Therapeutic and Toxic Potentials of Over-the-Counter Drugs: SLEEP AIDS

What are sleeping pills?

"Sleeping pills" refers to a generic term used to describe both prescription and over-the-
counter (OTC) medications. These medications are used to help individuals who have difficulty
falling asleep or staying asleep on their own. Sleeping pills are hypnotics, meaning that they
promote or extend sleep. They are also sometimes called sedatives, which while literally
meaning “calming,” more often can refer to “the ability to cause drowsiness.”

Over-the-counter sleep aids can be effective for an occasional sleepless night. There are a few
caveats, however. Most over-the-counter sleep aids contain antihistamines. Tolerance to the
sedative effects of antihistamines can develop quickly — so the longer you take them, the less
likely they are to make you sleepy.
The most common prescription sleeping pills, or hypnotics, are in the classes of drugs called
benzodiazepines or benzodiazepine receptor agonists. Sleeping pills can have serious side
effects if overused or abused. In addition, some over-the-counter sleep aids can leave you
feeling groggy and unwell the next day. This is the so-called hangover effect.
Medication interactions are possible as well, and much remains unknown about the safety and
effectiveness of over-the-counter sleep aids.
If you feel you might need sleeping pills, you should first consult your healthcare provider.

Why might someone have trouble sleeping?

A healthy adult needs an average of 6 to 8 hours of sleep per night. Sometimes, an individual
might have a problem getting this amount of sleep. This problem could be due to several
factors, including:

 Underlying health problems

 Medications taken for a pre-existing medical condition. These drugs might include
decongestants taken for colds and allergies, medications taken for high blood pressure
(including beta blockers), corticosteroids, and some drugs for asthma
 Using too much caffeine, especially late in the day
 Depression
 Stress
 Having a noisy or bright sleeping space
 Eating, drinking, or exercising too close to bedtime
 Working 2nd or 3rd shift and sleeping non-traditional hours
 Sleep-related problems, including (among others): obstructive sleep apnea (OSA), when
breathing can be impaired during sleep; and restless legs syndrome (RLS), in which a
 creeping or uncomfortable sensation in the legs is experienced at night, and is typically
relieved by moving or stretching the legs

Who gets insomnia?

Insomnia is a common problem. It refers to difficulties with initiating or maintaining sleep.

Forty-eight percent of Americans report occasional insomnia, and 22% say they suffer insomnia
every night or nearly every night. Females are 1.3 times more likely to report insomnia than
males. Insomnia is also more common in men and women over age 65, who are 1.5 times more
likely to complain of insomnia than younger people.

Insomnia can have serious long-term health and lifestyle consequences, including depression,
heart disease, and more falls and traffic accidents.

If you are experiencing insomnia, you should make an appointment with your doctor. He or she
will try to determine the reason why you are not sleeping and develop a treatment plan.

Who should use sleeping pills?

Your healthcare provider will begin your consultation by trying to determine the contributing
factors and length of your insomnia. He or she may at first suggest non-pharmaceutical
approaches to dealing with insomnia (see below for details). Alternatively, if these do not work,
or in conjunction with these techniques, he or she may determine that you could benefit from
the use of sleeping pills. This may be the case if your sleeplessness is acutely affecting your
health and daily life activities negatively.

Your doctor will start you out with the very lowest possible dose. He or she will also try to keep
you on these pills for the shortest amount of time possible. You will also be advised to continue
to try relaxation techniques and other healthy sleep habits in combination with the pills.

What are some of the different types of sleeping pills?

There are many different classes and brands of sleeping pills. Your doctor will suggest the one
he or she feels will best work for you based on the cause and length of time you have been
having trouble sleeping, as well as the specific type of insomnia you are experiencing. Your
doctor will also take into consideration any other health conditions you may have, or
medications you are taking. Commonly used sleeping pills include:

 Ambien®, Ambien® CR (zolpidem tartrate)

 Dalmane® (flurazepam hydrochloride)
 Halcion® (triazolam)
 Lunesta® (eszopiclone)
 Prosom® (estazolam)
 Restoril® (temazepam)
  Rozerem® (ramelteon)
 Silenor® (doxepin)
 Sonata® (zaleplon)
 Desyrel® (trazodone)
 Belsomra® (suvorexant)
 Over-the-counter sleeping pills (including antihistamines, melatonin, herbal
formulations, and others)
 Diphenhydramine (Benadryl, Aleve PM, others). Diphenhydramine is a sedating
antihistamine. Side effects might include daytime drowsiness, dry mouth, blurred vision,
constipation and urinary retention.
 Doxylamine succinate (Unisom SleepTabs). Doxylamine is also a sedating antihistamine.
Side effects are similar to those of diphenhydramine.
 Melatonin. The hormone melatonin helps control your natural sleep-wake cycle. Some
research suggests that melatonin supplements might be helpful in treating jet lag or
reducing the time it takes to fall asleep — although the effect is typically mild. Side
effects can include headaches and daytime sleepiness.
 Valerian. Supplements made from this plant are sometimes taken as sleep aids.
Although a few studies indicate some therapeutic benefit, other studies haven't found
the same benefits. Valerian generally doesn't appear to cause side effects.

How can insomnia be treated without pills?

There are several non-pharmaceutical approaches to dealing with insomnia that an individual
could try. These include:

 Avoiding caffeine and nicotine (which can be stimulating or activating)

 Creating a regular sleep schedule of going to bed and getting up at the same time each
day
 Avoiding naps, especially late in the afternoon
 Avoiding alcohol or eating large meals before going to bed
 Avoiding exercising right before bedtime
 Making your bedroom a quiet and dark room
 Avoiding looking at the clock throughout the night
 Trying to engage in relaxing activities such as meditation, yoga, or reading before
bedtime

What are potential side effects of sleeping pills?

Sleeping pills can have very serious side effects, which is why they should always be used with
the approval of a healthcare provider. These side effects can happen with both prescription and
over-the-counter sleeping pills. Possible side effects include:

 Oversleeping
  Being too drowsy to drive safely the next morning
 Being too drowsy to work or perform other necessary functions the next morning
 With some prescription sleeping pills, doing potentially dangerous activities such as
eating, walking, leaving your house, having sex, making phone calls, carrying on
conversations, or driving while you are not fully awake. You may not even be aware of
these activities as you are doing them in your sleep
 Allergic reaction (anaphylaxis)
 Facial swelling (angioedema)

Side effects may be worse in those who drink alcohol, the elderly, and individuals with sleep
apnea, as their breathing may be further impaired when using particular sleeping pills.

If you are experiencing any of these side effects, you should seek immediate medical attention.

Are there any other drawbacks to sleeping pills?

If used over a long period of time, an individual may become addicted to or dependent upon
sleeping pills. This overuse can have serious long-term health consequences, including:

 Memory problems
 Mental and behavioral disorders
 Learning problems
 Worsening of insomnia symptoms beyond their baseline when the pills are discontinued

It is important to seek immediate medical attention if you think you are becoming addicted to
your sleeping pills.
References:

Katzung, B. (2018). Basic and Clinical Pharmacology (14th Edition). McGraw Hill Education.

Mayo Clinic Staff (2019). Sleep aids: Understand over-the-counter options. Mayoclinic.org.
Retrieved from

https://www.mayoclinic.org/healthy-lifestyle/adult-health/in-depth/sleep-aids/art-
20047860

Cleveland Clinic Staff (2017). Sleeping Pills. Clevelandclinic.org. Retrieved from

https://my.clevelandclinic.org/health/drugs/15308-sleeping-pills