OTC-sleep-aidOver-the-counter sleeping pills are readily available at the pharmacy: drugs like ZzzQuil, Benadryl, Unisom and Tylenol PM. All promise sound, refreshing sleep. Just how well do live up to that promise, and are they as harmless as they’re said to be?

These sleep aids work by blocking the secretion of histamine, a neurotransmitter that keeps you awake. Nearly every insomnia sufferer I know has tried them at some time or another, and some are satisfied customers.

“Whatever’s in Unisom, I’ve found it works for me pretty well,” says Dale, a marketing expert I interviewed for my book, whose main problem is getting to sleep at the beginning of the night and who sometimes wakes up in the middle of the night. “It’s 80 to 90 percent reliable.”

Other people with insomnia dismiss over-the-counter sleep aids as worthless. Existing scientific research suggests their efficacy is indeed fairly limited.

The active ingredient in most OTC sleeping pills is diphenhydramine (some formulations of Unisom contain doxylamine, a similar drug). In one study, diphenhydramine moderately increased subjects’ sleep efficiency (i.e., they spent more of their time in bed sleeping rather than lying awake).* In another study, older insomniacs taking the drug woke up a little less frequently at night.** Pretty small gains. Yet what behaves like a sugar pill for one insomniac can apparently work magic for another.

Downsides of OTC Sleep Aids

You might think, because these drugs are sold over the counter, that you can use them however you see fit without risk. Some are advertised as “non-habit-forming.” But here it’s better to be cautious. Studies suggest that if you take them every night, you’ll wind up needing to increase the dose to get the same sedative effect.

“Over-the-counter antihistamines may have a role for short-term insomnia treatment in younger adults,” write the authors of a review paper published last year, “but tolerance develops rapidly.”*** So nightly use of OTC sleep aids is not a good idea.

Lingering Effects

The other problem with these antihistamines is that their sedative effects are relatively long lasting and can cause morning drowsiness. Compared to newer prescription sleep meds, they have long elimination half-lives. (Half-life is the time it takes for a dose of a drug in the blood plasma to decrease by half.)

Diphenhydramine has a half-life of 2.4 to 9.3 hours, and its half-life tends to increase with users’ age. It will leave some people—older adults, especially—feeling groggy in the morning. The half-life of doxylamine is about 10 hours, and typically longer in older adults. It, too, may cause morning drowsiness, which increases the risk of falls and driving incidents.

Dale has found a way to cut down on the grogginess. “I use half the recommended dosage,” he says. “That minimizes the hangover in the morning.”

If you’re using OTC sleep aids, keep these caveats in mind.

*    Valerian-hops and Diphenhydramine

**  Temazepam and Diphenhydramine

*** Histamine-1 receptor antagonism

Posted by Lois Maharg, The Savvy Insomniac

Lois Maharg has worked with language for many years. She taught ESL, coauthored two textbooks, and then became a reporter, writing about health, education, government, Latino affairs, and food. Her lifelong struggle with insomnia and interest in investigative reporting motivated her to write a book, The Savvy Insomniac: A Personal Journey through Science to Better Sleep. She now freelances as an editor and copy writer at On the Mark Editing.

4 Comments

  1. In my particular case I haven’t had any luck with OTC sleep aids. I have had some undesirable side effects in the past, and haven’t achieved a restful night sleep, and the next day a feel groggy.

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  2. Hi Karen,

    I’ve never found that OTC sleep aids help me much, either. My biggest problem is not being able to get to sleep at the beginning of the night. Taking something like Tylenol PM rarely makes a difference. But it DOES make me groggy in the morning. So the only time I even think about using OTC sleep meds is when I’m sick and planning to take the next day off.

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  3. Not so sure about over the counter stuff.

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  4. For anyone considering Avinol PM, here’s a little more information about it. One of its active ingredients is melatonin, which is mainly effective for people who want to change the timing of their sleep. For details, watch my video trailer (http://youtu.be/omxNT8y7w80) and see this blog I posted last May:

    https://thesavvyinsomniac.com/will-melatonin-keep-me-asleep

    The other active ingredient in Avinol PM is 5-HTP. It’s created by the body from tryptophan, an essential amino acid we get from food. Here’s a blog about foods high in tryptophan, which research shows are helpful to sleep:

    https://thesavvyinsomniac.com/food-for-sleep

    However, a few people supplementing their diets with 5-HTP have developed EMS, a rare disease, as a result. See this article by Consumer Lab for details:

    https://www.consumerlab.com/reviews/L-tryptophan_5-HTP/tryptophan/

    But no cases of EMS have occurred in the US.

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