OTC Insomnia Medications
There are many other medications that are used for the treatment of insomnia, as well as a number of both over-the-counter (OTC) and herbal remedies that are available and are in frequent use.
The most common OTC medication used as a sleep aid is antihistamines. Usually used for cold or allergy symptoms, these medications can cause drowsiness, which in this case is beneficial. Some common brand names are Unisom, Sominex, Nytol. The first issue with these drugs is the long term safety and effectiveness has never been established in medical research studies. Another problem with these drugs are their side effects, which include residual sleepiness as these medications can be long acting, decreased mental function during the day, and they may even cause elderly patients to become delirious. Other side effects include dry mouth, blurred vision, and difficulty urinating (which is a very big problem in elderly men with prostate issues).
Another “home remedy” is the use of alcohol. For information on how alcohol disrupts sleep see my post from April 17, 2007 (Can Alcohol Help Me Sleep?).
There are many other dietary supplements and herbal remedies that are commonly used for the treatment of insomnia. The most commonly used are melatonin, valerian, and L-tryptophan.
Melatonin is actually a naturally occurring chemical found in the brain that induces sleep. It is available as a nutritional supplement and therefore is not regulated by the FDA. This means that preparations vary in strength and potency, even when marked at a specific strength. It has been used as a helpful aid in jet-lag, but its long term usefulness in insomnia is not clear.
Valerian (Valeriana officinalis) is derived from a perennial plant, native to Asia and Europe and now grown in North America. It is also well known for its distinctive odor (which has been described as sweaty socks). It has been used for centuries for its calming effect and for problems with sleep. More recently a review of almost 600 clinical studies with valerian showed it to be safe, but mostly ineffective for the treatment of insomnia.
Finally, L-tryptophan (LT) is one of eight essential amino acids, which are the building blocks of proteins. LT was coming into widespread use in the 1980’s when it was linked to a rare, debilitating, and often deadly disease called eosinophilia myalgia syndrome. This epidemic was believed to be caused by impurities in LT batches that were produced in Japan. Due to these safety concerns and a lack of strong evidence showing its usefulness in insomnia, it is difficult to recommend as a treatment option (also it is not widely available in the USA). A similar, but equally questionable alternative to LT which is available in the US is called 5-hydroxy-tryptophan or 5-HTP.
Stay tuned, more to come on the topic of insomnia.
Allen Blaivas, FCCP, DABSM, is a graduate of New York College of Osteopathic Medicine and is a quadruple board-certified physician practicing in pulmonary, critical care, and sleep medicine. He runs the sleep laboratory at the VA New Jersey Health Care System and loves taking care of our nation’s veterans. He’s a clinical assistant professor of medicine at Rutgers New Jersey Medical School and holds clinical privileges at Hackensack University Medical Center and New York Presbyterian-Lower Manhattan. He has clinical research interest in obstructive sleep apnea and COPD.