may interact with common drugs

Valerian
-may strongly react with other sleep aids and with alcohol, and may react with other medications

So here’s the lo down on whether these OTC sleep aids work.

Antihistamine OTC Sleep Aids
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

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

“At first it worked okay for insomnia, though it zonked me out for 10 hours and I woke feeling very groggy! But after a week, rapid heartbeats began and I measured quite an increase in my blood pressure.” gushed a 59 year old

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.

“It takes about 2 hours for the drowsiness to kick in. If I take it during the night, I’ll still be slightly drowsy the next day. However, it takes about an hour after waking up for the drowsiness to start up again.” explained a 19 year old male

“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 (Benadryl). 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

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.