Fourteen years ago, my 78-year old father finally had surgery to replace his left knee. In the final year of World War II, Dad injured it while serving on a ship in the Pacific, but it never bothered him much until he got older. When the doctor told him he needed his knee replaced, he kept putting it off because of my mother’s progressing dementia. He insisted on taking care of her in their home, and it was only after she passed away that he had his knee replaced.
Rather than have him rehabilitate from surgery in a nursing home, my two sisters and I took turns staying with him around the clock, making sure he took his medicines and did his daily physical therapy.
As the sister with a medical background as both an Emergency Medical Technician (EMT) and pharmacist, I covered his first weeks home from the hospital, supervising his knee stretching exercises and driving him to his physical therapy appointments and other errands until he was medically cleared to do it himself.
On his first night home from the hospital,I noticed that he’d slept foronly three hours. Pouring him coffee the next morning, I brought up my concern.
“Dad, you only slept for 3 hours last night. Are you SURE you’re not in pain?”
“The pain pills work just fine, Lulu. Three hours is pretty typical for me; I’ve had trouble sleeping for years.”
“Well, you’re going to have get more rest than that, or you won’t get better very fast. People who don’t sleep well, don’t heal well.”
My father took only two prescription medicines. At 6 foot-one and 270 pounds, he’d never been susceptible to medications, so on the way home from his physical therapy appointment that afternoon, we stopped at his favorite grocery store to look for something to help him get more shut-eye.
As we headed toward the aisle with the sleeping medicines,I strolled alongside Dad with his new walker.
Most non-prescription sleeping pills are either diphenhydramine or doxylamine. Diphenhydramine lasts for about 6 hours and is a little safer in older adults than doxylamine, which lasts longer: up to 10 hours.
The dose of diphenhydramine marketed as a sleep aid is 50mg. Dad chose a bottle of 25mg diphenhydramine rather than the 50mg maximum strength. That night, he tried taking one tablet to help him go to sleep. It didn’t have much effect, so the next night, he doubled the dose.
Dad was smiling as I poured him coffee the following morning.
“I slept for five hours straight before waking up. It’s been years since I’ve slept that well. That stuff really made a difference.”
Many over-the-counter (OTC) sleep-aid products contain either diphenhydramine or its close cousin, doxylamine. But instead of relieving allergy symptoms like runny nose, itchy eyes, and sneezing, these antihistamines are sold as sleep aids because they also cause significant drowsiness in most people.
Benadryl® (diphenhydramine)is available as a 25mg tablet or capsule in the allergy section of your grocery or pharmacy. But in the sleep aid section, you’ll find diphenhydramine for sale as Sominex®, Nytol®, and zzQuil® side by side with 50mg Maximum Strength Unisom® tablets and capsules.
You can also buy sleep aids with a little something “extra”. Tylenol PM® and Advil PM® have a mild analgesic in addition to diphenhydramine. Tylenol PM® contains an extra-strength Tylenol (acetaminophen) 500mg in each tablet, and Advil PM® contains 200mg of ibuprofen.
Confusion, dry mouth, constipation, and urinary retention are common side effects of diphenhydramine and doxylamine. You should avoid or minimize the use of medicines that cause dry mouth for you, as the lack of saliva will accelerate tooth decay.
Here are 3 Tips on Taking a Non-prescription Sleep Aid:
- Avoid Alcohol.
Although it may relax you, it can also interfere with you staying asleep. Avoid alcohol entirely if you also take narcotic pain medicine, even if you take your pain pill several hours before bedtime.
- Try diphenhydramine first, before doxylamine.
The sleepiness from doxylamine may last up to 10 hours compared to 6 hours for diphenhydramine. Longer-acting sleep aid is not always an advantage, because you can feel “hungover” if the effects of your sleeping pill haven’t worn off by the time you need to wake up.
- Start with half a dose at first.
Always start with half a dose of any new sleeping pill if you are sensitive to it. If you’re not sleepy within 30 minutes, go ahead and take the other half.
Sweet dreams!
