WebMD Ask the Pharmacist

Sleep Aids: Ask the Pharmacist

Oct. 13, 2009. Pharmacist Kristen Binaso, RPh, answers your questions about sleep aids and medicines.

Question:

I often take Tylenol PM to fall asleep; is that a problem or should I see my physician?

Answer:

Good question. I would ask this patient if they are aware of the principles of good sleep hygiene (believe it or not, they exist!). They include: establishing a regular sleep pattern (basically go to bed and arise about the same time daily, even on weekends), make the bedroom comfortable for sleeping (no noise, light, comfortable temperature), engage in relaxing activities before bedtime, avoiding exercise 2-4 hours before bedtime, avoid eating at least two hours before bed, and avoid using caffeine, alcohol, or nicotine for at least 4-6 hours before bed. Tylenol PM contains diphenhydramine and it should be taken only if needed. If you are using it for more than 14 days, you should see your healthcare provider for further evaluation.

Question:

I am pregnant and having a hard time with depression and sleeping. Is there anything I can do or take to help me?

Answer:

I would highly recommend that you see your doctor or health care provider for further evaluation. The depression could be the reason why you cannot sleep but we also have to be careful since you are pregnant. Thanks for submitting a question.

Question:

Should I get the regular flu shot now or wait till the swine flu shot is available?

Answer:

You should go now to get the seasonal flu vaccine since it is available and not wait until the H1N1 vaccine arrives -- hopefully from a pharmacist since many pharmacists can now administer vaccines.

Question:

I have an elderly relative taking Ambien CR and having "sleepwalking" episodes and hallucinations. Would Rozerem be a better choice for side effects?

Answer:

This is a good question because when it comes to the elderly, we need to use different doses of medications that are much lower than normal. I would like to know the dose of the Ambien CR because the recommended dose is 6.25 mg due to the possibility of side effects in the elderly. If the patient is having these side effects on that dose, it's time to talk to the doctor or healthcare provider about other options, which may include Lunesta and Rozerem.

Question:

Is there anything for sleep OTC that does not cause symptoms like restlessness?

Answer:

This is a common side effect of the over-the-counter products that can be used as sleep aids because the active ingredient is an antihistamine. I would advise making an appointment with your doctor or healthcare provider for further evaluation, and advise them of the side effect you experience with the OTC products. You may require prescription medication instead because they work differently and are not antihistamines. Thanks for submitting a question today.

Question:

Why can't I sleep even when I take a sleep aid?

Answer:

I would need to ask this patient what they have been taking and if their problem is falling asleep or staying asleep. Over-the-counter sleep aids try to help you fall asleep but not stay asleep. In some cases, if you have taken products too long, you can end up with a condition called "rebound insomnia"-- which means you get another episode of insomnia, possibly worse than the first. If the problem is staying asleep, I would advise that you see your doctor or healthcare provider for further evaluation and possible prescription medication.

Question:

I want to take a prescription sleep aid. Since I am taking a vitamin supplement with ginseng and some other herbal ingredients, I want to make sure there will not be any adverse reactions. Can there be?

Answer:

This is an interesting question because what you may not realize is that your insomnia could be from the vitamin supplement with the herbals, so you may not need any medication at all. Did you know that ginseng can cause insomnia? This is one of the things that many people do not know, and because they are available over the counter, many forget about side effects they can cause. I would advise stopping the vitamin supplement and see how you feel. It is very important that you tell your pharmacist, doctor, or healthcare provider about vitamins and supplements because you could end up on unnecessary medications!

Question:

Is it safe to give my child a prescription medicine if it is six months past the discontinue date?

Answer:

It is not safe to give your child expired medication -- even if it is prescription or over the counter. Your child may be put at risk for having an allergic reaction to the medication breaking down and the medicine may not even work. It is not worth it, especially if it costs you a trip to the hospital. You should go through all of your medications once a year. Make sure you get those vitamins and over the counters as well. The process is really easy for disposal: We do not recommend flushing anymore -- instead get a zip-top bag, and place the medicines in the bag. You can then add some water to the bag to help them dissolve. Next, add kitty litter or coffee grinds, zip it up and throw it in the trash. For more information, visit www.smarxtdisposal.net.

Question:

I am 72, in great health but have been taking 1/2 a sleep aid (Costco Sleep Aid main ingredient Doxylaminesuccinate 25 mg). When I awake at 3 a.m., I can't get back to sleep. Am I doing myself harm?

Answer:

Great question. The over-the-counter sleep aids only help you fall asleep, not stay asleep through the night. You also want to be very careful with these type of products also for your age because they may cause side effects like dizziness, dry mouth, and constipation. I would advise speaking to your doctor or healthcare provider and making an appointment for further evaluation. Prescription medications are available to help you stay asleep through the night. Thanks for submitting a question today.

Question:

Hi. I'm currently 35 weeks pregnant and like most women who are 35 weeks pregnant, I’m having difficulty falling asleep. I have restless leg syndrome, as well. Can you tell me if Excedrin PM is safe to take during the third trimester? Excedrin PM contains acetaminophen and diphenhydramine. In my last pregnancy, I was prescribed Ambien. However, my next doctor's appointment isn't until Friday, and I wanted to find out if Excedrin PM was safe to take as an alternative.

Answer:

Since you are 35 weeks pregnant, Excedrin PM is not safe, due to the diphenhydramine component. I would not advise using this product until you have discussed it with your healthcare provider.

Question:

My 8-year-old daughter was prescribed Tamiflu, 75 milligram capsules. I was told to sprinkle it in her food, 2 capsules daily. She immediately detected it, of course, and is very cautious about eating and drinking. Do you have any suggestions on something to mix it with that she will not detect the medication? Any suggestions will help. Thanks.

Answer:

This is a perfect example of a good question to ask your pharmacist about. It is actually advised that you can open the capsules and mix with a sweetened liquid, like chocolate syrup, not sprinkled on food directly. It is always a good idea to ask about medications and how they can be taken when you pick up your medications at the pharmacy. You may have to wait a few minutes to talk to a pharmacist but it is worth the wait!

Question:

Is the H1N1 vaccine a live virus or killed virus vaccine?

Answer:

Actually, the H1N1 vaccine will be available as both. The nasal vaccine is the "live" virus and certain patient populations should not receive it, like pregnant women. There will also be a "killed virus" vaccine via injection that will be available as well (this one is OK for pregnant women). For more information, you can visit www.flu.gov.

Question:

Is it dangerous to take Tylenol PM on a regular basis to assist with sleep?

Answer:

The general rule of thumb is that you should not take products like Tylenol PM for more than 14 days. If you have been taking this for more than that, I would advise making an appointment with your doctor or healthcare provider for further evaluation. With continued use you may experience "rebound insomnia" which means you get a version of insomnia that can be much worse, or you could even develop a tolerance to Tylenol PM (which means no matter how much you take, it will not work). Another important issue is that you may be experiencing side effects like dry mouth, dizziness, and constipation, which could lead you to using additional medications to treat those side effects -- which would not be necessary if you were not taking the Tylenol PM.

Question:

I have been taking Unisom to help me sleep for about one year now. I started with one 25mg tab but after awhile it stopped working and I am now up to three per night and again not working. If I want to stop taking it all together to try something new, do I need to come off it slowly, i.e. take two for a few nights, then one, and then stop? Thank you.

Answer:

I am very concerned about the fact that you are taking very high doses of an over-the-counter medication and not following the instructions on the package. Because it is over the counter, it is only safe and effective when used properly. This is very risky and can lead to problems (like toxicity in your system that can cause cardiac problems, seizure, coma, and even death) and including the fact that you probably developed a tolerance to the medicine because they are not meant for long-term use. As you continued to increase the dose you also put yourself at risk for developing "rebound insomnia," which means you get insomnia that is worse in nature. You should stop using this medication and should make an appointment with your doctor or healthcare provider and advise them of your misuse of this medication.

Question:

I am 22 weeks pregnant and have a cold. Is it alright to take Tylenol PM?

Answer:

I would not advise taking Tylenol PM while you are pregnant, due to the fact that it contains an antihistamine that is not recommended during pregnancy. It would be helpful to know your symptoms so we don't "over-treat." Unfortunately, due to the fact that you are pregnant, your options are limited. If you have a stuffy nose, you can use a saline nasal spray like Ocean or Ayr. I would also recommend running a vaporizer in your bedroom.

Question:

Can you administer oral medication rectally due to nausea?

Answer:

This is a good question. No, you cannot administer "for oral use" medications rectally because they will not work. Medications that are approved for "rectal use" (will say so right on the packaging) are specifically made in a particular way so the medication can be absorbed into your body.

Question:

What sleep aids can I take that are not habit forming, but will give me a good night's sleep?

Answer:

The general rule of thumb is that you should not take products like Tylenol PM for more than 14 days. If you have been taking this for more than that, I would advise making an appointment with your doctor or healthcare provider for further evaluation. With continued use you may experience "rebound insomnia" which means you get a version of insomnia that can be much worse, or you could even develop a tolerance to Tylenol PM (which means no matter how much you take, it will not work). Another important issue is that you may be experiencing side effects like dry mouth, dizziness, and constipation, which could lead you to using additional medications to treat those side effects -- which would not be necessary if you were not taking the Tylenol PM.

Question:

I took one Nyquil because I am not feeling well. Can I take my normal dose of Ambien?

Answer:

This is a good question because many people do not know that Nyquil contains alcohol and that it should not be taken if you are on Ambien. It can intensify the sedation and drowsiness effects. I would ask this patient what exactly their symptoms are when they state they are "not feeling well" because they may not necessarily need a combination product like Nyquil.

Question:

What company manufactures Actos? My mother-in-law has to take this med and it’s kind of expensive. Her doctor told her to contact the company and they might send her an application for some help. She has a lot of health problems and sometimes can’t afford it, so she goes without until she gets money. I don’t think that not taking her meds is good for her health -- she’s 74.

Answer:

The manufacturer of Actos is Takeda Pharmaceuticals. If you go to www.actos.com and click on "special offers" you will see three different types of programs to help with the cost of the medication. You are thinking the right way: If she skips her medication, she will put herself in greater danger and may end up in the hospital -- which would definitely be a bigger bill. If you need help on locating these types of programs, talk to your pharmacist; we are happy to help.

Question:

My wife is six weeks pregnant and has a sleep disorder and has a prescription for Lunesta, but has not taken it since she discovered that she is pregnant. Do you think she can take Lunesta? If so, will it affect her or the baby?

Answer:

Great question and she did the right thing by not taking the medication since discovering she is pregnant. She needs to discuss this with her doctor or healthcare provider further about the risk versus benefit of Lunesta while she is pregnant. Thank you for joining us for WebMD Ask the Pharmacist. Be sure to come back on Oct. 27 at 1 p.m. ET when we’ll be focusing on pain relief. Sign up if you’d like an email reminder the day before our next event.