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 is usually not a cause for concern. However, if you cannot sleep on most nights for 2 to 3 weeks, talk to 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 eight hours long, although some people may need as few as four 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 upon awakening, 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 benadryl (diphenhydramine) and doxylamine. The primary use of antihistamines is to block the effect of histamine on the nasal passages reducing congestion, sneezing and coughing.  A side effect of antihistamines is the induction of drowsiness so they are sometimes used to treat insomnia. They may give people a groggy feeling the next morning. Antihistamines should also be avoided in people with heart disease and in 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 valium. They work on a molecular level with the brain chemical known as GABA. GABA opens chloride channels, quieting brain activity and allowing sleep. Benzodiazepines work in conjunction with GABA to enhance sleep. Some benzodiazepines used as sleep aids are Halcion (triazolam), Prosom (estazolam) and Restoril (temazepam).

Newer sleep medications are unrelated to benzodiazepines but block the same receptors and therefore mimic benzodiazepines.  Ambien (zolpidem), Sonata (zaleplon) and Lunesta (eszopiclone) are newer, non-benzodiazepine medications used to treat insomnia.  These drugs have fewer side effects and are being prescribed more commonly than the benzodiazepines. Other prescription drugs are in the “pipeline” for approval to treat insomnia.

In 2005, the U.S. Food and Drug Administration (FDA) approved Rozerem (ramelteon) for the treatment of insomnia characterized by difficulty falling asleep. It acts as a selective agonist at two melatonin receptors

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 them, and don't combine different kinds. Pregnant women should avoid sleeping pills altogether.

Two dietary supplements -- the valerian root and melatonin -- have recently been touted as "natural" sleep aids, but few studies have been conducted to determine their effectiveness, how they work or possible side effects. Melatonin, which is the most widely used supplement, is secreted by the brain's pineal gland in response to darkness, resulting in a lowered body temperature and drowsiness. Initial reports indicate the supplement is best used to regulate the body's internal clock when adjusting to jet lag of about an hour or to shift work.

Coping with sleeplessness

Peter Hauri, Ph.D., a sleep expert and author of "No More Sleepless Nights," says about 10 percent of the U.S. population has serious problems with insomnia that chronically affects their daily functioning. How he works with his patients may also help those with occasional sleep problems. "Insomniacs typically stay in bed too long in a shallow sleep, when they're half awake," he says. "It's not restful or restorative.

"It's a paradox," Dr. Hauri adds. "Most good sleepers don't stay in bed long enough, but most insomniacs stay in bed too long."

The clock is another problem. "A clock in the bedroom is poisonous if you can't sleep," he says. "You just keep looking at it. Set the alarm and then hide it."

Dr. Hauri also suggests that if you are having trouble sleeping, try a warm bath or glass of warm milk before bedtime. There may be an underlying medical or psychological problem that needs to be addressed. You may get too much caffeine, not get enough exercise or not unwind before you go to bed. "Some people worry so much about falling asleep that it makes it even more difficult," he says.

Taking a sleeping pill is appropriate when used according to directions during those rare occasions when sleeping is difficult. Examples are adjusting to jet lag; changes in your shift-rotation; a personal crisis, such as the loss of a loved one; or stress related to a specific event, such as giving a presentation.

There are two major drawbacks to taking sleep aids chronically:

  • The pills start to lose their effectiveness.

  • When a person stops taking the pill, it becomes even harder to sleep.

Remember that you may even have unrealistic assumptions or expectations about how much sleep you need. "You don't need much more than 71/2 hours of sleep a night," Dr. Hauri says.

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