What is the best sleep medication for someone who has already tried melatonin and magnesium (Mg) glycinate and is now taking diphenhydramine (Benedryl) every night?

From the Guidelines

I strongly recommend that you discontinue the long-term nightly use of diphenhydramine (Benadryl) and consider alternative sleep medications, such as eszopiclone or zolpidem, under the guidance of a healthcare provider. According to the American Academy of Sleep Medicine clinical practice guideline 1, eszopiclone and zolpidem are suggested as treatments for sleep onset and sleep maintenance insomnia in adults.

Some key points to consider when evaluating sleep medications include:

• The potential for tolerance development and anticholinergic side effects with long-term use of diphenhydramine 1
• The effectiveness of eszopiclone and zolpidem in improving sleep quality and duration 1
• The importance of improving sleep hygiene, such as maintaining consistent sleep-wake times and creating a dark and cool bedroom environment, before seeking prescription medications
• The potential benefits of cognitive behavioral therapy for insomnia (CBT-I) as a first-line treatment for insomnia

It is essential to consult with a healthcare provider to determine the best course of treatment for your specific sleep issues, medical history, and potential drug interactions. They can help you weigh the benefits and risks of different sleep medications and develop a personalized treatment plan.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Sleep Medication Options

Given that the individual has already tried melatonin and Mg glycinate and is currently taking Benadryl every night, it's essential to consider alternative sleep medication options.

• The individual may want to consider consulting a healthcare professional to discuss the potential risks and benefits of various sleep medications.
• According to 2, controlled-release melatonin and doxepin are recommended as first-line agents in older adults, while the z-drugs (zolpidem, eszopiclone, and zaleplon) should be reserved for use if the first-line agents are ineffective.

Z-Drugs and Other Options

• The z-drugs, such as zolpidem, may be considered for individuals who have difficulty falling asleep or staying asleep 2.
• However, a study found that zolpidem significantly impaired psychomotor and driving performance, and early memory recall, and these impairments were exacerbated with melatonin co-administration 3.
• Other options, such as sedating antihistamines (like Benadryl), are not recommended unless they are used primarily to treat another condition 2.

Safety and Efficacy of Melatonin

• Melatonin has been found to have a good safety profile, with minimal adverse effects, especially at low to moderate dosages (approximately 5-6 mg daily or less) 4, 5.
• A systematic review found that melatonin had a statistically significant positive impact on sleep measures without safety issues in older adults 6.
• However, the long-term effects of taking exogenous melatonin have been insufficiently studied and warrant additional investigation 5.

Next Steps

• It is crucial to consult a healthcare professional to determine the best course of treatment for the individual's specific sleep needs.
• The healthcare professional can help weigh the potential benefits and risks of various sleep medications and recommend the most suitable option.