May 27, 2020 by John Fernandez
Improving Sleep Health: Don’t Rely on Melatonin, Over-the-Counter Meds
Too many people make it through hectic, stressful days juggling work and family responsibilities, only to end up tossing and turning during disturbed or erratic sleep cycles. Add the persistent “blue light” of digital devices — laptops, smartphones and tablets — and it’s not surprising that the market for over-the-counter sleep medications is so robust.
There is also melatonin, a popular supplement that is made in a lab, a synthetic version of the human hormone that helps regulate sleep-wake cycles.
Physicians who specialize in sleep health, neurologists and sleep psychologists agree that relying on these over-the-counter drugs or supplements is not a viable or long-term solution to sleep disturbance problems, and they certainly are not the answer if you have serious disorders, such as obstructive sleep apnea (OSA) or insomnia.
OSA, the more common of the two forms of apnea, occurs when the muscles in the back of the throat fail to keep the airway open, despite efforts to breathe. Left untreated, sleep apnea can lead to other serious health issues, such as high blood pressure, heart disease, stroke and depression, studies have confirmed. Such a serious condition requires a diagnosis by a physician, who may prescribe medication for a specific period of time, and possibly other therapies that can treat persistent OSA or other sleep disorders or disturbances.
‘Less Medicine is Better’
“The point is that a magic bullet doesn’t exists that just zaps you into sleep without complications,” says Timothy Grant, M.D., medical director, Baptist Health Sleep Centers. “That’s why we have to explain to patients about the risks involved with these medications. Sometimes people’s lives are so impacted by their inability to sleep that they think they need something to break that cycle. But we always try to stress that less medicine or no medicine is better.”
Sleep health experts try to steer patients toward improving their “sleep hygiene,” which refers to different habits that are necessary for nighttime sleep quality and full daytime alertness.
Just a few simple changes can make the difference between a good night’s sleep and spending night tossing and turning. Lifestyle modifications can improve sleep health, and overall fitness, such as regular exercise (that doesn’t take place in the evening), proper nutrition, weight management and properly treating underlying chronic conditions, such as high blood pressure or diabetes. A sleep environment that is comfortably cool, dark and devoid of electronic devices is part of healthier sleep hygiene.
Relaxation and Behavioral Therapies
There are non-medical psychological and behavioral treatments for insomnia. Relaxation training, stimulus control, sleep restriction, and cognitive behavioral therapy (CBT) are examples. CBT works to overcome unhealthy beliefs and fears around sleep, and focus more on rational and positive thinking, according to the National Sleep Foundation. There is a substantial research supporting the use of CBT for insomnia, the Foundation says.
Some of these techniques can be self-taught, while others are adopted through the help of a therapist or sleep specialist.
“It’s very important to combine relaxation therapy, cognitive behavioral therapy and sleep hygiene with medicine, if medicine is prescribed at all,” says Dr. Grant.
Sleep medications, such as Nytol, Sominex, and Unisom, that are available without a prescription use antihistamines as their main active ingredient. An antihistamine is what someone would typically take for an allergy and it tends to make people sleepy, Dr. Grant points out.
Potential Problems With Melatonin
In the huge over-the-counter market for sleep aids, melatonin in the form of supplements has become widely accepted, says Marcy Wasman, Ph.D, sleep psychologist affiliated Baptist Health. But, as with any dietary supplements used regularly, the side effects and ingredients could be a problem for some users.
“Melatonin is so widespread that people think it’s not a big deal. It’s over the counter,” says Ms. Wasman. “But it can be a big deal.” She explains that a 2017 study indicates that the melatonin content of dietary supplements can vary greatly from what is listed on the label. Researchers from the Gosling Research Institute for Plant Preservation at the University of Guelph in Ontario, Canada, also founds that some products may be contaminated with serotonin, a controlled substance responsible for maintaining mood balance and fighting depression.
Some of these over-the-counter products may be a good solution for some to “get through one tough night,” but it should not be used regularly, especially without consulting with your physician and a sleep specialist.
“Relying on these products is like using a crutch repeatedly,” says Sergio Jaramillo, M.D., a neurologist with Baptist Health Neuroscience Center.” You are kind of giving up the power that you have within yourself to find sleep naturally — you are giving it up to a sleep aid. You want to empower yourself and keep that power so that you kind find sleep naturally, especially as we age and as we get less efficient in sleep. You don’t want to give up the power to find sleep naturally.”
See Baptist Health’s Facebook Live session on overcoming sleep disorders and developing healthy sleep habits. Hear from our experts: Dr. Timothy Grant, medical director, Baptist Health Sleep Centers; Dr. Sergio Jaramillo, neurologist, Baptist Health Neuroscience Center; and Dr. Marcy Wasman, sleep psychologist.