Aids for getting a good night's sleep
12/3/2018 by Robert Hoel, PharmD, RPh
Getting a good night's sleep is a challenge for a lot of Americans. The Centers for Disease Control and Prevention (CDC), reports that 35 percent of adults aren't getting sufficient sleep, which should average seven hours a night. To help achieve that healthy goal, 10 to 12 percent of adults use over-the-counter (OTC) sleep aids, according to the U.S. Department of Health and Human Services (HHS).
Catching ZZZs tougher for seniors
The statistics vary by demographic group, but sleep difficulties are more common as we get older. As we age, sleep is often interrupted by a variety of factors, including medications, sleep-interrupting trips to the bathroom, and high incidence of depression. Then, getting back to sleep becomes the problem. Consequently, we often seen seniors seeking medications to combat trouble sleeping.
Using OTC sleep medicines is very common in patients who have been regularly taking prescribed medications to treat insomnia. Nearly all sleep-promoting medicines, whether prescribed or OTC, have an especially high potential for side effects. Generally, it's best to avoid or limit use as much as possible.
OTC options for getting good shut-eye
As a pharmacist, I ask patients, "What medication do you take if you can't sleep?", followed by, "Does it help?" I hear a lot of different answers to these questions, so here's a look at what's available over the counter:
First-generation antihistamines
These products contain diphenhydramine or doxylamine. They may come with or without pain medicines, such as acetaminophen or ibuprofen.
These antihistamines are present in many products with "P.M." or "nighttime" in the name. Approval of these products has been "grandfathered" in, and they haven't been subjected to required safety and efficacy testing for sleep by the FDA. They also take longer to clear from our bodies the older we get.
We have good evidence that first-generation antihistamines cause sleepiness, but they come with frequent side effects, especially for seniors. That's because they work by chemically interrupting specific signaling mechanisms in the brain, which already are more disrupted by the aging process. Some side effects include:
- Confusion
- Morning grogginess
- Falling
- Slowed reaction times
- Short-term learning and memory impairment
- Possibly strokes and longer-term memory impairment
Melatonin
This is a hormone that has some evidence for improving our sleep cycle. We know that when day/night sleep patterns are disrupted, such as in people who work night shifts, melatonin can promote drowsiness.
Herbal supplements
Typical herbs used as sleep aids are valerian and chamomile. Most OTC herbals are classified as supplements, so they are not FDA regulated for standards of potency and benefit. They're usually referred to as "natural" and purportedly safe. They may enhance sleep, but there's no strong evidence showing real benefit. Herbal supplements also have possible side effects, including impaired motor functions, restlessness, agitation and others.
Magnesium
This mineral has been promoted to improve sleep quality, but there aren't enough clinical studies to recommend it as an effective sleep aid.
Theanine
An amino acid, theanine is promoted to enhance sleep quality, but once again, there aren't enough clinical studies to endorse it as effective for sleep.
All OTC or prescription sleep aids have the potential for negative consequences when misused with alcohol or other substances that affect brain function.
So if you're having trouble sleeping, ask your provider or pharmacist, "What do you think would be safe for me to take with my other medicines?" Often, the answer is to improve your sleep habits. Check out these helpful sleep tips from the National Sleep Foundation.
Robert Hoel, PharmD, RPh, is a clinical pharmacist working as a medication management pharmacist within Employee and Community Health's (ECH) Division of Community Internal Medicine (CIM). He enjoys helping providers, nurses and our patients with medication-related concerns and questions, with the goal of ensuring patients get the most benefit from their medications.