[Aurornis]

The comment above just said “sleeping pills” which is ambiguous. Melatonin is an OTC supplement. True “sleeping pills” are usually controlled substances and few doctors would prescribe them as first-line options for a patient who shows up with first time complaints of sleep problems. They won’t be prescribed long-term either. The part of the post that says doctors (plural) tried to prescribe the pills makes me think it’s not traditional sleeping pills, because in this environment you would be unlikely to find one doctor willing to prescribe scheduled sleeping pills long term at all, let alone multiple doctors pushing them.

The usual suggestions from doctors for first line treatment are more mild medications that have drowsiness as a side effect, prescribed at low dose. I would actually prefer many of these low dose options over some of the high dose melatonin supplements. Melatonin is a hormone and taking it can throw off natural production

[voxic11]

Lots of people take diphenhydramine products as sleeping pills and they are advertised as such OTC in the US. Long term Diphenhydramine use is associated with many negative health outcomes and despite the warning labels many people become dependent on them.

[Aurornis]

The parent post was talking about doctor prescribed medications.

The reason diphenhydramine Is associated with a slight increase in dementia risk is the anticholinergic properties. This risk increase is from correlational studies on other medications with anticholinergic medicines being taken for many years by elderly people, so the risk of taking Benadryl occasionally is low to none.

The prescription alternatives like doxepin have the same antihistamine properties without the anticholinergic properties when used at the prescribed dose.

This is an example where people can get themselves into the wrong outcome by assuming anything their doctor prescribes is a last resort quick fix, but anything they can source by themself is safer and superior.

[xp84]

Yes - I saw a very interesting video the other day that educated me a lot on Benadryl - apparently it has a lot of side effects, can cause dementia, and is probably best avoided.

[Aurornis]

Occasional Benadryl is fine. The dementia risk is from correlations found in other medicines that share some of the same properties, when taken for many years.

It’s not a good idea to take Benadryl for many years, but occasional use or even for months while going through a difficult period isn’t going to cause dementia.

[ragall]

The dementia risk is from disrupting the circadian rhythm and suppressing the REM phases.

[bigmadshoe]

It's worth keeping in mind that melatonin is also prescription-only in many countries e.g. UK, Canada, Japan, Australia.

[derekja]

OTC in canada

[bigmadshoe]

My bad, apparently it's prescription-only for children in particular.

[lII1lIlI11ll]

> True “sleeping pills” are usually controlled substances and few doctors would prescribe them as first-line options for a patient who shows up with first time complaints of sleep problems. They won’t be prescribed long-term either.

Modern orexin antagonist sleep medications are not addictive and can be taken long-term.

[astrange]

Trazodone is also not addictive and doesn't have bad side effects afaik.

[lII1lIlI11ll]

Trazodone does little to improve objective sleep quality [0] when used off-label for treating insomnia. From my n=1 experience it it useful as an adjunct to an orexin antagonist in special cases when I stressed/annoyed out of my mind by work or something else, but not as a primary "sleeping pill".

[0] https://pubmed.ncbi.nlm.nih.gov/29680424/

[Gluber]

In Austria a lot of times as second line ( after melatonin etc ) quetiapine is prescribed for its off label effects.

[fc417fc802]

> They won’t be prescribed long-term either.

Tramadol is routinely prescribed long term where I live. I know someone with a massive bottle good for something like 6 to 12 months of daily use. (I don't know if that's a good thing but it is certainly a thing.)

[Aurornis]

Tramadol is a pain medication, not a sleep medication.

It has opioid effects and can cause drowsiness but would never be prescribed for sleep.

It’s also typically a controlled substance. I don’t know where you live but I’d be surprised if anyone was handed a 12 month supply in a bottle.

[girvo]

There are a wild amount of countries where it’s not treated like the opioid that it is, for what it’s worth. Mostly not western ones, though.

[bluedevil2k]

You sure you don’t mean trazodone?