This column is the last in a series on the importance of adequate sleep for optimal mental and physical health, based on “Why We Sleep” by sleep scientist Matthew Walker, PhD. “Adequate sleep” refers to quantity (7 to 9 hours most nights) and quality (also known as sleep architecture—REM and NREM).  

At least a third of Americans are chronically sleep-deprived. Part of the reason is that fast-paced modern life is not conducive to adequate sleep. But many sleep-deprived people suffer from insomnia, meaning that they have difficulty falling asleep and/or staying asleep. Today’s column is about the pros and cons of sleep aids, which are a 30 billion dollar a year industry in this country.

Melatonin is sometimes called the “sleep hormone.” In the evening at dusk, the pineal gland in the brain releases melatonin into the bloodstream, which sends a message to the brain to get ready to sleep for the night. Melatonin supplements are not a powerful sleep aid, but are effective in the elderly, who tend to lose some of their output of this “sleep hormone.” And melatonin supplements are also effective in dealing with jet lag.

Melatonin can be found OTC (over-the-counter). However, like other supplements, melatonin supplements are not controlled by the FDA, so you never know what you’re getting. Impurities are common, and concentration of OTC melatonin ranges from 83 percent less than what’s claimed on the label, to almost 500 percent more than stated. Although melatonin is “natural,” supplements can have mild side effects.

There is a prescription melatonin-like compound called Rozerem (generic name ramelteon), which is approved by the FDA and which therefore can be trusted. It should be taken about 30 minutes before bedtime.

OTC sleep aids usually contain anti-histamines such as Benadryl (diphenhydramine) and Unisom (doxylamine), which commonly cause dry mouth, constipation, drowsiness the next day, and difficulty urinating. In seniors, antihistamines can cause confusion.

Marijuana is often used by younger people in particular for sleep. An interesting phenomenon is lack of sleep due to staying up late to use marijuana. Studies are ongoing, but short-term marijuana appears to help people fall asleep who have PTSD, restless leg syndrome, or chronic pain. Although marijuana improves sleep quality in the first half of the night, during the second half there is more awakening and fragmented sleep. Long-term insomnia use results in return of insomnia, and abrupt discontinuation cases rebound insomnia.

Valarian and chamomile are herbs that have mild sleep benefits, and have no side effects in normal doses such as tea.

Prescription sleep meds: There are many. The most commonly prescribed prescription sleep aid is zolpidem (Ambien), which is effective but can have worrisome side effects. Natural deep sleep cements memories, but Ambien-induced sleep is what Dr. Walker calls a “memory eraser.” This is of particular concern in kids, with developing brains. Furthermore, Ambien can cause confusion, and if taken for long periods of time rebound insomnia occurs when people try to discontinue it. Ambien lasts for several hours, so if you take it you should plan on staying in bed for 7-8 hours. For people who awaken at 2 or 3 in the morning, there is another, similar drug called Sonata, that just lasts a couple of hours. 

Antidepressants: Many antidepressants interfere with sleep, but there are 2 that aid sleep without interfering with sleep architecture. One is mirtazapine, although many people don’t tolerate it due to grogginess the next morning. Of interest is that lower doses cause more sedation than higher doses. The other antidepressant that is often prescribed for sleep is trazodone.

Bottom line: Dr. Walker is not a fan of the currently-available sleep meds, although he is not anti-medication and hopes that an effective, side effect-free sleep aid will be developed in the near future. In the meantime, he recommends the following:  1) Follow the sleep-hygiene tips in last-week’s column. 2) Cognitive behavioral therapy. 3) Mindful meditation.

Dr. Greg Feinsinger is a retired family physician who started the non-profit Center For Prevention and Treatment of Disease Through Nutrition. For questions or to schedule a free consultation about nutrition or heart attack prevention contact him at gfeinsinger@comcast.net or 970-379-5718.