Over the Counter Sleep Aids
Since the most major concern with sleep is a LACK of sleep, the post will focus on supplements available and OTC meds. I try to tell people to always practice good sleep hygiene or habits. Practice makes perfect. Therefore, promote relaxation and other behaviors that optimize sleep:
- Establish a bedtime routine
- Have a regular time to sleep and wake
- Avoid computers and other electronic devices 1 hour before bedtime
- Never lie in bed for more than 15 minutes if not able to sleep
- Do stress reduction activities before bedtime
- Avoid late-in-the-day extensive exercise
- Avoid late-in-the-day stimulant use, such as caffeine/tea
- Use a bed/bedroom for sleep or sex only
- Consider moving the phone and other devices away from the sleeping area
- Restrict phone and computer use to 1 or more hours before bedtime
- Abdominal breathing
- Progressive muscle relaxation and meditation
- Exercise (during the day)
- A warm bath, warm milk
- Change bedroom environment
Natural/Supplement Sleep Aids
Supplements and vitamins are not F.D.A. regulated, so doses, brands, and reactions may vary or simply not help at all. Therefore, encourage the patient to talk about healthy habits and keep track/write down substances that are being consumed on a regular basis.
Major Supplements for Sleep
- Magnesium: a moderate dose of magnesium is about 100-350mg, beyond 400mg you may have GI side effects but most people are deficient in magnesium (source: Women’s Health). I’ve also written about different forms of magnesium and its benefits.
- Melatonin: the supplement form of your body’s sleep hormone that helps you sleep. Dosing varies but it’s usually between 0.5-10mg but can go higher (source: WebMD).
- Valerian Root: considered nature’s valium due to working on the GABA receptors and having sleep and relaxation qualities (source: Healthline). Dosing is between 400-900mg (WebMD). I don’t know if it’s the brand I have, but the capsules smelled like feet, so I never bought them again -update I guess “Valerian Root” is supposed to smell bad, and many sleep products used the ingredient so FYI!
Additional Aids for Sleep
WebMD has a list of vitamins/supplements for insomnia, but just because most of the supplements won’t help with sleep and the research doesn’t provide evidence, doesn’t mean they can’t help with relaxation. Supplements also carry risks and are not regulated so if anything exceeds the recommended dose, it’s probably best to leave it alone:
- CANNABIDIOL (CBD): Insufficient Evidence
- GERMAN CHAMOMILE: Possibly Ineffective
- HOPS: Insufficient Evidence
- INDIAN SNAKEROOT: Insufficient Evidence
- KAVA: Insufficient Evidence
- LAVENDER: Insufficient Evidence
- LEMON BALM: Possibly Effective
- L-TRYPTOPHAN: Insufficient Evidence
- MELATONIN: Possibly Effective
- PASSIONFLOWER: Insufficient Evidence
- PYRIDOXINE (VITAMIN B6): Insufficient Evidence. AVOID B VITAMINS at bedtime, they’re commonly used for energy or in the AM.
- SWEET ORANGE: Insufficient Evidence
- SWEET VIOLET: Insufficient Evidence
OTC Sleep Brands
In general, OTC sleep brands fall into 2 major categories; which are diphenhydramine and melatonin. They have many different formulations and additives like combining the supplements previously mentioned. Melatonin is pretty straightforward and simple but diphenhydramine can generally cause more side effects.
Doxylamine succinate is an antihistamine, but it’s the best sleep aid that helps me without major issues (minus the bitter taste) unlike diphenhydramine -though they are both antihistamines. With that being said, read the fine print because almost everything has diphenhydramine in it and is more expensive whereas doxylamine succinate ONLY comes in tablets, usually has the cheaper store brand, and a lower dose (25mg), which should minimize the grogginess/risks:
Unisom comes in doxylamine succinate & diphenhydramine…
Not a Major Cure & Precautions
Over-the-counter sleep aids can be effective for an occasional sleepless night. However, there are a few limitations like most 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. Sometimes the tolerance can build the next day.
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.
Common Side-Effects of Sleep Aids
- 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 benefits, other studies haven’t found the same benefits. Valerian generally doesn’t appear to cause side effects (it just smells bad).
Store brands containing the same active ingredients as brand-name sleep aids are commonly available, too. Store brands have the same risks and benefits as their brand-name counterparts, often at a more reasonable cost.
Important Precautions
When using over-the-counter sleep aids, follow these steps:
- Start with your doctor. Ask your doctor if the sleep aid might interact with other medications or underlying conditions, and what dosage to take.
- Keep precautions in mind. Diphenhydramine and doxylamine aren’t recommended for people who have closed-angle glaucoma, asthma, chronic obstructive pulmonary disease, sleep apnea, severe liver disease, digestive system obstruction, or urinary retention. In addition, sleep aids pose risks for women who are pregnant or breastfeeding and might pose risks to people over age 75, including an increased risk of strokes and dementia.
- Take it one day at a time. Over-the-counter sleep aids are a temporary solution for insomnia. Generally, they’re not intended to be used for longer than two weeks.
- Avoid alcohol. Never mix alcohol and sleep aids. Alcohol can increase the sedative effects of the medication.
- Beware of side effects. Don’t drive or attempt other activities that require alertness while taking sleep aids.
Additional Information
