When you can’t sleep, should you reach for an over the counter sleep aid? Sleep deprivation occurs when someone doesn’t receive as much sleep as they need. Acute sleep deprivation occurs when the individual doesn’t get any sleep. Chronic sleep deprivation occurs when someone receives insufficient across sleep multiple nights. Losing out on just one hour of sleep for a few nights can lead to serious consequences, including a higher risk of accidents, illnesses, relationship difficulties, and decreases in self-control.
Insufficient sleep is a widespread problem in the United States with over 30% of Americans frequently getting less sleep than they need. Numerous causes for poor sleep quality exist including:
Anxiety (including a racing mind)
Pain (Fibromyalgia, joint pain, Gulf War Illness, arthritis, gastro related pain, and other types of pain)
Side effects of drugs (caffeine, prescription drugs, etc.)
Frequent bathroom trips
Dense, urban environments with noise and light pollution
Insomniacs reach for prescription and over the counter (OTC) drugs, supplements, and herbs to improve their ability to go to sleep or stay asleep.
Going to sleep is a complex process involving biology and psychology. The body’s biochemistry plays important roles in the ability to sleep. Hormones and chemicals that naturally occur in the body including acetylcholine, dopamine, epinephrine, glutamate, histamine, melatonin, and norepinephrine all play a role in the ability to go to sleep and stay asleep.
Sleep medicines hope to reduce the amount of time it takes to go to sleep, make it easier to stay asleep, and increase the total time slept.
Because anxiety and pain are often responsible for sleep problems, medications that address anxiety or pain and make you drowsy are the most effective insomnia treatments.
In this article, we’ll discuss the effectiveness of over the counter sleep medications, supplements, and herbal treatments as well as their potential side effects. We review over the counter sleep aids that include diphenhydramine, doxylamine, dimenhydrinate, melatonin, valerian root, and CBD Oil.
All prescription medications include warnings about serious and even life-threatening side effects that have been experienced by some patients. Ideally, insomnia treatments will allow sleeping to come easily without risking serious adverse effects or next day drowsiness that makes it difficult to function well. None of the commonly prescribed prescription drugs meet this criterion. Let’s see if over the counter insomnia treatments offer effective relief with less risk.
A few common ingredients are used in many different over the counter sleep aids sold under a variety of names. In addition, some over the counter medicines combine multiple drugs, sometimes to address pain, congestion, and anxiety.
Also, the active ingredient in products with the same name may be different in different versions of the drug. For example, Unisom is a sleeping pill with the active ingredient Doxylamine. But Unisom PM Pain doesn’t contain Doxylamine. Unisom PM Pain’s active ingredients are diphenhydramine and acetaminophen while Unisom SleepGels only contain diphenhydramine.
Our review makes it clear how important it is to read and understand the label before taking sleeping pills, especially in light of the potential for serious adverse consequences. Professional tip: Take a photo of the label on drugs you use with your cell phone for easy reference and to help you purchase the same type of active ingredient if you need to buy over the counter sleep aids in the future.
We’re going to cover the side effects of the main ingredients used in over the counter sleep aids. An article that covers all the possible combinations would be too long. You can look up the ingredients in any specific drug on Medscape and view the side effects and drug interactions.
Diphenhydramine is an antihistamine that causes drowsiness. Antihistamines counteract histamine (allergic reactions) in the body that cause nasal congestion, sneezing, and other allergic reactions.
Best Over the Counter Sleep Aids with Diphenhydramine
Adverse Side Effects Associated with Diphenhydramine
Side effects are symptoms some patients experience when they take a specific drug. Whether you will experience any of the side effects is unknown.
Serious Side Effects
Serious side effects can be life threatening or cause life threatening situations. For example, while dizziness by itself isn’t a big deal when someone is sitting down, it can lead to serious injuries or death when it occurs when they’re walking downstairs or causes the person to stumble into traffic.
Agranulocytosis (dangerous low white blood cell count)
Sedation ranging from mild drowsiness to deep sleep (most frequent side effect)
Thickening of bronchial secretions
Tightness of the chest
Tinnitus (ringing in the ears)
Less Common Side Effects
Rare Side Effects
Cholestasis (impaired bile function involving the liver)
Hepatitis (inflammation of the liver)
Hepatic failure (liver failure)
Hepatic function abnormality (abnormal liver function)
Jaundice (yellowing of skin or eyes due to high levels of bilirubin)
Side Effects with Higher Risk for Geriatric Patients
May interfere with safe driving and operation of machinery
Over the Counter Sleep Aids with Combinations of Supplements aren’t Recommended
Some of the herbal supplements are made into combination medications but combining sleeping aids, even herbal ones, is not recommended. There is not much research for the individual supplements, and even less when they are combined.
Many sleep aids work because they suppress the Central Nervous System (CNS) and having multiple drugs suppressing the CNS can cause dangerous reductions in heartbeat and breathing. Without clinical testing, using combinations is risky business.
There is evidence that using multiple sleeping herbs or sleeping supplements is ill-advised yet, because supplements are regulated like food, not drugs, companies combine multiple ingredients that aren’t tested for use in combination with one another and market them as over the counter sleep aids to unsuspecting consumers.
Understanding the ingredients that should not be combined and reading the labels is your best option to avoid adverse side effects.
Individually, the following substances have some evidence of being beneficial for sleep with a low risk of adverse side effects from short term use. The experts recommend not combining these supplements with one another.
Here are some examples of products that combine multiple supplements. Reviewing their labels provides an example of what to look out for.
Reading the box can prevent adverse reactions and save you money. Store brands are often available with the same active ingredient as national brand names at a reduced price.
Treating insomnia with prescription or over the counter sleeping aids is not the best solution. Professional mental health sessions with a therapist for insomnia can be highly effective with long-term benefits in as little as 1 – 6 sessions. Instead of adverse side effects, Cognitive Behavioral Therapy has beneficial side effects.
Improving stress management skills also reduces insomnia symptoms.
If your insomnia symptoms persist for more than 7 – 10 days, consult with your physician.
There isn’t enough research to know if melatonin use is safe over the long-term
Patients with epilepsy and those who take blood thinners should discuss melatonin with their doctor before they take melatonin
Use only reputable brands – random testing showed variations from the contents disclosed on the label and, in 26% of the bottles, serotonin was present. Too much serotonin can have harmful effects, even at slightly elevated levels.
Difficulty driving or operating machinery the next day.
Do not combine Valerian root with other herbal supplements that cause drowsiness (including chamomile, gotu kola, Jamaican dogwood, kava, melatonin, St. John’s wort, 5-hydroxytryptophan) California poppy, skullcap, yerba mansa, or catnip).
Do not drink alcohol when taking Valerian root.
Read labels carefully. For example, one of the most popular liquid valerian root products contains cane alcohol despite recommendations not to combine valerian root with alcohol. Another product combines numerous sedating ingredients including L-Theanine, Melatonin, P5P, Chamomile, and valerian root.
Look at the list of ingredients on this label and compare it to the list of herbal supplements standard warnings discourage using when taking Valerian root. Remember, clinical testing of the individual ingredients is limited and testing of their use in combination with other supplements is non-existent. Natural does not mean safe. Many poisons and deadly substances are natural.
CBD oil is made from the parts of hemp or marijuana that do not contain THC, the psychotropic chemical in hemp (THC), that causes a high. CBD oil is legal under Federal law as long as the oil doesn’t contain more than .3% THC. CBD oil remains illegal under the laws of a few states.
CBD Oil is becoming known for alleviating pain, anxiety, and assisting with sleep, both frequently interfere with sleep.
More research is needed to further understand all the side effects from using CBD Oil.
CBD Oil isn’t marijuana because the psychotropic ingredient, THC is minimal or absent in CBD Oil, but the legalization of marijuana by many states has fueled new research on the effects of both marijuana and CBD Oil. More research is still needed but early reports indicate that CBD has a favorable safety profile.
Animal studies indicate there may be risks to unborn children.
Insufficient research exists to comment upon the safety of CBD Oil used in combination with other drugs.
So far, most studies have been short-term (30 days or less) so less is known about risks associated with long-term use.
Is CBD Oil legal?
As of this writing, CBD oil is only illegal in three states (Idaho, Nebraska, and South Dakota). The Federal government made CBD Oil with less than .3% THC legal, but states can have laws that are more restrictive than the Federal laws. CBD oil doesn’t contain enough THC to cause the high that makes marijuana a popular recreational drug.
THC is the psychotropic chemical in hemp and some states, such as Idaho, require 0% THC for CBD Oil to be legal within its borders.
Natural vs Safe
It is important to note that natural ingredients are not automatically safe. Many natural ingredients can have harmful side effects or be toxic at high doses.
None of the over the counter sleep aids are recommended for long-term use. Prescription sleep aids also have this limitation. Sleep aids of any type aren’t the best choice for dealing with acute or chronic insomnia. They should only be used on a short-term basis while you work on sleep hygiene and meet with a therapist or develop stress management skills.
The best over the counter sleep aid for you depends on why you’re having difficulty sleeping. If pain is keeping you awake, try a pain reliever without sleep medication first. Heat can sometimes ease pain without drugs. Only resort to an over the counter pain medication combined with a sleep aid, such as Tylenol PM or Advil PM after discussing the situation with your doctor.
If anxiety, depression, stress, or a racing mind are keeping you awake, you have a number of options. Therapy is your best shot at long-term relief without adverse side effects. Improving your ability to manage stress is another way to ease the symptoms that interfere with your ability to go to sleep or go back to sleep after you wake up. CBD Oil is a good choice if it is legal in your state because it helps with anxiety and pain.
If poor sleep hygiene is interfering with your sleep health, making adjustments to your habits is healthier than popping an over the counter sleep aid.
While the risks associated with over the counter sleep aids are not as severe and don’t occur as frequently as the adverse side effects associated with prescription sleep aids, they can still pose dangerous and life-threatening risks that are best avoided whenever possible.
Always consider how the drugs you take to help you sleep might interact with other drugs or supplements you’re taking and with possible pregnancy or the need to drive or operate dangerous machinery.
We hope this article helps keep you safe and helps you sleep well.