You’re at the end of your rope, so you head to the pharmacy for the help you so desperately need to sleep. But wait, you aren’t sure if it’s safe, if it works, and if there’s a better way.  Stay tuned to learn about the benefits, side effects, and risk of sleep aids. 

 I’m Dr.Vickie Petz Kasper. If you’re ready to take control of your health, you’re in the right  place. I’ll give you practical steps to start your own journey toward better health because healthy looks great on you.

 This is episode 159, Sleeping Pills and Potions. What works and what doesn’t. You know that poor sleep is associated with heart disease, cancer, diabetes, obesity, immune dysfunction, high blood pressure, anxiety, depression, fatigue, irritability, and good grief, I could go on and on. So, taking something to help you sleep sounds like a good idea, right?  Today, we’ll discuss what you need to know before you go and get a prescription, supplement, or over the counter sleeping aid.

Look, we have to sleep. Our very lives and health depend on it. But the struggle is real. Insomnia is one of the most common symptoms people go to the doctor or health care provider for treatment.  

And what if I told you that good sleep is possible without medications? Well, it is. In fact, the first line treatment recommended to treat insomnia is not medication. The standard recommendation for managing insomnia is to eliminate things that go bump in the night and keep you awake.  Or, to treat underlying diseases that disrupt sleep. It’s not recommended to start with behavioral therapy or medications until these other things are maximized.

Ha! But good luck with that. If you go to your primary care provider and you don’t get a prescription, I’ll buy you a cup of coffee and we can both stay awake.  And, if you think you need to see a specialist, then you’ll probably get to spend the night in a sleep lab hotel hooked up to a bunch of wires and you may get answers, like, a CPAP, and that’s important if you have sleep apnea, but if not, you might not even hear from them. No wonder you’re looking for a good solution to sleep.  And though medications are not the first line recommendation, that is the topic of today’s episode. So let’s get to it. We’re going to start with prescription medications, then we’ll talk about over the counter medications and wrap up with supplements. 

There are three classes of drugs approved to treat insomnia. Benzodiazepine receptor agonist, histamine receptor antagonist, and melatonin receptor agonist. Listening to all that medical jargon may be sufficient to put you to sleep. But wait, let me explain. You’ll understand more after we go to mini medical school today and learn about receptors. 

These are made up of proteins and they receive chemical signals that produce a response.  Let me give you this analogy. You’ve got a lamp sitting on an end table, but it’s not plugged in, so there’s no light. And when you stick those two prongs into the socket, behold, now you can sit and read. And that’s kind of how a receptor works.

The plug fits into the plug in. So an agonist is like the plug. It fits. It turns it on. It lets the electricity flow.  But, if you had a toddler in the house, you might want to plug in one of those little plastic things so he doesn’t stick a butter knife in there and get shocked. So that would be an antagonist. 

Okay, now wake up and pay attention. We’ve got three classes of drugs to look at. Benzo receptor agonist and melatonin agonist. That plug in and histamine receptor antagonist that block the plugin. And then there’s another category called other. We’ll just call that the clapper, you know, clap, clap. And the light comes on, clap, clap, and the light goes off. 

There are eight drugs in the benzodiazepine receptor agonist family. And the first five are about my age, you know, born in the 60s. They are Estazolam, which is Prosom, Florazepam, which is Dalmane, Quamazepam, which is Doral, Temazepam, which is Restoril and Triazolam, which is Halcion. Now the millennials aren’t benzos, but they’re still benzo receptor agonist.

And you know, this generation got way more complicated spelling their kids’ names, so I’m probably gonna have to sound them out like a first grade teacher on the first day of school. 

Eszopiclone is Lunesta, Zaleplon is Sonata. Zolpidem is Ambien.  Those older drugs are crankier and cause more dependence although Restoril is the nicest in the category. There are other benzos which are technically prescribed for anxiety and  some people do use them to help them sleep. Do they work?

Here’s what the data says for the old guys. They help you fall asleep faster. A whole whopping 10 minutes faster. And they increase total sleep time by half an hour to an hour. That’s it.  What about risk? Well, they make you sleepy, which is kind of the point, but also they can make you dizzy, which can make you fall if you get up and go to the bathroom during the night. And if you mix them with opioids, the reaction can be fatal.  

Now, the younger guys function about as well as the older ones, but they have shorter half lives, so their effects don’t wear out their welcome so much with daytime grogginess. And they aren’t so deadly when socializing with opioids. But rarely, they do some bizarre things like compel you to shop or gamble in the middle of the night. All for 10 minutes faster to go to sleep and half hour to an hour longer sleeping. 

Okay, clap on, clap off, let’s talk about the other drugs.  These are dual orexin receptor antagonists.  Affectionately known as D O R A or Dora. 

The first one is Suvarexant, which is called Belsomra. The next one is Derodorexant, which sounds a lot like deodorant to me, and that’s exactly what I’m gonna call it because the brand name is Quviviq. And finally, there is Limboxerant, which has a really cool brand name, Dayvigo.  What? You’ve never heard of any of these? Well, that’s probably because they’re slightly less effective than the other drugs. They help you go to sleep seven minutes faster. But the main side effect is sleepiness, and people generally say they slept better.

The next topic in pharmacology class in mini medical school is the histamine antagonist. You know, the little plastic thing that goes in the wall socket so your toddler doesn’t.  Doxepin is a tricyclic antidepressant that functions this way, and even in low doses it causes the desirable effect of drowsiness. So, it’s approved for the treatment of drowsiness deficit. 

Unfortunately, there are some drugs it doesn’t play nice with. But, it does increase sleep time by Drum roll please! 25 to 30 minutes. Womp, womp, womp. And, it helps people stay asleep toward the end of the sleep cycle.

   And I think this underscores why one size does not fit all and prescriptions should be customized for individual needs.  The last class of drugs approved for the treatment of insomnia makes a lot of sense.  Ramelteon is a melatonin receptor agonist and the brand name Rosarem, get it? REM, R E M, as in rapid eye movement sleep.

It’s got a good mechanism of action, a good name. Problem is, it doesn’t work any better than placebo. So, you can skip the potential for fatigue, nausea, and worsening of liver disease and just take a sugar pill.  So, am I saying it doesn’t work at all? Of course not. Why would it be approved if it didn’t work?

Well, it’s not in Europe, but it does work to lengthen sleep time by a grand total of seven minutes. And I don’t know about you, but it’s going to take more than seven minutes to get rid of the bags under these eyes.  So that’s the gamut of drugs approved for the treatment of insomnia in the United States.

But wait, there’s more. Just because the FDA doesn’t approve something for a particular indication, that doesn’t mean that doctors can’t prescribe it. And sometimes, off label prescribing is a really good thing, though it’s a set up for a knock down, drag out fight with your insurance company for coverage.

In addition to using the antidepressant Doxepin, many doctors prescribe other antidepressants for sleep. Things like Amitriptyline and Trazodone, even though the American Academy of Sleep Medicine advises against it because of side effects and no data showing that it works.

Now, I always recommend that you consult with your health care provider regarding your medications. Always, always, always.  But, I also recommend that they consult with up to date society recommendations and guidelines. That’s just fair. And while they’re at it, they should look at the potential adverse reactions.

So, now maybe you’ve decided to skip the copay and just help yourself to the sleep aid aisle of the pharmacy. You could even ask the pharmacist to guide you, and I recommend that. There are two over the counter medications approved to treat insomnia. They are diphenhydramine, commonly known as Benadryl, and doxalamine, commonly known as Unisom.

Side note, over the counter medications are regulated  FDA, And both of these drugs are histamine blockers. Therefore, all of the fun side effects that come with that, like dry mouth, GI distress, dizziness, trouble emptying your bladder, and of course, sedation, which is the desired side effect.

These medications are often combined with things like Advil or Tylenol with an added P. M. at the end, so you know what’s in store for you. And here’s what’s in store for diphenhydramine. 8 less minutes to fall asleep and 12 more minutes of sleep. And for doxylamine, there’s no data available.

That’s it. That’s what we’ve got. So, maybe now you’ve decided just to take matters into your own hands and look for a supplement. And because you’ve listened to my previous podcast episode about dementia, you’re gonna skip right over the Prevagen, right? Promise me. Now, in the supplement section, you’re going to walk in understanding that claims, concentrations, and ingredients are not guaranteed.

They’re not regulated. They are, generally speaking, considered safe and ineffective. You heard that right. Safe. And ineffective. But what about melatonin? You swear it works, but does it?  Maybe. It is sedating in about 10 percent of people and in everyone else, it shifts the sleep phase.

So, there is a place for that such as jet lag, and I have an episode on jet lag in the show notes.  But even though it may help you drift off to sleep, it probably isn’t going to help you stay asleep. The half life is less than an hour, and in some people it causes stomach cramps, irritability, and even depression.

It’s best used in combination with other things that regulate your circadian rhythm. More to come on that. But a big one is light. And so this probably would be a great time to tell you about some exciting news I have for you.

I have an upcoming series of live webinars to talk about six hidden things that keep you tossing and turning at night.   And soon you’ll have access to an online course called Unlock the Secret to Sleep, your personal sleep solution. I have been working so hard on this for so long that I cannot wait to share it with you. 

I want to help you reset your sleep and get your Z’s. Now there are other supplements labeled as sleep aids and most of them again are safe and probably not effective. The exceptions on safety are kava and valerian root. Both of those have been associated with liver damage. Now it’s rare, but it’s very serious.

Other things you might find on this aisle are chamomile, Glycine, Gryphonia, Hops,  , Kava, L theanine, Lavender, , Passionflower, Nightshade, Skullcap, Strymonium, Tryptophan, , and Wild Jujube Seeds.  They’re all equally effective and work every bit as well as a sugar pill, but hey, sugar pills can have powerful placebo effects.

And one last thing I want to mention, and that is cannabis. Bottom line is there’s not enough research to say one way or another, whether it works. It does have the potential for addiction and it’s not legal everywhere. So there’s that.  But also it’s a problem that if you quit, you’ll likely experience sleep disturbances that can last for several months.   

 The bottom line is, I want you to know that you shouldn’t have to choose between serious health consequences of poor sleep and the side effects and risk of sleeping pills and potions.  If you suffer from insomnia, I do encourage you not to stop any medications without medical supervision and to have an honest conversation with your doctor. And if they want access to my resources, just give them my email address. I’m happy to share and they’re 100 percent legit, but if good sleep eludes you, I want you to know while there’s no magic pill for perfect sleep, there is a proven path to natural, restorative rest that can transform your life. Imagine waking up energized, focused, and ready to tackle your day without relying on sleeping pills or potions.

 Are you tired of tossing and turning at night? Desperately wishing for deep, restful sleep? 

I’m hosting two exclusive live webinars where I’ll share my evidence based approach to achieving consistent quality sleep. Join me on March 3rd or March 5th to discover how to fall asleep naturally. and wake up refreshed, practical strategies to boost your energy and mental clarity, and solutions to common sleep challenges that keep you awake at night.

 Plus you’ll get a chance to ask your most pressing sleep questions during a live Q& A session. So don’t miss this opportunity. To revolutionize your sleep.

Click the link in the show notes to save your spot now. Registration is required. And make sure you’re on my email list to receive exclusive pre webinar insights and special bonuses. Your journey to better sleep starts here. Sign up right now and let’s transform your nights and supercharge your days.  Because good sleep is crucial for good health and healthy looks great on you.  

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You know that poor sleep leaves you dragging through the day, feeling drained and foggy brained, and more than a little bit grouchy. But did you know that poor sleep can be deadly? Stay tuned to learn about seven serious diseases linked to poor sleep  I’m Dr.Vickie Petz Kasper. Healthy Looks Great On You podcast takes you to mini medical school so you can learn the power of lifestyle medicine.

If you’re ready to take control of your health, you’re in the right  place.

This is episode 158, The Risky Business of Poor Sleep, Seven Serious Diseases.  You know you need to get a good night’s sleep.  You want to rest and wake up feeling refreshed and restored, but it’s not that simple for everyone. Even though sleep is essential for life, chronic insomnia affects 30 percent of adults, and half of all people experience some degree of insomnia during their lives. So if you struggle to sleep, you certainly aren’t alone. But, before you start planning a zombie party for all of your friends who are raring to go long after bedtime, let’s take a look at the impact on your health. And, spoiler alert, it ain’t good for ya.  Not only does poor sleep affect the quality of life and emotional well being, it’s associated with an increased risk of seven serious diseases.

I mean, it’s bad enough to slog through the day sleepy, irritable, and feeling blah, but people with significant insomnia tend to have a shorter lifespan.  I mean, if they know Jesus, they can sleep in heavenly peace, but in the meantime, it’s best to maximize restorative sleep because of the impact on health.

And before you reach for the medicine bottle or go shopping down the supplement and sleep aid aisle, you’re going to want to stay tuned to this podcast because next week we’re going to break down all the pills and potions. But this week we’re going to talk about what the following conditions all have in common: heart disease, , type 2 diabetes, depression, obesity, Alzheimer’s dementia, immune dysfunction, and certain cancers. And you don’t even need to go to mini medical school to guess that poor sleep increases the risk of developing all seven of these serious diseases. Good sleep is crucial for good health.

I know, I know, you get it. You know sleep is super important. You want to sleep. You’ve tried to sleep, but you can’t. I hope you know, I feel your pain. I’ve been there and I understand the frustration of going to bed and knowing you’re not going to sleep. That’s why I’ve created some resources for you. Head on over to my website, www.healthylooksgreatonyou. com and grab “Turn Off Your Mind and Sleep.”  It’s a free downloadable tip sheet. It’s not a cure, but it’s a start. And then in March of 2025, I’ll be doing a series of live webinars called ” Six Hidden Reasons You’re Tossing and Turning.” Then in the middle of the month, I’ll release my online course: “Unlock the Secret to Sleep” to help you get the Z’s you need.

And if you take advantage of any of the free resources on my website, you’ll automatically be subscribed to get every episode of this podcast, plus all those bonuses right in your inbox. And you’ll be the first to know about additional opportunities to improve your sleep and health.  Now last month, I did a series of podcast episodes on dementia and now I’m transitioning to sleep.

But before we exit this road Let’s take a look at the intersection between brain health and sleep. I’ve already given you the list of seven diseases associated with poor sleep, and so this is not in order, but logically I thought we would discuss Alzheimer’s dementia first. And if you missed the series, there are links in the show notes to each episode, but if you just want the bottom line.

Lifestyle modifications are your best weapon to prevent this disease which is exploding in our aging population.  Now, today in mini medical school, we’re going to learn about beta amyloid, which is sometimes referred to as amyloid beta.  That’s kind of weird. I guess this peptide is a little confused about which name comes first.

You can call me beta amyloid or you can call me amyloid beta, but you don’t have to call me Ray.  Okay, that was a poor attempt at humor,  but I stand by the fact that laughter is still the best medicine.  What’s in a name? Well, Dr. Alzheimer himself identified senile plaques, which are those buildups of beta amyloid in the brain, as well as neurofibrillary tangles which come from Tau proteins. And he discovered all of this in the early 1900s.  In people with Alzheimer’s, amyloid proteins stick together and get folded over and they form plaques and that is toxic to brain cells. In fact, beta amyloid plaques are the hallmark finding in the brains of people with Alzheimer’s. But here’s the deal.  I’ve got amyloids and you’ve got amyloids in your brain, too.  But if you’re normal, then your glymphatic system washes it away and breaks it down.  Want to guess when this happens?  Yep, while you were sleeping.

Or in the case of insomnia, not. And clearly, there’s an increased risk of Alzheimer’s dementia in people with mid life insomnia.

As it turns out, a lot of things in midlife have long term effects on our health. So maybe if you think you got away with not paying attention to your health when you were young, now is the time to reset and change directions.  Need a little more motivation?

Well, let’s move on to the increased risk of cardiovascular disease. And that’s a catch all term that refers to heart disease, heart attack, and high blood pressure. Cardio means heart, and vascular refers to blood vessels. And guess what? You’ve got blood vessels in your heart and throughout your body. So what’s sleep got to do with it?

Well, I’m glad you asked. Insomnia is considered an independent risk factor for cardiovascular disease and is associated with a higher chance of dying from heart disease or anything else for that matter. We call that mortality. And listen, I know we are all going to die of something, but the goal of this podcast is to give you information, motivation, and inspiration to take care of this one body God gave us to last a lifetime on this earth.

So yeah, I’m going to die of something and so are you. But I’d really like to stick around for a while with the people I love, wouldn’t you? And I want to be healthy enough to play and enjoy life. And cardiovascular disease can rob you of the ability to do anything that requires stamina.

So don’t give me that, we’re all gonna die of something line. Eventually your car is going to have enough miles that the engine fails. But that doesn’t mean you shouldn’t get your oil changed on a regular basis.

Maintenance for your health is so much more important than maintenance for your vehicle. I mean, you can’t replace your body. So pay attention to your heart health and sleep. They’re all related. Now let’s explore why poor sleep  affects heart health. You know, when you sleep, not only is your glymphatic system clearing out toxins from your brain, but your sympathetic nervous system is just kind of chill, and your blood pressure drops.

But when instead your blood vessels don’t relax, that causes an elevation in blood pressure. And not only does that increase the risk of hypertension and heart disease, But also stroke.  Now, this is interesting. If you can’t sleep because you wake up during the night, or you wake up super early in the morning, then your blood pressure probably doesn’t do the normal dip.

But, if you have trouble falling asleep at the beginning of the night, it doesn’t seem to have as much effect on your blood pressure. You see, sleep is very specific and complex, and the type of sleep trouble you have affects your risk. If you’re interested in learning more about blood pressure, then when you go to my website, healthylooksgreatonyou.com, and search for four reasons to control your blood pressure, There’ll be an episode that pops up and of course I’ll put a link in the show notes.  Okay, we’ve covered the brain and the heart and blood vessels. Now sweetie, it’s time to talk about those sugar plums dancing in your head because insomnia is associated with an increased risk of type 2 diabetes as well as progression from pre diabetes to type 2 diabetes.

Want some good news? Improving your sleep can improve your glycemic control. That means it’s easier to normalize your blood sugars with a good full eight hours of shut eye. And specifically, short sleep duration is associated with an increased risk of diabetes.  Both inflammation and insulin resistance are increased with poor sleep.

And if you’re interested in more of the science made simple, listen to the episode, “Why is sleeping so hard?” But here’s the deal, sugar causes inflammation. And insulin is the key that opens the door to move the sugar out of the blood vessels and into your cells. So, it can be used as fuel. But with type 2 diabetes, this mechanism is impaired.

This all goes back to a coordinated effort by the body to balance various hormones like growth hormone, insulin, and cortisol. And yes, it’s all affected by sleep..  Next in the list of seven deadly diseases associated with poor sleep is cancer.

In fact, researchers have proposed a 24 percent increased risk of cancer in people with insomnia. And it’s certain cancers in particular, like lung cancer, colorectal cancer, breast cancer, and ovarian cancer. Turns out that disrupting your internal clock does more than keep you wide eyed and bushy tailed.

It’s theorized that cancer cells may take advantage of lower levels of the sleep hormone, melatonin. You see, melatonin is released in the brain and  sends out signals to synchronize many organs and bodily functions. And it plays a huge role in hormone balance. Things like estrogen, but also cortisol.

And this affects cellular growth and repair at the DNA level. That’s where genes are switched on and off by the immune system.  At the most basic level, cancer is an abnormal growth of cells. So, it’s plausible that skimping on the cleanup and reboot system for your body’s defenses gives the enemy an advantage.

Both inflammation and insulin resistance contribute to DNA damage and that can increase the risk for cancer. I feel like I could just repeat the word inflammation with each of these seven diseases. Inflammation in the blood vessels affects every organ supplied by.. blood.

And well, that pretty much covers it all,  but also inflammation’s life partner is the immune system.  You know, they’re still married, but they fight a lot trying to find the perfect balance between keeping out foreign invaders that have come to kill and destroy like infection and cancer and not going nuclear and exploding your body’s own cells.

So that leads to number five on the list of deadly diseases associated with poor sleep, and that is immune dysfunction,  and if you think you have a dysfunctional family Let me tell you about the immune system Try putting the bone marrow, the thymus gland, the spleen, mucous membrane, skin, tonsils, and lymph nodes in a room together and watch them go into attack mode.

They’ll crank out some white blood cells, antibodies, cytokine, and compliment to mount a defense against infection. And that’s a good thing. When bacteria, viruses, parasites, and fungus breaches our first line of protection, We need a strong immune system to fight them off. Turns out that fighting off infection is a process that’s also related to tumor suppression like we discussed with cancer.

But here’s the deal. The immune family is a rowdy bunch and sometimes they miss the target and attack their own. I mean, you’ve seen a room full of toddlers, right? They want everything. That’s mine. It’s mine. That’s their favorite phrase. So when they get overzealous, it causes autoimmune disease. Okay, now this is getting personal.

I have an autoimmune disease called myasthenia gravis. In this condition, the body makes antibodies against itself. And we all know that a house divided against itself cannot stand. And that’s what happened to me. Literally, my muscles were so weak, I couldn’t stand for very long, walk very far, or use my arms for any length of time.

Because every time my nerves tried to send a signal to my muscles, my misguided immune system interrupted the neurotransmitter as if it were there to hurt me. Now, what causes myasthenia gravis? Well, it’s not really known, but guess what? Poor sleep is associated with immune dysfunction. Now, I was a self described health nut for many years.

I ate a lot of whole, unprocessed foods, exercised regularly, managed my stress pretty well, and had a healthy group of connections.  Oh, and my mama always said, don’t drink, don’t smoke, don’t chew, and don’t go with those who do.

So I’ve never been one to be exposed to unhealthy levels of harmful substances. Now, I just listed five of the six pillars of lifestyle medicine. Hmm, let me see, what did I leave out? Oh, yeah, sleep. Until MG knocked me flat on my back, I ignored the importance of rest and sleep on my health  and it caught up with me.

And that’s one of the reasons I’m so passionate about restorative sleep.  Let those who’ve lived like the walking dead serve as a warning.  And if dementia, heart disease, cancer, diabetes, and immune health aren’t enough to convince you that you need to prioritize sleep. Then how about obesity?

And listen, do you see a theme developing? Aberrations in the circadian rhythm disrupt normal melatonin production, which in turn has a powerful influence in hormone regulation and balance. And all of that affects your levels of hunger and satisfaction, and ultimately, the number on the scales.  If you’ve ever wanted to reset your metabolism, then focus on resetting your sleep because they are closely related.

And obesity increases the risk of heart disease, cancer, high blood pressure, and of course, type 2 diabetes. This is starting to feel like a snowball, gaining more and more waist circumference as it rolls down the hill. Not only does lack of sleep slow down your metabolism, it increases the level of the hunger hormone, ghrelin, and it decreases the satiety hormone, leptin, that tells your brain you’re full.

I’ve already mentioned the connection between insulin and sleep. And insulin resistance is also a factor in excess weight gain. Both insomnia and obesity are epidemic. And look, you’re not going to lose weight by sleeping better at night.

But you might gain weight by not sleeping at night. And it might be easier for you to stay active and eat healthy if you get a good night’s rest.  Gosh, this whole thing is kind of depressing.  You knew I was going there, didn’t you? The seventh serious disease associated with poor sleep is depression.

And get this, people with insomnia have a tenfold increased risk of depression. In one of my previous episodes, I called sleep the mood mechanic. There’s a link in the show notes. But on the other side of the pillow. If you have depression, you have 75 percent more trouble falling asleep.

Now, how do they measure that? Well, in the past, they relied on surveys where research subjects just recalled their sleep. But now, we’re getting more and more data from wearables, like watches and rings and smart beds, like the sleep number bed. But the fact remains that sometimes it’s hard to tell. If depression causes sleep disruption, Or the other way around.

Listen, don’t stay awake at night worrying about it. If you have depression, talk to your doctor or healthcare provider about the right treatment for you and your insomnia. Because I’m guessing, if you have one, you have both.  However, that leads me to reason number two that I’m passionate about sleep.  The average doctor only gets two and a half hours of training on sleep in medical school.

So there’s that. And the number one recommendation to treat insomnia is not medication. So, you’re going to want to stay tuned and learn more so you can lower your risk of dementia, cardiovascular disease, type 2 diabetes, obesity, cancer, immune dysfunction, and depression.  Sleeping may not come easy for you, but it’s worth the effort to give your body a chance to do the work on the night shift and restore your mind and your health. Because healthy looks great on you.

the information contained in this podcast is for educational purposes only and is not considered to be a substitute for medical advice. You should continue to follow up with your physician or health care provider and take medication as prescribed. Though the information in this podcast is evidence based, new research may develop and recommendations may change.

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