Aids for getting a good night's sleep
5/11/2023 by Andrea Aguayo, Pharm.D., R.Ph.
Getting a good night's sleep is a challenge for a lot of Americans. According to the Centers for Disease Control and Prevention (CDC), about one in three adults report not getting enough sleep at night. An estimated 50-70 million Americans have some type of sleeping disorder. Not getting enough sleep can be linked to many chronic conditions such as heart disease and obesity. The American Academy of Sleep Medicine and the Sleep Research Society recommend adults sleep at least seven hours each night. To help achieve that healthy goal, 10 to 12 percent of adults use over-the-counter (OTC) sleep aids, according to the U.S. Department of Health and Human Services (HHS).
Catching ZZZs can be more difficult for seniors
The quality of sleep decreases as we age. People over 60 years or older are at higher risk for insomnia; sleep duration may shorten, and sleep latency (the time it takes to fall asleep) may increase. Sleep is often interrupted by a variety of factors, including medications, sleep-interrupting trips to the bathroom and high incidence of depression. Getting back to sleep then becomes the problem. Consequently, we often see seniors seeking medications to combat trouble sleeping.
Using OTC sleep medicines is quite common in patients who have been regularly taking prescribed medications to treat insomnia. Nearly all sleep-promoting medicines, whether prescribed or OTC, have an especially high potential for side effects. Generally, it's best to avoid or limit use as much as possible. Talk with your doctor or pharmacist before starting any over-the-counter medications or supplements to review any potential interactions with your other medications and potential adverse effects.
As a pharmacist, I ask patients, "What medication do you take if you can't sleep?" followed by, "Does it help?" I hear many different answers to these questions, so here's a look at what's available over the counter:
OTC options to help for a better night's sleep
Diphenhydramine or doxylamine
These are first-generation antihistamines. Other common names are Unisom or ZzzQuil. These antihistamines are also added with some formulations of pain medications, such as acetaminophen or ibuprofen with the addition of "P.M." or "nighttime" in the name.
Approval of these products has been grandfathered in, and they haven't been subjected to required safety and efficacy testing for sleep by the FDA. They also take longer to clear from our bodies the older we get.
We have good evidence that first-generation antihistamines cause sleepiness, but they come with frequent side effects, especially for seniors. That's because they work by chemically interrupting specific signaling mechanisms in the brain, which already are more disrupted by the aging process. Some side effects include:
- Confusion.
- Morning grogginess.
- Falling.
- Slowed reaction times.
- Short-term learning and memory impairment.
- Possibility of strokes and longer-term memory impairment.
Melatonin
This is a hormone that has some evidence for improving our sleep cycle. We know that when day/night sleep patterns are disrupted, like in people who work night shifts, melatonin can promote drowsiness.
Herbal supplements
Most OTC herbals are classified as supplements, so they are not FDA regulated for standards of potency and benefit. They're usually referred to as "natural" and purportedly safe. They may enhance sleep, but there's no strong evidence showing real benefit. Herbal supplements also have possible side effects, including impaired motor functions, restlessness, agitation and others.
Magnesium
This mineral has been promoted to improve sleep quality, but there aren't enough clinical studies to recommend it as an effective sleep aid.
Valerian Root
Valerian root is an herbal remedy, which has shown to modestly improve sleep quality in various studies but may take several weeks to see benefit. The herbal remedy does not seem to improve sleep duration or insomnia severity.
Theanine
An amino acid, theanine is promoted to enhance sleep quality, but once again, there aren't enough clinical studies to endorse it as effective for sleep.
Ashwagandha
Also known as “Indian Winter Cherry” or Indian Ginseng,” research has shown this herb may modestly improve sleep in patients with insomnia or non-restorative sleep. Summary The combination of OTC or prescription sleep aids and alcohol/other substances that affect brain function have the potential to increase the risk of serious side effects or life-threatening sedation.
So if you're having trouble sleeping, ask your provider or pharmacist, "What do you think would be safe for me to take with my other medicines?" Often, the answer is not medication or supplements but instead to improve your sleep habits. Check out these helpful sleep tips from the National Sleep Foundation.
Andrea Aguayo, PharmD, RPh, is a first year community-based resident rotating through various outpatient departments at Mayo Clinic in Arizona. She plans to continue her residency training at Mayo Clinic Health System in Eau Claire, Wisconsin. She is devoted to the patients she encounters daily in the clinic and enjoys working with the providers to find the best therapy and answering medication-related questions.