3 ms·

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

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.
- joveian 4y ago
  Thanks, and yes it is hard to tell for sure what is causing what (particularly since as you alluded to there is a huge variation between people when it comes to sleep). When I'm sufficiently rested in general (at least relatively speaking) I'll usually see the effect that has been noted in depression that sleeping less one night makes me more alert the next day (at least for a while - sleep deprevation usually makes me crash earlier in the day and makes later days worse) and like many people I often find that sleeping more than usual can make me feel more tired the next day (however, it still has quite a positive effect beyond that day). So even without considering medication deviations from usual can have differing short term vs long term effects. I often get weeks of < 5 hours of sleep a night most nights where the effects of sleep deprevation are huge and all of the sleep medications I've tried that let me sleep longer all have a positive effect on that functioning (I stay away from the GABA-A receptor agonists due to the various negatives and addiction potential, however I've heard a number of others say the same thing about them; I have tried a bunch of unusual stuff). The effect of the sleep deprevation also feels different from the direct medication effect and at least I would expect that sleep quality issues would feel more like sleep deprevation. Diphenhydramine is one of the better ones for me, but remember the half life is only the half life (except that it doesn't necessarily decay fully regularly like radiation, there is often a point where it gets fully cleared fairly quickly). I've noticed that even balofen (helps me stay asleep), which has a shorter half life, will loose its effectiveness much faster if I take it every day vs. every other day and two days off is better. Taking it for more days at a time requires more days off to recover effectiveness. Again hard to tell what is causing that (part of it for sure is "resetting" the adaptation) but it does often seem to have some positive residual effect the next night (particularly when taking it multiple days in a row). On the other side, low dose doxepin has a long half life and completely wipes me out during the day (although so do some second generation antihistamines so it is possible there is some unusal indirect effect). When I stoped taking it after most of a month of daily use I felt much better than usual during the day for a few days (I'm guessing this is what pitolisant (Wakix) feels like) even though I wasn't sleeping much at night (the reason I haven't tried pitolisant :/). During that month I took doxepin it gradually had less effect but I generally got better sleep than usual and the tiredness felt different from the sleep deprevation tiredness. Diphenhydramine if anything affects me in the morning and more with higher doses (the commonly recommended dose for sleep is way to high IMO, half of a fresh 25mg tablet works well for me, a full tablet even fairly old has the groggy effect the next morning; I do generally seem to have a very slow metabolism, though). I try not to take it too often since it has some widespread effects and may not be all that healthy. Two weeks of consistent use max is what I've seen recommended as well, although in my experience it is much better to avoid taking anything consecutive days if you can help it. Also, the lowest effective dose is best, often the recommended dose is higher than needed. Sleep issues can cause cognitive decline (it has for me certainly) so that also is hard to tell what is causing what. It is hard to really acknowledge cognitive decline (to yourself even) and I suspect trying to improve sleep in some way is an instinctive response. Alcohol and marijuana both potentially have some short term positive effects on sleep but may be damaging in various ways long term (particularly alcohol) and more so with heavier use. I think marijuana could potentially have some legit sleep use but it is often very pesticide heavy at this point and it also seems fairly addictive. For alcohol, in addition to being addictive it has quite the negative liver effect and I think the liver and kidneys are underappreciated when it comes to sleep quality (actually doxpein seems to be not that great on the liver either :( ). That is my thinking anyway, thanks for the discussion.

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.

joveian 4y ago
Thanks, and yes it is hard to tell for sure what is causing what (particularly since as you alluded to there is a huge variation between people when it comes to sleep). When I'm sufficiently rested in general (at least relatively speaking) I'll usually see the effect that has been noted in depression that sleeping less one night makes me more alert the next day (at least for a while - sleep deprevation usually makes me crash earlier in the day and makes later days worse) and like many people I often find that sleeping more than usual can make me feel more tired the next day (however, it still has quite a positive effect beyond that day). So even without considering medication deviations from usual can have differing short term vs long term effects. I often get weeks of < 5 hours of sleep a night most nights where the effects of sleep deprevation are huge and all of the sleep medications I've tried that let me sleep longer all have a positive effect on that functioning (I stay away from the GABA-A receptor agonists due to the various negatives and addiction potential, however I've heard a number of others say the same thing about them; I have tried a bunch of unusual stuff). The effect of the sleep deprevation also feels different from the direct medication effect and at least I would expect that sleep quality issues would feel more like sleep deprevation. Diphenhydramine is one of the better ones for me, but remember the half life is only the half life (except that it doesn't necessarily decay fully regularly like radiation, there is often a point where it gets fully cleared fairly quickly). I've noticed that even balofen (helps me stay asleep), which has a shorter half life, will loose its effectiveness much faster if I take it every day vs. every other day and two days off is better. Taking it for more days at a time requires more days off to recover effectiveness. Again hard to tell what is causing that (part of it for sure is "resetting" the adaptation) but it does often seem to have some positive residual effect the next night (particularly when taking it multiple days in a row). On the other side, low dose doxepin has a long half life and completely wipes me out during the day (although so do some second generation antihistamines so it is possible there is some unusal indirect effect). When I stoped taking it after most of a month of daily use I felt much better than usual during the day for a few days (I'm guessing this is what pitolisant (Wakix) feels like) even though I wasn't sleeping much at night (the reason I haven't tried pitolisant :/). During that month I took doxepin it gradually had less effect but I generally got better sleep than usual and the tiredness felt different from the sleep deprevation tiredness. Diphenhydramine if anything affects me in the morning and more with higher doses (the commonly recommended dose for sleep is way to high IMO, half of a fresh 25mg tablet works well for me, a full tablet even fairly old has the groggy effect the next morning; I do generally seem to have a very slow metabolism, though). I try not to take it too often since it has some widespread effects and may not be all that healthy. Two weeks of consistent use max is what I've seen recommended as well, although in my experience it is much better to avoid taking anything consecutive days if you can help it. Also, the lowest effective dose is best, often the recommended dose is higher than needed. Sleep issues can cause cognitive decline (it has for me certainly) so that also is hard to tell what is causing what. It is hard to really acknowledge cognitive decline (to yourself even) and I suspect trying to improve sleep in some way is an instinctive response. Alcohol and marijuana both potentially have some short term positive effects on sleep but may be damaging in various ways long term (particularly alcohol) and more so with heavier use. I think marijuana could potentially have some legit sleep use but it is often very pesticide heavy at this point and it also seems fairly addictive. For alcohol, in addition to being addictive it has quite the negative liver effect and I think the liver and kidneys are underappreciated when it comes to sleep quality (actually doxpein seems to be not that great on the liver either :( ). That is my thinking anyway, thanks for the discussion.