Nancy L. Keating

Q. I take ibuprofen p.m. on occasion -- maybe once a month or so -- to help me get to sleep. It seems to work. Is that OK?

A: Ibuprofen p.m. is a combination medication that contains ibuprofen and diphenhydramine. Diphenhydramine is the active ingredient in Benadryl, an antihistamine taken for allergies. The ibuprofen will help easy any aches or pains. The diphenhydramine makes most people drowsy. That's why ibuprofen p.m. is probably helping you get to sleep.

In general, it's OK for most people to use diphenhydramine to help them fall asleep. Small, infrequent doses are not likely to cause any harm, although diphenhydramine is not without its problems. The sedating effect may last, so you may be drowsy the next day, even if you did sleep well. And the list of possible side effects from diphenhydramine (blurred vision, constipation, dry mouth) would give anyone pause. Side effects are more common and pronounced in older people.

If you don't have any pain and sleep alone is the problem, I'd recommend taking just diphenhydramine. Although a low dose of ibuprofen is generally safe, why take an extra drug if you don't need it?

For people who have not tried diphenhydramine for sleep, start with a low dose, 25 milligrams before bed. If that doesn't seem to help and you don't feel groggy the next day, you can try 50 milligrams. Don't plan on driving or operating machinery the day after you take your first dose, or if you have increased the dose. You want to be certain that you're not one of the people with lasting drowsiness.

If you find you need to take diphenhydramine often, you may be experiencing insomnia, which is defined as complaints of disturbed sleep in the presence of adequate opportunity and circumstance to get it. Patients who have insomnia for 30 days or more are considered to have chronic insomnia, and experts recommend against treating chronic insomnia with diphenhydramine.

So, if you find yourself reaching for ibuprofen p.m. on a regular basis, I'd suggest you talk with your doctor about your sleep and what can be done to improve it.

(Nancy L. Keating, MD, MPH, is an associate professor of medicine and of health care policy at Harvard Medical School and an associate physician at Brigham and Women's Hospital, Boston, Mass.)

 

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Health - Is it OK to Take Ibuprofen P.M.?