Friday Feb 14, 2025
Sleeping Pills and Potions - What works and what doesn't
You're at the end of your rope, so you head to the pharmacy for the help you so desperately need to sleep. But wait, you aren't sure if it's safe, if it works, and if there's a better way. Stay tuned to learn about the benefits, side effects, and risk of sleep aids.
I'm Dr.Vickie Petz Kasper. If you're ready to take control of your health, you're in the right place. I'll give you practical steps to start your own journey toward better health because healthy looks great on you.
This is episode 159, Sleeping Pills and Potions. What works and what doesn't. You know that poor sleep is associated with heart disease, cancer, diabetes, obesity, immune dysfunction, high blood pressure, anxiety, depression, fatigue, irritability, and good grief, I could go on and on. So, taking something to help you sleep sounds like a good idea, right? Today, we'll discuss what you need to know before you go and get a prescription, supplement, or over the counter sleeping aid.
Look, we have to sleep. Our very lives and health depend on it. But the struggle is real. Insomnia is one of the most common symptoms people go to the doctor or health care provider for treatment.
And what if I told you that good sleep is possible without medications? Well, it is. In fact, the first line treatment recommended to treat insomnia is not medication. The standard recommendation for managing insomnia is to eliminate things that go bump in the night and keep you awake. Or, to treat underlying diseases that disrupt sleep. It's not recommended to start with behavioral therapy or medications until these other things are maximized.
Ha! But good luck with that. If you go to your primary care provider and you don't get a prescription, I'll buy you a cup of coffee and we can both stay awake. And, if you think you need to see a specialist, then you'll probably get to spend the night in a sleep lab hotel hooked up to a bunch of wires and you may get answers, like, a CPAP, and that's important if you have sleep apnea, but if not, you might not even hear from them. No wonder you're looking for a good solution to sleep. And though medications are not the first line recommendation, that is the topic of today's episode. So let's get to it. We're going to start with prescription medications, then we'll talk about over the counter medications and wrap up with supplements.
There are three classes of drugs approved to treat insomnia. Benzodiazepine receptor agonist, histamine receptor antagonist, and melatonin receptor agonist. Listening to all that medical jargon may be sufficient to put you to sleep. But wait, let me explain. You'll understand more after we go to mini medical school today and learn about receptors.
These are made up of proteins and they receive chemical signals that produce a response. Let me give you this analogy. You've got a lamp sitting on an end table, but it's not plugged in, so there's no light. And when you stick those two prongs into the socket, behold, now you can sit and read. And that's kind of how a receptor works.
The plug fits into the plug in. So an agonist is like the plug. It fits. It turns it on. It lets the electricity flow. But, if you had a toddler in the house, you might want to plug in one of those little plastic things so he doesn't stick a butter knife in there and get shocked. So that would be an antagonist.
Okay, now wake up and pay attention. We've got three classes of drugs to look at. Benzo receptor agonist and melatonin agonist. That plug in and histamine receptor antagonist that block the plugin. And then there's another category called other. We'll just call that the clapper, you know, clap, clap. And the light comes on, clap, clap, and the light goes off.
There are eight drugs in the benzodiazepine receptor agonist family. And the first five are about my age, you know, born in the 60s. They are Estazolam, which is Prosom, Florazepam, which is Dalmane, Quamazepam, which is Doral, Temazepam, which is Restoril and Triazolam, which is Halcion. Now the millennials aren't benzos, but they're still benzo receptor agonist.
And you know, this generation got way more complicated spelling their kids' names, so I'm probably gonna have to sound them out like a first grade teacher on the first day of school.
Eszopiclone is Lunesta, Zaleplon is Sonata. Zolpidem is Ambien. Those older drugs are crankier and cause more dependence although Restoril is the nicest in the category. There are other benzos which are technically prescribed for anxiety and some people do use them to help them sleep. Do they work?
Here's what the data says for the old guys. They help you fall asleep faster. A whole whopping 10 minutes faster. And they increase total sleep time by half an hour to an hour. That's it. What about risk? Well, they make you sleepy, which is kind of the point, but also they can make you dizzy, which can make you fall if you get up and go to the bathroom during the night. And if you mix them with opioids, the reaction can be fatal.
Now, the younger guys function about as well as the older ones, but they have shorter half lives, so their effects don't wear out their welcome so much with daytime grogginess. And they aren't so deadly when socializing with opioids. But rarely, they do some bizarre things like compel you to shop or gamble in the middle of the night. All for 10 minutes faster to go to sleep and half hour to an hour longer sleeping.
Okay, clap on, clap off, let's talk about the other drugs. These are dual orexin receptor antagonists. Affectionately known as D O R A or Dora.
The first one is Suvarexant, which is called Belsomra. The next one is Derodorexant, which sounds a lot like deodorant to me, and that's exactly what I'm gonna call it because the brand name is Quviviq. And finally, there is Limboxerant, which has a really cool brand name, Dayvigo. What? You've never heard of any of these? Well, that's probably because they're slightly less effective than the other drugs. They help you go to sleep seven minutes faster. But the main side effect is sleepiness, and people generally say they slept better.
The next topic in pharmacology class in mini medical school is the histamine antagonist. You know, the little plastic thing that goes in the wall socket so your toddler doesn't. Doxepin is a tricyclic antidepressant that functions this way, and even in low doses it causes the desirable effect of drowsiness. So, it's approved for the treatment of drowsiness deficit.
Unfortunately, there are some drugs it doesn't play nice with. But, it does increase sleep time by Drum roll please! 25 to 30 minutes. Womp, womp, womp. And, it helps people stay asleep toward the end of the sleep cycle.
And I think this underscores why one size does not fit all and prescriptions should be customized for individual needs. The last class of drugs approved for the treatment of insomnia makes a lot of sense. Ramelteon is a melatonin receptor agonist and the brand name Rosarem, get it? REM, R E M, as in rapid eye movement sleep.
It's got a good mechanism of action, a good name. Problem is, it doesn't work any better than placebo. So, you can skip the potential for fatigue, nausea, and worsening of liver disease and just take a sugar pill. So, am I saying it doesn't work at all? Of course not. Why would it be approved if it didn't work?
Well, it's not in Europe, but it does work to lengthen sleep time by a grand total of seven minutes. And I don't know about you, but it's going to take more than seven minutes to get rid of the bags under these eyes. So that's the gamut of drugs approved for the treatment of insomnia in the United States.
But wait, there's more. Just because the FDA doesn't approve something for a particular indication, that doesn't mean that doctors can't prescribe it. And sometimes, off label prescribing is a really good thing, though it's a set up for a knock down, drag out fight with your insurance company for coverage.
In addition to using the antidepressant Doxepin, many doctors prescribe other antidepressants for sleep. Things like Amitriptyline and Trazodone, even though the American Academy of Sleep Medicine advises against it because of side effects and no data showing that it works.
Now, I always recommend that you consult with your health care provider regarding your medications. Always, always, always. But, I also recommend that they consult with up to date society recommendations and guidelines. That's just fair. And while they're at it, they should look at the potential adverse reactions.
So, now maybe you've decided to skip the copay and just help yourself to the sleep aid aisle of the pharmacy. You could even ask the pharmacist to guide you, and I recommend that. There are two over the counter medications approved to treat insomnia. They are diphenhydramine, commonly known as Benadryl, and doxalamine, commonly known as Unisom.
Side note, over the counter medications are regulated FDA, And both of these drugs are histamine blockers. Therefore, all of the fun side effects that come with that, like dry mouth, GI distress, dizziness, trouble emptying your bladder, and of course, sedation, which is the desired side effect.
These medications are often combined with things like Advil or Tylenol with an added P. M. at the end, so you know what's in store for you. And here's what's in store for diphenhydramine. 8 less minutes to fall asleep and 12 more minutes of sleep. And for doxylamine, there's no data available.
That's it. That's what we've got. So, maybe now you've decided just to take matters into your own hands and look for a supplement. And because you've listened to my previous podcast episode about dementia, you're gonna skip right over the Prevagen, right? Promise me. Now, in the supplement section, you're going to walk in understanding that claims, concentrations, and ingredients are not guaranteed.
They're not regulated. They are, generally speaking, considered safe and ineffective. You heard that right. Safe. And ineffective. But what about melatonin? You swear it works, but does it? Maybe. It is sedating in about 10 percent of people and in everyone else, it shifts the sleep phase.
So, there is a place for that such as jet lag, and I have an episode on jet lag in the show notes. But even though it may help you drift off to sleep, it probably isn't going to help you stay asleep. The half life is less than an hour, and in some people it causes stomach cramps, irritability, and even depression.
It's best used in combination with other things that regulate your circadian rhythm. More to come on that. But a big one is light. And so this probably would be a great time to tell you about some exciting news I have for you.
I have an upcoming series of live webinars to talk about six hidden things that keep you tossing and turning at night. And soon you'll have access to an online course called Unlock the Secret to Sleep, your personal sleep solution. I have been working so hard on this for so long that I cannot wait to share it with you.
I want to help you reset your sleep and get your Z's. Now there are other supplements labeled as sleep aids and most of them again are safe and probably not effective. The exceptions on safety are kava and valerian root. Both of those have been associated with liver damage. Now it's rare, but it's very serious.
Other things you might find on this aisle are chamomile, Glycine, Gryphonia, Hops, , Kava, L theanine, Lavender, , Passionflower, Nightshade, Skullcap, Strymonium, Tryptophan, , and Wild Jujube Seeds. They're all equally effective and work every bit as well as a sugar pill, but hey, sugar pills can have powerful placebo effects.
And one last thing I want to mention, and that is cannabis. Bottom line is there's not enough research to say one way or another, whether it works. It does have the potential for addiction and it's not legal everywhere. So there's that. But also it's a problem that if you quit, you'll likely experience sleep disturbances that can last for several months.
The bottom line is, I want you to know that you shouldn't have to choose between serious health consequences of poor sleep and the side effects and risk of sleeping pills and potions. If you suffer from insomnia, I do encourage you not to stop any medications without medical supervision and to have an honest conversation with your doctor. And if they want access to my resources, just give them my email address. I'm happy to share and they're 100 percent legit, but if good sleep eludes you, I want you to know while there's no magic pill for perfect sleep, there is a proven path to natural, restorative rest that can transform your life. Imagine waking up energized, focused, and ready to tackle your day without relying on sleeping pills or potions.
Are you tired of tossing and turning at night? Desperately wishing for deep, restful sleep?
I'm hosting two exclusive live webinars where I'll share my evidence based approach to achieving consistent quality sleep. Join me on March 3rd or March 5th to discover how to fall asleep naturally. and wake up refreshed, practical strategies to boost your energy and mental clarity, and solutions to common sleep challenges that keep you awake at night.
Plus you'll get a chance to ask your most pressing sleep questions during a live Q& A session. So don't miss this opportunity. To revolutionize your sleep.
Click the link in the show notes to save your spot now. Registration is required. And make sure you're on my email list to receive exclusive pre webinar insights and special bonuses. Your journey to better sleep starts here. Sign up right now and let's transform your nights and supercharge your days. Because good sleep is crucial for good health and healthy looks great on you.
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