Patients coming in to a pharmacy looking for something over the counter to treat insomnia is a pretty common occurrence. I would say almost a daily one. Insomnia is when someone has trouble getting to sleep or staying asleep. I think everyone has had at least a few times in their lives that insomnia has been a problem.These tend to be the times where the stress in our lives is much greater than normal for a period of time. Whether it be stress from work or family, a death of someone close, planning a wedding, wondering if your favorite on Dancing with the Stars is going to make it to the next round. There are a multitude of reasons that we may have trouble sleeping in the short term.
"How long have you had the problem and is there any causes that come to mind?" would be a question I would ask before discussing possible OTC suggestions. Transient or short term insomnia we may be able to come up with an OTC solution for but if the problem is persisting more than 3 weeks or so, this is considered chronic insomnia and I would suggest seeing your primary care physician.
If we were to go out into the aisles and try to find an OTC appropriate for you, many times there appears to be tons of choices but usually most of those different boxes have the same active ingredients in them. The choices that come to mind are antihistamines, valerian and melatonin. These are sometimes in combination with each other or sold as an individual product.
Antihistamines are drugs that block histamine binding and relieve us from all the symptoms of seasonal allergies. The newer drugs like Claritin and Allegra are second generation antihistamines and differ from the older drugs like Chlor-trimeton and Benadryl in that they do not have central nervous system side effects at recommended doses. In the case of insomnia this is exactly what we want so the active ingredients in many sleep aids are either diphenhydramine (Benadryl) or Doxylamine (Unisom) which can have many side effects but primarily drowsiness. Not everyone will get this side effect however and would not be a good candidate for this type of product. Though insomnia is commonly seen in the elderly this sort of medication can cause many problems and I would highly recommend not self treating with this. Antihistimines can cause urinary retention (exacerbate benign prostate hyperplasia), cause confusion (usually worse the older we get), dizziness (resulting in falls and injury), increase pressure in the eye (patients with glaucoma should use caution) and cause dry mouth (chronically can lead to dental and gum disease). So as one can see just because something is considered over the counter doesn't mean there can't be major problems from taking it.
We could move onto Valerian root if one wanted to try a herbal product. Valerian extract has a long history of use for sleep and anxiety purposes and is still one of the more popular herbal preparations in Europe. It is thought to work in the body somewhat similarly to a class of prescription meds called benzodiazepines which include Xanax and Valium. It doesn't seem to interact with other meds except if you were already on a sedating medication and doesn't seem to have as many potential side effects. The other side of the coin is that Valerian hasn't shown to have as great a benefit in more recent studies that earlier ones. The study design is so important in order to get valid results and many studies involving herbs tend to be either too small or bias is apparent. One other thing to keep in mind is that herbals are usually not standardized by amounts of active ingredient like traditional medications so make sure to check the label for recommended dosing as this changes from manufacturer to manufacturer. All in all though this is a case of I don't think it will hurt you if you want to give it a try that fine.
Next possibility is melatonin. This is a substance that we produce in our bodies that seems to regulate our sleep/wake cycle. This may be most useful in insomnia caused by shift work or jet lag. Again studies are conflicting but this may be worth a try as there doesn't seem to be many documented drug interactions and side effects.
There are some behavioral changes that can be made in your life to help minimize insomnia as well called sleep hygiene.
1. Use the bed only for sleep and sex. Having a TV in the bedroom can contribute to insomnia.
2. Don't eat right before bed. Can also contribute to acid reflux.
3. Exercise regularly but try to keep it at least 3 hours before going to bed
4. Try to set up a regular time for sleeping and getting up in the morning.
5. Avoid caffeine even early in the day or consume less.
6. Consider using white noise like a fan so you don't hear every bump in the night.
7. As good as that afternoon nap is it may make it difficult to sleep at your regular time.
These suggestions may help a person with infrequent or short term insomnia but remember to see your doctor for persistent cases. It can have a huge mental and physical toll on you over a period of time. Often there can be an underlying cause and trouble sleeping is just a symptom. Also other medications may be a cause. Both of which are beyond the scope of this blog topic for now.
So until next time
Dr. Steven Jensen PharmD. recently opened in Saline at The Oaks plaza. This independent pharmacy offers both traditional and compounded prescriptions.