If you're having difficulty drifting off, over-the-counter and herbal products that promise to deliver you to dreamland are enticing options. Should you take them? Wendy Glauser

We tend to think of summer as a lazy season, but the fact is there’s a lot to keep us on our toes – whether it’s entertaining more often, packing for a vacation or keeping up with the garden. The evenings are bright and every living creature seems aflutter. No wonder we often hit the sack feeling restless.

“I have patients who will lie down in bed, but their stress levels are so high, they might as well be out running a marathon,” says Dr. Tina Christie, a naturopathic doctor in Brampton, Ont. If you have chronic, long-term insomnia, it’s best to consult a doctor (see “When Is Insomnia a Symptom of Something Else?” below). If you just suffer the occasional bout of insomnia, however, drugstores and natural health stores are on the case, marketing a range of pharmaceuticals, herbs and supplements to help induce sleep.

We’ve investigated the science behind these over-the-counter products and their side-effects to help you decide which ones, if any, are right for you.

Antihistamines
(Doxylamine and diphenhydramine)

How they work Histamine, the chemical that causes watery eyes and runny noses during allergic reactions, is also responsible for waking the brain from sleep and keeping it awake during the day. That’s why when some antihistamines suppress allergy symptoms, they also induce sleep. Popular over-the- counter sleep aids make the most of this fatigue-inducing effect. Over-the-counter sleep aids primarily contain one of two antihistamines: doxylamine or diphenhydramine.

Should you take them? There’s no question that sleep aids containing antihistamines effectively knock people out. But Dr. Charles Samuels, medical director of the Centre for Sleep and Human Performance in Calgary, doesn’t recommend these drugs because they tend to have lasting effects: People wake up feeling groggy. “People get hyper-focused on falling asleep, and they forget the point of sleep is to feel refreshed the next day,” says Dr. Samuels. He adds that while the odd person might wake up “feeling like a million bucks,” most will wake up with a drowsy hangover that can last up to a few hours.

Cautions and side-effects Common side-effects of diphenhydramine or doxylamine include dizziness, dry mouth, dry eyes, constipation and temporarily blurred vision. The drugs’ groggy-morning effects can lead to a delayed response time behind the wheel, so if you’ll need to drive early the next morn- ing, you shouldn’t take them, says Kristine Petrasko, a pharmacist and lecturer at the University of Manitoba’s faculty of pharmacy.
According to Petrasko, diphenhydramine or doxylamine should generally be used for
no more than three days a week, for up to two weeks. “If you need to use something every night, then there are other things happening that should be corrected first,” says Petrasko.

Melatonin

How it worksLike histamine, melatonin is a hormone produced by the brain. But the two have opposite effects when it comes to wakefulness. Melatonin signals to the body that it’s time to shut down for the night. Study results are mixed as to whether melatonin supplements (available in either pill or liquid form) work effectively against insomnia, with some trials showing they decrease the time it takes for participants to fall asleep and others showing they don’t.

Should you take it? If your internal clock is out of whack – perhaps due to jet lag or shift work – then your brain likely won’t produce melatonin at the time you want to go to sleep. By taking a supplement for the chemical, you can force your brain’s own melatonin release mechanism back on schedule. “Melatonin is what we use when people are sleeping out of their normal phase and need to get back on track,” says Dr. Samuels. Melatonin is therefore recommended for a period of three to four nights, during which the new sleeping routine is established.

Cautions and side-effects The long-term effects of melatonin are unknown. But there’s speculation, according to Dr. Christie, that the gland that naturally produces the hormone may shrink with prolonged use of the supple- ment, causing one to become dependent on the artificial form of melatonin. In the short term, there appear to be few or no side-effects associated with supplementation. Due to insufficient safety information, however, pregnant women are discouraged from taking melatonin. Dr. Samuels says that, like antihistamines, melatonin use can cause a hangover feeling the next morning. Melatonin use may also cause nightmares.

Valerian root

How it works As it turns out, our brains don’t have just one off switch. Many different mechanisms serve to relax us and bring about sleep. For example, gamma-aminobutyric acid (GABA), a neurotransmitter, reduces the activity of the neurons to which it binds and thus aids in shutting down the central nervous system for the night. Drugs such as Valium have been shown to mimic GABA, and it’s believed valerian works in the same way.
Valerian is much less potent than the drug that was all the rage among 1950s housewives, however, and the groundswell of scientific evidence argues it’s ineffective in treating insomnia. While a few studies have shown val- erian can work as well as pharmaceuticals do, a 2007 review of 37 studies concluded the herb is not significantly better than a placebo pill.

Should you take it?
It’s worth a shot. While the scientific community hasn’t found much evidence that valerian works for complicated insomnia cases, Dr. Samuels and Dr. Christie say that it does work for mild insomnia. “I know valerian can work and does work for some people,” says Dr. Christie, explaining that valerian tends to be effective for those who have rare bouts of sleeplessness. “But I have a lot of patients come to me with sleep problems who have used valerian and it hasn’t worked.”

Cautions and side-effects Valerian is one of the safest sleep aids. According to the review cited above, none of the participants in the 37 studies reported any serious side-effects. The herb has been associated with mild issues, including dizziness, nausea and head- aches, but such symptoms occur more rarely than with pharmaceutical sleeping aids.
Valerian doesn’t result in a hangover the next day. But it should not be taken with other sedating substances, such as benzodiazepines, fatigue-inducing antihistamines or alcohol, and it may interact with additional drugs as well, so it’s best to consult a doctor before taking the herb. “Natural doesn’t mean safe,” warns Petrasko.
Dr. Samuels adds that there’s a danger in buying valerian from health food stores, because there’s no regulation to ensure that what’s listed on the label is what’s in the bottle. He only recommends pharmaceutical- grade valerian, which is sold in drugstores.

Herbal teas

How they work Due to an absence of studies, herbs such as passionflower, St. John’s wort, hops and catnip (to name a few) don’t have insomnia-fighting credibility in the scientific community. However, in traditional medicine, such herbs have been used for centuries on account of their calming qualities. In tea form, these herbs come individually or in various combinations. The benefit of combining herbs is “you get that synergistic effect,” says Dr. Christie. While an individual herb may not be strong enough on its own, the strength of various herbs working together might be enough to catapult you into dreamland.
The basic herbal teas – chamomile and peppermint – can also be calming at night. “I have patients who say chamomile tea works wonderfully to help them sleep,” says Dr. Christie. “Chamomile is good to the immune system as well.”

Should you take them?
If all you need is a little help winding down at night, teas are a great option. The ritual of a warm drink at night is calming in itself. Since a huge part of falling asleep is convincing ourselves it’s OK to slow down, these little rituals can do psycho- logical wonders.

Cautions and side-effects Teas provide such low doses that they shouldn’t pose any danger, but if you decide to take any of the herbs in supplement form, be sure to consult a doctor first. “Herbs can interfere with anxiety medications, antidepressants and other phar- maceutical drugs,” says Dr. Christie. “You have to be careful.”

Calcium and magnesium

How they work Calcium and magnesium are minerals that are often marketed for their sleep-enabling qualities. Calcium may increase melatonin production and magnesium is “very nourishing for the nerves,” says Dr. Christie. Without magnesium, nerves are more jumpy and quick to react to minor stimuli. The two minerals also help to relax the muscles. But the scientific evidence that supplementation of calcium and magnesium improves sleep is limited, says Dr. Samuels.
Should you take them? If calcium and/or magnesium seem to be lacking in your diet, then supplementation could help to calm frayed nerves, relax muscles and thus help you sleep. But there’s no evidence to suggest that taking more than the recommended lim- its of the minerals has any additional benefit to the nerves and muscles.
Elderly people are more likely than younger people to fall short of the recommended requirements for the minerals and therefore they may want to consider supplementa- tion. If you suspect you’re not getting enough calcium and magnesium, you can have your blood levels of the minerals checked. Just ask your doctor about your levels of these two key minerals at your next annual physical.

Cautions and side-effects It is possible to overdose on mineral supplements, so be sure not to go beyond the recommended dosage. Calcium should always be taken with mag- nesium to aid in its absorption. The recommended ratio of calcium to magnesium is 2:1, with the amount of magnesium not exceeding 500 milligrams per day. If you eat a high-calcium diet – for example, you consume plenty of dairy products – you may wish to supplement magnesium alone, says Dr. Christie.

Can that popular antinausea drug help me sleep?
Do you pop a Gravol now and again to help you drift off? You’re not alone, says Dr. Charles Samuels, medical director of the Centre for Sleep and Human Performance in Calgary. “We definitely discourage the use of Gravol, but if you did a survey, I’m sure you’ll find many people take it.” The antinausea pill encourages sleep because it includes dimenhydrinate, which produces effects very much like those of a similar-sounding drug: the antihistamine diphenhydramine. While not quite as potent as its cousin, Gravol can cause the same next-day grogginess and side-effects, including blurred vision, dry mouth and headaches.
At any rate, says Kristine Petrasko, a pharmacist and lecturer at the University of Manitoba’s faculty of pharmacy, Gravol shouldn’t be used for insomnia. Since the drug isn’t labelled as a sleep aid, it hasn’t gone through testing for its effectiveness in this area – nor for the optimal dosage for insomnia. So people should talk to their doctors or pharmacists for alternatives. And it might not be safe to take the drug more frequently than simply when nausea strikes.

When is insomnia a symptom of something else?

Most of us suffer through the odd restless night. Perhaps you’re dreading a job interview the next morning or the adrenaline is still pumping after a hectic day of errands. Sleep aids are meant for this type of short-term, infrequent insomnia. When insomnia persists for weeks or months, however, there’s an underlying issue at play.
A number of physical and mental conditions can keep you up at night. Among the most common are sleep apnea, restless legs syndrome, anxiety and depression. Sleep clinics can help to diagnose and treat the reasons behind sleeplessness. “Not all sleep problems are the same,” says Dr. Charles Samuels, medical director of the Centre for Sleep and Human Performance in Calgary.
Sometimes the underlying issue has to do with lifestyle, rather than a medical condition. Workaholics and go-getters who don’t give themselves time to wind down will often hit the sack with their minds still racing. It’s impossible to fall asleep when adrenaline levels are high, and tossing and turning can cause further stress and, thus, more insomnia. Scheduling time to relax before bed – even if this time has to cut into planned sleep time – is one trick that Dr. Samuels recommends. For more information on healthy sleep habits, he suggests reading Say Good Night to Insomnia (Henry Holt, 2009) by Gregg D. Jacobs.

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