insomnia sleepless menopause sleeping pills, diphenhydramine

People with insomnia are caught between two hard rocks. On the one hand they are told that lack of sleep can lead to all sorts of health problems including high blood pressure, forgetfulness, diabetes and weight gain. It’s not surprising that they turn to over-the-counter PM sleeping pills. But are there hidden dangers?

Q. I have had a great deal of trouble sleeping since my husband passed away. For many years I have taken Tylenol PM or Advil PM along with alprazolam.

I have read that alprazolam can contribute to dementia, so I am trying to get off it. What about PM sleeping pills? Could they also contribute to dementia?

A. Alprazolam (Xanax) is approved for treating anxiety and panic, not insomnia. This drug is a benzodiazepine, in the same class as diazepam (Valium) and lorazepam (Ativan). Some studies have shown a connection between long-term use of benzodiazepines and the later development of dementia (Expert Opinion on Drug Safety, May, 2015).

Do NOT Stop Alprazolam Suddenly!

Stopping alprazolam suddenly could lead to worse insomnia or other withdrawal symptoms.

Benzodiazepine Withdrawal:

Anxiety, agitation, jitteriness, disorientation
Dizziness, brain zaps, shock-like sensations
Insomnia, irritability, impaired concentration, faulty memory
Fear, panic, depression, suicidal thoughts
Digestive upset, diarrhea
Tremor, headache
Tinnitus or ringing in the ears

A story from a reader:

ACW reports:

“I take alprazolam once per day at maximum. I have now been off of it for a week because of issues with having time to pick it up. I have insomnia, the ‘brain zaps,’ agitation…I’ve been walking around for three days having perpetual heart attack symptoms; no fun at all.”

PM Sleeping Pills and Dementia:

The PM part of your nighttime pain reliever is diphenhydramine (DPH). This antihistamine has strong anticholinergic activity. Drugs in this class have also been linked to an increased risk for dementia (JAMA Internal Medicine, March, 2015).

Learn more about anticholinergic drugs and memory at this link.

Are Your Drugs Raising Your Risk for Dementia?

There is considerable controversy about relying on DPH as a sleep aid or in PM sleeping pills. One analysis published in The Primary Care Companion for CNS Disorders (online, Dec. 31, 2015) reviewed randomized controlled studies conducted over the last 12 years. The authors concluded:

“Together, the scientific evidence suggests limited beneficial effects of diphenhydramine on sleep, an increased risk of next-day performance impairments, and potential rebound insomnia following discontinuation, although additional studies are needed to confirm these safety risks.”

Another study published in the American Journal of Geriatric Psychiatry (Mar-Apr, 2003) concluded:

“A group of 1,627 individuals age 65 and over were recruited and assessed during 1987-1989 and re-assessed during approximately biennial waves. Data included sleep medications, demographics, depressive symptoms, sleep complaints, and cognitive functioning (Mini-Mental State Exam [MMSE]).

“As the cohort aged, prescription sedative-hypnotic use remained relatively stable, whereas over-the-counter sedative use, principally diphenhydramine, increased substantially. The association of this drug with cognitive impairment in persons without dementia highlights its potential for causing adverse reactions in older adults.”

As we have mentioned many times on this website, it is the additive effect of various anticholinergic drugs that concerns us most. Someone who is taking PM sleeping pills together with a drug for overactive bladder and an antihistamine for allergies along with a sedative like alprazolam could have a substantial anticholinergic “burden.” Additive drug interactions of this nature are worrisome.

Did Sleeping Pill Cocktail Leave Insomniac Zombified?

We have recently revised our Guide to Getting a Good Night’s Sleep (now 15 pages). It lists a number of anticholinergic drugs that may affect memory and increase the risk for dementia. It also offers non-drug suggestions for overcoming insomnia. It is available as a PDF download at this link.

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  1. sandy eubank

    for many many years I have had trouble sleeping and by accident looking for something else
    found cannabis oil.I live in Austin Tx. and one of our large Pharmacies sell it,from the first night I took I slept 8-9 hours.I have been taking for 3 months and it has never failed to work.Igave to husband and same for him,now several friends are taking and works for them.
    —Yes I am doing a happy dance and thanking God for this answer—

  2. PP

    People should stop trying to treat the symptom of insomnia, and try to find the cause: Keep a log on foods eaten, timing of TV and Computer Screen time, and a number of other causes.
    Have found that I can’t work on the computer after dinner, or have sweets from mid afternoon. What about overwhelming sense of tasks, exercise in the evening, etc.
    Recently added a blue light filter to my computer which has helped. I wonder if the national insomnia epidemic is caused by extended use of computers, tablets, etc. with the blue lights. If it’s a lot of tasks weighing on you, get up and make a list of what needs to be done, or work on at least one–that should give you enough relief from the pressure to get to sleep. I also find that a couple of drops of lavender essential oil under my nose and on the pillow bring a speedy snooze.

  3. Janet

    I use Melatonin and nothing else except maybe tea. Works for me!

  4. Pat

    I eliminated my sleep problems and sleep aid medications by following this advice: wait 3-4 hours after leaving the dinner table before retiring, do not snack during that period and limit alcohol intake to no more than one glass of wine in the entire evening.

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