One of the more frequent topics I get asked about pertains to the usage and safety of various over-the-counter (OTC ) drugs. The two that seem to generate the most interest and widespread use are non-steroidal anti-inflammatory drugs (NSAIDs) and sleep-aids. While these partners in crime share some similar ingredients and side effects, they’re also very different as far as certain active ingredients and mechanism of action. So much so that they each deserve the adequate attention and proper breakdown provided through separate posts. The star of this week’s show will be the magical chemical combination synthesized in a lab and packaged in a pretty pill or succulent syrup in order to whisk us away to dreamland.
If you got lost in my creative description, we’re talking about sleep aids. For the purpose of this post we’re going to limit the focus to the OTC sleep aids and refrain from delving into the Ambien and Lunesta dimension filled with fluttering, neon purple butterflies. From past personal experience and outside feedback it would be accurate to rank Nyquil as one of the “GO-TOs” for sleep assistance.
Because of that we’ll break down some of its ingredients which are also commonly found in many others on your Walgreens shelf. Use this as a reference when and if you decide to go that route. Flip that box over so at the very least you’re aware of what you’re putting in your body and can perform your own risk vs. benefit educated analysis.
The first ingredient that demands attention is acetaminophen. This is the active ingredient in Tylenol and can be found in a wide variety of OTC drugs (Excedrin, Theraflu, etc.) under this name or others (paracetamol, acetyl-para-aminophenol, etc.). The fact that people still choose to utilize acetaminophen is baffling. In addition to a laundry list of side effects, the growing literature linking its potency to liver damage is staggering.
Acetaminophen is used to relieve pain, fever and assist as a remedy for allergies, cough, cold and the flu. However, in addition to the FDA acknowledged hepatotoxicity of the drug, continued use of the product has also been linked to kidney damage, asthma and even an increased risk of blood cancer. Not necessarily what you need when you are simply trying to catch some shut-eye.
Another heavy hitter in Nyquil and many other cough suppressants (including Robitussin) is dextromethorphan or DXM. This chemical is making headlines recently due to the growing recreational use and its hallucinogenic affects in large doses; so much so that the FDA has been re-evaluating certain aspects of the drug’s safety and restrictions.
Coincidentally, the procedure of reassessing already on the shelf drugs is commonplace. Nyquil and other products also used to contain the powerful nasal decongestant pseudoephedrine. However, products containing pseudoephedrine were pulled from the shelves seeing how it is one of the main ingredients in crystal meth. In an effort to keep products on the shelves, chemists have cooked up new concoctions to take the place of banned or restricted substances, but back to DXM.
As stated, this ingredient is added to for its antitussive or cough suppressant properties. Straight from Nyquil’s own site: rashes, itching, nausea, drowsiness, dizziness, hallucination and sudden infant death syndrome in babies are possible side effects from a “NORMAL DOSE.” DXM is actually classified as a dissociative drug (along with ketamine, nitrous oxide and PCP) that produces unresponsiveness to stimuli (like the need to cough) by blocking NMDA receptors in your brain. Unfortunately DXM also works on specific regions of the brain (including the retrosplenial and posterior cingulate cortex) and can cause potential disturbances in memory, learning, comprehension, and behavior.
Yikes, but I was only trying to sleep.
The last of the big 3 ingredients is doxylamine or doxylamine succinate. This drug falls in the class of a hypnotic and is utilized here as an antihistamine which serves as a short term sedative and sleep aid. Side effects include dry mouth, urinary retention, ataxia, drowsiness, memory problems, inability to concentrate, hallucinations, psychosis and hypersensitivity to surrounding environment. This is the ingredient that Nyquil adds to encourage sleep.
This brings up a good point. Taking a product which delivers numerous effects in order to utilize one seems quite reckless. Especially because you now know some of the other ingredients and what they can do.
Nyquil has attempted to address this with the release of ZZZquil which is labeled strictly as a sleep aid. In comparison this is a good thing because you’re cutting out all of the other unnecessary and potentially hazardous ingredients. The chemical used in ZZquil (and pretty much any OTC with “PM” after the name) is a more powerful antihistamine called diphenhydramine HCl.
It works at the level of neurotransmitters, which are the chemical messengers within the brain. It allows the neurotransmitter called histamine to build up in the spaces called synapses that are present between nerve cells. This leads to sedative effects and is accomplished by blocking its uptake into nearby cells. Diphenhydramine works both centrally within the brain as well as in peripheral nerve cells in other parts of the body.
Unfortunately, due to the above explained properties older people taking products with diphenhydramine such as Benadryl may be increasing their risk for cognitive impairment (delirium, slowed thinking, Alzheimer’s, etc.). Findings published in a 2009 issue of the ”Journal of Clinical Interventions in Aging” indicate that Benadryl, as a molecule that blocks the neurotransmitter acetylcholine, interrupts the normal functioning of the central and peripheral nervous systems. It was also noted that the effects of Benadryl are cumulative, so the more you consume, the more of an effect this will have on the nervous system and cognition.
This is another chemical that is under the FDA’s microscope and efforts have already been made to remove some products containing the substance from the market. Side effects of this chemical include dry mouth, nose and throat, drowsiness, dizziness, nausea, vomiting, loss of appetite, constipation, increased chest congestion, headache, muscle weakness, nervousness, and excitement (especially in children).
Bottom line with this is that you are taking a drug. You are introducing a foreign chemical into your body to un-naturally alter internal chemistry. Not only are you not curing or shortening the length of your problem, but you are also exposing yourself to a plethora of side effects from the active and “non-active” ingredients. You are attempting to silence your body’s way of telling you something is wrong.
Having said all that, although I preach and try to live like an idealist, I am a realist and realize that sleep is one of our most valuable commodities. Taking an OTC when you’re in a bind is not the end of the world. In light of the information given, I look at sleep aids like I do NSAIDs (Non-Steroidal Anti Inflammatory Drugs, i.e. Aspirin). Consideration to use either should be exercised only in emergency situations and with the full knowledge of what you are voluntarily ingesting. Utilizing any more than that as the usual solution to your pain or insomnia can be habit forming and dangerously disruptive to all aspects of your internal chemistry.
So what are your alternatives? Well, we addressed many aspects of proper sleep in previous posts ( https://clarkechiropracticwellness.com/2013/03/12/de-stress-your-life-part-1/ & https://clarkechiropracticwellness.com/2013/03/19/de-stress-your-life-part-2/ ), but simple things can be implemented first. Eat earlier in the evening. Eat smaller meals and less carbs as the day goes on. (Breakfast like a king, lunch like a prince, dinner like a pauper) Get up earlier. Exercise and make sure you expend some physical energy during the day. Allow yourself time to wind down before getting into bed. And when you do get into bed, make an effort to end the late night love affair with your television. Make it as dark as humanly possible in your room.
If these suggestions (implemented on a consistent basis) still don’t work, then consult your health care professional. Sleep, like all of our functions is controlled by the brain. Seeing someone who checks you for brain imbalances and the aforementioned HPA axis is a solid start. In my time in the clinic at Palmer College of Chiropractic a positive change in someone’s sleep pattern was one of the earliest and most welcomed changes seen at the beginning of treatment. It also served as a solid indicator that we were making positive changes within the brain and on the right track.
Sleep is absolutely necessary so that our bodies can utilize the energy not being used to sustain consciousness, to repair and revitalize for the next day. If you are someone who battles insomnia, I feel for you. Just know that there is help and it is imperative that you seek it. Also know that if you resort to a pill or syrup, especially habitually, your body will potentially pay the price.