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Getting a good night’s sleep is one of the pillars of good health, but for many people it is a real struggle. They toss and turn, worrying that they won’t be able to fall asleep at all. It is no wonder over-the-counter (OTC) sleeping pills containing diphenhydramine are so popular.
Are OTC Sleeping Pills Safe Enough for Regular Use?
Q. I started taking OTC sleep aids when I was working a late shift. Even when I got back to a more normal work pattern, I had to rely on diphenhydramine to fall asleep.
Sometimes I take two or three pills to stay asleep but then I wake up feeling groggy. Are these OTC pills bad for me?
How Does Diphenhydramine Affect the Brain?
A. Diphenhydramine (DPH) is a sedating antihistamine. It is the ingredient in the allergy medicine Benadryl. DPH is also the “PM” component of pain relievers like Advil PM, Aleve PM, Excedrin PM and Tylenol PM.
Some people complain of “brain fog” the morning after taking diphenhydramine. That would be especially likely if you double or triple the dose.
The American Academy of Sleep Medicine recently issued guidelines about DPH (Sateia et al, Journal of Clinical Sleep Medicine, Feb 15, 2017):
“We suggest that clinicians not use diphenhydramine as a treatment for sleep onset and sleep maintenance insomnia (versus no treatment) in adults.”
DPH Is an Anticholinergic Drug:
Our principal concern with DPH is that it is highly anticholinergic. (We wrote about why that is a problem here.) As a result, we are concerned that regular use of diphenhydramine over the long term might contribute to confusion or memory loss, not just morning-after brain fog (Risacher et al, JAMA Neurology, June 1, 2016). It would be better not to rely on OTC sleeping pills with DPH, but you will need to find other ways to get the sleep you need.
You will learn about other problems associated with DPH plus nondrug strategies for combatting insomnia in our Guide to Getting a Good Night’s Sleep. In addition to advice on herbs and supplements that can be helpful, this online resource lists a number of medications that might be inadvertently keeping you awake.
Susan
Georgia
I began having problems sleeping when I was in my early 40s. I took melatonin, Nyquil, Lunesta, and Ambien over the years. It was only when my gynecologist prescribed HRT that I began to sleep well. In the last seven years or so, I have found that whenever I had problems sleeping–and I’m talking about weeks of waking up at 3, 4, or 5 in the morning–it coincided with a drop in my estrogen levels. No doctor has ever made the connection before, but I’m a believer in HRT for that–and many other–reasons.
june
Austin
My experience exactly.
Yet my doctor keeps wanting me to go off a small dose of bio-identical estrogen/progesterone and take sleeping pills!
No way.
Gigi
I take Kirkland’s Sleep Aid, which contains Doxylamine Succinate. No pharmacist has even indicated that this was a problem nor has a sleep doctor; however, a memory psychologist told me that it is safer to take a prescription sleep aid than this. Any comments on this?
Gigi
North Carolina
I take Kirkland’s Sleep Aid which contains Doylamine Succinate on a regular basis. Is this formula dangerous for health and memory? Several pharmacists have told me that it is not a problem. None of my doctors has mentioned this as detriment to health; however, a memory expert told me that it is better to take
Margaret
Georgetown SC
I am 75. I take meds for pain, and some nights I just don’t feel tired enough to fall asleep. So, i take the diphenhydramine, more nights than I should, and I know this. If I don’t take something, i could be up as late as 2AM or 3. I thought the OTC drug would b better than the RX drug.
At my age, and my condition, I sometimes wonder, if every new found discovery, about practically ‘everything’ in this world, could make a person crazy just trying to keep up with it. And I know that sounds irrational, but maybe if I were 50 yrs. younger, I would be more serious about it.
That being said, I love reading your newsletter. I love having the knowledge you offer. Keep up the good work.
Ray C
State-run mental health has used such for many years. I would think they would know, or is it mental health just pushes pills on their patients. If so, we have a major problem in our health care system as we already do with quality of care depending on what one can afford. Medicare, Medicaid don’t receive same treatment as a major insurance.
Cindy M. Black
Seattle, WA
With some meds, it seems you have take high enough doses, over a sufficient period of time, to reach a “therapeutic window” (or non-therapeutic window) to catalyze any bad effects. With OTHER meds, it seems, any bad effect(s) occur on a pro-rata basis. Like, any bit of litter is still litter!
I wonder which it is with diphenhydramine. I take ONE “zzzz-Quil” in special circumstances, maybe once a month, and man, does it ever work. I often don’t even hear the alarm. I wonder if this is totally safe, or whether it still damages my brain ever so slightly.
Sandy
I take “pm” pills when I travel…..say 3-4 times a year for a week at a time. Is this too much?
Terry Graedon
That is probably not a problem. We worry most about people who end up taking these drugs for months at a time. But do take note of how well you function the next day.
genie deutsch
I use cheddar cheese to aid my sleep. It has tryptophan. I take some before I go to sleep and more when I wake up during the night.
Bet
MA
A naturopath suggested eating a small size slice of turkey breast before bed b/c it also contains tryptophan. I have the meat cutters slice a piece about 1 1/2 inches thick. Doesn’t always work but better than benadryl which caused major grogginess for me and memory problems.