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Short Summary
Main recommendation: Avoid nightly use of anticholinergic medications for sleep, because long-term use is linked in research to an increased risk of dementia. The speaker names six drugs in this class and says that occasional use for rare insomnia is probably fine, while nightly long-term use is the concern.
Key Points
- The anticholinergic class is linked in multiple research studies with increased dementia risk, and many doctors prescribe these drugs for insomnia even though they are not FDA-approved for that use.
- Sleepiness from a drug is not the same as healthy restful sleep; the speaker compares nightly use to drinking a fifth of vodka to pass out.
- Over-the-counter status does not mean safe: diphenhydramine is sold as Benadryl, Z-Quil, Unisom, and many generics.
- The six named drugs are diphenhydramine, amitriptyline (Elavil), doxepin (Sinequan, Silenor), hydroxyzine (Vistaril, Atarax), quetiapine (Seroquel), and trimipramine (Surmontil).
- Research so far shows older people using these for insomnia have higher dementia risk, but there is little research on younger adults using them nightly, which the speaker says is still a concern.
Details Worth Noting
- Concrete instructions: Avoid taking any of the six named anticholinergics every night for sleep, including over-the-counter diphenhydramine, and do not give diphenhydramine to children nightly for sleep. Occasional use for rare insomnia is described as probably fine. If you currently take one, speak with your doctor and ask whether the dementia link applies to you, whether you can switch to another option, or whether you can wean down and stop. Dr. Berry recommends that everyone over 40 avoid nightly use of these medications.
- The speaker is a family physician who presents these views in a video; the content is what the speaker says and is not individualized medical advice.
- Hydroxyzine is described as often given as a "safe" insomnia medication despite being an anticholinergic.
- Quetiapine's research so far concerns older adults, while the speaker argues the risk may also apply to people in their 20s to 40s.
- Dr. Berry says, in his opinion, trimipramine carries the dementia risk regardless of age.
Bottom Line
Dr. Berry recommends avoiding nightly long-term use of anticholinergic sleep aids, and he advises anyone currently taking one to talk with their doctor about alternatives rather than stopping abruptly on their own.
