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Crystal
10-21-2007, 10:44 PM
The insomniac's guide to OTC sleep aids*

Melatonin
Melatonin can help regulate sleep cycles, but it should not be taken by persons with a history of depression as it affects serotonin and can trigger depression.

Diphenhydramine

Advil PM and Tylenol PM both contain the active ingredient diphenhydramine, it is the active ingredient in Benadryl and it's in the same dose as one Benadryl pill. Generic diphenhydramine is as effective as name brands. Only difference with the pain killer mixes is they contain ibuprofen and acetaminophen, respectively. Only difference between generics and name brand is price.

Diphenhydramine is an antihistamine that induces sleepiness in most people who take it. It can have the opposite effect in some sensitive people. Many people find it to be as effective as Ambien or other similar Rx sleep aids, but it is generally not thought to be habit forming. Effects generally last 4-6 hours. Take it 20-30 minutes before your bedtime.

Valerian

Herbal supplement that helps induce sleepiness. This can be a good solution if your main problem is falling asleep. Keep pills in the refrigerator, they stink! Take one or two 20-30 minutes before bedtime. Not habit forming, I've never found anything about adverse affects.

Bedtime Tea by Yogi
A very tasty tea containing a variety of herbs known to induce sleepiness and relaxation. It's safe and effective at helping settle down to sleep. Contains valerian and chamomile, so don't drink it if you are sensitive to them.

Chamomile tea
Herbal tea used to induce relaxation, more mild that valerian. It is a member of the ragweed family so people with hayfever allergies may be sensitive to it.

Magnesium Malate or Malic Acid and Calcium Citrate
This mineral helps regulate muscle function and can be of great aid to persons whose sleep is interrupted by restless leg syndrome. recommendation is 1,000 mg Magnesium Malate / day. It takes about a week to kick in and has to be taken daily to stay effective.

Forms of magnesium that do not contain malic acid won't do the trick.

Taking the supplement with calcium helps increase absorption of both and is believed to help regulate sleep to some extent. Calcium from dietary sources is fine, but if you don't get enough then consider supplementing with calcium citrate which is better absorbed than calcium carbonate.

Tryptophan
This amino acid is a precursor to serotonin. It is found in small amounts in turkey and milk. Ingesting these before bed can help induce relaxation and sleepiness. L-typtophan is sold as a supplement. I have no experience with this.

Acupuncture
Thin needles inserted into specific points along the "energy meridians" in the body are thought to rebalance the body's life force or chi. I tried this for insomnia with a good amount of success.

Prescription sleep aids
Ambien induces sleepiness for four hour cycles. Even so, it is strongly recommended you get no less than 10 hour blocks of sleep time or morning grogginess can occur.

Timed release ambien is supposed to help people who have night waking problems sleep up to 8 hours.

Common side effects include sleep walking and sleep eating during a fugue state.

Dependency forming - main risk is that when you stop taking it you will have a period of rebound insomnia that can last several days to several weeks. It's usually prescribed for short term bouts of insomnia for only a few weeks, though it may be used on a regular basis for longer periods so long as the person is aware of the risks.

Relatively safe in pregnancy and lactation. Discuss risks vs. benefits with physician.

I took this with pretty good success for a period of several months, but to achieve all night sleep I had to use a variety of lifestyle changes, too. I weaned off it and only experienced a few nights of rebound.

SSRIs Selective Serotonin Reuptake Inhibitors. This class of anti-depressants can help regulate sleep cycles in some people when insomnia is related to or triggered by depression. Serotonin is involved in the sleep cycle.

Lunestra
Supposed to work similar to Ambien but longer lasting and without the dependency problem. Personally, I think anybody who says that any sleeping pill is not habit forming is full of shit and trying to sell you their product. Just my opinion, I have no personal experience with this medicine

benzodiazepines, barbiturates, Valium
these are rarely prescribed for sleep disorder anymore, they are all addictive. If one is recommended be sure to talk over the risks very carefully.

Lifestyle changes: Most effective
= Stop drinking alcohol. It interferes with sleep.

= Quit smoking, nicotine is a stimulant and interferes with sleep.

= Eat a healthy, balanced diet.

= Exercise on a regular basis. Studies show that regular moderate aerobic exercize helps regulate sleep, and that regular yoga helps induce relaxation.

= Set a regular bedtime and stick to it every night. Plan to get no less than 8 hours of sleep per night.

= Remove all distractions from bedroom and make it only for sleeping. No tv, no radio, no computer. The true believers even say no reading in bed.

= Meditate or spend at least 5-10 minutes relaxing in a quiet place each night. Self hypnosis. Guided relaxation tapes may help. (These are ok in the bedroom ;)

= Create a bedtime routine.

= Aromatherapy. Find a scent that is known to induce relaxation and spritz pillows before going to bed, or use it as a lotion or body oil every night. This is a signal to the body and mind that it is time to sleep. Lavender oil is a classic.

= Don't do things that stress you out or excite you at night close to bedtime. This includes posting at bf.com

= If you wake up at night, don't lie in bed with your head spinning trying to get back to sleep. Get up and do something restful, like read a book while sipping hot tea, until you feel sleepy again. Then return to bed. Do not start budgeting or debating at bf.com

* I am not a health professional. I do have a sleep disorder and have tried these methods myself to varying degrees of success, unless otherwise noted.

Crystal
10-21-2007, 10:45 PM
Melatonin
It shouldn't be taken by people with a history of depression or by people who take SSRIs.

http://www.apollolight.com/melatonin_and_depression.html

see other drug interactions and info here:
http://www.umm.edu/altmed/articles/melatonin-000315.htm

On dosage:
Rest easy: MIT study confirms melatonin's value as sleep aid

Elizabeth A. Thomson, News Office
March 1, 2005

A new study by MIT scientists and colleagues confirms that melatonin is an effective sleep aid for older insomniacs and others. Misuse of the hormone had led some to question its efficacy, but the latest work (published in the February issue of Sleep Medicine Reviews) could jump-start interest in the dietary supplement and help more people get a good night's sleep.

In earlier research, scientists led by Professor Richard Wurtman, principal investigator for the current study, showed that only a small dose of melatonin (about 0.3 milligrams) is necessary for a restful effect. Taken in that quantity, it not only helps people fall asleep, but also makes it easier for them to return to sleep after waking up during the night--a problem for many older adults.

The researchers also found, however, that commercially available melatonin pills contain 10 times the effective amount. And at that dose, "after a few days it stops working," said Wurtman, director of MIT's Clinical Research Center and the Cecil H. Green Distinguished Professor. When the melatonin receptors in the brain are exposed to too much of the hormone, they become unresponsive.

As a result of these inadvertent overdoses, "many people don't think melatonin works at all," said Wurtman, who is also affiliated with the Department of Brain and Cognitive Sciences. This belief, coupled with potentially serious side effects related to high doses such as hypothermia, has earned the hormone a bad reputation in some quarters--"and something that could be very useful to a lot of people isn't," said Wurtman, who said that he and his wife have been taking melatonin every night for about a year now.

To determine conclusively whether melatonin works or not, the scientists in the current study analyzed 17 peer-reviewed scientific papers about the hormone. To be included in this study, or meta-analysis, the experiments reported in each paper had to satisfy specific criteria. For example, each had to be placebo-controlled and include objective measurements on at least six adult subjects.

"A meta-analysis essentially tells 'yes' or 'no'--that a treatment does or does not have a significant effect," Wurtman said. "When a meta-analysis says 'yes,' there should no longer be any controversy about whether the treatment works."

The melatonin meta-analysis delivered a definitive "yes."

Wurtman notes that some of the 17 studies included in the analysis involved very high doses of the hormone over long periods, a "situation where we know it's not going to work." Yet the meta-analysis still showed that the hormone's positive effects on sleep "are statistically significant."

When Wurtman first discovered the efficacy of small doses of melatonin, he and MIT patented its use for dosages up to one milligram. Because the FDA defined the hormone as a dietary supplement, however, manufacturers were free to sell it in much higher dosages, "even though we knew they wouldn't work," Wurtman said.

As a result, until recently the hormone was commercially unavailable to the public in small doses. "People who knew that small doses were best often bought the high-dose pills, then divided them with a knife," Wurtman said. "But that's not very accurate."

The company Nature's Bounty has since licensed the work, and now the hormone is easily available in the effective dosages.

Wurtman's colleagues in the meta-analysis work are Amnon Brzezinski of Hadassah-Hebrew University Medical Center in Israel; Mark G. Vangel, a visiting scientist at the Clinical Research Center; Gillian Norrie and Ian Ford of the University of Glasgow in Scotland; and Irina Zhdanova of the Boston University School of Medicine.

The work was supported by the National Institutes of Health, the Center for Brain Sciences and Metabolism Charitable Trust, and the Womens' Health Center of Hadassah-Hebrew University Medical Center.

A version of this article appeared in MIT Tech Talk on March 9, 2005 (download PDF).

http://web.mit.edu/newsoffice/2005/melatonin.html