Resolving Sleeplessness

Whether it's in the bottom of a bottle of pills, a glass of wine, or a cup of herbal tea, many of us are searching for a good night's rest.

Sleeplessness was the topic of this month's Healthline, sponsored by South Jersey Healthcare and The Daily Journal.

Michele M. Dawson, a registered pharmacist at South Jersey Regional Medical Center answered two of your questions on the subject.

Question: Do all of the over-the-counter sleep aids have the same main ingredient and are they addictive or can you build up a tolerance to them?

Answer: The main ingredient of over-the-counter sleeping pills is an antihistamine. Antihistamines are generally taken for allergies. Histamine is a chemical messenger in the brain, which promotes wakefulness, so an antihistamine also has the effect of making you feel very sleepy. Some over-the-counter sleep aids also include a pain reliever. Common OTC sleep medications include:

# Diphenhydramine (found in Nytol, Sominex, Sleepinal, and Compoz)

# Doxylamine (Unisom, Nighttime Sleep Aid)

Over-the-counter sleep aids are meant to be used for short-term insomnia. Tolerance to the medication -- which means you need a higher dosage of the medication for it to work -- can develop in only a few days.

It's common to experience dizziness, dry mouth or prolonged drowsiness when taking these medicines.

Don't assume an over-the-counter medicine is safe for all people, Dawson said.

Sleep aids can be harmful to people with glaucoma, heart conditions, enlarged prostate, asthma, bronchitis, peptic ulcers, depression, Parkinson's disease or emotional/psychiatric disorders, Dawson said. The medicine can sometimes aggravate these conditions.

Women who are pregnant or who are breastfeeding also should not take these medicines, she said.

Some people prefer to seek a natural remedy, but Dawson urges people to apply the same caution as if they were taking a medicine.

Natural options may adversely interact with some medicines a person is taking.

The most common natural remedies are melatonin and valerian.

Melatonin is found within the body, Dawson said.

It's inconsistent as a sleep aid, she said, noting it works best for those seeking temporary relief such as shift workers or those suffering from jet lag.

Valerian is derived from a plant. It does make a person drowsy, but Dawson said it not always an effective sleep aid.

The drowsy feeling it causes may continue through to the following day.

Both melatonin and valerian come in a pill form.

It's very short-acting," Dawson said. "It's for people who are having problems falling asleep -- it won't help you continue to sleep all night."

If you take any sleep aid -- natural or pharmaceutical -- do not combine it with alcohol.

Read all the directions on the package and be sure to check with your pharmacist or physician to make sure it won't interact with other medications you are taking. Do not use sleep aids every night, Dawson said. It is possible your sleep problem could be something more serious, such as insomnia.

Q: It has been six years of sleepless nights for me. I get four hours of sleep and that is not a sound four hours. I may sleep one hour and lie awake another hour before I sleep again.

I have tried drinking warm milk, going to bed the same time every night for several weeks, eating a banana before bed, sleepytime tea, exercise (walking) in afternoon, warm baths, reading, doing puzzles all night, and drinking red wine with no improvement. Finally, I ended up taking Lunesta for two weeks. It did not make me tired or sleep at all. I also tried Ambien and then Ambien CR. Is there any help for me?

A: For chronic insomnia, a good sleep environment, relaxation and behavior techniques provide relief without risk of medication side effects or tolerance. In general, sleep medications are most effective as temporary aid, not a long-term solution.

Patients who have little improvement during the initial trial of cognitive behavioral therapy, pharmacologic therapy, or combination therapy may have other causes of poor sleep. Therefore, it is important to follow prescribed medication instructions for recommended duration of time by the physician.

Avoid caffeinated beverages from coffee, tea, soft drinks and chocolate after lunch late in the day.

Avoid alcohol near bedtime. Never drink alcohol in an attempt to fall asleep faster. Not only will alcohol disrupt your sleep even more, it can dangerously interact with the sleeping pill.

Only take sleep medications when you will be able to get a full night's sleep (seven to eight hours). Ask your doctor for specific instructions for decreasing or stopping use. In some cases, stopping medication abruptly can cause uncomfortable side effects and even rebound insomnia.

The bedroom should be reserved for sleep -- not for reading, eating, or doing puzzles.

If your own attempts to solve your sleep problems are unsuccessful, your doctor may be able to help with sleep problems caused by a sleep disorder, medication side-effects or interactions or illnesses.

Melatonin is found within the body, Dawson said.

It's inconsistent as a sleep aid, she said, noting it works best for those seeking temporary relief such as shift workers or those suffering from jet lag.

Valerian is derived from a plant. It does make a person drowsy, but Dawson said it not always an effective sleep aid.

The drowsy feeling it causes may continue through to the following day.

Both melatonin and valerian come in a pill form.

It's very short-acting," Dawson said. "It's for people who are having problems falling asleep -- it won't help you continue to sleep all night."

If you take any sleep aid -- natural or pharmaceutical -- do not combine it with alcohol.

Read all the directions on the package and be sure to check with your pharmacist or physician to make sure it won't interact with other medications you are taking. Do not use sleep aids every night, Dawson said. It is possible your sleep problem could be something more serious, such as insomnia.

Q: It has been six years of sleepless nights for me. I get four hours of sleep and that is not a sound four hours. I may sleep one hour and lie awake another hour before I sleep again.

I have tried drinking warm milk, going to bed the same time every night for several weeks, eating a banana before bed, sleepytime tea, exercise (walking) in afternoon, warm baths, reading, doing puzzles all night, and drinking red wine with no improvement. Finally, I ended up taking Lunesta for two weeks. It did not make me tired or sleep at all. I also tried Ambien and then Ambien CR. Is there any help for me?

A: For chronic insomnia, a good sleep environment, relaxation and behavior techniques provide relief without risk of medication side effects or tolerance. In general, sleep medications are most effective as temporary aid, not a long-term solution.

Patients who have little improvement during the initial trial of cognitive behavioral therapy, pharmacologic therapy, or combination therapy may have other causes of poor sleep. Therefore, it is important to follow prescribed medication instructions for recommended duration of time by the physician.

Avoid caffeinated beverages from coffee, tea, soft drinks and chocolate after lunch late in the day.

Avoid alcohol near bedtime. Never drink alcohol in an attempt to fall asleep faster. Not only will alcohol disrupt your sleep even more, it can dangerously interact with the sleeping pill.

Only take sleep medications when you will be able to get a full night's sleep (seven to eight hours). Ask your doctor for specific instructions for decreasing or stopping use. In some cases, stopping medication abruptly can cause uncomfortable side effects and even rebound insomnia.

The bedroom should be reserved for sleep -- not for reading, eating, or doing puzzles.

If your own attempts to solve your sleep problems are unsuccessful, your doctor may be able to help with sleep problems caused by a sleep disorder, medication side-effects or interactions or illnesses.

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