It doesn't matter how much more you try to squeeze into your busy life, at the end of the day, sleep is nonnegotiable. Maybe that's why there's an entire industry focussed on helping you achieve your ideal amount of shuteye [1] in the form of over-the-counter (OTC) medications. These sleeping aids come in liquid, gel capsule and tablet options [2], like ZzzQuil and Unisom, and seem to work like magic, delivering fast, easy access to rest. But that convenience might come at a cost if you're relaying solely on these aids to fall and stay asleep. Even the bottles and packages they come in include labels warning that use is not recommended beyond 14 days without the supervision of a doctor [3].
To help better understand why, POPSUGAR talked with two sleep experts who agreed that constant use of OTC sleep aids are, by and large, not worth the risk [4]. Read on for why, including what they're made of, potentially harmful side effects and interactions.
What Are the Common Ingredients in OTC Sleep Aids?
The top brands of OTC sleep aids contain one of two main ingredients: diphenhydramine and doxylamine [5]. Both prescription and OTC medications that contain these drugs are called sedative hypnotics, and generally speaking there's not much difference between the two.
One glaring similarity is that helping restless individuals fall and stay asleep isn't actually these ingredients' main purpose. These drugs are antihistamines, which are intended to be taken for allergy relief [6]. "The side effect of these medicines is they make you sleepy," says Aneesa Das, MD, an assistant professor of sleep medicine at The Ohio State University Wexner Medical Centre in Columbus, OH. "If you're going to take them, you have to take caution, because they have a lot of side effects, so they're not a great as a long term solution."
What Are the Potential Side Effects From OTC Sleep-Aids?
Some of those side effects include causing confusion, rapid heart rate, and increased risk for falls, Das says, adding that they're also associated with blurred vision, dry mouth, bad breath, constipation and urinary retention, which makes it difficult to go to the bathroom, especially for men. "There's something called the Beers List [7], which is part of the American Geriatric Society, and it's a list of medications that we have to be careful with [8]. Why? Because all these drugs that make you a little sleepy come with a high rate of falls and fractures, especially in elderly patients. And all sedative hypnotics, OTC or prescription, are on that list," says Rajkumar Dasgupta [9] (Dr. Raj), MD, an assistant professor of clinical medicine at the Pulmonary, Critical Care and Sleep Medicine division of Keck Medicine at the University of Southern California in Los Angeles.
"Diphenhydramine has also been associated with early-onset dementia [10]," Dr. Raj says. "Those with memory concerns, especially older patients, should avoid OTC sleep aids containing diphenhydramine and doxylamine."
Do OTC Sleep Aids Interact With Other Medicines?
If you're taking anything else, prescription or otherwise, OTC medications to aid with sleep could react with those ingredients and lead to even more harmful side effects. "If you have underlying medical conditions, OTC sleep aid medications may have interactions, or make those conditions worse," Dr. Raj says. The National Institutes of Health links to a service where you can check drug-drug interactions [12], called Drug Interactions API, but you should consult a doctor.
Additionally, people should avoid combining OTC sleep aid medications with alcohol, the doctors say. "This would be extreme and it's not common, but you can develop parasomnia," Dr. Raj says, describing the diagnosis as abnormal occurrences while you sleep [13], like sleepwalking.
What If I Take Other Medicines That Make You Sleepy as Sleeping Aids?
Medicines like NyQuil, Tylenol PM or Advil PM can make you sleepy because they include either diphenhydramine or doxylamine, but they're primary use is not to serve as a sleeping aid, but to treat other ailments, like pain and fever, with their other ingredients.
If you reach for these often to help you sleep, you might want to reconsider. "Any time you find yourself taking add-on medicines that you don't need there's a major downside," says Dr. Raj. That's especially true when it comes to non-steroidal medications, like ibuprofen, because they may cause gastro-intestinal upset, or ultimately, ulcers [14].
No problem, you'll just have a glass of wine before bed, right? Think again. Although alcohol is a depressant and may have the initial effect of increasing drowsiness, consuming it may have the opposite effect in the long run. "While alcohol may sometimes help you fall asleep quicker, it actually increases sleep fragmentation [15] in the second half of the night, so the net change with alcohol is that it decreases your sleep quality," Das says.
So Is It Safe to Take OTC Sleep Aids Every Day?
If you decide to try OTC sleep aids to improve your sleep, know that they're not intended to be used for more than two weeks at a time [16], at the very least to avoid masking the symptoms of a larger issue.
Even then, their use can come with risks, as mentioned above. A better option might be working on revamping your daily habits [17], like only using your bed for sleeping, and sticking to the same wake up time, every single day.