ARE YOU TOSSING AND TURNING YOUR WAY to a sleepless journey night after night? Today’s topic is sleep aids: yes or no?
In the quest for that elusive, perfect night’s sleep, many patients turn to the medicine cabinet for a quick fix.
But before you follow their lead, I want to help you unpack the pros and cons of reaching for sleep supplements.
From melatonin to herbal brews, are these sleep aids the dream solution or a potential nightmare?
Grab your favorite pillow (mine is remarkably soft and pliable) and settle in as we explore the world of sleep supplements and help you decide whether it’s wise to let these bedtime drugs tuck you in.
People Commonly Use Sleep Supplements
I decided to write this article after reading this Washington Post headline:
Eighteen percent of U.S. adults use medication to help them sleep.
The percentage is from a 2023 US Centers for Disease Control and Prevention report.
The analysis also indicated that over 6% admitted to taking sleep medicines daily, and another 2% took them most days.
How Much Sleep Should You Get?
Most adults should aim for at least seven hours of nightly sleep.
According to the United States Centers for Disease Control (CDC), that’s true.
Alas, about a third of us do not get sufficient zzz’s.
Why are we so bad at sleep?
Mental Health America explains that nearly one in five American adults lose sleep because of stress.
Unfortunately, short sleep raises our chances of suffering from several health problems, including the following:
- Heart disease
- High blood pressure
- Diabetes, type 2
- Obesity
- Dementia
- Poor mental health
- Attention, behavioral, and learning problems
Of course, I will only end this piece with some tips on getting better sleep.
Supplements: Yea or Nay?
Fortunately, I don’t have insomnia — trouble falling (or staying) asleep.
Many who suffer turn to medications, either over-the-counter or prescribed ones.
Be careful: Long-term use of sleep medicines can cause significant side effects and interfere with other medications.
Sleep Medicine Toxicities
I won’t be comprehensive here, but I will highlight some of the perils of sleep medications.
The relationship between the use of sleep medications and cognitive decline has been under scrutiny for some time.
There is a potential link between chronic use of sleep medications and an elevated risk of dementia, although research findings are nuanced by significant complexities.
Let’s turn to a particular sleep medicine, benzodiazepine.
Beware Benzodiazepines
A 2020 study analyzed eight years of health records from over 6,300 seniors aged 65 and above.
French and Canadian researchers discovered this:
Regular users of sleep aids face a higher likelihood of developing dementia. Moreover, Alzheimer’s risk increased with the cumulative fose of benzodiazepines taken by individuals.
The problem?
Sleep problems can reflect early dementia, so whether the sleep medicines directly contributed to the development of dementia (or serve as indicators of the early stages of the condition) remains uncertain.
Another Study Suggests Benzodiazepine’s Perils
A separate study from Seattle followed 3434 men and women, averaging 74 years old, none of whom had previously been diagnosed with dementia.
Over 15 years, 20 percent of the subjects received a dementia diagnosis.
The study authors noted a significant increase in dementia risk among those who reported frequent or nightly use of sleep medications.
As with the previous study, researchers could not establish causality. Remember: Sleep disturbances can be an early marker of dementia.
We need more research to understand the benzodiazepine and dementia relationship, but I would avoid long-term use of this drug class.
Benzodiazepine Examples
Benzodiazepine examples include:
- Alprazolam (Xanax®)
- Chlordiazepoxide (Librium®)
- Clorazepate (Tranxene®)
- Diazepam (Valium®)
- Halazepam (Paxipam®)
- Lorzepam (Ativan®)
- Oxazepam (Serax®)
- Prazepam (Centrax®)
- Quazepam (Doral®).
If you are using any of these drugs as long-term sleep aids, please check with your healthcare provider about sorting out your sleep issues and potential alternative medicines.
And don’t stop “cold turkey.” It can be dangerous to do so.
Anti-cholinergic Drugs Might Increase Dementia Risk
Long-term use of anti-cholinergic drugs might increase your dementia risk.
What are these drugs?
Over-the-counter anti-cholinergics include the following:
- Diphenhydramine (Benadryl, Tylenol PM, Advil PM, Unisom SleepGels)
- Brompheniramine (Dimetapp)
- Dimenhydrinate (Dramamine)
- Doxylamine (Unisom SleepTabs)
I won’t list the prescribed ones, but you can find a compilation here:
Anti-cholinergics
Anti-cholinergic drugs are used to treat many conditions, including chronic obstructive pulmonary disorder (COPD) and…
Chronic Use of Drugs Like Benadryl
Long-term use of anti-cholinergics (or use of these drugs in older people) has been associated with increased dementia risk.
Researchers offered these conclusions based on an analysis of the Quebec (Canada) experience:
“Higher cumulative anticholinergic use is associated with an increased risk for dementia.”
They added that “efforts to increase awareness among health care professionals and older adults about this potential medication-related risk are important to minimize anti-cholinergic use over time.”
More on Anti-cholinergics
The U.S. Food and Drug Administration recognizes diphenhydramine (Benadryl, Tylenol PM, Advil PM, Unisom SleepGels) as safe for those over 12.
However, these products should only be used occasionally for insomnia and for under two weeks at a time.
The American Gerontologic Association expresses concern about anti-cholinergic medication use in older adults.
The organization is concerned that seniors may be more likely to experience unwanted side effects than younger people.
If you’ve been prescribed one of these drugs and have concerns about this risk, please talk to your doctor or other healthcare provider.
Don’t discontinue the drugs on your own. It may not be safe to quit most benzodiazepines and anti-cholinergic drugs “cold turkey.”
Please work with your clinician to create a plan to taper off them.
Getting Better Sleep
Here are some tips I use to get better sleep.
- Set a regular bedtime. I almost always go to bed at the same time and wake up at the same time each morning, including on the weekends.
- Limit caffeine. You already know, but to be clear, consuming caffeine to stay awake during the day can keep you up at night. I avoid coffee starting at least eight hours before bed.
- De-stress. My favorite go-to is a warm shower a couple of hours before bedtime. I also meditate.
- Get adequate daytime physical activity. I avoid vigorous exercise with a few hours of bedtime.
- Get some sunlight. I can regulate my body’s sleep-wake (circadian) cycle by getting out for some natural daylight during my daily walks. I aim for 30 minutes of sun exposure when possible.
- I don’t consume alcohol. Moreover, I try not to eat (especially high-fat or sugary foods) or drink within a few hours of bedtime.
- I keep my bedroom dark, cool, and quiet. I avoid activities there other than the two S’s (sleep and sex).
Non-drug treatments for insomnia include cognitive-behavioral therapy, relaxation techniques, yoga, and sleep hygiene practices.
For additional sleep guidelines, please visit the National Sleep Foundation’s website. (But, of course no screens immediately pre-bedtime.)
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