Regarding Diphenhydramine Hydrochloride

[zeion]

Hello.

I've been using sleeping pills with 25mg of diphenhydramine hydrochloride occasionally to help me sleep.
I take 2 pills each time maybe 3 times a week.
I'm just wondering if there is any long term effects if I continue to do this regularly?
(I've read the article on Wikipedia already, just wanted some personal input.)

As well, would you recommend any alternatives to help me sleep better?
I've began to try to exercise more already.

Thanks.

 

[ormondotvos]

need.more.information

 

[nismaratwork]

Hello.

I've been using sleeping pills with 25mg of diphenhydramine hydrochloride occasionally to help me sleep.
I take 2 pills each time maybe 3 times a week.
I'm just wondering if there is any long term effects if I continue to do this regularly?
(I've read the article on Wikipedia already, just wanted some personal input.)

As well, would you recommend any alternatives to help me sleep better?
I've began to try to exercise more already.

Thanks.

My first reaction is what any doctor you ask will have: why are do you feel the need to take sleep aids 3 times a week? All drugs have possible adverse effects, and unless you've explored the full range of simple tools to get to sleep (generally under the term: "Sleep Hygiene"), I don't see why you should take this. Check your caffeine intake, and the time at which you take it in. Try to have small 'ritual' around sleep, such as brushing teeth and the like. Something as simple as progressive muscle relaxation and breathing exercises are very effective in cases where there is no underlying medical or psychological issue.


That, however, is not what you asked. What you're taking is better known to the average person as 'Dramamine', a medication often purchased OTC or by Rx for motion sickness. As anyone who's used Dramamine knows, it has the unfortunate side effect of causing drowsiness in many people. It is therefore, the adverse effect of one application which is exploited here for the advantage of the sleeper.

I should say, it's not EXACTLY Dramamine, but a mixture of diphenhydramine and buffer = Dramamine (diphenhydrate). Really, diphenhydramine is everything that Dramamine is, but in its original formulation to max the hypnotic effect (as with most antihistamines). There ARE effects, although any allergic reaction would likely have manifested by this time.

Obviously this is not exactly the most dangerous pharmaceutical out there, but it does have some notable adverse reactions. I for one, wouldn't like a long QT develop (Q-T interval of cardiac sinus rhythm), which can be deadly alone, but can also be exacerbated by other drugs into causing a lethal event, even at a young age. This drug is a sufficiently powerful hynotic that it definitely has the capacity to form a psychological habit, especially if used to alleviate anxiety or induce sleep for a similar reason.

The other thing, which relates this to Scopolamine, is the profound anticholinergic effect. Now, unless you start taking this in unsafe quantities you don't have to worry about anticholingergic toxidrome, but dry mouth at night alone can increase tooth decay and gum disease... a LOT.

The only other one, and this relates to the first thing I said, is the line you should have read from Wikipedia: "Since 2002, the US FDA requires special labeling warning against using multiple products that contain diphenhydramine.[18] Diphenhydramine has been shown to build tolerance against its sedation effectiveness very quickly, with placebo-like results after a third day of common dosage.[19]"

The tale of any drug that allows someone to build tolerance is the same: dependence, or possible toxicity. Because it's an anticholinergic, there's an upper limit to what you can take before developing serious side effects, ones that would stop a rational person from using the drug. Of course, this leaves the person in search of a new way to get to sleep, and that often leads to drinking (bad idea), or prescription medications. The latter is fine if you need it, but not just for the sake of mild insomnia.

BOTTOM LINE: The fact that you take a sleep aid 3 times a week at the maximum dosage (in the west at least) should be a cause to visit your doctor. There are better options with no side effects that you can probably learn. It's not so much that this is a terrible and dangerous drug, but that the benefit to you vs. the risk is terrible when you can get the same benefit for 0 risk.

 

[zeion]

Thanks for that. It was very informative.

Something as simple as progressive muscle relaxation and breathing exercises are very effective in cases where there is no underlying medical or psychological issue.

Do you have any reliable links for this that I can look at?

 

[nismaratwork]

Thanks for that. It was very informative.



Do you have any reliable links for this that I can look at?

Happily!

This is very good, and made for a professional talking another through this, which I find is a great way to learn a technique:
http://londoncognitive.com/2010/12/26/progressive-muscle-relaxation-script/

This is from about.com, so basic, but with good links:
http://ptsd.about.com/od/glossary/g/PMRdef.htm

In general this falls under the rubric of CBT (Cognitive Behavioral Therapy), but be aware that you want to deal with DOCTORS who specialize in CBT, not "certified CBT..."

Here by the way, is a paper about the use of this technique to treat insomnia (primary meaning... insomnia! in this case at least).

http://pdfcast.org/pdf/cognitive-behavioral-therapy-for-primary-insomnia

If you need any more information, I'll happily post more.

 

[TylerH]

This thread is surprisingly benign, compared to my expectations.

 

[Proton Soup]

This thread is surprisingly benign, compared to my expectations.

quite narcotic, isn't it?

imagine my surprise to learn that diphenhydramine is an SSRI. (has that got something to do with the cardiac effects, nismar?) personally, i don't like it as a sleep aid. it knocks me out, but the quality of sleep sucks. always end up feeling groggy.

http://www.psychosomaticmedicine.org/content/vol61/issue5/images/large/G0456F7.jpeg

http://www.psychosomaticmedicine.org/cgi/content/full/61/5/591


i would avoid taking vitamins in the evening. caffeine has about a 4 hour half-life iirc. light is going to suppress your natural serotonin pulse. and yeppers, exercise helps, too.

 

[TylerH]

What about vitamins? I take mine right before I go to bed...

Also, since it is on-topic, what are the long term effects of abusing diphenhydramine?

 

[nismaratwork]

quite narcotic, isn't it?

imagine my surprise to learn that diphenhydramine is an SSRI. (has that got something to do with the cardiac effects, nismar?) personally, i don't like it as a sleep aid. it knocks me out, but the quality of sleep sucks. always end up feeling groggy.

http://www.psychosomaticmedicine.org/content/vol61/issue5/images/large/G0456F7.jpeg

http://www.psychosomaticmedicine.org/cgi/content/full/61/5/591


i would avoid taking vitamins in the evening. caffeine has about a 4 hour half-life iirc. light is going to suppress your natural serotonin pulse. and yeppers, exercise helps, too.

You are correct sir, YES!... sorry, I was possessed by Ed McMahon for a moment. Still, you're still right about the SSRI action, although that action is sufficiently minimal that you need to take a high dose to run into issues normally associated with SSRI's. A lot of the grogginess and other issues are due to a rather nasty conflict between the anticholinergic effects, a little SSRI smack, and the usual H1 antihistamine inhibition. I agree with you that it's a hell of a drug to be taking on a regular basis, if only for lifestyle.

Of course, it's that mixed action that so often draws people with anxiety to these OTC medications.

TylerH: It's not indicated for such long term use, but tolerance and dependence are the main concerns. In that context, as Proton has poitned out this acts to some extent as an SSRI, and a crude one. You're going to increase the cardiac risk, and at the same time you're straining yourself further with potentially serious complications that arise from any anticholinergic (another cause of cardiac issues possibly, but not the long Q-T interval).

That's fancy talk for: It's not really known, except that it's not teratogenic, carcinogenic, and people aren't robbing stores for the pills or dropping dead from them (AFAIK).

I find that ginger works for me if I have mild motion sickness (rare), and while it takes more work to address the root of sleep issues, it's worth it for your mental and physical health. For sleep, there's really no substitute for a few months of building good habits.

 

[nismaratwork]

What about vitamins? I take mine right before I go to bed...

Also, since it is on-topic, what are the long term effects of abusing diphenhydramine?

Bad boy.

You should take vitamins with food for best effect, and some people experience GI symptoms if they take them before bed. In terms of sleep due to some action of the vitamin... well... maybe. Niacin and a few others can cause flushing and a kind of alertness, but usually in massive doses. I doubt as much as I can that they're an issue, but I'd still switch it up and take it with lunch.

 

[mugaliens]

As well, would you recommend any alternatives to help me sleep better?

300 micrograms of melatonin. Stores offer up to miligrams, but it's FAR more than what we need.

I've began to try to exercise more already.

Good! A definate step in the right direction!

 

[zeion]

Hello,

I've been able to sleep comparatively well last night without taking any drugs.
I decided to lock my cats out (I live with two) and closed all the blinds to improve "Sleep Hygiene".

I've also started practicing "Progressive Muscle Relaxation"; which made me realize that I had the habit of tensing my forehead and stomach when I tried to fall asleep. Relaxing those, I was able to rest more comfortably.

300 micrograms of melatonin.!

I will try to get some of these when I have the chance.

Hopefully I will be able to keep this up,
Thanks for all the help.

 

[nismaratwork]

Hello,

I've been able to sleep comparatively well last night without taking any drugs.
I decided to lock my cats out (I live with two) and closed all the blinds to improve "Sleep Hygiene".

I've also started practicing "Progressive Muscle Relaxation"; which made me realize that I had the habit of tensing my forehead and stomach when I tried to fall asleep. Relaxing those, I was able to rest more comfortably.




I will try to get some of these when I have the chance.

Hopefully I will be able to keep this up,
Thanks for all the help.

Thanks very much for the update, it's good to know that you're finding some traction here. One thing, you mention cats... any chance that you're a very light sleeper, and in the early stages of sleep you're easily roused? In that case, you could keep the cats in, but use a relatively quiet white-noise generator.

btw.. PMR is great in any situation where you tense, or feel anxious. It's just one of those interesting properties of human biology that makes it work, and psychology that allows it to have long-term benefits. After all, when you KNOW that you can relax within yourself without aid, it actually becomes easier. Of course, to know, you have to work at it first... you see the trouble. It's no wonder at all that people turn to sleep aids, especially given how devastating it is to lose a lot of sleep.

 

[bobze]

Thanks very much for the update, it's good to know that you're finding some traction here. One thing, you mention cats... any chance that you're a very light sleeper, and in the early stages of sleep you're easily roused? In that case, you could keep the cats in, but use a relatively quiet white-noise generator.

btw.. PMR is great in any situation where you tense, or feel anxious. It's just one of those interesting properties of human biology that makes it work, and psychology that allows it to have long-term benefits. After all, when you KNOW that you can relax within yourself without aid, it actually becomes easier. Of course, to know, you have to work at it first... you see the trouble. It's no wonder at all that people turn to sleep aids, especially given how devastating it is to lose a lot of sleep.

Thumbs up at that. I find, lots of people I've talked to that have a hard time falling asleep, like myself, do so because they are easily roused out of the "fall asleep" stage.

I sleep with a fan on all year round (pointed away from me in the winter), just for the noise it creates. Strange that it can be "too quite" to fall asleep for some.

My wife was (and still is) the same way. She is such a light sleeper, without the noise of the fan, she'll be up during the night at least 5 times--Maybe more. I recall during our undergrads not having a fan one time and she would wake up (and wake me up!) 10 times a night! It certainly got old quick.

Edit: Proton, you need to resize that picture!

 

[nismaratwork]

Thumbs up at that. I find, lots of people I've talked to that have a hard time falling asleep, like myself, do so because they are easily roused out of the "fall asleep" stage.

I sleep with a fan on all year round (pointed away from me in the winter), just for the noise it creates. Strange that it can be "too quite" to fall asleep for some.

My wife was (and still is) the same way. She is such a light sleeper, without the noise of the fan, she'll be up during the night at least 5 times--Maybe more. I recall during our undergrads not having a fan one time and she would wake up (and wake me up!) 10 times a night! It certainly got old quick.

Edit: Proton, you need to resize that picture!

I'm very glad you figured out a way to work with that! I'm a fan all year round guy too... it's just... peaceful. It's good to know that I'm not totally off-base too... after all, what works in life and what you communicate online don't always quite dovetail.