To Sleep: Perchance To Take Lots of Pills
Testing over-the-counter sleep aids, herbal and non.
In my role as a Slate shopper, I have made many curious purchases. I've grown accustomed to questioning looks as the checkout guy rings up 30 toothpastes, or 28 toothbrushes, or 15 cases of beer ... OK, the beer wasn't for a story. Still, I was bracing for the most questioning checkout look of all as I approached a drugstore counter holding seven boxes of sleeping pills. I thought the kid at the register might refuse the sale, or refer me to a psych ward, or at least call over the manager. As it was, he never even blinked. Which is good, because now I can tell you all about over-the-counter sleep aids.
When it comes to OTC pills, you're basically looking at two options: 1) antihistamines; or 2) herbal remedies. Antihistamines use either diphenhydramine hydrochloride (brands include: Sominex, Compoz, Tylenol PM, and Unisom SleepGels) or doxylamine succinate (Unisom tablets, Equate). The two ingredients are pretty interchangeable. Each inhibits the same neurotransmitter to depress your central nervous system. These antihistamines are the same stuff you might take for allergies, which is why allergy medications make you so drowsy.
On the herbal side, there's valerian root, chamomile, passionflower, humulus lupulus, melatonin, and so on. Nobody seems to know how these work for sure. I've used melatonin once before (or, more accurately, misused it), and it gave me horrid dreams about metal hooks, so I'll never go back. But I was eager to try out some other crunchy solutions.
As for prescription sleep aids, I didn't go there. The most common are benzodiazepines (Xanax, Halcion), which work by boosting a neurotransmitter called GABA (didn't they do "Neurotransmitter Dancing Queen"?). Again, this slows down your central nervous system. A similar set of drugs includes Ambien and Sonata, which are not benzodiazepines but work in much the same way. You take these pills at night, just before you want to sleep, same as with the antihistamines and herbals. Some claim the benzodiazepines and, even more so, Ambien and Sonata, get out of your system quicker than antihistamines—meaning less "hangover effect" the next morning. But the prescription drugs can be more habit forming. And I wanted to stick with stuff I could buy right around the corner—to battle sudden bouts of sleeplessness—rather than set up a doctor's appointment as one would for chronic insomnia. I ended up trying out OTC pills in several different scenarios.
1. Jet Lag
Can sleep aids beat it? On a recent trip to Japan, I arrived in Tokyo in the afternoon, then needed to get a good night's sleep (despite a 14-hour time difference) and wake up for a 9 a.m. meeting. Basically, an impossible task. I took a Unisom Maximum Strength SleepGel (50 mg of diphenhydramine hydrochloride) in Tokyo at 11 p.m., when it felt like midafternoon for me, and it actually worked OK. I managed to stay asleep until 6:30 a.m., which was better than I'd hoped for, and I made it through the day. Thanks, Unisom!
The next night, still wickedly lagged, I took two Simply Sleep caplets (together, another 50 mg of diphenhydramine hydrochloride—same as the Unisom), but only managed to sleep until 5:45 a.m. I blame it on the sheer momentum of jet lag, not the pills.
On the third night, as a control, I took no pills and woke up at 4:30 a.m. Unacceptable. So I took two Simply Sleep caplets and managed to sleep until 9:30 a.m. Perfect. Except I should have taken one caplet—I might have avoided the severe grog that plagued me all day and made interaction with Japanese people an even greater effort.
Conclusion: These pills are not a bad way to deal with jet lag, in an emergency. Also, there's no chemical difference between Unisom Maximum Strength SleepGels and Simply Sleep, yet there are two important distinctions. 1) Unisom's "gel" is much nicer going down—the Simply Sleep actually caught in my throat half-dissolved and tasted so bad that I gagged. 2) You can't split Unisom Maximum Strength's dose—it's one gel that can't be cut in half—while Simply Sleep's two caplets give you more flexibility for a half-dose (25 mg) if you're scared of feeling out-of-it when you wake up.
2. Sacking Out
Sometimes you need to hibernate. I did not wish to be awake for any part of the 13-hour plane ride back from Japan—not even when they were showing America's Sweethearts. Could OTC pills do the trick? This time, I went herbal.
Calms Forté is a homeopathic sleep aid containing passionflower, humulus lupulus, chamomile, and a whole buttload of other ingredients. At least one Slatester swears by this remedy, and it's a well-known alternative treatment for insomnia (it also claims to treat attention deficit disorder and general nervousness). I took two Calms Forté caplets (recommended dosage: one to three) right after getting on the plane in Tokyo and promptly slept for the next 12 hours continuously. I woke up just before landing in New York, feeling quite rested and refreshed. The only way to fly! Of course, you need a solid 12 hours with nothing to do for this to work.
While on Calms Forté, I had a very long, very trippy dream. In this dream, I had memory lapses, Memento-style, and was freaked by revelations of things I'd done but then forgotten. This was, in fact, an appropriate sleeping pill dream, as sleep aids often cause disorientation. In the course of researching this story, I got a bit wigged out by moments of confusion while under the pills' effects. But that strange dream on the plane was so cool it made me want to take Calms Forté again.
3. Insomnia I'm not a chronic insomniac. Like many folks, I am prone to occasional nights of bad sleeplessness—maybe once a month. These are awful. Nothing is worse than lying awake in bed for six hours, mind racing, all the while knowing you'll be useless the next day. I've long wondered if there was something I could do about it. It's not worth it to get a prescription drug like Ambien, as the recommended course of treatment with these is to take them at night for a week or so and then stop, hoping they've brought you back onto a normal sleep schedule. I wanted a quicker fix to use every once in a while.
So on a night when I found myself having insomnia, I took Compoz (50 mg of diphenhydramine hydrochloride) at 2:15 a.m. I was asleep by 3 a.m., which is better than my usual habit of being awake until 4:30 or later. But the drug kept me asleep the next morning until noon, and even then I had to drag myself out of bed. It's always hard for me to get up, but this was a whole new level. I was shaking off the effects of the drug until evening.
I immediately realized that this stuff is basically worthless for occasional insomnia. By the time you realize you're not falling asleep, it's too late to take a sleeping pill and still function the next day. The half-life is way too long. If you do want to experiment with this, I strongly suggest you take a half-dose or you may not even be able to safely drive to work in the morning. Further experiments with Unisom and with Equate (which uses doxylamine succinate) confirmed my suspicions, as I consistently got bad pill hangovers. All afternoon on the following days I was drifting in and out of conversations.
As I didn't have time to wait for lots of separate insomnia bouts, I cheated twice by drinking coffee (which usually keeps me up all night) and pitting it head-to-head against pills. This was not a good idea. The first time, I washed down two Calms Forté caplets with a huge mug of java at 10:30 p.m. Within 45 minutes, I was tired and ready for sleep. Score one for the pills! But as I lay in bed, a terrible thing happened. My body felt exhausted, barely able to move, yet my mind continued to race the way it does on coffee. This was like being paralyzed and was really horrifying. (I also had another trippy dream on Calms Forté: It involved an intriguing new strategy for darts, and let's just say the distinction between "dartboard" and "sternum" became somewhat meaningless.) When I tried the coffee battle again with Unisom, it took longer to fall asleep (about two hours), but I didn't have the paralysis thing. Still, my girlfriend reports I tossed and turned in bed that night like a caged animal.
One intriguing technique might be using sleep aids as a precautionary measure. Let's say you've got a big day tomorrow and can't afford even the chance of insomnia. You could take a pill at 9 p.m., knowing the effects will mostly be gone by morning. I tried this a few times, and it sort of worked, but I was still pretty hungover, even with the extra lead time. Still, it's a bit silly to take a drug when you probably don't need it (unless it's a really fun drug).
The one pill that didn't work at all was Alluna, an herbal with valerian root and hops extracts. It didn't make me tired, but then again it also gave me no hangover, so I guess I can recommend it.
4. Just for Kicks
After getting a good night's sleep (without pills), I woke up one weekend morning and immediately took a half-dose of Sominex (25 mg diphenhydramine hydrochloride) just to see what would happen. I didn't fall back asleep, but man did it take the edge off. I've never been so calm and unexcitable in my life—and believe me, that's saying something. I might recommend the daytime half-dose technique for family reunions or any time you just want to kick back and let the river flow.
So How Do You Sleep at Night?
In the end, I was not a big fan of sleep aids. If you have chronic insomnia, they are not the answer—you need to see a doctor and change your lifestyle. If you get insomnia once in a while, like me, I think the best solution is to live with it. Taking a pill to combat it late at night will ruin you for the next day. And you can get "rebound insomnia" if you've been taking pills and then stop. So just grab a book, relax, and settle in for some sleeplessness—it builds character.
As for jet lag, sacking out on plane rides, and dulling the pain of a family get-together, you might want to try out Calms Forté. It's powerful enough to put you out for 12 hours straight, yet offers a flexible dosage. It gave me crazy dreams. And its natural ingredients—unlike the antihistamines—don't interact with alcohol and other medications. Score one for homeopathy!
Seth Stevenson is a frequent contributor to Slate. He is the author of Grounded: A Down to Earth Journey Around the World.
Illustrations by Nina Frenkel.