Sleep is essential to our overall mental wellbeing. If you are having difficulties sleeping, speak to your GP as they can prescribe the appropriate medication or offer cognitive behavioural therapy as potential solutions.
UK media coverage of a recent paper on hypnotic prescribing raised concerns and promoted cognitive behavioral therapy (CBT) as an alternative therapy option, prompting further examination into people’s responses in terms of depharmaceuticalisation or de-pharmaceuticalisation. This paper theorises these reactions from UK citizens as an aspect of (de-)pharmaceuticalisation.
Over-the-counter sleeping pills
Over-the-counter sleeping pills may help improve your rest, but it is important to remember they should only be used sparingly as they won’t treat insomnia completely and may interact with medications you already take. When considering over-the-counter pills for insomnia relief, be sure to speak to a healthcare provider first – often nondrug treatments and behavioral changes may suffice as remedies for improved rest.
Antihistamines are the cornerstone of most over-the-counter sleep aids and often serve as their active ingredient to promote drowsiness. You’ve likely sworn by antihistamines for allergy symptoms like runny nose and sneezing; their action inhibits histamine, the substance responsible for these unpleasant sensations; yet histamine inhibition has also been known to lead to sleepiness.
OTC sleeping pills should only be taken under medical advice and should not exceed several days’ usage; increasing or decreasing dosage too quickly could cause unpleasant side effects and rebound insomnia. Furthermore, following usage directions carefully is crucial to avoid unwanted side effects or rebound insomnia from occurring.
Antihistamines
Many over-the-counter sleeping tablets contain antihistamines as active ingredients. Antihistamines are typically prescribed to treat allergies like hay fever, yet may cause drowsiness as a side-effect. Unfortunately, however, such medication can leave users feeling tired the following morning, rendering it ineffective as long-term sleep aids.
First-generation antihistamines such as diphenhydramine, doxylamine and chlorpheniramine often lead to drowsiness as a side effect and may even cause rapid heart rate which causes dizziness and nausea. Many newer second and third-generation antihistamines do not have sedated effects and less likely cross blood-brain barriers and cause drowsiness than older antihistamines.
Sleep aids that contain antihistamines are often called “drowsy-relief medicines”, and they’re best used to temporarily remedy insomnia related to allergies or colds. However, sleep aids may also help with chronic insomnia; it’s best to consult a medical professional for diagnosis and advice prior to beginning any new medications. Alcohol should also be avoided while taking these sleep aids since this could increase their drowsy-inducing effects. Your physician should advise taking antihistamines only as instructed, since long-term use could be harmful.
Benzodiazepines
Benzodiazepines (benzos) are sedatives that work by slowing nerve signals and decreasing activity in the brain, binding to receptors on cells activated by Gamma Aminobutyric Acid (GABA). Although benzos have various chemical structures, all act similarly and have similar side effects; dizziness, confusion and impaired judgement may occur and should only be taken as prescribed; long-term use has been associated with anxiety, depression and withdrawal symptoms as well as short half lives and addiction issues.
Benzos can be effective in treating insomnia when taken for short periods, yet prolonged use could become habit-forming and lead to next-day rebound anxiety, so they should only be used as a last resort and for no more than several weeks at a time. They should also not be combined with other drugs or alcohol as this increases the risk of dangerous interactions; mixed benzos with alcohol could cause paradoxical reactions like increased anxiety or hallucinations for users who take both substances together.
Newer anti-anxiety medications may provide better long-term solutions for insomnia treatment if you also suffer from depression. Some, such as melatonin, can improve sleep while Z drugs provide stronger anti-anxiety benefits – plus their half life is much shorter than with traditional benzodiazepines.
Z drugs
While not strictly speaking benzodiazepines, they do function similarly and carry similar risks of dependency and shorten-acting nature that reduce next day hangover effects compared to some other forms of sleep medication. They should only be prescribed after having tried other non-medication treatments have failed first, or in cases of older adults as they can cause excessive relaxation that might interfere with daily tasks and daily living.
Short-term interventional studies have demonstrated the efficacy of Z drugs as superior treatments to placebo or other pharmacological solutions in improving subjective sleep quality and decreasing wakefulness, but have also been associated with an increased risk of falls and fractures – this phenomenon being especially evident among older people.
Standard over-the-counter sleeping pills rely on antihistamines such as diphenhydramine (found in brands like Nytol, Sominex and Sleepinal) or doxylamine (found in Unisom and Nighttime Sleep Aid) to promote drowsiness. Some OTC sleeping tablets combine antihistamines with pain reliever acetaminophen.
When taking prescription or over-the-counter (OTC) sleep medicines, it is crucial that you follow all instructions exactly. If any questions arise regarding how best to use the medicine and likely side effects, always contact your healthcare provider immediately and mention any additional medicines such as herbs or supplements you are currently taking.