Sleep Week: Prescription Drugs, OTC Sleep Aids, Supplements — What’s Best for Helping You Sleep?

Your questions on which sleeping pills to pop — answered.

It’s Be Well Philly Sleep Week! All week long, we’re celebrating sleep and all the wonderful things good quality shuteye does for your body. We reached out to Philly’s top sleep experts to answer all your sleep questions in one fell swoop. Check back this week for more installments of our ultimate sleep FAQ. And to see them all in one place, pick up a copy of Philadelphia magazine’s May issue, on newsstands now. 

» Also in Sleep Week: “Do Wearable Sleep Trackers Actually Work?”

My doctor prescribed sleeping pills, but I’m scared of the side effects. What other options do I have?

If you can’t sleep, you’re in good company. A recent survey showed that 27 percent of U.S. adults have trouble falling or staying asleep most nights, and 68 percent have trouble at least once a week. The problem with older sleeping pills like some benzodiazepines wasn’t just that they were addictive, according to Karl Doghramji of Jefferson: “A tolerance develops, they don’t work as well, and you get ‘rebound insomnia’ when you go off them.” Some newer drugs aren’t addictive. But those taking prescription sleeping pills are still twice as likely to be in auto accidents as non-users, and the FDA has cut the recommended dosage for some pills in half. That’s the bad news. The really bad news is that sleeping pills are shockingly ineffective. The newest, Belsomra, got users to sleep just six minutes faster and for 16 minutes longer per night than placebos in testing by Consumer Reports, and the older ones, like zolpidem and benzos, weren’t much better. The main effect the pills have, some doctors say, is that they make you less likely to remember being awake.

So what’s a tosser-and-turner to do? Cognitive behavioral therapy for insomnia, or CBT-I, can be more effective than pills, says Michael Perlis, director of Penn’s Behavioral Sleep Medicine Program. Fifty to 70 percent of those who complete it get at least 50 percent better—“In other words, if you’re normally awake for 60 minutes trying to get to sleep, it’s down to 30 minutes in two to eight weeks.” And half of those who respond go on to full recovery, where they’re asleep every night in 15 minutes or so. If that sounds like bliss, be forewarned: CBT-I isn’t easy or fun. “It gets harder before it gets better,” says Perlis. “But people come to us who’ve had insomnia for 10 years and want an instant cure. You’ve put up with this for 10 years, and you can’t suffer for a week or two?”

That said, Einstein’s David Greenspan notes that there are good reasons why people have trouble sleeping from time to time—a job loss, a death in the family, other crises. It’s okay to take pills briefly to get you over a bout of insomnia. It’s when your sleeplessness becomes chronic that you want to try CBT-I.

What about the over-the-counter stuff? Does it work?

The reason most over-the-counter sleeping pills make you drowsy is that they contain the antihistamine diphenhydramine—yup, the same active ingredient as Benadryl. In addition to preventing allergy symptoms, this chemical compound keeps your body’s naturally occurring histamines from regulating sleep and wakefulness, and disrupting that process causes drowsiness. The good news is, your body won’t build up a tolerance to them. But sleep aids do come with a host of possible side effects, including dry mouth, constipation, dizziness and more. Plus, the older you get, the more sensitive you become to those side effects—and the side effects become more pronounced. “OTC sleep aids are not the cleanest medications,” says Catherine Riley, a pulmonary, critical care and sleep medicine specialist at Bryn Mawr Hospital. “I’ve seen patients who have real issues with not being able to urinate.” Riley says if patients insist on trying OTC meds, she recommends they do so for no more than a few days, and never with additional sedatives, including alcohol and pain meds.

Can supplements and natural remedies help you sleep? Are they safe?

The sleep-supplement aisle at CVS is kind of like the Wild West: The products aren’t regulated by the FDA, so really, anything goes. As Fredric Jaffe explains, “There’s no standardization in terms of dosage, preparation or delivery,” and most supplements and natural remedies haven’t been extensively studied. This isn’t to say they don’t ever work—you just need to be wary.

Many herbal supplements, like valerian root and chamomile, which is often found in sleepytime teas, work the same way big-name prescription sleep aids do: They decrease anxiety and help you relax, making sleep easier to come by. The upside, anecdotally, is that they don’t leave you with that drowsy next-day hangover feeling. But while they might help you fall asleep, they won’t necessarily help you stay asleep.

Then there’s melatonin. It’s a hormone your body naturally releases in the evening to prep you for sleep by drowning out your wakefulness signal; for most people, the signal peaks around 8 p.m. Taking a melatonin supplement in the evening adds to your body’s natural supply, which, as Jaffe puts it, can help to “throw a blanket on the underlying biological rhythm telling you to stay awake.” But be warned: Dosage amounts in commercially available melatonin supplements are all over the map—a 2005 meta-analysis conducted by researchers at MIT found you may only need a tenth of the standard dosage to get melatonin’s restful effects—so it’s worth checking with your doctor before you start taking one.

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