This article is part of an ongoing series entitled, Beyond Rx: OTC Corner, which will include topics such as OTC medications, dietary supplements, and other health care approaches that will help nurse practitioners and physician assistants provide patients with tools to manage their health.
Robert D. Sheeler, MD, is guest editor of the series. He is an associate professor of family medicine, Mayo Clinic, in Rochester, Minn. He is board certified in family medicine, integrative medicine, and holistic medicine.
Insomnia is defined as difficulty falling or staying asleep, the absence of restful sleep, or poor quality of sleep. There are many causes of insomnia, but some of the most common are medications, stress, anxiety, depression, and environmental changes. Other causes include excessive daytime napping, caffeine consumption, and poor sleep habits.1
It is important to note that insomnia is a symptom and not a disease. It is a frequent complaint expressed by patients to healthcare providers. Although there are prescription medications for insomnia, this article focuses on nonprescription medications and modalities.
Self-treatment with over-the-counter (OTC) medications should only be used for short periods of time, along with instituting better sleep hygiene. The most common OTC medications used for insomnia are listed in Table 1.2 It is always important to verify that the medications used do not interact with any other medications a patient may be taking. Certain OTC medications for insomnia may worsen some medical conditions.
Melatonin has become a popular OTC agent for insomnia.3 Melatonin is a hormone secreted by the pineal gland in the brain. It helps regulate sleep. It assists synchronization of the circadian “clock” with the day-night cycle and attenuates the wake-promoting signal.
The circadian rhythm is an internal 24-hour clock that plays a critical role in when we fall asleep and when we wake up. When it is dark, the body produces more melatonin. During daylight hours, the production of melatonin decreases. Being exposed to bright lights in the evening, or too little light during the day, can disrupt the body’s normal melatonin cycles. For example, jet-lag, shift work, and poor vision can all disrupt melatonin cycles.4 Because melatonin has beneficial effects on sleep, in addition to affecting the 24-hour circadian clock, melatonin therapy can relieve insomnia.