Drug Facts: Sleep Aids (OTC)

What is an over-the-counter sleep aid?

An over-the-counter (OTC) sleep aid is any of a number of medications that is intended to treat occasional sleepless nights (not insomnia).  As the name implies, a prescription is not required to obtain these medicines.  These medications typically contain antihistamines, such as diphenhydramine (such as Nyquil™) and doxylamine (such as Benadryl™),  or some form of pain killer.   They are not to be confused with prescription sleep aids, many of which are hypnotics and which are generally prescribed to treat insomnia.   There are numerous commercially available OTC products sold as sleep aids, including, but not limited to, SleepMax PM™, Unisom™, Simply Sleep™, Advil PM™, and Tylenol PM™. 

How, why, and how often are over-the-counter sleep aids abused?

OTC sleep aids tend to make people drowsy or less alert.   Studies related to some of the key ingredients in these medications, including diphenhydramine, have found that there is a potential for human abuse of these substances.  Studies of the precise extent to which OTC sleep aids (again, to be differentiated from prescription sleep aids) are being abused by adolescents are not prevalent in the literature.  However, antihistamines, including those found in OTC sleep aids, can be (and often are) ingested in large quantities by individuals who are attempting suicide. 

On the other hand, prescription sleep aid abuse is becoming more prevalent; use of prescription pills among younger adults (ages 20-44) doubled between 2000 and 2004, and, during that time, the number of sleep aid prescriptions given to children and adolescents climbed 85%.  Interestingly, abuse of prescription sleep aids is not usually associated with insomnia, but, rather, with excessive dosages and alcohol/other drug use.  It is important to recognize that OTC and prescription sleep aids are very different substances and that their uses and potential for abuse are very different.

What problems can arise from over-the-counter sleep aid abuse?

Because OTC sleep aids tend to make people drowsy, they should not be taken by individuals who are using alcohol or other drugs with sedating effects, as the interaction is potentially dangerous.   OTC sleep aids also have negative interactions in people with preexisting breathing problems, glaucoma, chronic bronchitis, pregnancy (or nursing), or trouble urinating due to an enlarged prostate gland.   Furthermore, OTC sleep aid use can cause daytime sleepiness on the following day, depending on the person, if the drug remains in the system longer than the sleeping period.   These medications should not be taken for more than 7 to 10 days in a row as the user may experience negative side effects. 

What else should I know about over-the-counter sleep aids?

An overdose of OTC sleep aids can be fatal, and needs to be treated seriously.  Again; OTC sleep aids are not designed to treat insomnia, and should not be taken over a long period of time.

  Staff. (2008). Sleep aids. Retrieved online on 7/10/08, from: http://www.merck.com/mmhe.

  Goldberg, J.R. (2007). Sleep aids: All you ever wanted to know… but were too tired to ask. Retrieved online on 7/10/08, from: http://www.sleepfoundation.org.

  Staff. (2008). Sleep aids. Retrieved online on 7/10/08 from: http://www.walgreens.com.

  Jun, J.H., Thorndike, E.B., and Schindler, C.W. (2004). Abuse liability and stimulant properties of dextromethorphan and diphenhydramine combinations in rats. Psychopharmacology, 172, 277-282.

  Khosla, U., Ruel, K., and Hunt, D.P. (2003). Antihistamine-induced Rhabdomyolysis. Southern Medical Journal, 96(10), 1023-1026.

  Staff. (2006). Sleep aid abuse getting more attention. Alcohol & Drug Use Weekly, 18(2), 8.