4 ms·

This is the case for almost every drug/agent that has “sleep aid” properties. From Benadryl to Ambien and alcohol, marijuana, etc they help induce sleep (fall

This is the case for almost every drug/agent that has “sleep aid” properties. From Benadryl to Ambien and alcohol, marijuana, etc they help induce sleep (fall asleep faster) but generally the actual quality of sleep is worse. I always take pause when I hear people talk about the “benefit” of having a drink or using marijuana (typically “Indica strain”) before bed to help sleep. We’re all unique but generally I wonder how they would view their restfulness compared to ideal sleep strategies like diet, exercise, screen usage/stimulation, routine, etc.

ryukafalz 4y ago
Melatonin presumably being the exception, right? Since it's the same sleep hormone you're producing naturally. (In reasonable doses anyway.)
- kkielhofner 4y ago
  I’m certainly not a doctor but I’ve heard varying reports on melatonin. While produced naturally it’s like anything else - we have receptors for everything from marijuana to heroin because our bodies produce similar molecules (endorphins for pain suppression during fight or flight, dopamine for reward systems, etc). So saying we “produce melatonin” doesn’t imply safety. From what little I’ve read and understand it does seem to be very individualized, dosage dependent, etc.
- simplyluke 4y ago
  I’m far from an expert here, but I’ve noticed quite a few prominent scientists including Dr. Andrew Huberman recommending against frequent use of it, particularly in children. Part of the issue is label accuracy on supplements for it can be off by several orders of magnitude. https://hubermanlab.com/sleep-toolkit-tools-for-optimizing-sleep-and-sleep-wake-timing/ https://hubermanlab.com/sleep-toolkit-tools-for-optimizing-s...
VirusNewbie 4y ago
Interesting enough, I always wondered why it seemed like I slept better with alcohol, and getting a sleep tracker helped me understand: alcohol lowers REM sleep, but increases deep sleep. In my case, without alcohol I’m abundant in REM but lacking in deep sleep. So in my case, one drink improves my sleep quality! However I don’t think alcohol is healthy, so I don’t regularly imbibe, but it would be nice to find something healthy that would make that trade off for me.
- joveian 4y ago
  Alcohol is a GABA receptor agonist, similar to many sleep drugs. It isn't necessarly REM vs deep sleep; it sounds like alcohol is metabolized quickly enough that there can be a REM rebound effect later in the night when most REM sleep happens anyway[1]. I doubt REM and deep sleep cover much of of the important aspects of how medication affects sleep, it is just the available measurement not necessarily a particularly good one (not that it is unimporatant, it is just an extremely high level overview of what is going on). [1] Roehrs and Roth. Sleep, Sleepiness, and Alcohol Use. Alcohol Res Health. 2001; 25(2): 101–109. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6707127/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6707127/
joveian 4y ago
I don't think it is the case that diphenhydramine (Benadryl) reduces REM sleep (or other antihistamines like low dose doxepin), at least not by much. Certainly it didn't seem to in my case when I took diphenhydramine before my sleep study and ended up with high amounts of REM sleep. Some drugs have a very large reduction in REM or deep sleep, but I don't think this applies to many of the currently used sleep mediations. Additionally, the difference in sleep architecture in healthy study participants is a very different thing from the effect on people who are having trouble sleeping vs what sleep they would get without the sleep aid. In my experience the daytime effects of sleep medication are much more severe than any issues with sleep quality (at least the worst of these seem much more likely to be direct effects than effects of poor sleep quality due to the timinv vs the half life of the medication). Tolerance seems like a bigger issue with long term use than sleep architecture as such, you end up with all negatives because you are mostly or entirely back to how you would be without the sleep medication but still getting the side effects and quitting causes sleep to get worse. In general I agree that avoiding medication generally as much as possible is a good idea, but sleep medication can in the short term have quite positive effects if you are sufficiently sleep deprived. In my case (various severe sleep issues), non-medication strategies don't have nearly the positive effect as medication. For somewhat longer use I've found it helpful to alternate sleep medications, although I'm not aware of any actual studies doing that and it is always possible that it could cause damage. I'm doubtful that current methods of evaluating long term effects related to sleep are effective so it is best to be careful if possible. But with enough sleep deprevation it is extremely obvious that the immediate effects of short term sleep medication use can be quite positive.
- kkielhofner 4y ago
  These are excellent points. I haven't done much (any?) research on the topic nor have I ever had significant problems with sleep - certainly not to the point of participating in a sleep study. What I do know from VERY occasional use of these sleep aids (< 5 times/yr) there is a trade-off for wakefulness and cognitive performance the next day. As you note Benadryl especially has a certain hangover groggy/fuzzy feel to it. I attributed that to reduction in sleep quality but it could certainly be due to Benadry half-life (or something). However, from a quick search it appears the max half-life for Benadryl is 9.2 hours, which given the recommendation of only taking it when you are able (ideally) to get ~8 hours of sleep makes sense. I also notice this in my friends who (as I mentioned) use alcohol and/or marijuana as sleep aids. You can definitely see the cognitive decline. Your comments about long-term use are helpful as well. I think it's pretty well established that they can be "habit forming" with an effectiveness drop-off relatively quickly - for some as soon as a few days of consistent use. For things like Ambien there are also the "Ambien zombie" stories which, while seemingly rare, can be pretty scary. But, from what I remember, prescribing physicians generally recommend no more than two weeks of consistent use? Not having sleep issues personally I certainly don't judge those who do and are trying to balance the significant quality of life reductions experienced with chronic sleep deprivation vs negatives in the use of sleep aids. There's a reason sleep deprivation is used for torture and if you look at new parents (especially the "two under two" crowd) they often seem very vacant and generally out of it to the point where it seems pretty dangerous. I suppose I'm lucky in that I only experience minor sleep issues very occasionally when my diet and exercise routine is thrown off.

ryukafalz 4y ago

Melatonin presumably being the exception, right? Since it's the same sleep hormone you're producing naturally. (In reasonable doses anyway.)

kkielhofner 4y ago
I’m certainly not a doctor but I’ve heard varying reports on melatonin. While produced naturally it’s like anything else - we have receptors for everything from marijuana to heroin because our bodies produce similar molecules (endorphins for pain suppression during fight or flight, dopamine for reward systems, etc). So saying we “produce melatonin” doesn’t imply safety. From what little I’ve read and understand it does seem to be very individualized, dosage dependent, etc.
simplyluke 4y ago
I’m far from an expert here, but I’ve noticed quite a few prominent scientists including Dr. Andrew Huberman recommending against frequent use of it, particularly in children. Part of the issue is label accuracy on supplements for it can be off by several orders of magnitude. https://hubermanlab.com/sleep-toolkit-tools-for-optimizing-sleep-and-sleep-wake-timing/ https://hubermanlab.com/sleep-toolkit-tools-for-optimizing-s...

VirusNewbie 4y ago

Interesting enough, I always wondered why it seemed like I slept better with alcohol, and getting a sleep tracker helped me understand: alcohol lowers REM sleep, but increases deep sleep. In my case, without alcohol I’m abundant in REM but lacking in deep sleep. So in my case, one drink improves my sleep quality! However I don’t think alcohol is healthy, so I don’t regularly imbibe, but it would be nice to find something healthy that would make that trade off for me.

joveian 4y ago
Alcohol is a GABA receptor agonist, similar to many sleep drugs. It isn't necessarly REM vs deep sleep; it sounds like alcohol is metabolized quickly enough that there can be a REM rebound effect later in the night when most REM sleep happens anyway[1]. I doubt REM and deep sleep cover much of of the important aspects of how medication affects sleep, it is just the available measurement not necessarily a particularly good one (not that it is unimporatant, it is just an extremely high level overview of what is going on). [1] Roehrs and Roth. Sleep, Sleepiness, and Alcohol Use. Alcohol Res Health. 2001; 25(2): 101–109. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6707127/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6707127/

joveian 4y ago

I don't think it is the case that diphenhydramine (Benadryl) reduces REM sleep (or other antihistamines like low dose doxepin), at least not by much. Certainly it didn't seem to in my case when I took diphenhydramine before my sleep study and ended up with high amounts of REM sleep. Some drugs have a very large reduction in REM or deep sleep, but I don't think this applies to many of the currently used sleep mediations. Additionally, the difference in sleep architecture in healthy study participants is a very different thing from the effect on people who are having trouble sleeping vs what sleep they would get without the sleep aid. In my experience the daytime effects of sleep medication are much more severe than any issues with sleep quality (at least the worst of these seem much more likely to be direct effects than effects of poor sleep quality due to the timinv vs the half life of the medication). Tolerance seems like a bigger issue with long term use than sleep architecture as such, you end up with all negatives because you are mostly or entirely back to how you would be without the sleep medication but still getting the side effects and quitting causes sleep to get worse. In general I agree that avoiding medication generally as much as possible is a good idea, but sleep medication can in the short term have quite positive effects if you are sufficiently sleep deprived. In my case (various severe sleep issues), non-medication strategies don't have nearly the positive effect as medication. For somewhat longer use I've found it helpful to alternate sleep medications, although I'm not aware of any actual studies doing that and it is always possible that it could cause damage. I'm doubtful that current methods of evaluating long term effects related to sleep are effective so it is best to be careful if possible. But with enough sleep deprevation it is extremely obvious that the immediate effects of short term sleep medication use can be quite positive.

kkielhofner 4y ago
These are excellent points. I haven't done much (any?) research on the topic nor have I ever had significant problems with sleep - certainly not to the point of participating in a sleep study. What I do know from VERY occasional use of these sleep aids (< 5 times/yr) there is a trade-off for wakefulness and cognitive performance the next day. As you note Benadryl especially has a certain hangover groggy/fuzzy feel to it. I attributed that to reduction in sleep quality but it could certainly be due to Benadry half-life (or something). However, from a quick search it appears the max half-life for Benadryl is 9.2 hours, which given the recommendation of only taking it when you are able (ideally) to get ~8 hours of sleep makes sense. I also notice this in my friends who (as I mentioned) use alcohol and/or marijuana as sleep aids. You can definitely see the cognitive decline. Your comments about long-term use are helpful as well. I think it's pretty well established that they can be "habit forming" with an effectiveness drop-off relatively quickly - for some as soon as a few days of consistent use. For things like Ambien there are also the "Ambien zombie" stories which, while seemingly rare, can be pretty scary. But, from what I remember, prescribing physicians generally recommend no more than two weeks of consistent use? Not having sleep issues personally I certainly don't judge those who do and are trying to balance the significant quality of life reductions experienced with chronic sleep deprivation vs negatives in the use of sleep aids. There's a reason sleep deprivation is used for torture and if you look at new parents (especially the "two under two" crowd) they often seem very vacant and generally out of it to the point where it seems pretty dangerous. I suppose I'm lucky in that I only experience minor sleep issues very occasionally when my diet and exercise routine is thrown off.