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When suffering through your chronic insomnia, many medications are available but can also be linked tolerance. Fear not, there are a number of great OTC pills to consider that will not lead to the same type of dependence.

With at least one third of the population suffering from chronic insomnia at any given time in the United States, medications are at the forefront as a chronic insomnia treatment [1].  Some of the first medications that were traditionally considered were antidepressants such as trazadone, benzodiazpines and anti-psychotics [2]. All these medications had some effect on improving the symptoms but they also lead to one very unfortunate outcome — dependence.  This phenomenon is the physiological change that occurs to receptors that make you need to take higher dosages of the medication in order to find the same response [3]. Luckily, there are a number of medications on the market that can treat chronic insomnia without the risk of dependence like some of the earliest therapies. 

Number 1: Melatonin  

Melatonin pills for sleep can be easily purchased in any pharmacy world-wide and represent a great OTC-solution for chronic insomnia. Meta-analyses confirm that patients who rely on melatonin experience: 

  • decreased sleep onset latency (fall asleep fast) 
  • increased total sleep time and
  • improved overall sleep quality.  

Even more impressive, the effects of melatonin do not dissipate after prolonged melatonin use [4].  

Melatonin has advantages over other products on the market because it is a compound that our brain naturally produces in order to help manage our "sleep-wake cycle." Melatonin sleeping pills can be used as an alternative to benzodiazepines and patients can respond with the same levels of improvement without the risky side effect profile of a more potent medication [5].  Melatonin naturally peaks in the body just prior to bedtime and is often the reason why patients become more fatigued at the end of the day.

In order to mirror the same natural effect, it is recommended to take melatonin sleeping tablets no more than 2 hours before bedtime [6]. 

If you are also squeamish and find it hard to swallow any type of capsule or tablet, a number of melatonin-rich foods containing high levels of natural melatonin can also be consumed to reach the same therapeutic response. Citrus foods and nuts are some of the most beneficial melatonin-rich foods that can help you fall asleep. Alcohol is high in melatonin too and would probably make you drowsy very quickly, but it also carries additional side effects and risks. 

Number 2: Diphenyhydramine (Benadryl) 

Another OTC-combination to consider when you are looking for a natural sleep aid can be diphenhydramine — more commonly known as Benadryl.  

Benadryl is part of the antihistamine family. Although Benadryl is best suited for treating your runny nose, it has a side effect panel most notably known for drowsiness. Antihistamines are effective at producing sleepiness rapidly, but studies have shown that after 4 days of twice-daily 50 mg Benadryl tablets, patients in the treatment group showed no distinguishable sleepiness compared to the baseline seen in the control group. Although the patients showed statistically significant differences in sleep latency onset (ability to fall asleep) and sleep efficiency, after 4 days, this class of antihistamine lead to tolerance. [7]

Although at such high doses, antihistamines are known to lead to tolerance, the recommended dosage for Benadryl to treat chronic insomnia would only require 25 mg once daily just prior to bedtime [8]. Because you are only taking a fourth of the dose, it stands to reason that this tolerance will be much more delayed so this can be considered a safe alternative. These studies only confirm that there is a tolerance to the daytime sedative effects of these antihistamines and conclude that this same pattern may not be present when taking the medications only during the night [9]. 

Number 3:  Valerian Hops Combination 

Valerian is the last potential OTC compound that can be considered for your chronic insomnia therapy. This compound is derived from an extract from a plant and has been used since Ancient Greece as a remedy for chronic insomnia. It works on the same GABA receptors that make benzodiazepines so effective at treating chronic insomnia but it is believed to lack the same dependence that is seen with the latter [10]. Valerian is also closely connected to treating anxiety in children: one study indicated that anxiety symptoms improved for the vast majority of children, to the point where they were no longer suffering from anxiety, sleeping problems and depression, and children also tolerated the treatment with Valerian well [11].

Many studies have been conducted to determine the effectiveness of valerian by itself as a means to cure chronic insomnia with mixed results. In most studies, valerian was found to produce a subjective improvement in symptoms of chronic insomnia but lacked a quantitative compounded in sleep latency onset and total sleep time.[12]

A recent study shows more promising results, however. When patients used valerian-hops combination, they were found to have increased total sleep and improved sleep efficiency but just under statistically significant parameters. These same participants noted significant improvement in the severity of their insomnia symptoms as well as significant improvement in the quality of life. [13]