Science Matters
Sleep Aids
Medical Myths : “Diphenhydramine, Melatonin, L-Tryptophan, & Valerian are effec-tive and safe over-the-counter medications”
SCIENCE: there is no good science which supports these OTC sleep aids & insuffi-cient evidence regarding safety.
BACKGROUND
Insomnia refers to difficulty with sleep for at least a month. It is reported that 33-50% of the population has some insomnia symptoms with a total of around 6-10% with severe persistent difficulties with sleep. This amounts to 30 Billion -107 Billion dollars a year spent in trying to pharmacologically improve sleep. Certainly, in the ED, we see many children, adults and elderly in whom “I just can’t sleep or he just wont sleep” is a common complaint. In response to these complaints, some in the ED will recommend Benedryl (diphenhydramine) to “help the kid sleep on the plane” or help Grandma go to bed. Others recommend melatonin, L-tryptophan, or valerian.
National Clinical Guidelines
“Over-the-counter antihistamine or antihistamine/analgesia type drugs (OTC “sleep aids”) as well as herbal and nutritional substances (eg. valerian and melatonin) are not recommended in the treatment of chronic insomnia due to the relative lack of efficacy and safety data.” (Consensus panel recommendation)
Diphenhydramine, melatonin, L-tryptophan, and valerian—these are all “not recom-mended for treating either sleep onset or sleep maintenance insomnia” —according to the 2017 clinical practice guideline by the American Academy of Sleep Medicine.
Scientific Studies
Most studies are small numbers, several are placebo controlled. None of the studies with diphenhydramine , melatonin , L-tryptophan , or valerian prove any significant benefit. None of them collected data on harms.
REFERENCES
Sateia, MJ, et al. “Clinical Practice Guideline for the Pharmacological Treatment of Chronic In-somnia in Adults: An American Academy of Sleep Medicine Clinical Practice Guideline.” J Clin Sleep Med 2017 Feb. 15; 13(2): 307-349.