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Ask the Medical Expert Archives 2000-2004

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Insomnia & Sleeping Pills
May 2000

Q. Six years ago my doctor prescribed me sleeping pills for my insomnia. Now, he suggests over-the-counter medication. Will they affect my health? Are there any problems associated with prolonged use of over-the-counter sleep aids?

A. Insomnia is a very common problem. Inadequate sleep can be caused by numerous factors. Drugs and alcohol are the most common causes. Caffeine is the most common pharmacologic cause of insomnia. Alcohol and nicotine can interfere with normal sleep cycles. Amphetamines and cocaine keep people up. Stress, pain and various other adverse stimuli may cause insomnia. There also may be some other medical disorders such as sleep apnea or periodic limb movement disorder, amongst many others that may lead to abnormal sleep. Treatment, of course, is best directed at trying to get rid of the underlying cause of one's insomnia. In many cases, insomnia is self-limited and gets better on its own (jet lag). However, some people develop chronic insomnia. Many people have resorted to over-the-counter sleep aids as you have. Most of them contain an antihistamine such as Benadryl. This is the same ingredient in many allergy medications, and exerts its sleep effect by causing the side effect of drowsiness in many patients. I am not aware of any serious long-term adverse effects of this drug. However, caution should be used for patients who have narrow angle glaucoma, urinary retention or constipation. It also is not recommended in pregnancy. Upon discontinuation of sleeping pills, there is often a period of withdrawal where increase insomnia may occur for a time. Treatment would include proper sleep hygiene, which is very important, such as avoiding daytime naps, avoiding the above drugs, a quiet place to sleep, and so on. Prescription drugs may be used for a short time, but generally are not recommended for treatment beyond two weeks. Also, there is inadequate evidence to support the effectiveness and long-term safety of melatonin (an herbal product). The National Sleep Foundation may be of assistance at (310) 288-0570.

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