Everybody knows that if it’s over-the-counter, it’s got to be safe. Or is it really? After all, prescription sleeping pills are a lot more tightly regulated by doctors and the FDA. Not to mention a lot more expensive.

Let’s just start with what everybody knows already about over-the-counter sleep aids. Just so everybody’s on the same page.

Firstly, the main ingredient of over-the-counter sleep aids is an antihistamine. Antihistamines are generally taken for allergies, but also make you feel very sleepy.
And yes, while they make you get to sleep faster, there is little evidence that they improve the quality of your sleep at all, much less help treat insomnia.

Meaning, if you really had good quality sleep, won’t you be productive in your following wake hours? That brings me to the second fact that everybody already knows about OTC sleep aids.

OTC sleep aids tend to cause “morning hangovers” or what is explained as residual next-morning sedation due to the fact that antihistamines have long half-lives. That simply means they stay very long in the bodies and therefore continue to cause drowsiness.

So most people usually try to live with that limitation by simply staying away from driving or handling heavy machinery. However, did you know that you would also have to put up with constipation and a racing heartbeat through your day? Did you also know that you could be in a state of confusion, delirium and have urinary retention? These are called anticholinergic side effects of antihistamines. That certainly wouldn’t do for that important office meeting next morning.

Thirdly, common over-the-counter sleep medications are Sleep-Eze, Sominex, Nytol, and Unison that are mostly either diphenhydramine or doxylamine antihistamines.
However, other common OTC sleep aids like Tylenol PM and Advil PM are actually combinations of the painkillers acetaminophen and ibuprofen with an antihistamine, diphenhydramine.

And that is why, the Medical Letter, which reviews drugs, recommends against using antihistamines for sleep. Some doctors say users of Tylenol PM may be taking acetaminophen they do not need. Acetaminophen overdoses can cause liver failure.

As for ibuprofen, common side effects mainly involve the gastrointestinal system. It can cause ulcerations, abdominal pain, cramping, nausea, gastritis, and even serious gastrointestinal bleeding. Sometimes, stomach ulceration and bleeding can occur without abdominal pain, and black tarry stools, weakness, and dizziness upon standing may be the only signs of internal bleeding.

And finally, back to the premise that if it’s over the counter, it’s got to be safe. That is truly the costliest and harmful fallacy that everybody has believed about OTC sleep aids being safer than prescription sleeping pills.

The reason is this. OTC sleep aids are not regulated and therefore, prone to abuse. If the OTC sleep aids were used as they were originally intended for i.e. to treat allergies or relieve mild pain that usually resolve within days, their sedative side effects would have been limited.

And because using OTC sleep aids does not require a doctor’s consultation and supervision, potential drug interactions would not have been flagged out and underlying serious side effects would have gone undetected.

Also, you can develop a tolerance for over-the-counter sleep aids after using them for just a few days. You may find quickly that you’ll need to pop in more pills each time to accomplish the same effect.

Last but not least, a so-called transcient insomnia may progress into a chronic insomnia if the root of the problem is not resolved. A slippery slope indeed. Don’t we all agree that insomnia is just a symptom of an underlying problem? And for many of us occasional insomniacs, it’s always triggered by something called stress.

Here’s a tip. Today, researchers have found that the best treatment for insomnia with the highest success rates is to change our thought patterns to then change our behaviors into those that induce sleep. So, it’s really all in the mind.