Logan Reid
While it is unclear whether hospitals administered antihistamines for sleep, it is a known fact that antihistamines like Benadryl can cause drowsiness. This side effect has led to their use as a sleep aid. However, medical professionals advise against using antihistamines for sleep due to the risk of long-term side effects, particularly in older adults and children. Instead, alternative treatments such as cognitive behavioural therapy (CBT) and melatonin are recommended to address insomnia.
| Characteristics | Values |
|---|---|
| Antihistamines used as sleep aids | Benadryl, diphenhydramine, doxylamine succinate |
| Side effects | Dizziness, altered mental state, urinary retention, dry mouth, parasomnias, hyperactivity in children, increased risk of dementia and Alzheimer's disease |
| Populations that should not use antihistamines as sleep aids | Pregnant people, older adults, children under 4 years old, people with certain health conditions (e.g. liver or kidney disease, asthma, glaucoma, etc.) |
| Recommended alternatives to antihistamines for insomnia | Cognitive behavioral therapy (CBT), melatonin, good sleep hygiene practices (e.g. maintaining a consistent sleep schedule, avoiding caffeine and alcohol, reducing screen time before bed) |
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What You'll Learn
Antihistamines like Benadryl can make people drowsy
Antihistamines work by blocking the effects of histamine in the body. As one gets ready for sleep, histamine levels in the brain decrease, inducing non-rapid eye movement sleep (NREM). Antihistamines like Benadryl can thus be effective in making people drowsy. However, there is little research to back up their effectiveness as sleep aids. Instead, they are recommended for occasional use only.
Diphenhydramine is a common antihistamine that is used to treat insomnia. It is usually taken 30 minutes before planned sleep. However, it is important to note that diphenhydramine should not be used to cause sleepiness in children, as it can have serious side effects or even cause death in young children. Similarly, it is not recommended for older adults except to manage serious allergic reactions.
For people who suffer from long-term insomnia, it is recommended to visit a physician or sleep disorders specialist. The American Academy of Sleep Medicine suggests cognitive behavioral therapy (CBT) as a first-line treatment for insomnia. CBT focuses on sleep hygiene and strengthening the bed-sleep connection. It helps adjust circadian rhythm and reduces anxiety about insomnia. Alternative sleep aids like melatonin can also be considered.
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Side effects include dry mouth, altered mental state, and urinary retention
Antihistamines are commonly known to cause drowsiness, making them a seemingly convenient solution for those struggling with sleep. However, side effects like dry mouth, altered mental state, and urinary retention can pose risks, especially for the elderly.
Dry Mouth
The dry mouth side effect associated with antihistamines is a common occurrence. This is because antihistamines work by blocking the action of histamine, a chemical substance that plays a role in allergic reactions and wakefulness. By blocking histamine receptors in the body, antihistamines can inadvertently affect the production of saliva, resulting in a dry mouth. While dry mouth may not seem like a severe condition, it can lead to discomfort and impact an individual's quality of life.
Altered Mental State
Antihistamines can cause an altered mental state, which may include feelings of confusion, disorientation, and even hallucinations in some cases. This side effect is particularly concerning, especially for older adults, as it increases the risk of falls and injuries. An altered mental state can also lead to dangerous behaviours, such as sleepwalking and other parasomnias, where individuals may engage in complex activities while asleep, such as eating or driving a car, without conscious awareness.
Urinary Retention
Urinary retention, or difficulty urinating, is another potential side effect of antihistamines. This can be particularly problematic for individuals with pre-existing urinary issues or an enlarged prostate gland. Urinary retention can lead to discomfort, urinary tract infections, and, in severe cases, kidney damage if left untreated.
While antihistamines may help with falling asleep, they do not improve overall sleep quality. Additionally, long-term use of antihistamines can lead to tolerance and dependence, and they may even have the opposite effect, causing hyperactivity, especially in children. Experts recommend alternative treatments for insomnia, such as cognitive behavioural therapy (CBT), which focuses on improving sleep hygiene and strengthening the association between bed and sleep.
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They can cause hyperactivity in children
Antihistamines are commonly used to treat allergic reactions and insomnia. While they can cause drowsiness, experts advise against using them as a sleep aid due to the risk of adverse side effects, especially in the elderly and children.
First-generation antihistamines, such as Benadryl, are older medications that are less selective and interfere with multiple pathways in the body, causing various side effects. These antihistamines can cross the blood-brain barrier and affect non-histamine receptors, leading to a higher likelihood of adverse reactions compared to second-generation or non-sedating antihistamines.
In children, first-generation antihistamines can cause paradoxical stimulation, resulting in hyperactivity, excitation, tremors, hallucinations, and convulsions. Additionally, excessive doses can lead to respiratory depression, coma, and even death. As a result, sedating antihistamines are contraindicated for children under six years of age for cough and cold symptoms and for children under two years of age for all indications.
Second-generation antihistamines, on the other hand, have been extensively studied for their efficacy and safety in children. They are faster-acting, have a longer duration of action, and are less sedating than first-generation antihistamines. Loratadine and cetirizine are examples of non-sedating antihistamines that are preferred for treating allergies in children.
Instead of relying on antihistamines as a sleep aid, experts recommend alternative treatments such as cognitive-behavioral therapy (CBT), which focuses on sleep hygiene and strengthening the association between bed and sleep. Good sleep hygiene practices include maintaining a consistent sleep schedule, avoiding caffeine and alcohol in the evenings, minimizing electronic device use before bed, and keeping the bedroom cool and dark.
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Long-term use may increase the risk of dementia and Alzheimer's
While antihistamines can make people drowsy, and therefore may help them fall asleep, they do not improve overall sleep quality. In some cases, they can even have the opposite effect and cause hyperactivity, especially in children. For this reason, sleep experts advise against taking antihistamines as a sleep aid.
Antihistamines are also associated with several side effects, including altered mental state, urinary retention, and dry mouth. While these side effects are generally mild and well tolerated in young patients without other medical problems, they can pose a risk, especially for the elderly. For example, antihistamines can cause sleepwalking and other parasomnias.
Furthermore, long-term use of antihistamines may increase the risk of dementia and Alzheimer's disease. A report published in JAMA Internal Medicine highlighted a link between long-term use of anticholinergic medications like Benadryl and dementia. While this study and other observational studies have found this association, they do not prove causation. However, anticholinergic drugs can cause confusion and increase the risk of falls in older people. Anticholinergics block the action of acetylcholine, a substance that transmits messages in the nervous system and is involved in learning and memory. The risk of developing dementia increases with the cumulative dose and duration of anticholinergic use.
Doctors advise taking the lowest possible dose of antihistamines or using alternative medications for symptom relief. It is important to note that the studies on the link between antihistamines and dementia have produced mixed results, and there is no clear-cut answer about whether antihistamines increase dementia risk. However, given the potential side effects and the existence of alternative treatments for allergies and insomnia, it is recommended to exercise caution and explore other options.
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Experts recommend CBT as a safer alternative treatment for insomnia
While antihistamines like Benadryl can make people drowsy, experts advise against using them as a sleep aid. Side effects can include altered mental state, urinary retention, and dry mouth. Long-term use may also lead to harmful side effects, especially in older adults.
As an alternative, experts recommend cognitive behavioral therapy (CBT) as a first-line treatment for insomnia. CBT-I is a short, structured, and evidence-based approach to treating insomnia. It is considered effective for both short-term and chronic insomnia. During treatment, a trained CBT-I provider helps to identify thoughts, feelings, and behaviors that are contributing to insomnia. They then work with the patient to restructure these thoughts and feelings to be more conducive to sleep. Treatment typically takes 6-8 sessions, although this may vary depending on the patient's needs.
CBT-I focuses on three main factors that contribute to insomnia: identifying and eliminating habits that were developed to improve sleep but have become ineffective; reducing sleep-related worry and other sources of heightened arousal; and strengthening the bed-sleep connection. Techniques used in CBT-I include stimulus control, sleep restriction, and relaxation training. Good sleep hygiene is also a core component of CBT-I, which involves increasing practices that encourage sleep and reducing those that hinder it. This includes maintaining a consistent sleep schedule, avoiding caffeine and alcohol, and minimizing the use of electronic devices before bed.
In addition to CBT, other alternative treatments for insomnia include melatonin, meditation, and ASMR.
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Frequently asked questions
While antihistamines can cause drowsiness and help people fall asleep, they do not improve overall sleep quality. They can even have the opposite effect and cause hyperactivity, especially in children.
Antihistamines have side effects that include altered mental state, urinary retention, and dry mouth. While these side effects are generally mild and well tolerated in young patients without other medical problems, they can pose a risk, especially for the elderly. Antihistamines may also increase the risk for dementia and Alzheimer’s disease if taken long-term.
Antihistamines are not recommended for sleep as little research supports their effectiveness. The American Academy of Sleep Medicine recommends cognitive behavioural therapy (CBT) as a first-line treatment for insomnia.
Nonprescription cough and cold combination products that contain antihistamines can cause serious side effects or even death in young children. They should not be given to children under 4 years of age. Diphenhydramine, a type of antihistamine, should not be used to cause sleepiness in children.
