OTC Sleep Aids: A Risky Business

Many of us assume that over-the-counter drugs are safer than prescription drugs.

Yet the long-term effects of any drug can remain unknown for decades, and now researchers have found a correlation between long-term and/or high-dose use of OTC sleep aids and dementia.

Over-the-counter sleeping pills may not be as safe as we thinkSome insomniacs are leery of prescription sleeping pills but feel OK about sleep aids sold at the drugstore.

“I’m not really looking for medical intervention,” said Dale, a marketing manager who spoke to me about his insomnia as I was conducting interviews for my book. “I’m absolutely not interested in anything strong. But if it’s sold over the counter and I can take a half dose of it, that’s fine.”

Many of us assume that over-the-counter drugs are safer than prescription drugs. Yet the long-term effects of any drug can remain unknown for decades, and now researchers have found a correlation between long-term and/or high-dose use of OTC sleep aids and dementia.

Which Drugs Are Involved?

These drugs are called anticholinergics, among them the first-generation antihistamines that are now marketed as sleep aids. The active ingredient in these sleep aids is diphenhydramine or doxylamine. Here’s a list of common brand names:

  • Benadryl
  • Sominex
  • ZzzQuil
  • Tylenol PM
  • Excedrin PM
  • Nytol
  • Unisom
  • Store brands containing diphenhydramine and doxylamine.

Anticholinergic drugs block the action of acetylcholine, a neurotransmitter that plays an important role in waking us up and keeping us vigilant. When we’re awake, acetylcholine neurons are active in several areas of the brain. But the brains of people with Alzheimer’s disease show a marked reduction of acetylcholine and acetylcholine-secreting nerve cells. Other common anticholinergic medications include tricyclic antidepressants such as doxepin (Sinequan) and antimuscarinic drugs for bladder control such as oxybutynin (Ditropan).

Gist of the Study

Investigators at the University of Washington began tracking the medical records of 3,434 healthy 65-year-olds to see if anticholinergic medications increased their risk of developing dementia. About 23 percent of these older adults went on to develop dementia over a 7-year period.

Compared with people who did not take anticholinergic drugs, people taking at least 4 mg of diphenhydramine daily (1 capsule of Benadryl or ZzzQuil contains 25 mg of diphenhydramine), 10 mg of doxepin daily, and 5mg of oxybutynin for more than 3 years had a small increased risk of developing dementia. The risk increased in a linear fashion with higher doses and longer use.

Results in Perspective

This is not the first study to link dementia to the use of anticholinergic drugs. Researchers in Australia found that taking more anticholinergic medications was associated with greater risk of hospitalization for confusion or dementia. Researchers in Spain have concluded that long-term use of anticholinergic drugs “may generate a worsening of cognitive functions” and can also “initiate signs of dementia.”

None of the studies show that the relationship between anticholinergics and dementia is causal. Yet they do suggest that frequent use of OTC sleep aids may not be as harmless as many insomniacs suppose.

So what to do? Several prescription sleeping pills have also been connected to an increased risk of dementia, and a small body of research suggests that poor sleep may itself be a factor in the development of cognitive impairment. Now is the time to check into drug-free treatments for insomnia and be more sparing in the use of sleep meds, whether they’re handed over by a pharmacist or you can buy them right off the shelf.

 

Do Sleeping Pills Hasten Dementia?

As if it weren’t bad enough that sleeping pills may increase your susceptibility to the common cold and shorten your life, a new study suggests that insomnia and sleeping pills like Ambien and Imovane (similar to Lunesta) increase your chances of developing dementia after age 50.

Is your day brighter yet?

sleeping pills may be a risk factor for dementiaAs if it weren’t bad enough that sleeping pills may increase your susceptibility to the common cold and shorten your life, a new study suggests that insomnia and sleeping pills like Ambien and Imovane (similar to Lunesta) increase your chances of developing dementia after age 50. Is your day brighter yet?

Study Details

Authors of the study on sleeping pills and dementia examined data from a large database in Taiwan with two questions in mind:

1)  How does the risk of dementia compare in patients with and without insomnia? and

2)  Is there an association between sleeping pill use and the risk of dementia in older adults?

The study included over 34,000 patients ages 50 and above. About 5,700 were diagnosed with long-term insomnia during a 3-year period and were prescribed sleeping pills. For each of these patients, investigators looked at 5 others without insomnia and compared them.

Overall, insomnia patients taking prescription hypnotics were over twice as likely to receive a dementia diagnosis as patients who did not have insomnia or use sleeping pills. Insomnia patients in the 50- to 65-year age range were over 5 times as likely to develop dementia. Longer-acting sleeping pills (benzodiazepines like Klonopin and Dalmane) and higher doses of sleeping pills also increased the risk of dementia.

Limitations

But note the study’s limitations. Investigators controlled for factors like hypertension and diabetes but were unable to control for education and socioeconomic status, smoking and alcohol consumption, and body mass, all of which play a role in the development of dementia.

A more serious limitation is the fact that researchers could not ascertain whether the increased risk of dementia was due mainly to the sleeping pills or to insomnia itself. And, as P.L. Chen and colleagues point out, it could be that the sleep disturbances that developed in these middle-aged and older patients were actually early symptoms of dementia already in the works.

Still, any controlled study that points to possible side effects of sleeping pills should give pause to people who use them, and I am one. The pharmaceutical industry and researchers funded by the industry insist the newer sleeping pills have fewer side effects, and this may be true. But I’m still convinced that caution should be the watchword for long-term users. Only take them when you need them, and use the lowest dose that works.