Unisom SleepGelsÂ, SleepMinisÂ, and SleepMelts all contain diphenhydramine, while Unisom SleepTabs contains a different antihistamine, doxylamine succinate. Like SleepGelsÂ, MinisÂ, and MeltsÂ, Unisom PM contains diphenhydramine, but it also contains 200mg of acetaminophen to address minor pain while you sleep. Unisom Simple Slumbers are drug-free, and contain 5mg of melatonin, plus passionflower, lemon balm, and Vitamin B6. All Unisom products help you get to sleep faster. Use all products only as directed.
Unisom Simple Slumbers is drug-free and non-habit-forming. It can be taken as needed for occasional sleeplessness. Consult a health professional if you are experiencing long-term sleep difficulties.
Midnite Sleep Aid is a natural sleep aid that contains valerian root and melatonin. Valerian root is a traditional herbal remedy that has been used for centuries to promote sleep. Clinical studies have shown that valerian root can help to reduce the time it takes to fall asleep and improve sleep quality. Melatonin is a hormone that is naturally produced by the body to regulate sleep. When taken as a supplement, it can help to promote sleep by making it easier to fall asleep and stay asleep. Midnite Sleep Aid also contains passionflower, chamomile, and lemon balm, which are all traditional herbs that have been used to calm the nerves and promote sleep.
If you are looking for a natural way to get a good night's sleep, then Midnite Sleep Aid may be right for you. It is important to speak with your healthcare provider before taking any supplements, especially if you have any medical conditions or are taking any medications.
Marie Lorraine Johnson works as an outpatient dietitian at Bright Sky Nutrition in Missouri, where she specializes in weight loss, nonalcoholic fatty liver disease treatment, and diabetes remission. She also works as a personal trainer and fitness instructor teaching interval-based cycling classes at Cyclebar.
Little is known about the long-term effects of taking melatonin. If you find that you have to take it most nights for more than 1 month, you should talk with a healthcare professional to rule out underlying sleep disorders or other health conditions that may be affecting your sleep.
Caution should also be applied in the use of melatonin for patients with dementia. Although Wang and others,10 in a metaanalysis published in 2017, reported that melatonin may improve nocturnal sleep time in patients with dementia, a Cochrane review published the previous year found no evidence that melatonin affected any major sleep outcomes in this population.11 Reassuringly, no detrimental effect on cognition or activities of daily living was detected.11
Melatonin is only one option in the armamentarium of sleep solutions for older adults. On the extremely harmful end of the spectrum are benzodiazepines, the so-called Z-drugs (nonbenzodiazepines), trazodone, quetiapine, and over-the-counter antihistamines, many of which are used off-label. Almost 17% of 85-year-olds take benzodiazepines, despite questionable clinical benefit.15 Benzodiazepines reduce sleep-onset latency by 4.2 min and modestly increase total sleep duration, but the latter effect tends to wear off after 4 weeks.16 Benzodiazepines are associated with significant adverse effects, such as cognitive decline, delirium, falls, fractures, and dependence.17,18 The Z-drugs, including zopiclone and zolpidem, are not safer alternatives to benzodiazepines because they are also associated with a significant risk of adverse events, such as delirium, falls, and fractures, with minimal improvement in sleep latency and duration.17 Among over-the-counter medications, antihistamines such as diphenhydramine were identified as the most frequently used nonprescription products for sleep in a subset of older adults19; however, these drugs should be avoided for this purpose because tolerance develops when they are used as hypnotics, and they carry strong anticholinergic properties.17
Given the paucity of hypnotics that are safe for use by elderly patients, should melatonin be considered a legitimate alternative? Certainly the effect of melatonin on sleep, as demonstrated in clinical studies, remains of questionable clinical significance. However, when balancing the risks of insomnia itself, including impaired daytime functioning, cognitive impairment, falls, reduced quality of life, and increased mortality, and the known risks associated with benzodiazepines and Z-drugs, some may consider melatonin to be a reasonable alternative when nonpharmacological therapies have failed.12 In Europe, Clay and others20 reported that campaigns to reduce the use of benzodiazepines and derivatives were less successful when not associated with availability and sales uptake of melatonin.
Indeed, melatonin is already used by many patients as an over-the-counter product and, in this context, pharmacists should encourage appropriate use. For this purpose, identification of drug-induced insomnia is essential, to prevent medication cascades.12 Sleep patterns should be assessed to differentiate pathological insomnia from normal age-related sleep changes and to establish realistic sleep expectations.12 Patients should also be referred for appropriate medical assessment, because comorbidities contributing to insomnia (e.g., pain, heart failure, obstructive sleep apnea, restless leg syndrome) are frequent among elderly patients.12 As first-line therapy for insomnia, cognitive behavioural therapy should be recommended,12,16 and various online resources are available to pharmacists who wish to support patients in this area (e.g., the noncommercial Canadian websites and ).16 Subsequently, education for patients about the documented marginal efficacy and potential adverse effects of melatonin (as well as other prescription and nonprescription sedatives) may help them in making an informed choice.
Melatonin (N-acetyl-5-methoxytryptamine), a hormone released by the pineal gland, binds to the MT1 and MT2 receptors and regulates circadian rhythm.7 Its production is controlled by light, whereby levels of serum melatonin increase during the evening hours, reaching peak concentration between 0200 and 0400, and are suppressed by light, with low concentrations occurring during daytime.1,3,4,7 Studies have shown that melatonin level declines with age, which may increase conditions related to circadian rhythm, such as sleep disorders.1,3,4
Melatonin administered orally has been reported to imitate endogenous melatonin by shifting the circadian clock earlier, thus promoting sleep onset and morning awakening. Numerous studies of the effects of melatonin on sleep in elderly patients have been published,11,12 but their results have been inconsistent because of a lack of high-quality randomized controlled trials. Results from these studies have shown no overall improvement in objective measures of sleep, with a lack of significant effect on sleep time, sleep latency, number of awakenings, and sleep efficiency.11,12 Safety concerns, especially among elderly patients, are residual daytime drowsiness, tiredness upon rising, and increased sleep disruption.11,12
Cognitive behavioural therapy for insomnia is a nonpharmacological approach that has been shown to improve sleep hygiene. It is based on various elements of sleep hygiene and behaviour modification, such as restricting the amount of time in bed, reducing external stimuli, promoting relaxation through meditation, limiting caffeine and alcohol intake, and avoiding daytime napping and exercise close to bedtime. Randomized controlled trials involving older patients have found that these interventions can achieve long-term improvements in sleep and reductions in hypnotic use by older patients.15
In summary, the quality of the evidence for using melatonin to treat insomnia in elderly patients is weak. Furthermore, some clinically significant side effects have been reported with its use in this population. In Canada, melatonin can be obtained as an over-the-counter supplement and in health food stores; hence, adverse effects are likely under-reported. As alternatives to melatonin therapy, factors that may contribute to insomnia should be reduced and nonpharmacological treatments suggested to the patient, along with cognitive behavioural interventions. Patients should also be educated about changes in sleep pattern with aging. Pharmacists can play an important role in providing this information.
While we tend to stare at the clock, toss and turn for hours, or flip on the light and watch TV when sleep eludes us, there are much better ways to cope and help ourselves get back to sleep, says Johns Hopkins sleep expert Luis F. Buenaver, Ph.D., C.B.S.M. Instead, try these six sleeping tips. They can help you get back to sleep tonight and pave the way for sound sleep tomorrow night and beyond.
Turn your alarm clock to face the wall and resist the temptation to check the time on your smartphone. Counting the minutes of missed sleep since waking up in the middle of the night increases stress and anxiety, which could delay your return to slumber. In addition, exposure to blue and green light from your clock, phone, tablet or computer can make you feel more alert.
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