Many people have over-the-counter suggestions to address insomnia, and rarely are any of those suggestions going to result in good, long-term sleep.
“The bottom line is that there is no effective, safe over-the-counter or herbal remedy for insomnia right now,” says Jennifer Martin, PhD, a clinical psychologist and professor of medicine at the David Geffen School of Medicine at the University of California at Los Angeles.
“There are several over-the-counter sleep aids that are marketed, but none of them actually show any benefit over placebo,” says Dr. Martin, who also serves on the board of directors for the American Academy of Sleep Medicine, says. “None of them are recommended.”
Often, she says, people will suggest melatonin as a sleep aid, especially when people have a lot of trouble sleeping after traveling across time zones.
“Melatonin can be helpful in resetting your body clock,” says Tom Roth, PhD, director of the Sleep Disorders and Research Center at Henry Ford Hospital and professor of psychiatry at Wayne State University School of Medicine in Detroit. “So, if you travel from New York to California and you take melatonin properly, you will be able to get up at the appropriate time. While melatonin may be able to reset your body clock, it will do nothing for you in terms of insomnia. It is a chronobiologic agent, not a hypnotic.”
Dr. Martin suggests that melatonin works about as well as placebo. “When people with insomnia are getting into bed at night, they feel really anxious about their ability to sleep. They worry about it during the day, and that daytime impact is what we look for when we think about chronic insomnia disorder. When we talk about that clinical disorder, melatonin is no better than placebo at treating it.
“But here’s the rub: In the case of insomnia, placebos work pretty well, and part of the reason, we think, is that when people take sleeping pills it makes them feel less worried and anxious about falling asleep, and they fall asleep faster,” she says.
“One of the challenges in insomnia is that trying harder to fall asleep makes things worse,” Dr. Martin says. “Melatonin is no better than placebo, but that doesn’t mean that your friends who say that it helps them aren’t actually sleeping better. It’s not the melatonin, it’s just that they think they are taking something that helps them sleep.”
Dr. Roth also suggests that taking melatonin to reset the body clock after a trip across the country or across the ocean is not just a matter of popping a pill. “It is not a simple procedure to use melatonin to treat a patient’s jet lag so they reset their wake up time. It has to be directed in very specific ways. There is a certain time you have to take it; there is a specific dose, and other factors,” he says. “But if you have insomnia, resetting the biological clock will not treat that condition.”
He also cautioned against the use of melatonin that is sold over-the-counter, especially in so-called health food stores. “Patients should be wary of getting sleep aids from health food stores,” Dr. Roth says. “Some of the melatonin labeled products sold in these stores may not even contain melatonin at all. None of the so-called nature sleep products have ever been shown to be effective in treating insomnia.”
Other people may recommend drugs such as Tylenol PM, Advil PM, or Benadryl as treatment for insomnia, but these agents and myriad similar products contain diphenhydramine, an antihistamine. “Sleepiness is a side effect of antihistamines,” Dr. Martin says, “and these drugs are capitalizing on that side effect. People develop tolerance to them if they are used more than two or three nights in a row.”
Dr. Roth agrees. “There can be lots of side effects with these over-the-counter medications, especially in people over age 65, in addition to the fact that efficacy hasn’t really been that well demonstrated,” he says.
“Sometimes I feel badly for my patients because they spend a lot of money on these things — and there is great advertising — but there is not a lot of data to support those claims,” Dr. Martin says. “If they need testimonials to market the drug, they probably don’t have data.”
Dr. Martin also says that people with insomnia or other conditions may be directed to take natural products, including one call kava. Kava, also called kava kava, is a member of the nightshade family of plants and native to the South Pacific islands. Pacific Islanders have used it for hundreds of years as a ceremonial drink to promote a state of relaxation.
While it may be touted as a sleep aid, Dr. Martin says, “Kava can have liver toxicity issues, so that is actually discouraged as an insomnia treatment — especially if people are taking other medications that are metabolized in the liver. Its use can be unsafe.”
Another over-the-counter — so to speak — sleep aid is the bed you sleep on. Promises of better sleep for multiple types of technologically advanced beds offer to give you a good night’s sleep, but Dr. Roth says he doesn’t take much stock in their treatment for insomnia. “There have not been any convincing studies that show the bed you use — even those costing thousands of dollars — are going to help in insomnia.”
And, Dr. Martin adds: “When it comes to beds, there isn’t a one-size-fits all recommendation here, but if you are sleeping on a mattress that is more than 10 years old, and you wake up feeling stiff or sore, replace it. For people with allergies, keep the mattress clean with a washable cover or by vacuuming it regularly.”
Next: Sleeping Mistakes
Disclosure: Roth disclosed that he consults for many companies who do work in insomnia, including Merck, Eisai, Novartis. Martin disclosed no relevant relationships with industry.
Source: Various telephone interviews.