The Pitt Prescription: Sleep aids

The Pitt Prescription is a bi-weekly blog where student pharmacist and Senior Staff Writer Elizabeth Donnelly provides tips on how to stay healthy in college.

I wear my Fitbit to bed every night because it tracks my sleep patterns. It provides me with how long I spent in each stage of sleep as well as my overall sleep quality score. In the recent weeks, my score and amount of sleep per night have been slowly decreasing and I know why — stress.
College can be immensely stressful, especially during exam season from the end of November moving through the beginning of December. It feels like EVERYTHING is due in the next couple of weeks, and to top it all off we have a week of final exams at the end of it all. It’s no wonder many students report sleep issues, especially around exam season.

According to a 2017 study, 60% of college students experience poor quality of sleep. Sleep is a vital aspect of life, and the lack of it can be severely detrimental to one’s health.

As mentioned in the previous edition of The Pitt Prescription, sleep is a huge determinant of an individual’s health. Allowing your body to get the proper amount of sleep each night aids with bodily functions, like supporting the immune system and wakefulness.The CDC recommends that adults 18 years and older get a minimum of seven hours of sleep per night. Getting less than the recommended amount can lower your immune system responses and lead to chronic diseases like diabetes, obesity, cardiovascular disease and depression.

According to the previously mentioned study, stress plays an important role in regards to sleep. The more stressed someone is, the more likely they are to report or show signs of insomnia, which is the inability to initiate or maintain sleep. In the study, 51.9% of the college students fulfilled all criteria for some sort of insomnia disorder according to the DSM-5 guidelines. With the stress of finals approaching, many students have already begun sleeping less as they are worrying about their exams.

The CDC has guidelines to help those who have poor “sleep hygiene,” which is another way to say sleeping habits. They recommend that you go to bed and wake up at the same time every day, stop using electronics before sleep, not consume large meals or caffeine before bed and exercise throughout the day — but not too close to bedtime. Large quantities of alcohol can also affect your sleep patterns and lead to a more restless night, so it is recommended to avoid binge drinking before bed — read more about alcohol in the Halloween edition. However, these tasks are easier said than done.

If you are making lifestyle changes but still cannot get the healthy amount of sleep, then there is the option of using medications. Many people with sleep problems want the “quick fix” that sleep aids can give, but these are not long term solutions. Sleep medications do not cure insomnia and in some cases, they can worsen sleep hygiene — like in the case of someone who becomes dependent on a sleep aid and can no longer function without it.

There are some sleep aids available over the counter, but there are differences between them, so make sure to always read the labels and ask your pharmacist if you have any questions. According to Mayo Clinic, OTC sleep aids can be really effective for occasional use, but since the majority contain antihistamines, tolerance can develop rapidly and they will lose their effect. Another main concern is what is known as the “hangover effect” — some OTC sleep aids can cause grogginess and leave you feeling tired or drowsy the next day. There is also always the possibility of sleep aids interacting with any other medications you’re taking, which is why it is best to talk to your doctor or pharmacist before taking these drugs.

According to Mayo Clinic, sleep aids containing diphenhydramine or doxylamine are good choices for those experiencing occasional insomnia.

Products containing diphenhydramine (the active ingredient in Benadryl) are typically considered the best choice for the treatment of insomnia. Any generic form of diphenhydramine can be used as a sleep aid, but the brand name products that use it include Unisom SleepGels and Sominex. Different products have different amounts of the active ingredient, so make sure to always read the label. For example, Unisom SleepGels and Sominex MAX caplets contain 50 mg of diphenhydramine in each capsule/caplet whereas Sominex tablets only have 25 mg in each tablet. It can be very confusing, so be sure to read the label carefully.

Products containing doxylamine are also an alternative. An example of a brand that contains this drug are the Unisom SleepTabs, which contain 25 mg of doxylamine. This is not the preferred short-term treatment of insomnia, though, as doxylamine has been studied less than diphenhydramine.

MedLine Plus recommends taking products containing either diphenhydramine or doxylamine about 30 minutes before going to bed and avoiding alcohol consumption while using them. They have very similar side effects, including next-day drowsiness, dizziness/blurred vision and dry mouth/throat. These medications are not intended for long-term use (no more than two weeks). Sleep medications are only aids in getting a healthy night’s sleep — lifestyle modifications as well as cognitive behavioral therapy may be necessary to improve one’s insomnia in the long term.

Melatonin is another alternative used to treat insomnia, however it has a milder effect. Melatonin is a hormone naturally produced by the body that helps regulate the sleep-wake cycle. According to Mayo Clinic, research suggests that melatonin may help people who are unable to fall asleep by slightly improving total sleep time and quality of sleep. It is also a very effective way to treat jet-lag after long trips. Melatonin is generally safe to take, however it can cause headaches, dizziness, nausea and drowsiness. Melatonin has a wide range of doses, with the most common being 3 mg and 5 mg, but the safest practice is to start low and dose slow — which means to begin at the lowest dose and work your way up higher if needed.

While there are many options for sleep aids, the three active ingredients mentioned here are the best OTC choices. If you are experiencing symptoms of insomnia, try the following:

  1. Start with lifestyle and behavior changes — avoid excessive caffeine and alcohol intake, create a sleep schedule and stick to it and get regular exercise early in the day while eating right.
  2. Talk with your doctor or pharmacist to determine if a sleep aid may be appropriate for you.
  3. Decide which medication to take — diphenhydramine is the first line treatment for insomnia, but doxylamine can be used as well. Melatonin can also help, but has less significant effects. Make sure to look at the package inserts and check for any interactions with medications you’re currently taking.
  4. Once you’ve selected a sleep aid, start at the lowest dose and work your way up if necessary. Monitor for any side effects once you start taking it. Be sure you have enough time to sleep before taking the aid — at least seven hours — otherwise you will wake up groggy since your body didn’t have enough time to metabolize the medication. Also be sure to avoid taking another dose in the middle of the night.
  5. If you are still experiencing sleeplessness or poor quality of sleep after two weeks, talk to your doctor to find an alternative.

Sleep is such an important aspect of life and college students — myself included — often sacrifice it for schoolwork or social activities. Working towards improving sleep health is beneficial for everyone, so don’t hesitate to implement lifestyle changes to better your sleep and your overall quality of life.