Melatonin and Non-Prescription Sleep Aids

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By Eugena Brooks

Recently, in a series of educational opportunities for patients, Wallace Mendelson, M.D. discussed the use of melatonin and also over the counter (OTC) sleep aids. Stress factors presented by daily life can occasionally leave one lying awake at night. If you are a sleep apnea sufferer as I am a good night’s sleep is a precious commodity. If the truth be told, good sleep is precious commodity no matter who you are. Understanding what to do about regulating your sleep is critical to your good sleep health and overall health. Many people turn to OTC sleep aids but are they really helping us? To that end, Dr. Mendelson’s educational webinar helps to clear up some issues and sheds some light on things we may have not considered before.

Dr. Mendelson is currently in the clinical practice of psychiatry, and he was formerly Professor of Psychiatry and Clinical Pharmacology at the University of Chicago. At that time, he was also Director of the Sleep Research Laboratory there. He has held professorships at Ohio State University and the State University of New York at Stony Brook, was Chief of the Section on Sleep Studies at the National Institute of Mental Health in Bethesda, MD, and Director of the Sleep Disorders Center at the Cleveland Clinic.

There are three general information points of interest to be considered regarding non-prescription sleep aids:

  1. OTC medications — including sleep aids or PM drugs– are a market of over $400 million annually.
  2. Most common are antihistamines usually made with diphenhydramine.
  3. Since prescriptions are not required, many people believe OTZ sleep aids are milder and safer.

According to Dr. Mendelson this is not a good assumption.

First marketed in the 1940s for conditions relating to allergies, movement disorders and inflammation, diphenhydramine (a component in various OTC nighttime sleep aids and allergy medications) caused daytime drowsiness. Diphenhydramine eventually was sold under a variety of names as a sleep aid and paired with acetaminophen in nighttime drugs.

Concerns begin when the user is left feeling drowsy or “hung over” the next day. In reference, Dr. Mendelson cites a positron emission tomography (PET) scan brain imaging study that found significant effects on histamine receptors even though participants did not believe they were sleepy.

Neurotransmitter acetylcholine blockers in the central and the peripheral nervous system can cause dry mouth, blurred vision, difficulty urinating, memory recall and confusion. Long term use has been associated with cognitive impairment and may result in confused states with the elderly.

Lastly, that another study tracking 3000 people over three years found a 50% greater chance of developing dementia than those that took it less than 3 months. While diphenhydramine seems to be effective when first used, it rapidly becomes less effective so over time. Studies about exact effects are unclear. However, half the number of people reported a withdrawal like sleep disturbance.

All medications, prescription or OTC, have a variety of side effects, according to Dr. Mendelson.

All things considered under these conditions it isn’t any wonder that many people seek out natural remedies. As an alternative to the nighttime sleep aids, Dr. Mendelson recommends the dietary supplement melatonin instead. Melatonin is a hormone secreted when it’s nighttime and dark by the pineal gland near the back of the brain and causes sleepiness. Because of its organic origins melatonin has been the “go-to-choice” for three million Americans in recent years.

As a dietary supplement melatonin can be found in most pharmacies or health stores. A much better alternative to sleep aids, melatonin has been found to be helpful with delayed sleep phase syndrome. A condition where one’s internal body clock is somewhat out of sync with that considered to be a normal time schedule. Delayed indicates getting sleepy several hours after it was an optimal time to get in some good hours of sleep. Also considered helpful with non-24-hour sleep-wake disorder (non-24) another body clock related issue where the internal body clock runs without any reference to what is considered a normal schedule. There is also some evidence that it is helpful with jet lag as well.

When it comes to insomnia the effects of melatonin become less certain. One review described its attributes as unclear and the findings of another study suggested that there might be a slight benefit. There are some side effects: 20% have reported daytime sleepiness. Others have reported headaches and dizziness, and there are some concerns about melatonin interacting with some medications such as blood thinners, diabetes and birth control. So as always it is wise to have your doctor in the loop.

Other concerns are since it is sold as a dietary supplement there is little government oversight in the production of melatonin. A study reported the actual amount of melatonin varied as much as 83% less and 478% more than what was on the label. These and other interesting subjects can be further explored in Dr. Mendelsons’ book ‘Understanding Sleeping Pills,” available at Amazon.