How to Choose Safe Sleep Aids

There are a variety of prescription and over-the-counter (OTC) medications that can help treat chronic insomnia and occasional sleeplessness. While none of these medications is without risk, understanding the contraindications (specific situations under which certain drugs should not be taken) and taking them properly can help prevent adverse reactions. There are also several techniques you can use to improve your sleep that do not require medication.

Part 1 - Using Prescription Sleep Aids Safely

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→ Treat underlying conditions first. While prescription sleep aids are a good choice for some people who suffer from insomnia, they are not right for people whose sleeplessness has a treatable underlying cause. See your doctor to determine if you may need medications or other treatment to address underlying conditions before you consider a sleep aid.

→ Common disorders that interfere with sleep include chronic pain, acid reflux, sleep apnea, and leg movement disorders such as restless leg syndrome. Depression, anxiety, and stress may also interfere with your sleep patterns.

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→ Understand that all medications have risks. While science has come a long way, there is still no such thing as risk-free sleep aid. All of these medications have the potential to cause adverse side effects, such as drowsiness, confusion, and dependency. If you are considering taking a prescription sleep aid, be sure to have a conversation with your doctor about the risks and benefits.

→ The most common effects associated with sleep medication include increasing daytime sleepiness, drowsiness, dizziness, lightheadedness, cognitive impairment, impaired motor coordination, and chemical dependence. Less common side effects of sleeping aids include complex sleep disorders, such as sleepwalking, driving, making telephone calls, eating, and having sex while not fully awake.

→ Sleep aids may also cause a temporary worsening of depression symptoms.

→ Doxepin and Ramelteon are two sleep aids that are not thought to have a risk of dependency.

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→ Opt for short-acting drugs when possible. If you are considering taking a prescription sleep aid, ask your doctor if a short-acting drug would be right for you. While side effects still happen with short-acting drugs (which are absorbed by the the body quickly), they are less common than they are with long-acting drugs (which take longer to be absorbed).

→ Short-acting drugs include Ramelteon, Triazolam, Zaleplon, and Zolpidem. Long-acting drugs include Doxepin, Estazolam, Eszopiclone, Temazepam, and Zolpidem extended release.

→ Long-acting drugs may be more appropriate for some people, especially those who have a problem with staying asleep, versus falling asleep.

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→ Know if an antidepressant is right for you. While antidepressants are not approved by the FDA as sleep aids, there are some antidepressants that are also sedatives. Low doses of these drugs may be appropriate for treating insomnia in patients who also suffer from depression or anxiety.

→ Amitriptyline, Mirtazapine, Trazodone are all antidepressants with sedating effects.

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→ Follow your doctor's instructions. If you are given a prescription for a sleep aid, it's important to follow the dosing instructions carefully. Taking too much or too little of the drug may cause unwanted side effects.

→ Never reduce or increase your dosage without discussing it with your doctor first, even if you feel that the dosing is not right for you.

→ Stopping your medication suddenly can cause rebound insomnia.

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→ Use extra caution if you are older. Prescription sleep aids can cause anyone to feel groggy and confused the next morning, but these side effects tend to worsen with age. Be especially cautious about taking sleep aids if you are 50 or older.

→ Older people may be more susceptible to side effects because the body breaks down medication more slowly with age.

→ If you are 50 or older, talk to your doctor about the correct dose for you, as it may be best to take less than the recommended dose to start.

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→ Avoid driving right away. Because prescription sleeping aids can cause side effects like grogginess, it's a good idea to avoid doing anything that requires a lot of focus until you understand how the drug affects you. Driving and operating machinery are especially dangerous, so avoid these activities for at least one day after you start taking a new sleeping medication.

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→ Report complex sleep behaviors. Sedative and hypnotic drugs can sometimes cause people to engage in complex behaviors, such as eating and driving, while asleep. When this happens, people typically have no memory of the events the next morning. This can be very dangerous, so let your doctor know if you have any reason to believe that you have been engaging in any complex sleep behaviors while taking a prescription sleep aid.

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→ Get immediate medical treatment for allergic reactions. While it is not very common, some people have serious allergic reactions to prescription sleep aids. If you experience anaphylaxis or facial swelling, it's important to get medical help right away, as these reactions can interfere with your ability to breathe.

Part 2 - Choosing the Right Over-the-Counter Sleep Aids

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→ Don't use alcohol as a sleep aid. Some people self-medicate with alcohol when they have difficulty falling asleep, but this is not a good idea. While alcohol may make you feel tired, it worsens the quality of your sleep, so you are less likely to wake up feeling refreshed the next morning.

→ Never drink alcohol if you are taking any kind of prescription or or over-the-counter sleep aid, as it may cause adverse reactions.

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→ Use over-the-counter medications for short periods only. OTC sleep aids can be very effective if you use them occasionally; however, it is easy to build up a tolerance to the antihistamines that most of these medications contain, which will render the drugs ineffective for you. To avoid building up a tolerance, don't take over-the-counter sleep aids consistently for long periods of time.

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→ Know the contraindications for OTC sleep aids. Diphenhydramine and doxylamine are the active ingredients in most OTC sleep aids. These medications are generally safe for short-term use, but they are not recommended for the following individuals:

→ People with closed-angle glaucoma

→ People with asthma

→ People with chronic obstructive pulmonary disease

→ People with sleep apnea

→ People with severe liver disease

→ People with digestive system obstruction

→ People with urinary retention

→ Women who are pregnant or breastfeeding

→ People over the age of 75

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→ Understand the pros and cons of melatonin. Melatonin is a sleep-inducing hormone that is naturally produced by the body. Melatonin supplement pills are popular sleep aids, which may be effective for some, but are not right for everyone.

→ Melatonin supplements tend to be more effective for individuals who suffer from circadian rhythm disorders (including jet lag) than they are for people who have chronic insomnia.

→ Although it is "natural," melatonin can still cause side effects, including sleep walking, nausea and next-day drowsiness.

→ Because it is not regulated by the FDA, melatonin pills can vary in potency from one brand to another. Start out with 0.1–0.3 mg for sleep. If you cannot find a preparation with these doses then it is best to buy the 1.0 mg pills and split them in half. Start "low and slow." Keep in mind you can also find delayed and immediate release pills, which can help you further fine-tune your dosage.

→ Take melatonin about an hour before planning to go to bed and adjust this time as necessary.

→ Certain drugs, such as beta-blockers, can interfere with your production of melatonin. Caffeine and alcohol are known to have an effect on melatonin synthesis and metabolism.

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→ Get the facts on Valerian. Valerian is an herbal supplement that is commonly taken as a sleep aid. It may be effective for some people, but just like every other sleep aid, it may cause side effects and it is not the right choice for everyone.

→ Valerian is typically most effective when it is taken regularly for at least two weeks, so it is a better choice for people with chronic insomnia than it is for people who have occasional sleep problems.

→ Common side effects include dizziness, headaches, and stomach upset.

→ Valerian is not safe for women who are pregnant or breast-feeding, for children under three years old, or for people with liver disease.

→ Valerian is not regulated by the FDA, so there are no official recommendations regarding correct dosing.

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→ Beware of drug interactions. All over-the-counter sleep aids, including herbal sleep aids, may interact with prescription and other over-the-counter medications. Always talk to your doctor about all of the medications you are taking.

→ Melatonin can interact with birth control pills, immunosuppressants, diabetes medications, and blood thinners.

→ Valerian can interact with St. John's Wort.

Part 3 - Using Non-Medical Tricks to Aid Your Sleep

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→ Adjust the temperature. Most people sleep better when they are not too hot, but not too cold. To help yourself fall asleep faster and sleep better, adjust your thermostat so that the temperature is between 62 and 70°F (16.6 to 21.1°C) while you sleep.

→ Everyone is different, so try experimenting with different temperatures to find out what works best for you.

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→ Choose the right blanket. The perfect blanket can also dramatically increase the quality of your sleep. There is no one size fits all solution, so you may have to try a few different blankets before you find the perfect one for you.

→ A light to medium-weight blanket is ideal, as heavy blankets can cause you to become too hot at night, which can disrupt your sleep. Heated blankets may also cause you to become too hot.

→ If you have allergies, make sure to choose a non-allergenic blanket and wash it weekly in hot water to get rid of any allergens.

→ Weighted blankets are ideal for people who suffer from anxiety, as they provide pressure similar to a hug, making you feel safe.

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→ Make lifestyle changes to promote good sleep hygiene. There are a variety of simple changes you can make to your lifestyle that may help encourage sleep. If you are having sleep problems, you may want to try the following techniques before you resort to medication:

→ Try to go to bed and wake up at the same time every day, even on weekends.

→ Start winding down for sleep a few hours for bed with relaxing activities, such as a warm bath or shower, meditating, or drinking decaf tea.

→ Avoid caffeine in the afternoon and evening.

→ Don't nap during the day, as this can cause you to be less tired at night.

→ Exercise regularly to help burn energy.

→ Reduce or manage the amount of stress in your life.

TIPS

→ You can reduce the likelihood that you will feel drowsy the day after taking a sleeping aid (either prescription or OTC) by ensuring that you have a full eight hours to devote to sleep before you take it.

→ If you find that you need to use an over-the-counter sleep aid most nights, you should see your doctor for further evaluation.