Forty-eight percent of Americans report insomnia occasionally, while 22 percent experience insomnia every or almost every night. Insomnia can have a very serious impact on quality of life, productivity and safety. Many people with sleep problems want a quick fix and turn to sleep aid medications. Sleep medications don’t cure insomnia and in some cases, can make the problem worse. Some things to consider when using an over the counter or prescription sleep medication include:
- Development of tolerance or dependence
- Side effects
- Drug interactions
End Confusion at the Pharmacy
· For all sleep medications:
o Follow the directions closely
o Tell your doctor and pharmacist about ALL other medications (OTC, Rx, dietary supplements) you are taking; these medications are potent and can interact with other drugs
o Avoid alcohol when taking sleep medications
o Never drive a car or operate machinery after taking a sleeping pill
o Be sure to practice good sleep hygiene
- Eliminate daytime naps
- Follow a regular sleep pattern: go to bed and arise at about the same time each day
- Exercise regularly but not late in the evening – complete exercise at least 3 hours before bedtime and preferably 5-6 hours before bedtime
- Avoid eating heavy meals or large snacks immediately before bedtime
- Avoid alcohol later in the evening
- Avoid caffeine later in the day (after noon in some people)
- Engage in relaxing activities before bedtime
- Make sure the bed and bedroom are comfortable for sleeping
- If unable to fall asleep, leave the bedroom and participate in a relaxing activity for 20-30 minutes
· Nonprescription (OTC) medications are available to treat insomnia but there are differences between them
o Sleep aid products containing diphenhydramine are the best choice for the treatment of insomnia. Examples of these products include Unisom Sleep Gels, Sominex, and generic diphenhydramine products. The dose is 25-50mg at bedtime. Start with the lower dose and if necessary increase to 50mg.
· Tips: READ the label. The amount of active ingredient varies from product to product. For example, Sominex contains 25mg of diphenhydramine while Unisom Sleep Gels contain 50mg of diphenhydramine. Generic products may save you money.
o Doxylamine is another active ingredient available OTC to treat insomnia. It is contained in Unisom Tablets. Do not get confused between the two products. Doxylamine has been studied less than diphendydramine and is not the preferred treatment.
o Some sleep aids like Tylenol PM also contain a pain reliever as well as diphenhydramine. These products are helpful when sleeplessness is accompanied by aches and pains.
o All of the OTC products are for short-term use. If insomnia persists more than 7-10 days, see your doctor.
o All of these OTC sleep aids can interact with other medications; do not mix with other medications or alcohol without checking with your doctor or pharmacist.
o All individuals who take sleep aids need to also focus on improving their sleep practices.
o Side effects can include drowsiness the next day, dizziness, dry mouth/throat, dizziness.
o Talk to your pharmacist about OTC sleep medications – he/she can help you choose the best one for your situation.
· Prescription medications are available from your doctor
o Medications with a fast onset and short duration of action (to avoid excessive day time sedation) are usually preferred
o Some examples are: Lunesta, Ambien, Sonata, Roserem
o Other, older medications are available but they may cause residual sedation
o All of the prescription sleep aid medicines can interact with other medications; do not mix with other medications or alcohol without checking with your doctor or pharmacist
o The elderly, and anyone who needs to get up during the night should take these products cautiously and only if the benefit outweighs the risk. The sedating effects of hypnotics increase the risk for falls. Doses should be lower for the elderly.
· Alcohol should not be used as a sleep aid. Alcohol can cause restless sleep with awakenings within 2-4 hours and total sleep duration can decrease.
Submitted by:
Jan Engle, Pharm.D., FAPhA
Executive Associate Dean
Professor and Head, Department of Pharmacy Practice
UIC College of Pharmacy
UIC Pharmacy
Past President, American Pharmacists Association
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