Sleep aids

Over-the-counter products are short-term solutions, but there are other ways to improve sleep.
 
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  • Updated:9 Jan 2005
 

01 .Introduction

Sleep aids

In brief

  • Antihistamines, valerian and other herbal preparations are the main over-the-counter remedies on offer.
  • They may or may not work for you, some can have side effects and none is recommended for long-term insomnia.

Estimates vary, but something like 10–40% of the population has trouble from time to time either getting to sleep or staying asleep. For up to 15% of people, sleep problems are a long-term difficulty.

Often brought about by a major life stressor like ill health, a new job or a relationship break-up, even a few nights’ poor sleep can leave you feeling irritable, lethargic and with a sense that you’re functioning below par. Over a period of time, insomnia can affect your work, health and relationships.

A constant inability to get off to sleep or stay asleep may well have got you pondering whether to get a little chemical or herbal assistance from the chemist.

We asked the experts and had a look at the evidence available to find out how safe and effective these products are. We also sought advice and got some tips to help you get the sleep you may be craving. So rest assured — sleep problems can be treated.

Please note: this information was current as of January 2005 but is still a useful guide today.


 
 

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Insomnia can be transient — that is, just occurring for a couple of days — or short-term, lasting for a couple of weeks. If it occurs at least three times a week for longer than one month, it’s classified as chronic insomnia.

Sleep disturbance can be a secondary condition of an illness such as depression or cardiovascular disease, or as a result of physical pain, substance abuse or a side effect to certain medications. It can also be stress-related or due to poor sleeping habits (known as ‘sleep hygiene’). Other sleep disorders, which need medical attention, include narcolepsy, restless legs syndrome (an overwhelming urge to move your legs) and sleep apnoea.

Insomnia may manifest itself as a difficulty going off to sleep, constant waking throughout the night, or waking early in the morning and being unable to get back to sleep. As we age, sleep problems can increase. Older people commonly suffer from insomnia as a reaction to physical pain or as a side effect of medication or illness.

Setting up a cycle

We’ve all managed to drag ourselves through a day at work after a late night, but having persistent insomnia can be distressing. Experts can paint a picture of how it might come about. Some people may have a vulnerability to insomnia in the first place.

But usually there’s an ‘activating event’ — a stressful situation like moving home or a sick child. Sleep problems start and then the sufferer starts to expect them and to see themselves as an insomniac. They may find evidence as to why they’re not sleeping, put a lot of effort into trying to sleep and try to compensate by spending more time in bed. But then bed becomes a stressful, ‘unsafe’ place to be.

At this point many people rush to the chemist to get some help in a bottle or jar. Possibly fuelled by the fear of becoming addicted to prescribed drugs, many sufferers opt for something ‘natural’.

03.Complementary medicines

 

We shopped around and found 15 different products consisting of preparations that contained:

  • solely valerian (five)
  • valerian and magnesium (one)
  • valerian and other herbs (six).

Only three preparations didn’t contain valerian.

Of all of the popular herbal sedatives, valerian has undergone the most clinical trials to try to establish its effectiveness and safety as a treatment for insomnia. It also has a very long tradition of use as a medicinal herb.

Although some of the clinical trials showed possible benefits of valerian as a treatment for insomnia, results were contradictory and therefore inconclusive.

Preliminary findings suggest valerian may improve sleep for children with intellectual disabilities, who commonly suffer from sleeping difficulties, but again more research is needed.

Valerian

According to the labels of our valerian preparations they contained between 86 and 2500 milligrams of valerian per tablet or capsule. Those that contained less than 1800 mg in each tablet recommended taking two or more at a time, usually 30 to 60 minutes before bed. In clinical trials, doses of valerian root extract to treat insomnia ranged from 300 to 900 mg, administered half-an-hour to an hour before bed. But in the products we purchased, the recommended dose of valerian ranged from 258 to 4000 mg — a huge variation between brands.

Valerian is also described as “standardised” on many of the labels, but according to Australia’s medicine regulatory body, the Therapeutic Goods Administration (TGA), there’s no definition of the term “standardised” in the legislation.

Although valerian seems to be generally benign, there have been rare reports of liver damage. Stomach upset, headache and vivid dreams are some other rarely reported side effects. Valerian shouldn’t be used during pregnancy or breastfeeding as its safety for such users hasn’t been established — one of the active ingredients in valerian has been shown to be able to cause DNA changes in cells. While risk of cell damage is probably low, it may not be something you’d want to use regularly.

There’s also evidence valerian might take a couple of weeks to become effective, by which time the insomnia might have disappeared anyway.

In conclusion, while it does seem that valerian has potential as a sleep aid, most experts agree that further trials need to be carried out to find out more about this herb and its effects.

Other herbal aids

The remaining complementary preparations we bought contained a variety of herbs including passionflower, hops and chamomile. These herbs, while traditionally used to treat anxiety and sleeplessness, have limited or no clinical trials to support their safety and efficacy as sleep aids.

Some of the products also contained vitamins and minerals such as calcium, magnesium, vitamin B6 and vitamin K. We couldn’t find any evidence to say the small amounts in these preparations would induce relaxation or sleep.

Most of the products claimed to relieve or help relieve insomnia and sleeplessness, although a product distributed by NUTRA-LIFE claimed to “help calm and reduce nervousness and aid relaxation, particularly in cases of sleep disorders”.

We contacted the manufacturers to ask for supporting evidence. Out of 10 companies, we heard back from five: NUTRA-LIFE, BRAUER, BLACKMORES, CARLSON HEALTH and IPA (distributor of SOUL PATTINSON goods), but none added anything significant to the limited evidence we could find for the ingredients. However, all the complementary products are listed with the Therapeutic Goods Administration (TGA), which means they contain well-established ingredients used for a long time and are considered by the TGA to be low-risk.

It’s worth noting that even with low-risk medicines, there can be rare cases of adverse effects. For instance, an Australian woman was hospitalised after a severe reaction to passionflower. There have also been reports of liver damage from use of preparations containing American skullcap, which we found in one preparation. While rare, these cases are a reminder to be careful when using herbal preparations.

Always let your doctor know if you’re taking any kind of over-the-counter complementary medicine. Herbal preparations, like other drugs, can modify chemical processes in the body and interact with other medications. As CHOICE has often noted, the problem with herbal remedies is that ‘herbal’ sounds safe, but they’re not tested in the same way as other medications.

The other option for over-the-counter sleep aid products is antihistamines like promethazine and doxylamine.

While these may send some people off to sleep, they can have the opposite effect on others. Antihistamines can also have side effects, most notoriously drowsiness or a hangover effect the next day. They may affect your work or ability to drive a car.

Antihistamines can interact with other medications, including certain kinds of anti-depressant and prescription hypnotics. People with certain medical conditions, such as asthma, glaucoma and epilepsy, shouldn’t use them. Always tell your pharmacist about any medical condition you have or medication you’re taking, including complementary preparations, before using Pharmacy Only medication.

If you decide to try them, they’re only recommended for short-term use. As with all sleep aid products, if you don’t improve see a doctor, as insomnia could be an indication of an underlying medical problem.

Antihistamines aren’t recommended for use during pregnancy or breastfeeding. It’s not known how safe they are for children under 12, and some children become hyperactive on them. Always get a copy of the relevant Consumer Medicine Information from your pharmacist and ask about anything you don’t understand.

Some experts think that even though antihistamines may be acceptable during acute (short-term) insomnia, if medication is required it’s preferable to have a doctor prescribe the appropriate drugs. Although it’s easier to buy antihistamines over-the-counter, seeing a doctor is useful as they may be able to advise on other ways to combat insomnia. And prescribed medication for insomnia may be more effective, because, as one expert told us, “Antihistamines are worse than prescribed drugs because people’s reactions to them are varied.”
Sleep apnoea, a condition where the sufferer stops breathing for at least 10 seconds, over and over again throughout the night, can be divided into two types. The most common type, obstructive sleep apnoea (OSA), is caused when the airway passage is obstructed during sleep, for instance by the tongue. In central sleep apnoea, a far less common condition, respiration at night is affected by a disorder in brain function; its symptoms and diagnosis are similar but treatment may involve more elements.

OSA can be brought about or hastened by factors such as obesity or weight gain, smoking, alcohol and sedative use. It may also be the result of a person’s anatomy, such as enlarged tonsils.

If you suffer from sleep apnoea you’ll wake many times during the night (in order to start breathing again), although you may not remember doing so. These constant sleep disruptions usually result in daytime sleepiness. While many sufferers also have a snoring problem that may help diagnosis, it’s not always a symptom.

OSA is in fact often undiagnosed, leaving the sufferer tired, irritable and possibly vulnerable to health problems such as high blood pressure, diabetes and coronary disease. Other problems, such as falling asleep at the wheel, can also result from leaving OSA unchecked. If you find it hard to stay awake during the day (especially in the afternoon), wake up feeling tired despite the amount of sleep you’ve had or fall asleep easily in the afternoon, have yourself assessed for OSA. This involves having a polysomnogram — a test measuring various physiological activities while you sleep — to determine if you have the condition. A number of treatments are available for OSA. Sometimes weight loss, not sleeping on your back and avoiding alcohol and sedatives are enough to manage the condition. In more severe cases, dental appliances may be used to keep the airway open.

Nasal CPAP (continuous positive airway pressure) is considered the most effective, non-invasive treatment for OSA. The CPAP machine has a nasal mask that blows air through the nose and holds the airway open, helping the sufferer breathe regularly through the night. Surgery is also an option. For children with OSA this often involves taking out their tonsils and adenoids. Occasionally, adults may also undergo surgical procedures for the condition. Studies suggest medication is an ineffective treatment for OSA.
  • Make sure your room is comfortable — not too hot or cold, with a comfortable mattress on the bed, some fresh air and a minimum of noise (use a white noise machine, a fan or earplugs if noise is a problem).
  • Establish that the bed is for sleep or sex only — don’t work, read, argue or worry there.
  • People who suffer from sleep disorders often have faulty perceptions about sleep. Experts point out that if you don’t sleep you still get sleepy, but a lot of people don’t use that fact to help themselves. If you get insomnia you tend to go to bed early and stay in bed late to give yourself the maximum possibility of sleeping. However, when you don’t sleep this can create a negative association with going to bed. So don’t get into bed until you’re really sleepy.
  • If you don’t fall asleep after a period of about 15 minutes, get up and do something relaxing — have a bath, read a book (nothing too stimulating — no thrillers!), listen to soft music — then get back into bed when you’re sleepy. Get up again if you still can’t sleep. It might take a few goes, but you should eventually nod off.
  • While a lot of people think having a few stiff drinks is a good recipe for getting off to sleep and staying there, experts say it’s a no-no: alcohol disturbs sleep patterns.