Sleep Aids And Stimulants (cont.)
John P. Cunha, DO, FACOEP
John P. Cunha, DO, is a U.S. board-certified Emergency Medicine Physician. Dr. Cunha's educational background includes a BS in Biology from Rutgers, the State University of New Jersey, and a DO from the Kansas City University of Medicine and Biosciences in Kansas City, MO. He completed residency training in Emergency Medicine at Newark Beth Israel Medical Center in Newark, New Jersey.
William C. Shiel Jr., MD, FACP, FACR
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
In this Article
- What is insomnia and what causes it?
- What are non-drug treatments for insomnia?
- What over-the-counter (OTC) medicines are there for insomnia treatment?
- What prescription medicines are there for insomnia treatment?
- What stimulant products are available OTC?
- Find a local Sleep Specialist in your town
What are natural treatments for insomnia?
There are several ways insomnia may be treated without the use of medication. These include behavioral modification and use of natural herbal remedies.
When a person consults a health care practitioner about insomnia, the practitioner may ask the person to keep a sleep log for several weeks to monitor sleep habits. The treatment options for short-term or chronic insomnia include not only medications, but often sleep habit and behavioral modifications for optimal long-term results.
Evaluating sleep habits is important in the management of insomnia. Treatment of underlying sleep disorders and in some instances, changing sleep habits may correct the problem without the need for medications. Good sleep habits (also referred to as good sleep hygiene) should include:
- Regular sleep times
- A comfortable bed and quiet room at a comfortable, temperature
- Darkened room
- Regular exercise but not close to bedtime or late in the evening
- A bedroom that is not used for work or other activities not related to sleep
- Avoidance of stimulants (for example, caffeine, or tobacco), alcohol, and large meals close to bedtime (avoidance 2-4 hours before bedtime if possible)
- Many people watch television before falling asleep. TV can be a very stimulating medium and needs to be closely evaluated if it adds to a person's insomnia.
- Relaxation techniques such as breathing exercises or yoga
- No naps during the day
- Try drinking warm milk before bed. It is high in the amino acid tryptophan, which helps induce sleep.
Melatonin (for example, Melatonex) is the only hormone available OTC for insomnia. Melatonin is a hormone that is produced by the pineal gland. Melatonin helps regulate the body's clock or sleep-wake cycle. The secretion of melatonin is increased by darkness and decreased by light. The exact mechanism of how melatonin induces sleep has not been determined. Melatonin also decreases mental alertness and body temperature.
Melatonin is sold as a dietary supplement and is, therefore, not regulated by the FDA. It is commonly used for jet lag, insomnia, and sleep disturbances related to working the late night shift. Some limited evidence suggests that melatonin may be useful for treating sleep disturbances.
In 2005, MIT released the results of a meta-analysis of 17 peer-reviewed studies using melatonin. It showed that melatonin was effective in helping people fall asleep at doses of 0.3 milligrams (mg). In some preparations the dosage of melatonin is significantly higher and these larger doses have shown to be less effective after only a few days of use.
If a person would like to try melatonin tablets, check first with a health care practitioner.
Dosing: There is no established dose or time of administration. Individuals should follow the product labeling for dosing and administration.
Pregnancy and lactation: The use of melatonin during pregnancy or lactation has not been studied adequately. At high doses (more than 300 mg), melatonin may affect contraception (birth control) and increase levels of prolactin in the body. Based on past experience with other agents and the possibility of unknown risks to the fetus, melatonin should be avoided during pregnancy or lactation until more information is available.
Children: The use of melatonin in children should be avoided until more information about safety is available.
Drug interactions: Although melatonin is sold as a dietary supplement, it should be thought of as a drug. It has side effects and may have drug interactions that have not been identified. The level of melatonin that the body produces is increased by certain drugs, such as selective serotonin reuptake inhibitor antidepressants [for example, fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil)] and monoamine oxidase inhibitors [for example, tranylcypromine (Parnate), phenelzine (Nardil)]. The interaction between these antidepressants and melatonin that is used as a sleeping aid has not been assessed.
Side effects: The most common adverse effect of melatonin is drowsiness. Therefore, tasks that require alertness (for example, driving) should be avoided for four to five hours after taking melatonin. Melatonin also may also cause itching, abnormal heartbeats, and headaches. Long-term side effects of melatonin have not been studied.
Melatonin is either derived from animal sources or synthesized in a laboratory. Melatonin obtained from animal sources has a higher likelihood of contamination, which can cause allergic reactions and viral transmission, than synthetic melatonin.
Melatonin may stimulate the immune system. Therefore, people with severe allergies or other disorders that may be caused by an overactive immune system (for example, systemic lupus erythematosus, rheumatoid arthritis) should avoid using melatonin.
Other herbal products: Natural herbal supplements such as valerian, chamomile, kava kava, and others have been touted as remedies for insomnia. However, the safety or effectiveness of these products has not been documented and it is important to consult a physician if a person is taking or plan to take any herbal supplements to treat insomnia.
Viewers share their comments
Find out what women really need.