Insomnia medications - non prescription

By: William Deardorff, PhD, ABPP
September 7, 2006

Medications are among the most commonly used treatments for insomnia and can be quite effective. However, medications should always be used judiciously and in conjunction with the non-pharmacological approaches as discussed previously. There are several classes of medications used for sleep, including over-the-counter (OTC) medications and “natural” or herbal remedies, sedative-hypnotic medications, and sedating antidepressants.

Sleep aid guidelines

Most experts recommend taking medications for insomnia only as a “last resort” after the behavioral techniques discussed previously have been attempted. The National Sleep Foundation suggests the following guidelines for use of medications to treat sleeping disorders:

• The cause of the sleep disorder has been identified and is best treated with medication.

• Sleeping difficulties are causing problems in daily activities.

• Behavioral approaches have not been completely effective.

• Treatment with medication should “begin with the lowest possible effective dose.”

• Be short term if used nightly.

• Be intermittent if used long term.

• Be used only in combination with good sleep practices and behavioral approaches.

Over the counter (OTC) medications as short-term sleep aids

Over-the-counter medications for the treatment of a sleep problem are those that can be purchased without a prescription. Examples of over-the-counter sleep aids include:

• Sleep-Eze

• Sominex

• Nytol, and others.

OTC sleep medications should only be used on a short term basis, since extended use of these medications can actually exacerbate insomnia. According to the American Academy of Sleep Medicine, antihistamine is the most common ingredient in OTC sleep aids. The OTC sleep medications rely on the sedating effects of the antihistamine to facilitate sleep. If patients attempt to use an OTC sleep aid, they should immediately discontinue their use if they experience any adverse side effects such as:

• dry mouth

• dry eyes

• urinary retention

• confusion

• drowsiness the following day

• forgetfulness

• constipation

In addition, these sleep medications may interact negatively with other medications, so a doctor should be consulted prior to using these for a sleeping problem. It should also be noted that the sleep that is experienced when taking over-the-counter sleeping aids is not of the same quality as normal sleep. Research has demonstrated that some people who take OTC sleep aids spend as little as 5% of their total sleep time in deep sleep as compared to approximately 10% to 25% in healthy sleepers.

Herbal remedies as non-FDA approved sleep aids

There are many natural and herbal remedies available over-the-counter for sleeping disorders. These include such things as Melatonin, which is a hormone that is known to be involved in the regulation of sleep and wakefulness. In addition, herbal products include such things as valerian, chamomile, Kava Kava, and others. It is important to note a few things about these herbal remedy products:

• they have not been exposed to the rigorous testing by the FDA that is required of all prescription products

• even though these remedies are sold over-the-counter, they are still “medications” that cause chemical changes in the body

• these substances can interact with medications in an adverse manner

• the safety profiles of these products are often unknown.

The reader may remember that several years ago many individuals used the substance Tryptophan, an amino acid to promote sleep. Dozens of individuals using this substance for sleeping were affected by a serious disorder called eosinophilia myalgia syndrome (EMS) due to a contaminant that entered the product during its manufacturing. Tryptophan has since been removed from the market in the U.S. This is just an example of how products that are unregulated can be potentially harmful even though they are available for sale over-the-counter. Thus, when considering use of any of these types of products, be sure to consult a physician, research them thoroughly, and “let the buyer beware.”