It's 2:00 a.m. and you're staring at the ceiling. You check the clock every five minutes to calculate how much sleep you can squeeze in before the alarm jolts you awake. You've tried warm milk and relaxation tapes, yet you're still wide-awake. Should you take a sleeping pill?
If this sounds like your nightly routine, take heart. Insomnia affects millions of people, and new sleep aids and other remedies claiming to solve the problem are plentiful. What's the best course of action and how do you know if sleeping pills or other sleep preparations are safe enough for regular use?
Before taking an over-the-counter sleep aid, speak to your doctor. Gary K. Zammit, PhD, president of the Sleep Disorders Institute at St. Luke's Hospital in New York City, advises that "not all sleep aids are the same and over-the-counter preparations may not be recommended for your problem. Overall, one should keep in mind that insomnia not only results in considerable nighttime distress for the insomnia sufferer, it is associated with next-day impairment, and may even have effects on health and mood."
Dr. Zammit also stresses that everyone's needs are different. "Some people need to use a medication nightly, [while] others need medication that offers flexible options and few side effects," he says.
Sleeping pills are available over-the-counter and by prescription. Use these tips when considering the use of sleep aids:
Many over-the-counter sleep aids contain antihistamines, while other contain the hormone melatonin .
Sleep aids containing antihistamines are common. They include medications, such as Tylenol PM , Nytol , and Unisom , among others. Some people take a pure antihistamine drug, such as Benadryl , to help them fall asleep. The main problem with these remedies is known as the "hangover effect," in which the next morning you may feel sluggish, sleepy, or have difficulty performing daily tasks.
Melatonin is a hormone that is secreted in the brain and helps our bodies to regulate the sleep-wake cycle. Melatonin is sold as a dietary supplement, rather than as a medication, and is therefore not subject to regulation by the Food and Drug Administration (FDA) for standards of potency and purity, so proceed with caution.
Dr. Zammit concurs, "Over-the-counter health food products are not exposed to the same kind of rigorous clinical testing as prescription medications. Therefore, people should speak with their doctors and consider prescription medication if it is advised. Insomnia results in distress and impairment, so using no treatment or the wrong treatment may pose risks."
There is research that supports that melatonin may help treat jet lag. If you decide to try melatonin, talk to your doctor.
There are several prescription sleep aids available. Commonly prescribed classes of drugs include: benzodiazepines, nonbenzodiazepine, benzodiazepine-receptor agonists, and antidepressants. Benzodiazepines include medications such as Valium , Xanax , Klonopin , and many others.
Some prescription sleep aids, such as the benzodiazepines, have been associated with problems of dependence, but, according to Dr. Zammit, "Recent data suggests that most people who are given sleep aids use them appropriately." Studies are showing that dependence may be less of a problem with newer medications, such as Ambien and Sonata .
According to the National Sleep Foundation, many factors can influence potential side effects of prescription sleep aids, including:
High doses of sleep medications may result in what is known as rebound insomnia. This occurs when a person stops taking a sleep medication and subsequently experiences a few nights of insomnia that is more severe than what was originally experienced prior to treatment. Rebound insomnia generally occurs with medications that have a short or intermediate half-life and can be avoided by slowly tapering the dose. Consult your physician prior to stopping or increasing your dose.
The goal is to have healthy sleep habits, which may prevent the need for sleep aids. The National Sleep Foundation recommends the following:
If you suffer from chronic insomnia, see your doctor. You may be experiencing a symptom of a larger problem, such as clinical depression or a sleep disorder. Your doctor will help you find the treatment plan or medication that's best for you.
RESOURCES:
National Center on Sleep Disorders
Research
http://www.nhlbi.nih.gov/about/ncsdr/index.htm
National Sleep Foundation
http://www.sleepfoundation.org/
CANADIAN RESOURCES:
Better Sleep Council Canada
http://www.bettersleep.ca/
The Canadian Sleep Society
http://www.css.to/
References:
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Manifestations and management of chronic insomnia in adults. NIH State-Of-The-Science Conference Statement. June 2005.
National Sleep Foundation website. Available at: http://www.sleepfoundation.org .
Sack RL, Auckley D, Auger RR, et al. Circadian rhythm sleep disorders: Part I, basic principles, shift work and jet lag disorders. Sleep. 2007;30:1460-1483.
Townsend DR. Sleep & caffeine. American Academy of Sleep Medicine website. Available at: http://www.sleepeducation.com/Topic.aspx?id=45 . Updated August 3, 2006. Accessed January 12, 2009.
Trickett S. Free Yourself From Tranquilizers and Sleeping Pills: a Natural Approach. Berkeley, CA: Ulysses Press; 1997.
Walsh JK, Roehrs T, Roth T. Pharmacologic treatment of primary insomnia. In: Kryger MH, Roth T, Dement W, eds. Principles and Practice of Sleep Medicine. 4th ed. Philadelphia, PA: Elsevier Saunders; 2005: 749-760.
Last reviewed January 2009 by Judy Chang, MD, FAASM
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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