Insomnia, Antihistamines, and Alzheimer’s Disease

Insomnia and other sleep disorders are serious problems that are estimated to directly affect 50% of the American population to some extent.  Sleep disorders have become such an issue that the Center for Disease Control and Prevention (CDC) has classified insufficient sleep as a public health epidemic.1  People that do not get adequate sleep are more likely to experience trouble concentrating, memory problems, decreased work productivity, and traffic accidents.2–4  Inadequate sleep can also put you at a higher risk of developing chronic diseases including high blood pressure, Type-2 diabetes, depression, obesity, and cancer.1,2

It is no surprise that correcting sleep problems is a top priority for the general public and healthcare providers alike when you consider all of the negative consequences of inadequate sleep and the fact that 50-70 million people have a sleep or wakefulness disorder.  Subsequently, we see a relatively high number of people using over-the-counter (OTC) and/or prescription sleep aids on a fairly regular basis.  But what if OTC and prescription sleep aids were also significantly contributing to increased health risks?

You may recall one of our past newsletters discussing a study that identified a possible link between the use of a class of medications commonly used to treat insomnia and anxiety, called benzodiazepines (BDZ’s), with an increased risk of developing Alzheimer’s disease.5  Now, it appears that BDZ’s are not the only sleep-inducing medication with significant links to neurological disorders including cognitive disturbances, dementia and Alzheimer’s disease.  New research has indentified yet another class of medications with potential for causing long-term neurological effects.  This class of medications, called “anticholinergics,” includes common antihistamines routinely found in OTC sleep aids.

A recent study, considered to be the largest and most rigorous study of its kind, followed 3,500 participants with an average age of 73 over 7 years and found some alarming results.  The study looked at the participant’s use of short-term and extended use of common OTC sleep-aids including Benadryl, Advil PM, Tylenol PM, and Motrin PM (all containing the antihistamine diphenhydramine as the active ingredient) and found that daily use of these medications for as little as 3 months increased a persons risk of developing dementia.6

The risk of developing dementia appeared to be a cumulative dose response, meaning that the longer you had used the sleep aid the higher risk you had of developing dementia.  People that had used these OTC products daily for 3-7 years had a 54% increased risk of developing dementia compared to only 19% increased risk for those that had used them for 3-12 months.6 It should be noted that current OTC and prescription drug labels recommend not using these medications for longer than 2 weeks unless recommended and monitored by your doctor, though people frequently disregard this warning.

The finding should not come as a complete surprise to most doctors and pharmacists.  We have known for several decades that anticholinergic drugs can cause mental disturbances and cognitive impairment, especially in the elderly.  In fact, most anticholinergic drugs including common sleep-inducing antihistamines are included on a list of medications that are potentially dangerous or inappropriate for use in people over age 65 for this very reason (see The Beers Criteria).7  We also know that the effects of anticholinergic drugs are tied into Alzheimer’s disease because the most commonly prescribed medication for Alzheimer’s disease (donepezil/Aricept) is actually a “cholinergic” drug – meaning it exerts the opposite pharmacological effect of anticholinergic drugs found in OTC sleep aids.

The neurological effects of anticholinergics has been known, but was largely thought to be an acute reaction, meaning the effects would disappear after stopping the medication. However, this notion was challenged with the most recent data that suggested that the increased risk of dementia persisted even years after discontinuing the medication, meaning that the neurological effects of anticholinergic medications may be irreversible.6 This significant finding is concerning due to the widespread and frequently long-term use of antihistamine-based OTC sleep aids.Finding Safer Alternatives

You are not without hope when it comes to finding safe and effective sleep aids that do not come with all of the negative side effects and consequences of common OTC and prescription sleep aids.  Viniferamine Sleep Support uses natural ingredients that have been shown to help regulate your sleep cycle and promote restful sleep.  It utilizes natural sleep-inducing melatonin along with the relaxing effects of magnesium and curcumin.8–10  It also provides potent antioxidants from the olives, green tea, and grapevines that have each been shown to reduce the risk of cognitive decline, dementia, and even Alzheimer’s.11–13

You need to sleep and there are times when it might be appropriate to include strong OTC or prescription sleep aids, however this is something you should work with your health care providers to determine.  Just because a sleep aid is available without a prescription does not mean that it does not contain potent pharmaceutical agents that can cause negative side effects, even years after they have been used.  Viniferamine Sleep Support only uses natural ingredients with well-established safety and efficacy, even with extended use.  If you have been having trouble sleeping and are worried about the long-term effects of OTC or prescription sleep aids, you may benefit from trying Viniferamine Sleep Support.  You may experience additional benefit by incorporating Viniferamine Mood SupportViniferamine Energy Support can also be used to help address daytime fatigue and drowsiness.

 

References

1.        Centers for Disease Control and Prevention. National Sleep Awareness Week Unhealthy Sleep-Related Behaviors. MMWR. 2011;60(8):1–36. 

2.        Daley M, Morin CM, LeBlanc M, Grégoire J-P, Savard J. The economic burden of insomnia: direct and indirect costs for individuals with insomnia syndrome, insomnia symptoms, and good sleepers. Sleep. 2009;32(1):55–64.

3.        Spira AP, Kaufmann CN, Kasper JD, et al. Association between insomnia symptoms and functional status in U.S. older adults. J Gerontol B Psychol Sci Soc Sci. 2014;69(7):S35–41.

4.        Vgontzas AN, Fernandez-mendoza J, Bixler EO, et al. Persistent Insomnia : the Role of Objective Short Sleep Duration and Mental Health. Sleep. 2012;35(1):61–68. 

5.        Billioti de Gage S, Moride Y, Ducruet T, et al. Benzodiazepine use and risk of Alzheimer’s disease: case-control study. BMJ. 2014;349(sep09 2):g5205–g5205.

6.        Gray SL, Anderson ML, Dublin S, et al. Cumulative Use of Strong Anticholinergic Medications and Incident Dementia. JAMA Intern Med. 2015;175(3):401–7.

7.        American Geriatrics Society. American Geriatrics Society updated Beers Criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2012;60(4):616–31.

8.        Zhdanova I V, Wurtman RJ, Regan MM, Taylor J a, Shi JP, Leclair OU. Melatonin treatment for age-related insomnia. J Clin Endocrinol Metab. 2001;86(10):4727–30. 

9.        Abbasi B, Kimiagar M, Sadeghniiat K, Shirazi MM, Hedayati M, Rashidkhani B. The effect of magnesium supplementation on primary insomnia in elderly: A double-blind placebo-controlled clinical trial. J Res Med Sci. 2012;17(12):1161–9.

10.     Xu Y, Lin D, Li S, et al. Curcumin reverses impaired cognition and neuronal plasticity induced by chronic stress. Neuropharmacology. 2009;57(4):463–71.

11.     Bastianetto S, Quirion R. Natural Antioxidants and Neurodegenerative Disease. Eur J Clin Nutr. 2004;45:3447–3452. 

12.     Féart C, Samieri C, Rondeau V, et al. Adherence to a Mediterranean diet, cognitive decline, and risk of dementia. JAMA. 2009;302(6):638–48.

13.     Ogle WO, Speisman RB, Ormerod BK. Potential of Treating Age-Related Depression and Cognitive Decline with Nutraceutical Approaches: A Mini-Review. Gerontology. 2012:1–9.


About the author:
Kyle Hilsabeck, PharmD., is the Vice President of Pharmaceutical Affairs at McCord Holdings and licensed by the Iowa Board of Pharmacy.  He completed bachelors degrees in biology and biochemistry at Wartburg College before earning his Doctorate of Pharmacy from the University of Iowa College of Pharmacy. Upon graduation, he completed a community pharmacy practice residency through the University of Iowa where he focused primarily on nutritional aspects of care including the use of vitamin, mineral, and herbal supplements.  He has taught courses for the University of Iowa College of Pharmacy on vitamins, minerals, herbs, and nutritional supplements and given many presentations on the subject as well.  He has a passion for improving patient care specifically with regards to the safety and quality of the nutritional supplements and health information people use.  

 

Disclaimer: These statements have not been reviewed by the FDA. These products are dietary supplements and are not intended to treat, cure, or prevent any disease. The decision to use these products should be discussed with a trusted healthcare provider. The authors and the publisher of this work have made every effort to use sources believed to be reliable to provide information that is accurate and compatible with the standards generally accepted at the time of publication. The authors and the publisher shall not be liable for any special, consequential, or exemplary damages resulting, in whole or in part, from the readers’ use of, or reliance on, the information contained in this article. The publisher has no responsibility for the persistence or accuracy of URLs for external or third party Internet websites referred to in this publication and does not guarantee that any content on such websites is, or will remain, accurate or appropriate.

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