Better sleeping through chemistry? Employees need to know the risks…
In case you missed the last edition of Six Things, it was all about sleep hygiene. We were originally going to lump sleep medications in with sleep hygiene, but, based on what Quizzify has learned from responses to its sleep quizzes, there is enough misunderstanding on the subject of sleep meds that we decided to create a dedicated “Six Things” post, rather than append it to the previous one.
Wellness programs need to recognize that employees live in the real world, and that real-world issues need to be addressed. (For that reason, we were the first vendor to address opioids https://www.quizzify.com/opioids-employer-quiz.)
For sleep, we need to go beyond "sleep hygiene" and directly address the 10% to 15% of employees who use drugs to get to sleep. As a special bonus, at the end, I will tell you how I use drugs to get to sleep. Stay tuned.
1. Benadryl is probably not safe for long-term nightly use
While Benadryl is one of the safest drugs around for occasional and short-term use, few employees are aware of the risk of nightly use of Benadryl. https://drugabuse.com/hooked-on-benadryl-its-much-more-than-a-harmless-dependency/ The feeling generally is, if it’s over-the-counter and it’s been around forever, it must be pretty harmless. However, as you will learn in our upcoming Six Things Employees Don’t Know About Heartburn Pills, there are very few drugs designed and labeled for short-term use that are safe for long-term regular use.
By way of background, Benadryl is an antihistamine originally developed, using technology older than virtually everyone reading this posting, to relieve allergies. Its sleep-inducing property was originally a bug but is now a feature.
2. Employees may be taking Benadryl without knowing it
Benadryl goes by the generic name of diphenhydramine. It’s contained in – get ready -- 115 over-the-counter drugs. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5541127/ Included in that list of drugs are popular products like Advil PM, Aleve PM, and Anacin PM. And that’s just the A’s. The list literally goes from A to Z, with the last entry being ZZZ-Quil.
3. Since they don’t think of Benadryl or these “PM” drugs as sleeping pills, employees may not realize the risk of dependence
Most employees can recognize a sleeping pill when it’s labeled as such. But when they see a familiar name, sold over the counter, they may not realize that it’s the “PM” (or “ZZZ”) part of the name to be concerned about, not the brand name. PM drugs can create a dependence. A dependence is not an addiction but many people don't know the difference. Frankly, we didn’t know the difference until we started researching the subject.
4. Ambien may have a less concerning safety profile than OTC drugs containing Benadryl
Some people experience immediate side effects from Ambien, like short-term amnesia. Some side effects – like sleepwalking – are bizarre enough to get in the media every now and then. But the thing about short-term side effects is that you know whether you are experiencing them or not, and can discontinue a drug if you are.
Much more concerning are long-term risks. These are insidious harms to your body that you won’t recognize for years -- and if and when you do, often damage has already been done. Further, sometimes –as will be described in Six Things Employees Don’t Know about Heartburn Pills – the cause-and-effect relationship between the pill and the long-term harm is fairly opaque.
Google on long-term risks of zolpidem (Ambien). You’ll see some. (Don’t pay much attention to the clickbait from addiction recovery centers.) Now google on the long-term risks of Benadryl. Once again, tune out the clickbait. Which list is more concerning to you? We can’t tell you which drug to choose, just that you need to be informed on both and make your own decision.
What you won’t see for Ambien that you will see for Benadryl is dementia. (Once again, this is with long-term regular use. Benadryl is considered very safe for occasional use.) https://www.health.harvard.edu/blog/common-anticholinergic-drugs-like-benadryl-linked-increased-dementia-risk-201501287667
It is unlikely that employees know that.
5. Doctors may prescribe too much Ambien (zolpidem) at first
If you want to take a concrete step right now to help your employees, remove 10 mg. dosages of zolpidem from your formulary. For many years, most doctors prescribed this dosage both initially and, if needed, subsequently. The FDA changed the recommended first dosage to 5 mg. six years ago for women, but many doctors apparently didn’t read that memo. Likewise, PBMs. It is very common for thirty 10 mg. pills to carry the same copay as thirty 5 mg. pills. Hardly an incentive to prescribe or take a lower dose.
Further, employees – men as well as women -- should be advised not only to discuss 5 mg. with their doctor, but also to ask about cutting even that dosage in half to see if it works at 2.5 mg.
Finally, Ambien-type drugs may in very rare cases cause erratic, even injurious, behavior while sleeping. They now have a warning label to that effect. The odds are remote, but all the more reason to start at a half-dose.
6. Even sleep drugs like Lunesta that are labeled for long-term use create a dependence
It is simply not possible, using today’s technology, to create a sleep-inducing drug that does not carry a risk of dependence. Getting labels approved by the FDA is as much sleight-of-hand as it is science. There is really no difference in the likelihood of creating a dependence between Lunesta and Ambien or other sleep aids.
7. BONUS! A seventh thing employees should know
Before your employees get a prescription for a sleep drug, they should match the drug to their problem, rather than just demanding Ambien (zolpidem). Trouble falling asleep? Ambien may be a fit. But if you have trouble staying asleep instead, discuss other options with the doctor. Lunesta may be a better bet, or even something else. https://www.health.harvard.edu/staying-healthy/the-savvy-sleeper-wean-yourself-off-sleep-aids
And now...here's what I've done with my Ambiens for 20 years. Yes, I have a dependence, which you now know is different from an addiction. But they still work, and I wake up totally refreshed with no need for caffeine. My secret: I chew 'em. (I can even distinguish different generic brands based on taste.) That way they get into your system faster, but they also get out of your system faster, so most of your sleep is natural. I chew 5 mg at about 10:30 and then the other 5 mg at 3:30.
This won't be featured in Quizzify. (No actual science behind it...and our Harvard Medical School friends would never approve it.) But try it. I mean, assuming you are already using Ambiens. Don't start on my account.
Few topics are more relevant to more employees -- with more potential for harm if misunderstood. Urge your wellness vendor to address medicinal sleep aids. Or contact Quizzify to learn more about sleep hygiene, sleep meds and other topics.