If you regularly have trouble sleeping, it’s a sign that something is out of balance. It could be something as simple as too much caffeine, or dehydration. Or it could be a symptom of an emerging underlying medical or psychological problem. Whatever the reason, it won’t be cured with an over the counter sleeping pill. At best, an over the counter sleeping pill will provide a temporary band aid. At worst, it’ll erode your sleep confidence and worsen your sleep problem in the long run.
Insomnia is the most common sleep problem among the public and there two recognised treatments for it; medication prescribed by a medical doctor, usually a GP; or Cognitive Behavioural Therapy for Insomnia (CBT-i) provided by an accredited professional. The medication prescribed by a doctor can only be used safely for 2-4 weeks. The other treatment, Cognitive Behavioural Therapy for Insomnia is a multipronged behavioural approach that is proven to be more effective than pills in the long term.
CBT-i focuses on exploring the connection between the way we think, the things we do, and how we sleep. CBT-i improves psychological sleep outcomes and is a more effective treatment than benzodiazepine and non-benzodiazepine medication in the long term. Benzodiazepine medication is effective in the short term.
Notwithstanding these proven treatment options, many sufferers of insomnia choose to use complementary and alternative medicines (CAM) or over the counter pills before they seek assistance from a trained professional. CAM products include vitamin and mineral supplements, herbal and botanical medicines, homeopathic preparations and aromatherapy oils.
At any one point in time 80% of insomnia sufferers are self-medicating with complementary and alternative medicines (CAM) and 80% of the adult population will be using an over-the-counter pill to help them sleep. Not only that, 60% of the 80% are taking more than one pill to achieve a good night’s sleep. The American College of Physicians, ASM, and the European Union Insomnia Guidelines all advise against these strategies for treating insomnia because sleep can be affected by a large number of medical, physical and psychological problems. Effective treatment of insomnia needs to take each facet into account before determining an effective treatment plan.
While it is possible to buy these products in our local pharmacies and supermarkets, that does not mean they are safer to use. They’re even less safe if you are using them combined with other prescribed medications.
There are two types of over the counter sleep pills, one type based on antihistamines and the other on various herbal supplements with sedative components.
Over the counter sleep pills that contain first generation antihistamines are potent and long acting. The goal is sedation. These sleep pills often block a neurochemical called acetylcholine, and inhibits parasympathetic nerve impulses, i.e. helps to block involuntary muscle movement. Acetylcholine is important for memory. A side effect of these pills for some is that it does the exact opposite of what you want them to do. It keeps you awake, i.e. paradoxical excitation.
Herbal supplements have combinations of melatonin and herbs with sedative components like valerian. Their effectiveness depends on the amount, part of the plant used, and the compound it is in. As a result, effectiveness studies are challenging to compare. These supplements have properties similar to prescription medications, e.g. St. John’s Wort has properties similar to Prozac and valerian has properties similar to Ativan, a benzodiazepine prescribed for anxiety. Therefore, taking over the counter sleep pills purchased in your local supermarket or pharmacy is like taking prescription medications.
Taking over the counter sleep pills can be risky and it is recommended you check with your doctor before embarking on long-term use. Over the counter sleep pills and complementary medicine are not free from side-effects or interactions with other neurochemicals in your body, let alone any other prescribed medication.
While your body may feel healthy, prolonged use of over-the-counter sleeping pills (more than 15 days) can increase the likelihood of the following health risks:
1. Drug tolerance. You may, over a period of time, build up a tolerance to over the counter sleep pills, and you will have to take more and more for them to work, which in turn can lead to more side effects.
2. Drug dependence. You may come to rely on your over the counter sleeping pills to sleep and you may be unable to sleep or have even worse sleep without them. Prescription pills and the prospect of an uninterrupted night’s sleep can be very seductive, making it difficult to stop taking them.
3. Withdrawal symptoms. If you have been taking your over the counter sleep pills for some time, you may experience withdrawal symptoms, such as nausea, sweating, and shaking.
4. Drug interactions. Over the counter sleep pills can interact with other pills and prescription medications. This can worsen the side effects.
5. Rebound insomnia. If you decide to stop taking your over the counter sleep pills, sometimes the insomnia can return even worse than before.
6. Accidents. Antihistamines can keep you groggy for a couple of hours after waking. It is advised not to drive or operate heavy machinery the following day.
7. Contaminants. Overseas products can contain contaminants/unwanted substances so to minimise that risk select pills that have been approved by the TGA for quality and safety ‘AUST L’, although this is not a guarantee.
8. Liver toxicity. This occurs due to the drug/herb interaction in the body.
9. Dementia. This is a proven risk for prolonged first-generation antihistamine use.
10. Incidental stroke. This becomes a risk after 15 days of use of a first generation antihistamine.
Whatever the reason for your sleeplessness, it won’t be resolved with over the counter sleep pills. If you are talking pills to overcome jet-lag quicker, a prescription sedative is a better alternative, as the duration of action is shorter.
If you have been prescribed a prescription medication to help you sleep better and it has worked, it can be anxiety provoking to know that you will have to give it up and perhaps forgo the benefits. Seeking out an over the counter sleep pill to prolong the benefits of a prescription medication may feel like a good idea, but it is not without its risks.
While taking an over-the-counter sleep pill to sleep may not feel addictive as you may not crave it. However, consistent sleeping pill use can embed a belief around the connection between taking the pill and sleep. Consequently, your sleep confidence erodes, and you set up an internal narrative which believes you won’t sleep without it and the ensuing anxiety at the thought of going-without becomes too much to contemplate. And it is the thought of going without that keeps you purchasing over the counter sleep pills and running the risk of experiencing rebound insomnia i.e. the ensuing insomnia is worse than the insomnia you had at the start.
If you have been prescribed medication to sleep or become dependent on over the counter sleep pills, you can benefit from a multipronged approach which includes talking therapy, CBT-i, and breathing coaching so you no longer need external assistance to sleep well.
Clients who have worked with me in one-on-one counselling sessions have been able to sleep better and decrease their dependence on over the counter sleep pills and prescription medications. A previous client has shared this with me, “I have had sleep issues all my life and been taking medication for a loooong time. Your insights were incredible. I now understand my attitude to sleeping tablets. Over the last 6 weeks I have been able to halve my dosage and still fall asleep.” In a follow up consult, this client has been able to stop taking her sleep prescription medication and feels so much more confident about her ability sleep well each night.
Any effective over the counter sleeping pill is a potent drug and so, should only be used with care, occasionally. There are proven methods to naturally overcome insomnia, so you do not need to risk your future health on your immediate sleep needs.
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