DEAR DR. ROACH: My wife was having problems getting to sleep and has stocked our medicine cabinet with various p.m. versions of popular pain relievers that have been advertised as sleep aids. Recently, I’ve had problems getting to sleep as well and began taking a single pill before retiring, but I can’t honestly say that they’re helping.

I would appreciate your opinion if these particular “sleep aids” work as advertised, and if so, can you recommend a preferred brand? Additionally, I seem to recall reading that continued use of certain pain relievers can lead to intestinal problems. Should I be concerned that a single, nightly dose of these types of pain relievers can lead to problems?

• T.F.

ANSWER: Over-the-counter medications that are labeled with “p.m.” and advertised as sleep aids are combinations of pain relievers (acetaminophen (Tylenol), ibuprofen (Advil and others), naproxen (Aleve), and diphenhydramine (Benadryl and others). Although they are moderately effective as a sleep aid, I don’t recommend them, particularly due to the diphenhy-

dramine component.

Diphenhydramine is an antihistamine that has a side effect of making many (but not all) people drowsy; therefore, it is used to help people fall asleep. However, even this side effect has the potential for more side effects. I am particularly worried about the data consistently showing an increased risk for falls (especially among those who are older and take these medications). I am also worried about motor vehicle accidents when people drive the day after taking them.

Older men can get worsened prostate trouble with these, and although the evidence isn’t absolutely convincing, people who regularly take older, sedating antihistamines like diphenhydramine do have an increased risk of developing dementia. (Newer, nonsedating antihistamines like Claritin, Allegra or Zyrtec are not associated with dementia.)

Anti-inflammatory drugs like ibuprofen or naproxen can cause intestine troubles, particularly bleeding. However, the risk from a single tablet at night is small.

It’s people who take the higher anti-inflammatory doses who are at the highest risk.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu.

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