Other Therapies - Insomnia: Sleep Disorders
Content provided by the Faculty of the Harvard Medical School
Other therapies
Two other therapies — light therapy and melatonin — have been used to treat insomnia with varying degrees of success. As of 2005, neither has been found as effective as changing your habits or taking medications.
Light therapy. Some experts recommend exposure to bright light to reset an insomniac's internal clock. Researchers from Flinders University in Adelaide, South Australia, successfully used bright light therapy to improve the sleep of nine insomniacs prone to waking between 3 a.m. and 5 a.m. After two evenings of exposure to bright light, the participants slept more than an hour longer. A comparison group of insomniacs exposed to dim lighting showed no improvement. However, light therapy is not commonly used to treat insomnia at most sleep centers because other treatments such as behavior modification are usually more effective.
Progressive muscle relaxationLooking for a drug-free method to help you relax, free your mind of worries, and fall asleep? Progressive muscle relaxation is a tried and true technique for achieving both physical and mental relaxation.
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Melatonin. In the mid-1980s, researchers began to investigate whether oral doses of melatonin, a hormone secreted by the pineal gland (see "Mechanisms of your ‘sleep clock'"), might help reset the biological clocks of travelers, shift workers, and people with insomnia. It seems to be most helpful for people with low levels of naturally occurring melatonin. So far, however, there are insufficient data for the FDA to approve this supplement as a treatment for insomnia.
In one small study, researchers in Israel tested melatonin as a sleep aid in 12 men and women, average age 76, who had insomnia. People who took melatonin before going to bed fell asleep faster and slept about 10% longer than those who received a placebo. There were no adverse reactions. Other studies, however, found that melatonin did not have any effect on sleep.
A synthetic form of melatonin is sold in health food stores and pharmacies. In the United States, this product — which is not regulated by the FDA — is considered a nutritional supplement, so there is no guarantee of its purity or efficacy. In Great Britain and Canada, melatonin is now classified as a medicine and is no longer available over the counter. To date, there is no reliable information available about its effects during pregnancy or its interactions with other drugs.
Nonprescription sleep aidsYour drugstore undoubtedly carries a bewildering variety of over-the-counter (OTC) sleep medications, and there's clearly a market for such products. One small survey of people ages 60 and over found that more than a quarter had taken OTC sleeping aids in the preceding year — and that 1 in 12 did so daily. But do these products work? Should you use them? And if you do, should you choose a standard OTC sleeping pill, an herbal remedy, a dietary supplement, or items like nasal strips? Standard OTC sleeping pills. Behind the riot of competing brands, this class of products is surprisingly straightforward. Each one — whether a tablet, capsule, or gelcap — contains an antihistamine (see "Medications for treating insomnia") as its primary active ingredient. Most OTC sleep aids — including Compoz, Nytol, Sominex, and others — contain 25–50 mg of the antihistamine diphenhydramine (see below). A few, such as Unisom SleepTabs, contain 25 mg of doxylamine, another antihistamine. Others — including Aspirin-Free Anacin PM and Extra Strength Tylenol PM — combine antihistamines with 500 mg of the pain reliever acetaminophen. OTC antihistamines have a sedating effect and are generally safe. But they can cause nausea and, more rarely, fast or irregular heartbeat, blurred vision, or heightened sensitivity to sunlight. Complications are generally more common in children and people over age 60. Alcohol heightens the effect of these medications, which can also interact adversely with some drugs, including central nervous system depressants and monoamine oxidase inhibitors (MAOIs) such as phenelzine (Nardil) and tranylcypromine (Parnate). If you take OTC sleeping pills, be sure to ask your physician about the possibility of interactions with other medications. Because of their side effects — and because these OTC medications are often ineffective in relieving sleep problems — sleep experts generally advise against using them. Dietary supplements and alternative medicines. A 2004 study of alternative medicine use discovered that 36% of adult Americans had used alternative medicines during the past 12 months, including herbal sleep aids. Your local drugstore probably shelves these products alongside other herbal remedies and vitamins. As with other dietary supplements, the FDA does not regulate these products, so they aren't tested for safety, effectiveness, quality, or accuracy of labeling. Although marketed as "natural," these products may contain biologically active substances that can have side effects or can interact with other medications or herbal remedies. If you're thinking about using such products (or already do so) be sure to inform your physician. Unlike standard OTC sleeping pills, which contain a single antihistamine, many herbal products include a variety of active ingredients. Before using these products, check with your doctor or pharmacist to see whether the ingredients might interact with other medications you're taking. Even a single herb is a complex chemical stew. Valerian root extract, for example, contains more than 100 specifically identified substances. Researchers don't know precisely which of these accounts for the herb's effect, nor can they say exactly how they might interact with other medications. Finally, the per-dose price of these remedies varies far more than that of standard sleeping pills. Scientific understanding of these substances is limited, and what we know generally comes from small, short-term studies. Thus, most doctors discourage the use of herbal medicines as sleep aids. But the market for such products is booming. Readily available alternative sleep remedies include the following: Valerian (Valeriana officinalis). Valerian is a popular herbal medicine in the United States. A few studies suggest that it's mildly sedating and can help people fall asleep and improve their sleep quality. But valerian shouldn't be mixed with barbiturates or alcohol. As with other unregulated remedies, the quality of valerian-containing products varies widely. In its July 2001 report, ConsumerLab — a commercial laboratory that periodically tests the quality of herbal remedies — detailed its analysis of 17 valerian-based products. Nearly a quarter appeared to contain no valerian whatsoever, and an equal number had less than half the amount claimed on their labels. Products made with valerian extract proved more trustworthy in this regard than those made with "root powder." Kava (Piper methysticum). Kava comes from a plant cultivated in the South Pacific islands. The German Commission E — which tests the quality and effectiveness of herbal remedies marketed in Germany — has found it effective in the treatment of anxiety. Some studies have reported that it is effective for insomnia as well. But scientists don't understand how it works. High doses over prolonged periods can cause skin reactions and liver failure, and in 2002 the FDA warned users of the potential risk of liver damage after a previously healthy 45-year-old woman took kava, suddenly developed liver failure, and required a liver transplant. Melatonin. Some studies show that the hormone melatonin helps people fall asleep, increases sleeping time, and improves daytime alertness. It seems most effective for insomnia related to disruption of circadian rhythms, as in jet lag or shift work, and for people with low melatonin levels. Still, other studies have concluded that it doesn't improve sleep (see "Other therapies"), and the FDA hasn't seen enough evidence of its usefulness to approve it as a treatment for insomnia. In addition, little is known of its safety in long-term use. Chamomile. Chamomile is a plant in the daisy family, and chamomile tea has long been used as a relaxant and sleep aid. Chamomile is both mild and safe — though rare allergic reactions, including bronchial constriction, can occur. If you're allergic to plants in the daisy family, which include the ubiquitous ragweed, you should probably avoid this herb. There are no scientific studies showing chamomile is effective in treating insomnia. Mechanical devices. Specially designed orthopedic pillows may help people with insomnia sleep better. For people with sleep problems due to snoring or nasal congestion, adhesive-backed nasal strips — or devices such as NoseWorks, a small plastic nasal support — may provide relief. Manufacturers contend that such products help keep nasal passages open, reduce snoring, and increase airflow, thus improving sleep. But little independent research has evaluated these claims. |
Standard over-the-counter sleep aids | |
| Brand | Formulation |
| Nytol QuickCaps | 25 mg diphenhydramine (per capsule) |
| Simply Sleep | 25 mg diphenhydramine (per caplet) |
| Sleepinal Maximum Strength SoftGels | 50 mg diphenhydramine (per softgel) |
| Sominex Maximum Strength | 50 mg diphenhydramine (per capsule) |
| Tylenol PM | 500 mg acetaminophen, 25 mg diphenhydramine |
| Unisom SleepTabs | 25 mg doxylamine (per tablet) |
| Unisom SleepGels, Maximum Strength | 50 mg diphenhydramine (per softgel) |
| Last updated: | January 23, 2007 |
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Medical content reviewed by the Faculty of the Harvard Medical School. Harvard Health Publications, Copyright © 2007 by President and Fellows of Harvard College. All rights reserved. Used with permission of StayWell.
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