Insomnia and Over-the-Counter Sleep Aids

By: Alere Staff

Insomnia, trouble sleeping at night, is sometimes a problem for about 30% of adults, and often a problem for about 10% of adults. A National Institute of Health report states insomnia is more than just a nighttime problem, but also affects daytime quality of life, and mental and physical health.1 In addition, not getting enough sleep increases the risk of having high blood pressure, heart disease, and other medical conditions.2

Insomnia is a common problem in late life and problems sleeping are often wrongly considered a normal part of aging. Even though more than 50% of seniors have insomnia, it is often not treated properly. Non-medication solutions are not offered to patients as much as they could be by healthcare providers.3

Medicines to aid sleep may be recommended if insomnia interferes with your daytime activities. Discuss sleep medicines with a doctor or nurse. If a sleeping medicine does not work for you within the first few weeks, your healthcare provider may recommend trying a different medicine or may refer you to a sleep disorder center.

Lifestyle Changes

If you have insomnia or trouble sleeping, avoid substances that could make it worse. According to the National Institute of Health, avoid substances such as:

  • Caffeine, tobacco, and other stimulants
  • Certain over-the-counter and prescription medicines that can disrupt sleep (some cold and allergy medicines)
  • An alcoholic drink before bed might make it easier to fall asleep, but alcohol triggers a lighter than normal sleep
The FDA Office of Women’s Health offers these Tips for Better Sleep4:
  • Go to bed and get up at the same time each day.
  • Don't exercise within two hours of bedtime.
  • Don't eat large meals within two hours of bedtime.
  • Don't nap later than 3:00 p.m.
  • Sleep in a dark, quiet room that isn't too hot or cold for you.
  • If you can't fall asleep within 20 minutes, get up and do something quiet until you feel sleepy.
  • Wind down in the 30 minutes before bedtime by doing something relaxing, such as reading or listening to music.
Over-the-Counter Medications

Not all sleep aids are prescribed. The FDA (Food & Drug Administration) has approved over-the-counter (OTC) medications for use for up to two weeks to help relieve occasional sleepiness in people ages 12 and older. If you continue to have sleeping problems beyond the two weeks, you should see your doctor.

But just because they're available over-the-counter doesn't mean they don't have side effects, says Marina Chang, R.Ph., pharmacist and team leader in FDA's Division of Nonprescription Regulation Development. "They don't have the same level of precision as the prescription drugs. They don't completely stop working after 8 hours – many people feel drowsy for longer than 8 hours after taking them."4

Chang advises reading the product label and exercising caution when taking OTC sleep aids until you learn how they will affect you. "They affect people differently," she says. "They are not for everybody."4

Some sleep aid OTC products may contain antihistamines. Although these may make you sleepy, you should talk to your doctor before using them as antihistamines can pose risks for some people. There is little evidence that these sleep aids are beneficial for treating insomnia. Antihistamines can cause daytime sleepiness and other side effects, such as dry mouth, blurred vision, and difficulty emptying the bladder.

Natural Sleep Aids

If you're searching for a natural sleep aid to put an end to your insomnia, here's something to keep in mind. Some sleep aids and herbal remedies may help induce sleepiness. But natural products and dietary supplements are not regulated by the FDA for quality, dosing, and formulation. That makes it difficult to judge their safety and effectiveness. That's why it's important to know as much as you can about sleep herbs before you try a product.

Dietary supplements, herbal compounds, and homeopathic preparations often are promoted as sleep aids. Ingredients may include melatonin, valerian, kava-kava, hops, lavender, passion flower, and skullcap. These products generally are regarded as safe but most have not been carefully studied for interactions with other medications. In fact, the FDA has issued a safety warning regarding reports of liver toxicity with kava-kava.1

One of the most common OTC sleep aids is melatonin - a hormone that is normally produced by a gland in the brain. Melatonin regulates the body's circadian rhythms. Those are daily rhythms such as your sleep-wake cycle. The levels of melatonin in the blood are highest prior to bedtime. According to the National Institute of Health, melatonin is believed to be safe when used for less than three months.5

However, melatonin might slow blood clotting. Taking melatonin along with medications that also slow clotting such as warfarin might increase the chances of bruising and bleeding. Melatonin might increase the effect of herbs that slow blood clotting and might increase the risk of bleeding in some people.6

Talking to Your Doctor

Talk to your doctor if you have trouble sleeping. Your doctor will likely look at your medical and sleep histories, and perform a physical exam. They might also recommend a sleep study. Always talk to your doctor before starting or stopping any medications or dietary supplements while taking warfarin.

  1. Neubauer, D, MD. The Evolution and Development of Insomnia Pharmacotherapies. J Clin Sleep Med. 2007 August 15; 3(5 Suppl): S11–S16.
  2. Healthy Sleep At A Glance. The National Heart, Lung and Blood Institute, U.S. Department of Health and Human Services National. NIH Publication No. 09-7426 August 2009.
  3. Kamel NS, Gammack JK. Insomnia in the elderly: cause, approach, and treatment. Am J Med. 2006 Jun;119(6):463-9.
  4. FDA Consumer Health Information Publication 073107. Side Effects of Sleep Drugs. July 31, 2007.
  5. Nina Buscemi, PhD, et al. A Meta-Analysis: The Efficacy and Safety of Exogenous Melatonin for Primary Sleep Disorders. J Gen Intern Med. 2005 December; 20(12): 1151–1158.
  6. A Service of the U.S. National Library of Medicine, NIH, National Institure of Health. MedLine Plus Natural Medicines Comprehensive Database.