I can't sleep, but sleeping pills are scary... Should I try buying a 'sleep aid' at the pharmacy?

There are many reports that sleeping aids are not effective in improving insomnia. This article explores why the effects of sleeping aids are limited and what happens if you take more than the recommended dose.

 

 

For temporary insomnia, diphenhydramine and doxylamine.

Sleep inducers can be broadly divided into antihistamine (first-generation) sleep aids and herbal ingredient sleep aids. Among these, antihistamine-based medications originally have a mechanism to soothe itching, allergies, and motion sickness, but they are used as sleep aids by taking advantage of the drowsiness side effect after ingestion. Antihistamine sleep inducers are further divided based on their main ingredients into ▲diphenhydramine and ▲doxylamine (doxylamine). Representative products with diphenhydramine as the main ingredient include Hanmi Pharmaceutical's 'Sleppel Tablets' and GC Green Cross's 'Cool Dream Soft Capsules,' while products with doxylamine as the main ingredient include Alpha Pharmaceutical's 'Azol Tablets' and Alico Pharmaceutical's 'Aron Tablets.'

Although the sleep-inducing effects of diphenhydramine and doxylamine are similar, there is a difference in their half-lives (the time it takes for the drug's concentration in the body to decrease by half), which is related to the duration of their effects. Typically, doxylamine has a longer half-life than diphenhydramine, allowing for an average sleep maintenance of about 6 to 8 hours in some individuals, whereas diphenhydramine generally maintains sleep for a shorter period of about 4 to 6 hours.

On the other hand, herbal preparations like 'Redolminjeong' from Gwangdong Pharmaceutical are known to regulate melatonin, a hormone involved in sleep, thereby calming the mind and body. However, the sleep-inducing effect does not appear immediately and requires long-term use for gradual results. Pharmacist Eom Joon-chul from Comfortable Pharmacy (Academic Committee Member of the Korea Pharmacist Academic Research Institute) said, "In the case of antihistamines, drowsiness occurs within 30 minutes of taking them, whereas many consumers say that even after a month of taking Redolmin, there is no effect or it is weak," and "It is necessary to inform consumers purchasing Redolmin that it is a long-term nutritional supplement."

The phrase "It seems to have no effect even if I eat it" is a common statement among insomnia patients who take sleep aids. This is because the regulation standards for over-the-counter medicines under the Pharmacists Act prioritize safety over efficacy. In fact, over-the-counter medicines must have fewer side effects on the human body compared to prescription drugs. Therefore, over-the-counter sleep aids must be controlled to have no greater side effects than prescription sleeping pills, which means they cannot be made as potent as prescription sleep medications in terms of effectiveness. Kim Ye-ji, a member of the Academic Committee of the Korean Pharmaceutical Association (pharmacist), said, "Over-the-counter medicines, according to Article 2 of the Pharmacists Act, should have minimal risk of misuse and should be safe even when used without a doctor's prescription."

Therefore, while sedatives have fewer side effects compared to sleeping pills, side effects do exist with sedatives as well.

Side effects of antihistamine agents include dry mouth, dry eyes, urinary retention (difficulty urinating), and constipation. These are called antihistamine or anticholinergic side effects, and anticholinergic side effects tend to be more severe in elderly patients over 65 years old, so elderly patients with insomnia should avoid using antihistamine sedatives. Additionally, patients with prostate disease may experience difficulty urinating due to urinary retention, and glaucoma patients should be cautious when using antihistamine agents because there is a risk of increased intraocular pressure.

In the case of Redolmine, side effects are mild, such as headaches, indigestion, rash, redness, and itching, which are less severe than antihistamines. However, it can affect anesthesia, so people scheduled for surgery should not use it.

In addition, it is advisable for ▲mental health patients and ▲pregnant and breastfeeding women to carefully decide on the use of both antihistamine-based and herbal sleep aids after consulting with a doctor or pharmacist.

Even when taking sleep aids, if the recommended dosage is exceeded and misused, not only will the effectiveness not improve due to tolerance, but it can also cause additional side effects. Pharmacist Eom Joon-chul said, "Over-the-counter sleep aids do not become more effective when taken in larger amounts," and "In the case of antihistamines like doxylamine or diphenhydramine, excessive high doses can increase the risk of heart arrhythmias."

Pharmacists recommend reflecting on lifestyle habits before taking sleep aids. They suggest checking for habits that reduce sleep quality, such as napping, consuming caffeinated beverages, or frequent trips to the bathroom, as well as reviewing existing medications for ingredients that may cause insomnia, before deciding to take sleep aids. Academic Committee Member Kim Ye-ji said, "Choosing chrysanthemum tea or jujube tea instead of caffeinated drinks is better," and "Developing a habit of not looking at your phone before bed is also helpful."

Finally, there are cases where people consider taking sleep aids not only for insomnia treatment but also for jet lag adjustment after international travel. Many reviews report effectiveness with melatonin-based products. However, unlike plant-based melatonin supplements available domestically, chemically synthesized melatonin sustained-release tablets are classified as prescription drugs requiring a doctor's prescription. For this reason, some people bypass visiting a hospital and purchase melatonin sustained-release tablets directly from overseas online, which is strictly illegal. Pharmacist Joon-chul Ahn stated, "Since ordering melatonin sustained-release tablets from overseas is illegal, the government will not provide compensation for any side effects that occur after taking them."