When you can’t sleep, should you reach for an over the counter sleep aid? Sleep deprivation occurs when someone doesn’t receive as much sleep as they need. Acute sleep deprivation occurs when the individual doesn’t get any sleep. Chronic sleep deprivation occurs when someone receives insufficient across sleep multiple nights. Losing out on just one hour of sleep for a few nights can lead to serious consequences, including a higher risk of accidents, illnesses, relationship difficulties, and decreases in self-control.
Insufficient sleep is a widespread problem in the United States with over 30% of Americans frequently getting less sleep than they need. Numerous causes for poor sleep quality exist including:
- Anxiety (including a racing mind)
- Stress
- Depression
- Pain (Fibromyalgia, joint pain, Gulf War Illness, arthritis, gastro related pain, and other types of pain)
- Insufficient time to get adequate sleep
- Binge-watching shows or video games
- Poor sleep hygiene
- Side effects of drugs (caffeine, prescription drugs, etc.)
- Illnesses
- Frequent bathroom trips
- Uncomfortable bed
- Dense, urban environments with noise and light pollution
Insomniacs reach for prescription and over the counter (OTC) drugs, supplements, and herbs to improve their ability to go to sleep or stay asleep.
Going to sleep is a complex process involving biology and psychology. The body’s biochemistry plays important roles in the ability to sleep. Hormones and chemicals that naturally occur in the body including acetylcholine, dopamine, epinephrine, glutamate, histamine, melatonin, and norepinephrine all play a role in the ability to go to sleep and stay asleep.
Sleep medicines hope to reduce the amount of time it takes to go to sleep, make it easier to stay asleep, and increase the total time slept.
Because anxiety and pain are often responsible for sleep problems, medications that address anxiety or pain and make you drowsy are the most effective insomnia treatments.
In this article, we’ll discuss the effectiveness of over the counter sleep medications, supplements, and herbal treatments as well as their potential side effects. We review over the counter sleep aids that include diphenhydramine, doxylamine, dimenhydrinate, melatonin, valerian root, and CBD Oil.
All prescription medications include warnings about serious and even life-threatening side effects that have been experienced by some patients. Ideally, insomnia treatments will allow sleeping to come easily without risking serious adverse effects or next day drowsiness that makes it difficult to function well. None of the commonly prescribed prescription drugs meet this criterion. Let’s see if over the counter insomnia treatments offer effective relief with less risk.
Best Over-the-Counter Sleep Aid (Quick Summary)
- Benadryl,Sominex,ZZZQuil(Diphenhydramine)
- Unisom (Doxylamine)
- N-acetyl-5-methoxytryptamine (Melatonin)
- Dramamine (Dimenhydrinate)
- Valerian Root(Valerian Root)
- Premium Hemp Oil,Vegan Hemp Oil(CBD Oil)
A few common ingredients are used in many different over the counter sleep aids sold under a variety of names. In addition, some over the counter medicines combine multiple drugs, sometimes to address pain, congestion, and anxiety.
Also, the active ingredient in products with the same name may be different in different versions of the drug. For example, Unisom is a sleeping pill with the active ingredient Doxylamine. But Unisom PM Pain doesn’t contain Doxylamine. Unisom PM Pain’s active ingredients are diphenhydramine and acetaminophen while Unisom SleepGels only contain diphenhydramine.
Our review makes it clear how important it is to read and understand the label before taking sleeping pills, especially in light of the potential for serious adverse consequences. Professional tip: Take a photo of the label on drugs you use with your cell phone for easy reference and to help you purchase the same type of active ingredient if you need to buy over the counter sleep aids in the future.
We’re going to cover the side effects of the main ingredients used in over the counter sleep aids. An article that covers all the possible combinations would be too long. You can look up the ingredients in any specific drug on Medscape and view the side effects and drug interactions.
1. Diphenhydramine
Diphenhydramine is an antihistamine that causes drowsiness. Antihistamines counteract histamine (allergic reactions) in the body that cause nasal congestion, sneezing, and other allergic reactions.
Best Over the Counter Sleep Aids with Diphenhydramine
Adverse Side Effects Associated with Diphenhydramine
Side effects are symptoms some patients experience when they take a specific drug. Whether you will experience any of the side effects is unknown.
Serious Side Effects
Serious side effects can be life threatening or cause life threatening situations. For example, while dizziness by itself isn’t a big deal when someone is sitting down, it can lead to serious injuries or death when it occurs when they’re walking downstairs or causes the person to stumble into traffic.
- Agranulocytosis (dangerous low white blood cell count)
- Blurred vision
- Confusion
- Convulsions (uncontrollable, rapid muscle contractions)
- Dementia-likesymptoms
- May decrease cognitive function in geriatric patients
- Hypotension (low blood pressure that can cause fainting)
- Tachycardia (fast heart beat)
- Thrombocytopenia (low blood platelet count – affects clotting)
- Palpitations (fast heartbeat, fluttering, or skipping a beat)
- Vertigo (dizziness, room spinning sensations)
Less Serious Side Effects
- Anorexia (loss of appetite)
- Constipation
- Diplopia (double vision)
- Drowsiness (can interfere with functioning the next day)
- Dry mouth
- Dry nasal mucosa
- Euphoria (elevated mood)
- Hemolytic anemia (low red blood cell count)
- Hyperpyrexia (a tendency to overheat)
- Menstrual irregularities
- Nervousness
- Neuritis (nerve inflammation that causes pain, pin & needle feelings, weakness, or numbness)
- Pharyngeal dryness (dry, scratchy throat)
- Thick bronchial sputum
- Tinnitus (noise or ringing in the ears)
- Restlessness
- Urinary retention (difficulty eliminating liquid waste)
Warnings
Can depress the Central Nervous System (CNS)
May impair ability to drive or operate machinery the next day
Do not combine with alcohol
Elderly patients experience an increased risk of falls and other side effects
Do not use for insomnia in geriatric patients
Other combinations using Diphenhydramine
Products that combine acetaminophen, diphenhydramine, and phenylephrine:
- Benadryl Allergy & Cold
- Sudafed PE Severe Cold
- Delsym Cough + Cold Night Time
Products that combine acetaminophen and diphenhydramine:
- Excedrin PM
- Tylenol PM
- Percogesic
- Percogesic Extra Strength
- Goody’s PM
- Midol PM
- Unisom PM Pain
Products that combine aspirin and diphenhydramine:
- Alka-Seltzer PM
- Bayer PM
Products that combine diphenhydramine and phenylephrine:
- Children’s Dimetapp Nighttime Cold & Congestion
Products that combine naproxen and diphenhydramine:
Products that combine acetaminophen, aspirin, and diphenhydramine:
Products that combine diphenhydramine and ibuprofen:
Products that combine diphenhydramine and pseudoephedrine:
- Benadryl Children’s Allergy and Cold Fastmelt
- Benadryl D Allergy and Sinus Fastmelt
- Benadryl D Children’s Allergy and Sinus
Products that combine acetaminophen, diphenhydramine, and dextromethorphan:
- Diabetic Tussin Nighttime Cold & Flu
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2. Doxylamine Succinate
Doxylamine succinate is also an antihistamine that causes drowsiness.
Best Over the Counter Sleep Aids with Doxylamine
Unisom
Adverse Effects Associated with Doxylamine Succinate
Serious Side Effects
- Blurred vision
- Disorientation
- Diplopia (double vision)
- Dizziness
- Palpitations (fast heartbeat, fluttering, or skipping a beat)
- Tachycardia (fast heartbeat)
- Vertigo (dizziness, sense the room is spinning)
Less Serious Side Effects
- Anorexia (loss of appetite)
- Constipation
- Diarrhea
- Drowsiness (can interfere with functioning the next day)
- Dry mouth
- Dysuria (painful urination)
- Epigastric pain (pain/discomfort localized below the ribs near the upper abdomen)
- Paradoxical CNS stimulation
- Urinary retention (inability to void the bladder)
Warnings
Do not combine with alcohol or other CNS depressive substances (organic or medicinal)
Do not use for more than two weeks
Other combinations for Doxylamine
Products that combine doxylamine with dextromethorphan:
- Vicks NyQuil Cough
- Safetussin PM
Products that combine acetaminophen, doxylamine, and phenylephrine:
- Alka-Seltzer Plus Severe Allergy Sinus Congestion & Headache
- Vicks NyQuil Sinus
- QlearQuil Nighttime Sinus & Congestion Relief
Products that combine acetaminophen, doxylamine, dextromethorphan, and pseudoephedrine:
- Vicks NyQuil D
- Vicks NyQuil
Product that combines aspirin, doxylamine, dextromethorphan, and phenylephrine:
- Alka-Seltzer Plus Night Cold & Cough Effervescent
Products that combine doxylamine and pyridoxine:
- Diclegis
- Bonjesta
Products that combine acetaminophen, doxylamine, and dextromethorphan:
- Coricidin HBP Nighttime Multi-Symptom Cold
- Tylenol Cough & Sore Throat Nighttime
- Vicks NyQuil Cold & Flu
Products that combine acetaminophen, doxylamine, dextromethorphan, and phenylephrine:
- Alka-Seltzer Plus Night Cold Formula
- Tylenol Cold Multi-Symptom Nighttime Liquid
- Alka-Seltzer Plus Night Severe Cold
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3. Dimenhydrinate
Primarily used for motion sickness. Because drowsiness is a common side effect, it may be used as an off label treatment for insomnia.
Best Over the counter sleep aid with Dimenhydrinate
Dramamine
Adverse Effects Associated with Dimenhydrinate
Serious Side Effects
- Acute labyrinthitis (inner ear inflammation)
- Agranulocytosis (low white blood cell count)
- Arrhythmias (e.g., extrasystole, heart block)
- Blurred vision
- Paradoxical CNS stimulation (children and occasionally in adults)
- CNS depression
- Diplopia (double vision can be very dangerous, especially if it occurs while driving)
- Dizziness
- Disturbed coordination
- Faintness
- Leukopenia (low white blood cell count – reduces ability to fight infection)
- Pancytopenia (low red, white, and platelet counts)
- Tachycardia, palpitation ECG changes (e.g., widened QRS)
- Thrombocytopenia (low blood platelet count)
- Toxic psychosis (psychosis as the result of exposure to drugs)
- Vertigo
- Visual disturbances
Less Serious Side Effects
- Anorexia (loss of appetite)
- Chills
- Constipation
- Diarrhea
- Drowsiness
- Dryness of mouth, nose, and throat
- Dysuria (painful urination)
- Early menses
- Epigastric distress (upper abdominal pain – heartburn, gas, bloat)
- Facial dyskinesia (involuntary repetitive motions)
- Headache
- Hemolytic anemia
- Hypertension
- Hypotension
- Impotence
- Insomnia
- Irritability
- Lassitude (low energy)
- Muscular weakness
- Nausea
- Nasal stuffiness
- Nervousness
- Paresthesia (abnormal sensations in the skin)
- Sedation ranging from mild drowsiness to deep sleep (most frequent side effect)
- Sweating
- Thickening of bronchial secretions
- Tightness of the chest
- Tinnitus (ringing in the ears)
- Tremors
- Urinary retention
- Vomiting
- Wheezing
Less Common Side Effects
- Euphoria
- Insomnia
- Nervousness Delirium
- Palpitation
- Restlessness
- Seizures
- Tremors
Rare Side Effects
- Cholestasis (impaired bile function involving the liver)
- Hepatitis (inflammation of the liver)
- Hepatic failure (liver failure)
- Hepatic function abnormality (abnormal liver function)
- Jaundice (yellowing of skin or eyes due to high levels of bilirubin)
Side Effects with Higher Risk for Geriatric Patients
- Dizziness
- Sedation
- Hypotension
Warnings
May interfere with safe driving and operation of machinery
Over the Counter Sleep Aids with Combinations of Supplements aren’t Recommended
Some of the herbal supplements are made into combination medications but combining sleeping aids, even herbal ones, is not recommended. There is not much research for the individual supplements, and even less when they are combined.
Many sleep aids work because they suppress the Central Nervous System (CNS) and having multiple drugs suppressing the CNS can cause dangerous reductions in heartbeat and breathing. Without clinical testing, using combinations is risky business.
There is evidence that using multiple sleeping herbs or sleeping supplements is ill-advised yet, because supplements are regulated like food, not drugs, companies combine multiple ingredients that aren’t tested for use in combination with one another and market them as over the counter sleep aids to unsuspecting consumers.
Understanding the ingredients that should not be combined and reading the labels is your best option to avoid adverse side effects.
Individually, the following substances have some evidence of being beneficial for sleep with a low risk of adverse side effects from short term use. The experts recommend not combining these supplements with one another.
- Chamomile
- Tryptophan
- Kava
- Lemon balm
- L-tryptophan
- Passion flower
- Valerian Root
- Melatonin
Here are some examples of products that combine multiple supplements. Reviewing their labels provides an example of what to look out for.
Overall Cautions
Reading the box can prevent adverse reactions and save you money. Store brands are often available with the same active ingredient as national brand names at a reduced price.
Treating insomnia with prescription or over the counter sleeping aids is not the best solution. Professional mental health sessions with a therapist for insomnia can be highly effective with long-term benefits in as little as 1 – 6 sessions. Instead of adverse side effects, Cognitive Behavioral Therapy has beneficial side effects.
Improving stress management skills also reduces insomnia symptoms.
If your insomnia symptoms persist for more than 7 – 10 days, consult with your physician.
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4. Melatonin
This natural hormone works to control the body’s sleep-wake cycle and is most commonly used to adjust the sleep cycle to fit a new time zone following travel across several time zones.
Best Over the Counter Sleep Aids with Melatonin
- N-acetyl-5-methoxytryptamine
- Pineal hormone melatonin
Adverse Side Effects Associated with Melatonin
- Abdominal cramps
- Alertness decreased
- Circadian rhythm disruption (sleep cycle)
- Daytime fatigue
- Depression (transient)
- Dizziness
- Drowsiness
- Dysphoria in depressed patients
- Headache
- Irritability
Warnings
There isn’t enough research to know if melatonin use is safe over the long-term
Patients with epilepsy and those who take blood thinners should discuss melatonin with their doctor before they take melatonin
Use only reputable brands – random testing showed variations from the contents disclosed on the label and, in 26% of the bottles, serotonin was present. Too much serotonin can have harmful effects, even at slightly elevated levels.
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5. Valerian Root
Valerian root has been used for centuries to improve sleep.
Best Over the Counter Supplements Sleep Aids with Valerian Root
Serious Side Effects
- Cardiac disturbances
- Hepatotoxicity (liver damage)
Adverse Effects Associated with Valerian Root
- Allergic reactions
- Appetite (loss of)
- Daytime drowsiness
- Dry mouth
- Excitability
- Feeling excited or uneasy
- Headache
- Hives
- Insomnia
- Morning drowsiness
- Nausea (especially in the upper stomach)
- Sedation
- Strange dreams
- Uneasiness
- Upset stomach
- Thinking problems
- Withdrawal syndrome (chronic use)
Warnings
Difficulty driving or operating machinery the next day.
Do not combine Valerian root with other herbal supplements that cause drowsiness (including chamomile, gotu kola, Jamaican dogwood, kava, melatonin, St. John’s wort, 5-hydroxytryptophan) California poppy, skullcap, yerba mansa, or catnip).
Do not drink alcohol when taking Valerian root.
Read labels carefully. For example, one of the most popular liquid valerian root products contains cane alcohol despite recommendations not to combine valerian root with alcohol. Another product combines numerous sedating ingredients including L-Theanine, Melatonin, P5P, Chamomile, and valerian root.
Look at the list of ingredients on this label and compare it to the list of herbal supplements standard warnings discourage using when taking Valerian root. Remember, clinical testing of the individual ingredients is limited and testing of their use in combination with other supplements is non-existent. Natural does not mean safe. Many poisons and deadly substances are natural.
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6. CBD Oil
CBD oil is made from the parts of hemp or marijuana that do not contain THC, the psychotropic chemical in hemp (THC), that causes a high. CBD oil is legal under Federal law as long as the oil doesn’t contain more than .3% THC. CBD oil remains illegal under the laws of a few states.
CBD Oil is becoming known for alleviating pain, anxiety, and assisting with sleep, both frequently interfere with sleep.
Best Over the counter sleep aids with CBD Oil
Adverse Effects Associated with CBD Oil
- Appetite changes
- Changes in weight
- Diarrhea
- Tiredness
More research is needed to further understand all the side effects from using CBD Oil.
Warnings
CBD Oil isn’t marijuana because the psychotropic ingredient, THC is minimal or absent in CBD Oil, but the legalization of marijuana by many states has fueled new research on the effects of both marijuana and CBD Oil. More research is still needed but early reports indicate that CBD has a favorable safety profile.
Animal studies indicate there may be risks to unborn children.
Insufficient research exists to comment upon the safety of CBD Oil used in combination with other drugs.
So far, most studies have been short-term (30 days or less) so less is known about risks associated with long-term use.
Is CBD Oil legal?
As of this writing, CBD oil is only illegal in three states (Idaho, Nebraska, and South Dakota). The Federal government made CBD Oil with less than .3% THC legal, but states can have laws that are more restrictive than the Federal laws. CBD oil doesn’t contain enough THC to cause the high that makes marijuana a popular recreational drug.
THC is the psychotropic chemical in hemp and some states, such as Idaho, require 0% THC for CBD Oil to be legal within its borders.
Natural vs Safe
It is important to note that natural ingredients are not automatically safe. Many natural ingredients can have harmful side effects or be toxic at high doses.
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Conclusion
None of the over the counter sleep aids are recommended for long-term use. Prescription sleep aids also have this limitation. Sleep aids of any type aren’t the best choice for dealing with acute or chronic insomnia. They should only be used on a short-term basis while you work on sleep hygiene and meet with a therapist or develop stress management skills.
The best over the counter sleep aid for you depends on why you’re having difficulty sleeping. If pain is keeping you awake, try a pain reliever without sleep medication first. Heat can sometimes ease pain without drugs. Only resort to an over the counter pain medication combined with a sleep aid, such as Tylenol PM or Advil PM after discussing the situation with your doctor.
If anxiety, depression, stress, or a racing mind are keeping you awake, you have a number of options. Therapy is your best shot at long-term relief without adverse side effects. Improving your ability to manage stress is another way to ease the symptoms that interfere with your ability to go to sleep or go back to sleep after you wake up. CBD Oil is a good choice if it is legal in your state because it helps with anxiety and pain.
If poor sleep hygiene is interfering with your sleep health, making adjustments to your habits is healthier than popping an over the counter sleep aid.
While the risks associated with over the counter sleep aids are not as severe and don’t occur as frequently as the adverse side effects associated with prescription sleep aids, they can still pose dangerous and life-threatening risks that are best avoided whenever possible.
Always consider how the drugs you take to help you sleep might interact with other drugs or supplements you’re taking and with possible pregnancy or the need to drive or operate dangerous machinery.
We hope this article helps keep you safe and helps you sleep well.
Sweet Dreams.
