What over-the-counter (OTC) medication is recommended for short-term sleep aid?

Over-the-Counter Medications for Short-Term Sleep Aid

For short-term sleep aid, melatonin (3mg) is the most appropriate over-the-counter medication, offering efficacy for occasional sleeplessness with minimal adverse effects and no habit-forming properties. 1, 2

First-Line OTC Options

Melatonin

• Available as 3mg tablets (and other dosages)
• FDA-labeled as "drug-free and non-habit forming" for occasional sleeplessness 1
• Most evidence supporting efficacy among OTC sleep aids for older adults without significant safety concerns 2
• Particularly effective in prolonged-release formulations 3
• Benefits:
  • Helps establish normal sleep patterns
  • Vegan and fast-dissolving options available
  • Minimal adverse effects profile

Diphenhydramine (First-Generation Antihistamine)

• Can be effective for occasional use but has significant limitations:
  • Causes daytime sedation and impairment
  • Has anticholinergic side effects
  • Potential cognitive impairment, especially concerning in older adults 4
  • Dizziness and imbalance are commonly reported side effects 5
  • Inappropriate for regular or long-term use 6

Important Considerations

Appropriate Use

• OTC sleep aids are indicated only for occasional difficulty with sleep, not for chronic use 6
• Limit use to the lowest effective dose for the shortest duration 4
• Younger adults (≤25 years) and females are more likely to use OTC sleep aids 5
• Older adults are more likely to inappropriately use diphenhydramine products for 15+ days per month 6

Safety Concerns

• First-generation antihistamines like diphenhydramine carry risks of:
  • Next-day sedation
  • Cognitive impairment
  • Falls (particularly concerning in older adults)
  • Anticholinergic effects 4, 6
• Recent systematic reviews suggest limited beneficial effects for diphenhydramine and valerian with potential safety concerns 3

Non-Pharmacological Approaches

• Consider these before or alongside OTC medications:
  • Sleep hygiene education
  • Regular exercise
  • Cognitive Behavioral Therapy for Insomnia (CBT-I) is considered first-line for chronic insomnia 4
  • Progressive Deep Muscle Relaxation
  • Mindfulness-Based Techniques 4

Clinical Pearls

• For persistent insomnia beyond occasional use, patients should consult healthcare providers rather than self-medicating with OTC products
• Melatonin has shown the most consistent beneficial effects on sleep onset and quality with favorable tolerability compared to other OTC options 3
• Diphenhydramine should be used with caution, particularly in older adults, due to anticholinergic effects and fall risk 6
• The safety and efficacy of OTC sleep aids have not been well established for chronic use, especially in older adults 6