Sensible Use of Sleep Aids
From time to time, almost everyone has a bad night when sleep is elusive. Short-term insomnia lasts only a few days and usually isn't a cause for concern. But if you can't sleep on most nights for 2 to 3 weeks, talk with your health care provider. Insomnia that lasts this long usually continues until the cause is treated. For short-term problems getting to sleep or staying asleep, taking an over-the-counter (OTC) sleep aid can be a safe and effective way to get a good night's sleep.
A good night's sleep for most adults is about 8 hours long, although some people may need as few as 6 hours or as many as 10. How do you know how much sleep you need? Think of how you feel in the morning. If you feel refreshed when you wake up, you've had enough sleep.
What's in a sleeping pill?
Most OTC sleep aids contain antihistamines. Some common antihistamines found in OTC sleep aids are diphenhydramine and doxylamine. The primary use of antihistamines is to block the effect of histamine on the nasal passages, reducing congestion, sneezing, and coughing. Histamine also promotes wakefulness. A side effect of antihistamines is drowsiness, so they are sometimes used to treat insomnia. They may give people a groggy feeling the next morning and/or may slow your thinking. Antihistamines should also be avoided in people with heart disease and by older people. Older people may become confused with antihistamines, and older men can develop problems urinating.
Prescription sleeping pills are different. They act in areas of the brain to help promote sleep. Since the 1970s, the most commonly prescribed are benzodiazepines, such as temazepam, diazepam, lorazepam, alprazolam, and triazolam. They work on the brain chemical known as GABA. GABA opens chloride channels, quieting brain activity, and allowing sleep. Benzodiazepines work with GABA to help bring on sleep.
Newer sleep medications, also known as the "z" drugs, aren't related to benzodiazepines, but they block the same receptors and therefore act like benzodiazepines. Zolpidem, zaleplon, and eszopiclone are newer, nonbenzodiazepine medications used to treat insomnia. These drugs may have fewer side effects and are being prescribed more commonly than the benzodiazepines. These drugs should be used with caution because they can make a person feel confused during sleep and may cause sleepwalking or sleep-enacting behaviors called parasomnias. Other prescription drugs are in the "pipeline" to treat insomnia.
In 2005, the FDA approved Rozerem (ramelteon) to treat insomnia marked by difficulty falling asleep. It acts on melatonin receptors in the brain.
If you are taking a prescription or OTC sleep aid, don't ever take more than the recommended dose, don't drink alcohol while taking it, and don't combine different kinds. If you're pregnant, you should avoid sleeping pills altogether.
Two dietary supplements – valerian root and melatonin – have recently been touted as "natural" sleep aids, but few studies have been done to find out how effective they are, how they work, or what side effects they may have. Valerian root may cause liver damage. Melatonin, the most widely used supplement, is produced by the brain's pineal gland in response to darkness. This lowers body temperature and brings on drowsiness. This supplement may help regulate your body's internal clock when adjusting to jet lag of about an hour and also for shift work.
Coping with sleeplessness
If you are having trouble sleeping, try a warm bath or glass of warm milk before bedtime. Consider that you may have an underlying medical or psychological problem that's causing your sleep difficulties. You may be drinking too much caffeine, not getting enough exercise, or not unwinding before you go to bed.
Taking a sleeping pill is appropriate if you use it according to directions during those rare occasions when you have problems sleeping. Examples are:
Adjusting to jet lag
Adjusting to changes in your work shift
Dealing with a personal crisis, such as the loss of a loved one
Coping with stress related to a specific event, such as giving a presentation
There are 2 major drawbacks to taking sleep aids on a long-term basis:
The pills may start to lose their effectiveness.
You may become dependent on the sleeping pill. When you stop taking a sleeping pill, it becomes even harder to sleep.
Remember that you may even have unrealistic assumptions or expectations about how much sleep you need. Most people don't need much more than 7½ hours of sleep a night.