OTC sleep aids and supplements: What's best and safe?

You've followed all the tips for getting enough sleep — sleeping on a regular schedule, avoiding caffeine and daytime naps, exercising regularly and managing stress. Still, a good night's rest remains out of reach. You may be thinking about over-the-counter (OTC) sleep aids or other sleep supplements. If your problem has been bothering you for more than a few weeks, make an appointment with your doctor. It's important to know what's causing your insomnia.

OTC sleep aids are effective for an occasional sleepless night. But the more often you take them, the less effective they become. And OTC sleep aids may leave you feeling groggy and unwell the next day, particularly if you're an older adult. If you're considering sleeping supplements, it's important to understand that much is unknown about their safety and effectiveness.

Common OTC sleep aids

Various OTC sleep aids are available in any pharmacy. Most of these medications contain antihistamines, which can cause drowsiness. Store brands containing the same active ingredients as brand-name sleep aids are commonly available. Store brands have the same risks and benefits as their brand-name counterparts, often at a more reasonable cost.

Talk to your doctor before taking any OTC sleep aid if you're currently taking an antidepressant in the class of drugs called monoamine oxidase inhibitors (MAOIs) — such as phenelzine (Nardil) or tranylcypromine (Parnate) — or did so as recently as two weeks ago. Also check with your doctor first if you take any other drugs for depression, psychiatric or emotional conditions, or Parkinson's disease.

Although antihistamine-based medications may improve mild symptoms of insomnia for a short period of time, they aren't likely to help for longer than a couple of weeks.

Here are some common OTC sleep aids:

Diphenhydramine (Sominex, Benadryl, Tylenol PM, others)
These may cause:

• Dry mouth
• Dizziness
• Prolonged drowsiness lasting into the next day
• Memory problems

They are not recommended if you're breast-feeding. They also may not be safe if you're pregnant or have a history of:

• Glaucoma
• Heart problems
• Enlarged prostate

Doxylamine (Unisom)
This medication may cause prolonged drowsiness. It also may not be safe if you're pregnant or breast-feeding or you have a history of:

• Asthma
• Bronchitis
• Glaucoma
• Peptic ulcer
• Enlarged prostate

With these types of OTC sleeping aids, don't drive or attempt other activities that require alertness while taking the drug.

Dietary supplements

Various dietary supplements have been touted as effective insomnia treatments, but there's much that isn't known about their effectiveness or safety. The most widely publicized may be the hormone melatonin and the herb valerian.

Melatonin
Melatonin is thought to help control your body's internal clock. The melatonin supplements most often found in health food stores and pharmacies are manufactured versions of the natural hormone. These supplements are most helpful for people experiencing jet lag or the effects of shift work. They have less and inconsistent effects as a sleep aid. There are many unanswered questions about melatonin. Some people who've taken melatonin have reported:

• Daytime drowsiness
• Headaches
• Dizziness

Other side effects reported include stomach discomfort, short-lasting depression symptoms, mild tremor, mild anxiety, irritability and confusion.

Melatonin may interact with a variety of common drugs, so talk with your doctor before trying it. The best dose isn't certain, and the long-term effects are unknown.

Melatonin may not be safe if you're:

• Pregnant
• Breast-feeding
• Younger than age 20

Valerian
Supplements made from this plant may reduce the amount of time it takes to fall asleep and help you sleep better. However, it's not clear what the active ingredient is. Also, the potencies of various ingredients vary from preparation to preparation.

Although the Food and Drug Administration considers valerian to be generally safe, side effects may include:

• Headache
• Excitability or uneasiness
• Heart disturbances

Valerian may not be safe if you're pregnant or breast-feeding. Valerian may strongly react with other sleep aids and with alcohol, and may react with other medications, as well. The best dose isn't certain, and the long-term effects are unknown. Talk to your doctor before taking valerian.

Taking sleeping pills

If your best attempts to get a good night's sleep have failed, your best bet is to make an appointment with your doctor. Often, specific causes for insomnia may be found that are reversible. Nondrug approaches including cognitive behavioral therapy can be effective. Prescription sleeping pills may be both effective and safe, if taken as prescribed. Consider OTC sleep aids or supplements with caution.

• Start with your doctor. You don't need your doctor's OK to take an over-the-counter sleep aid, but it's a good idea to check with your doctor anyway. He or she can make sure the sleep aid won't interact with other medications or medical conditions. Your doctor can also help you determine the best dosage. In some cases, your doctor may recommend prescription sleeping pills. If you and your doctor decide further evaluation is needed, you may be referred to a sleep specialist.
• Take it one day at a time. Sleep aids are a temporary solution for insomnia. Most over-the-counter varieties are intended to be used for only two to three nights at a time. Taken too often, some sleep aids may cause rebound insomnia — sleeplessness that returns in full force when you stop taking the medication.
• Avoid alcohol. Never mix alcohol and sleep aids. Alcohol increases the sedative effects of the pills. Even a small amount of alcohol combined with sleep aids can make you feel dizzy, confused or faint.
• Quit carefully. When you're ready to stop taking sleep aids, follow your doctor's instructions or the directions on the label. Some medications must be stopped gradually.
• Watch for side effects. If you feel sleepy or dizzy during the day, talk to your doctor about changing the dosage or discontinuing the pills.

Everyone benefits from a good night's sleep. If you continue to have trouble sleeping, consult your doctor for additional help.

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