What are the benefits and risks of over-the-counter sleep medications?

You can walk into a drugstore and choose from an array of sleep aids, offered without prescription. The main ingredient of over-the-counter sleeping pills is an antihistamine. Antihistamines are generally taken for allergies, but also make you feel very sleepy.

Common over-the-counter sleep medications are Sleep-Eze, Sominex, Nytol, and Unison; they contain antihistamines such as:
diphenhydramine hydrochloride,
diphenhydramine citrate, or
doxylamine succinate.
In general, over-the-counter sleep medications are not a good choice because they:
Are not intended for long-term use.
Interfere with mental alertness during the day, so you should avoid driving and other similar tasks. You may also be at risk for falling.
Reduce the quality of your sleep by reducing time you spend in deep sleep.
Use over-the-counter sleep medications only for transient or short-term insomnia and in conjunction with changes to your sleeping habits. Be sure to pay attention to your body’s physical response to these sleep medications. Immediately discontinue use if you experience any severe adverse effects.

About Sleep Debt- is it real?

What are the signs of sleep deprivation and how can I tell if I have a sleep debt?
Some of the signs of sleep deprivation include:
difficulty waking up in the morning,
lack of concentration,
falling asleep during work or class, and
feelings of moodiness, irritability, depression, or anxiety.
If you are tired or drowsy during the day, you probably haven’t gotten enough sleep, and you have a “sleep debt.” A sleep debt can be from one night’s poor sleep or the accumulation of many days of not enough sleep.
You can make up for a sleep debt with extra sleep, but a chronic sleep debt can have serious long-term effects, including immune system problems, metabolic changes that can lead to obesity, and hyperactivity.The Epworth Sleepiness Scale is a standard simple test to determine your sleep debt. Try this online test of sleep debt and get an instant tally of your level of sleepiness.

Sleep Needs

Typical Sleep Needs
Group
Amount of Sleep Needed
Infants
About 16 hours per day of sleep
Babies and toddlers
From 6 months to 3 years: between 10 and 14 hours per day. Young children generally get their sleep from a combination of nighttime sleep and naps.

Children
Ages 3 to 6: between 10 and 12 hours of sleep
Ages 6 to 9: about 10 hours of sleep
Ages 9 to 12: about 9 hours of sleep


Teenagers
About 9 hours of sleep per night. Teens have trouble getting enough sleep not only because of their busy schedules, but also because they are biologically programmed to want to stay up later and sleep later in the morning, which usually doesn’t mesh with school schedules.

Adults
For most adults, 7 to 8 hours a night appears to be the best amount of sleep, although some people may need as few as 5 hours or as many as 10 hours of sleep each night.
Older adults
Current thought is that older adults need as much, if not more, sleep than middle-aged adults. Taking a midday nap may help.

Pregnant women
During pregnancy, women may need a few more hours of sleep per night.

How much sleep do you need?

A rule of thumb: If you wake up feeling refreshed, and you don’t feel sleepy during the day, you are getting enough sleep. If you have an occasional night of poor sleep, you probably will need to sleep more the next night to make up for it.
The amount of sleep that you need depends on a number of factors, including:
your genetic make-up,
the amount of exercise you get,
what you do during your waking hours,
your age,
whether you are still growing, and
the quality of your sleep.

Did you know that sleep deprivation causes...?

Lack of sleep, and especially a chronic lack of sleep, is associated with:
Poor decision-making, poor judgment, increased risk-taking
Poor performance in school, on the job, and in sports
Impaired driving performance and more car accidents

Increased incidence of obesity, diabetes, illness in general, high blood pressure, and heart disease
Impaired memory, concentration, and ability to learn
Physical impairment, poor coordination, delayed reaction time
Anxiety, depression, and other emotional problems
Magnification of the effects of alcohol on the body
Exacerbation of the symptoms of ADHD, such as impulse control, irritability, and lack of concentration
Getting less than 6 hours of sleep per night can affect coordination, reaction time, and judgment. A study comparing the effects of sleep deprivation and alcohol found that “people who drive after being awake for 17 to 19 hours performed worse than those with a blood alcohol level of .05 percent [the legal limit for drunkenness in most European countries].”

Is sleep really that necessary?

Sleep helps you to restore and rejuvenate many body functions:
Memory and learning – Sleep seems to organize memories, as well as help you to recover memories. After you learn something new, sleep may solidify the learning in your brain.
Mood enhancement and social behaviors - The parts of the brain that control emotions, decision-making, and social interactions slow down dramatically during sleep, allowing optimal performance when awake. REM sleep seems especially important for a good mood during the day. Tired people are often cranky and easily frustrated.
Nervous system – Some sleep experts suggest that neurons used during the day repair themselves during sleep. When we experience sleep deprivation, neurons are unable to perform effectively, and the nervous system is impaired.
Immune system – Without adequate sleep, the immune system becomes weak, and the body becomes more vulnerable to infection and disease.
Growth and development – Growth hormones are released during sleep, and sleep is vital to proper physical and mental development.

The REM Sleep Stage

What happens during the REM sleep stage?
During REM sleep, you dream actively, but your limb muscles are immobile. Your breathing is rapid, irregular, and shallow. Your heart rate increases, your blood pressure rises, males may have penile erections, and females may have clitoral enlargement. Your brain is at least as active during REM sleep as it is when you are awake.
Because your major muscles do not move during REM sleep, you will not act out your dreams. (Sleepwalking occurs during NREM sleep.)
If our REM sleep is disrupted one night, our bodies don't follow the normal sleep cycle progression the next time we doze off. Instead, we often slip directly into REM sleep and go through extended periods of REM until we "catch up" on this stage of sleep.
Infants spend about 50 per cent of their sleep time in REM sleep; after infancy, you spend fifteen to twenty per cent of your sleep time in REM sleep.

Stages of Sleep- good to know.

Sleep is divided into two types: REM (Rapid Eye Movement) sleep and NREM (non-REM) sleep. REM sleep is when we dream. NREM sleep is further divided into four stages. A typical night of sleep follows this pattern:

Stage 1 (Drowsiness) - When you first fall asleep, you are in Stage 1 sleep (Drowsiness). Stage 1 lasts just five or ten minutes. Eyes move slowly under the eyelids, and muscle activity slows down. You are easily awakened during Stage 1 sleep.
Stage 2 (Light Sleep) -Next, you go into Stage 2 sleep (Light Sleep). In Stage 2, eye movements stop, heart rate slows, and body temperature decreases.
Stages 3 & 4 (Deep Sleep) - Then you enter Stages 3 and 4 (Deep Sleep). During stages 3 and 4, you are difficult to awaken. People who are awakened during Deep Sleep do not adjust immediately and often feel groggy and disoriented for several minutes after they wake up. Children may experience bedwetting, night terrors, or sleepwalking during Deep Sleep.
REM sleep - At about 70 to 90 minutes into your sleep cycle, you enter REM sleep. You usually have three to five REM episodes per night. Your eyes jerk rapidly in various directions under your eyelids, thus the name Rapid Eye Movement (REM) Sleep.
The first sleep cycles each night contain relatively short REM periods and long periods of deep sleep. As the night progresses, REM sleep periods increase in length while deep sleep decreases. By morning, people spend nearly all their sleep time in stages 1, 2, and REM.

The Head and Neck

PillowPositive is a unique positional sleeping aid - a patented cervical pillow that has been clinically tested and shown to be helpful in reducing snoring. PillowPositive encourages you to position your head so that snoring is reduced whether sleeping on your back or in a side position.
The Nelson Sound Sleeper - The Nelson Sound Sleeper is an ergonomic pillow with optional internal speakers. It is designed to support the entire body from the lumbar to the head. The Sound Sleeper provides an inclined sleeping position which supports the spine in its natural curvature while a person is sleeping on the back. Its unique and patented design allows the sleeper to roll to either side and supports the body in such a way that it takes the pressure off the shoulder and distributes the weight along the head, neck, shoulder, and rib cage. Since music can be heard through the pillow, both back and side sleeping positions provide a pleasant and restful environment.

What happens when we sleep?

Sleep is one of the body’s most mysterious processes. The idea of sleeping well conjures up restful images of fluffy pillows, comfortable blankets, and minimal activity. However, many people find sleep elusive. And the more we worry about our insomnia, the worse our sleep problems get.

Sleep is a periodic state of rest during which consciousness of the world is interrupted. Additionally, sleep is marked by:
decreased movement of the skeletal muscles;
a relaxed posture, usually lying down;
reduced response to stimulation, such as sounds and touch;
slowed-down metabolism; and
complex and active brain wave patterns.

Insomnia Information

When to seek medical advice
If insomnia has been interfering with your daytime functioning for a month or longer, see your doctor to determine what might be the cause of your sleep problem and how it might be treated.

Screening and diagnosis
Insomnia can be difficult to diagnose because the kind of sleep patterns and degree of daytime fatigue that some people consider indications of insomnia other people consider normal.
Your doctor may ask you questions about your sleep patterns, such as how long you've experienced your symptoms and whether they occur every night. Your doctor may also ask about whether you snore, how well you function during the day, whether you take any medications and whether you have other health disorders. You may be asked to complete a questionnaire to determine your wake-sleep pattern and your level of daytime sleepiness.
It's possible that your doctor may suggest you spend a night at a sleep disorders center. These centers are accredited by the American Academy of Sleep Medicine. A team of people at the center can monitor and record a variety of body activities during the night, including brain waves, breathing, heartbeat, eye movements and body movements. But for most people whose main complaint is insomnia, polysomnography does not provide useful information.

source-mayoclinic.com

Insomnia in kids and teens

Sleep problems may be a concern for children and teenagers as well. In addition to many of the same causes of insomnia as those of adults, some children and teenagers simply have trouble getting to sleep or resist a regular bedtime because their inherent (circadian) clocks are more delayed. When the clock on the wall says it's 10 p.m., their bodies may feel like it's only 8 p.m.

Insomnia gets worse with age

Insomnia becomes more prevalent with age. As you get older, changes can occur that may affect your sleep. You may experience:
§ A change in sleep patterns. Sleep often becomes less restful as you age, but a lack of restful sleep isn't a normal consequence of aging. You spend more time in stages 1 and 2 of non-rapid eye movement (NREM) sleep and less time in stages 3 and 4. Stage 1 is transitional sleep, stage 2 is light sleep, and stages 3 and 4 are deep (delta) sleep, the most restful kind. Because you're sleeping more lightly, you're also more likely to wake up. With age, your internal clock often advances, which means you get tired earlier in the evening and consequently wake up earlier in the morning.
§ A change in activity. You may be less physically or socially active. Activity helps promote a good night's sleep. You may also have more free time and, because of this, drink more caffeine or alcohol or take a daily nap. These things can also interfere with sleep at night.
§ A change in health. The chronic pain of conditions such as arthritis or back problems as well as depression, anxiety and stress can interfere with sleep. Older men often develop noncancerous enlargement of the prostate gland (benign prostatic hyperplasia), which can cause the need to urinate frequently, interrupting sleep. In women, hot flashes that accompany menopause can be equally disruptive.
Other sleep-related disorders, such as sleep apnea and restless legs syndrome, also become more common with age. Sleep apnea causes you to stop breathing periodically throughout the night and then awaken. Restless legs syndrome causes unpleasant sensations in your legs and an almost irresistible desire to move them, which may prevent you from falling asleep.

Wanna know what causes your insomnia?

Common insomnia causes include:
§ Stress. Concerns about work, school, health or family can keep your mind too active, making you unable to relax. Excessive boredom, such as after retirement or during a long illness, may occur and also can create stress and keep you awake.
§ Anxiety. Everyday anxieties as well as severe anxiety disorders may keep your mind too alert to fall asleep.
§ Depression. You may either sleep too much or have trouble sleeping if you're depressed. This may be due to chemical imbalances in your brain or because worries that accompany depression may keep you from relaxing enough to fall asleep.
§ Stimulants. Prescription drugs, including some antidepressants, high blood pressure and corticosteroid medications, can interfere with sleep. Many over-the-counter (OTC) medications, including some pain medication combinations, decongestants and weight-loss products, contain caffeine and other stimulants. Antihistamines may initially make you groggy, but they can worsen urinary problems, causing you to get up more during the night.
§ Change in your environment or work schedule. Travel or working a late or early shift can disrupt your body's circadian rhythms, making you unable to get to sleep when you want to. The word "circadian" comes from two Latin words: "circa" for "about" and "dia" for "day." Your circadian rhythms act as internal clocks, guiding such things as your wake-sleep cycle, metabolism and body temperature.
§ Long-term use of sleep medications. If you need sleep medications for longer than several weeks, talk with your doctor, preferably one who specializes in sleep medicine.
§ Medical conditions that cause pain. These include arthritis, fibromyalgiaand neuropathies, among other conditions. Making sure that your medical conditions are well treated may help with your insomnia.
§ Behavioral insomnia. This may occur when you worry excessively about not being able to sleep well and try too hard to fall asleep. Most people with this condition sleep better when they're away from their usual sleep environment or when they don't try to sleep, such as when they're watching TV or reading.
§ Eating too much too late in the evening. Having a light snack before bedtime is OK, but eating too much may cause you to feel physically uncomfortable while lying down, making it difficult to get to sleep. Many people also experience heartburn, a backflow of acid and food from the stomach to the esophagus after eating. This uncomfortable feeling may keep you awake.

source-mayoclinic.com

Do you have insomnia?

Insomnia symptoms may include:

Difficulty falling asleep at night
Waking up during the night
Waking up too early
Daytime fatigue or sleepiness
Daytime irritability

Sleep aids put to the test

I ended up trying out OTC pills in several different scenarios.
1. Jet Lag

Can sleep aids beat it? On a recent trip to Japan, I arrived in Tokyo in the afternoon, then needed to get a good night's sleep (despite a 14-hour time difference) and wake up for a 9 a.m. meeting. Basically, an impossible task. I took a Unisom Maximum Strength SleepGel (50 mg of diphenhydramine hydrochloride) in Tokyo at 11 p.m., when it felt like midafternoon for me, and it actually worked OK. I managed to stay asleep until 6:30 a.m., which was better than I'd hoped for, and I made it through the day. Thanks, Unisom!
The next night, still wickedly lagged, I took two Simply Sleep caplets (together, another 50 mg of diphenhydramine hydrochloride—same as the Unisom), but only managed to sleep until 5:45 a.m. I blame it on the sheer momentum of jet lag, not the pills.
On the third night, as a control, I took no pills and woke up at 4:30 a.m. Unacceptable. So I took two Simply Sleep caplets and managed to sleep until 9:30 a.m. Perfect. Except I should have taken one caplet—I might have avoided the severe grog that plagued me all day and made interaction with Japanese people an even greater effort.
Conclusion: These pills are not a bad way to deal with jet lag, in an emergency. Also, there's no chemical difference between Unisom Maximum Strength SleepGels and Simply Sleep, yet there are two important distinctions. 1) Unisom's "gel" is much nicer going down—the Simply Sleep actually caught in my throat half-dissolved and tasted so bad that I gagged. 2) You can't split Unisom Maximum Strength's dose—it's one gel that can't be cut in half—while Simply Sleep's two caplets give you more flexibility for a half-dose (25 mg) if you're scared of feeling out-of-it when you wake up.
2. Sacking Out

Sometimes you need to hibernate. I did not wish to be awake for any part of the 13-hour plane ride back from Japan—not even when they were showing America's Sweethearts. Could OTC pills do the trick? This time, I went herbal.
Calms Forté is a homeopathic sleep aid containing passionflower, humulus lupulus, chamomile, and a whole buttload of other ingredients. At least one Slatester swears by this remedy, and it's a well-known alternative treatment for insomnia (it also claims to treat attention deficit disorder and general nervousness). I took two Calms Forté caplets (recommended dosage: one to three) right after getting on the plane in Tokyo and promptly slept for the next 12 hours continuously. I woke up just before landing in New York, feeling quite rested and refreshed. The only way to fly! Of course, you need a solid 12 hours with nothing to do for this to work.
While on Calms Forté, I had a very long, very trippy dream. In this dream, I had memory lapses, Memento-style, and was freaked by revelations of things I'd done but then forgotten. This was, in fact, an appropriate sleeping pill dream, as sleep aids often cause disorientation. In the course of researching this story, I got a bit wigged out by moments of confusion while under the pills' effects. But that strange dream on the plane was so cool it made me want to take Calms Forté again.
3. Insomnia

I'm not a chronic insomniac. Like many folks, I am prone to occasional nights of bad sleeplessness—maybe once a month. These are awful. Nothing is worse than lying awake in bed for six hours, mind racing, all the while knowing you'll be useless the next day. I've long wondered if there was something I could do about it. It's not worth it to get a prescription drug like Ambien, as the recommended course of treatment with these is to take them at night for a week or so and then stop, hoping they've brought you back onto a normal sleep schedule. I wanted a quicker fix to use every once in a while.
So on a night when I found myself having insomnia, I took Compoz (50 mg of diphenhydramine hydrochloride) at 2:15 a.m. I was asleep by 3 a.m., which is better than my usual habit of being awake until 4:30 or later. But the drug kept me asleep the next morning until noon, and even then I had to drag myself out of bed. It's always hard for me to get up, but this was a whole new level. I was shaking off the effects of the drug until evening.
I immediately realized that this stuff is basically worthless for occasional insomnia. By the time you realize you're not falling asleep, it's too late to take a sleeping pill and still function the next day. The half-life is way too long. If you do want to experiment with this, I strongly suggest you take a half-dose or you may not even be able to safely drive to work in the morning. Further experiments with Unisom and with Equate (which uses doxylamine succinate) confirmed my suspicions, as I consistently got bad pill hangovers. All afternoon on the following days I was drifting in and out of conversations.
As I didn't have time to wait for lots of separate insomnia bouts, I cheated twice by drinking coffee (which usually keeps me up all night) and pitting it head-to-head against pills. This was not a good idea. The first time, I washed down two Calms Forté caplets with a huge mug of java at 10:30 p.m. Within 45 minutes, I was tired and ready for sleep. Score one for the pills! But as I lay in bed, a terrible thing happened. My body felt exhausted, barely able to move, yet my mind continued to race the way it does on coffee. This was like being paralyzed and was really horrifying. (I also had another trippy dream on Calms Forté: It involved an intriguing new strategy for darts, and let's just say the distinction between "dartboard" and "sternum" became somewhat meaningless.) When I tried the coffee battle again with Unisom, it took longer to fall asleep (about two hours), but I didn't have the paralysis thing. Still, my girlfriend reports I tossed and turned in bed that night like a caged animal.
One intriguing technique might be using sleep aids as a precautionary measure. Let's say you've got a big day tomorrow and can't afford even the chance of insomnia. You could take a pill at 9 p.m., knowing the effects will mostly be gone by morning. I tried this a few times, and it sort of worked, but I was still pretty hungover, even with the extra lead time. Still, it's a bit silly to take a drug when you probably don't need it (unless it's a really fun drug).
The one pill that didn't work at all was Alluna, an herbal with valerian root and hops extracts. It didn't make me tired, but then again it also gave me no hangover, so I guess I can recommend it.
4. Just for KicksAfter getting a good night's sleep (without pills), I woke up one weekend morning and immediately took a half-dose of Sominex (25 mg diphenhydramine hydrochloride) just to see what would happen. I didn't fall back asleep, but man did it take the edge off. I've never been so calm and unexcitable in my life—and believe me, that's saying something. I might recommend the daytime half-dose technique for family reunions or any time you just want to kick back and let the river flow.

By Seth Stevenson

Chronic Insomnia

Nearly everyone has occasional sleepless nights, perhaps due to stress, heartburn, or drinking too much caffeine or alcohol. Chronic insomnia is defined when you have problems falling asleep, maintaining sleep, or experience nonrestorative sleep that occurs on a regular or frequent basis, often for no apparent reason.
How much sleep is enough varies from person to person. Although 7 1/2 hours of sleep is about average, some people do well on four to five hours of sleep. Other people need nine to 10 hours of sleep each night.
Insomnia can affect not only your energy level and mood, but also your health as well because sleep helps bolster your immune system. Fatigue, at any age, leads to diminished mental alertness and concentration. Lack of sleep caused by insomnia is linked to accidents both on the road and on the job.
Insomnia is a common problem that may be temporary or chronic. As many as one in 10 Americans have chronic insomnia, and at least one in four has difficulty sleeping sometimes. But that doesn't mean you have to just put up with sleepless nights. Some simple changes in your daily routine and habits may result in better sleep.

source- mayoclinic

funny!

In the end, I was not a big fan of sleep aids. If you have chronic insomnia, they are not the answer—you need to see a doctor and change your lifestyle. If you get insomnia once in a while, like me, I think the best solution is to live with it. Taking a pill to combat it late at night will ruin you for the next day. And you can get "rebound insomnia" if you've been taking pills and then stop. So just grab a book, relax, and settle in for some sleeplessness—it builds character.
As for jet lag, sacking out on plane rides, and dulling the pain of a family get-together, you might want to try out Calms Forté. It's powerful enough to put you out for 12 hours straight, yet offers a flexible dosage. It gave me crazy dreams. And its natural ingredients—unlike the antihistamines—don't interact with alcohol and other medications. Score one for homeopathy!
-seth stevenson

Jet lag

Jet Lag

Can sleep aids beat it? On a recent trip to Japan, I arrived in Tokyo in the
afternoon, then needed to get a good night's sleep (despite a 14-hour time
difference) and wake up for a 9 a.m. meeting. Basically, an impossible task. I
took a Unisom Maximum Strength SleepGel (50 mg of diphenhydramine hydrochloride)
in Tokyo at 11 p.m., when it felt like midafternoon for me, and it actually
worked OK. I managed to stay asleep until 6:30 a.m., which was better than I'd
hoped for, and I made it through the day. Thanks, Unisom!
The next night,
still wickedly lagged, I took two Simply Sleep caplets (together, another 50 mg
of diphenhydramine hydrochloride—same as the Unisom), but only managed to sleep
until 5:45 a.m. I blame it on the sheer momentum of jet lag, not the
pills.
On the third night, as a control, I took no pills and woke up at 4:30
a.m. Unacceptable. So I took two Simply Sleep caplets and managed to sleep until
9:30 a.m. Perfect. Except I should have taken one caplet—I might have avoided
the severe grog that plagued me all day and made interaction with Japanese
people an even greater effort.
Conclusion: These pills are not a bad way to
deal with jet lag, in an emergency. Also, there's no chemical difference between
Unisom Maximum Strength SleepGels and Simply Sleep, yet there are two important
distinctions. 1) Unisom's "gel" is much nicer going down—the Simply Sleep
actually caught in my throat half-dissolved and tasted so bad that I gagged. 2)
You can't split Unisom Maximum Strength's dose—it's one gel that can't be cut in
half—while Simply Sleep's two caplets give you more flexibility for a half-dose
(25 mg) if you're scared of feeling out-of-it when you wake up.

by- Seth Stevenson

Prescription sleep aids

As for prescription sleep aids, the most common are benzodiazepines (Xanax, Halcion), which work by boosting a neurotransmitter called GABA (didn't they do "Neurotransmitter Dancing Queen"?). Again, this slows down your central nervous system. A similar set of drugs includes Ambien and Sonata, which are not benzodiazepines but work in much the same way. You take these pills at night, just before you want to sleep, same as with the antihistamines and herbals. Some claim the benzodiazepines and, even more so, Ambien and Sonata, get out of your system quicker than antihistamines—meaning less "hangover effect" the next morning. But the prescription drugs can be more habit forming. -Seth Stevenson