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Comment by ProfessorLayton | Hacker News Reader

Melatonin works mildly well for me for a few days, but quickly stops working again, which is unfortunate. I will admit I also have some anxiety issues I need to work on.

For better or worse, a low dose of diphenhydramine hcl (12mg) has continued working for me for over a decade without needing to up the dose. My personal experience as far as habit forming goes: I only take it on work nights, and sleep just fine on weekends, or if I'm on vacation. My main issue with sleeping is the specific times I need to do it. If I'm able to sleep when I'm sleepy, and wake up when I'm not, then I don't need any medication. Unfortunately, that doesn't fit in with a typical work schedule.

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The problem with is diphenhydramine is the increased Alzheimer's risk: https://www.health.harvard.edu/blog/common-anticholinergic-d...

Fascinating, thanks for that link. I had never heard of the "anticholinergic cognitive burden scale".

http://www.miltonkeynesccg.nhs.uk/resources/uploads/ACB_scal...

Well that's concerning. I brought up long-term use to my GP, and didn't seem too concerned, but asked me to switch to melatonin, which I tried for a while.

These studies are extremely difficult to make an informed decision on, thanks to nearly everything being "linked" to some disease. See: Red meat [1]

I need to wean off it though. Thankfully dementia doesn't run in my family.

https://www.iarc.fr/wp-content/uploads/2018/07/pr240_E.pdf

Have you tried trazadone or mirtapine? I've had good results with trazadone, bu would wake up after 5-6 hours with adolescent-like erections and read that it can actually cause priapism; mirtazapine works wonderfully(also a very strong antihistamine at lower dosages) but it leaves me groggy for 24 hours.

On the subject of mirtazapine, I was like a zombie for the first week @15mg and ready to ditch it but the doc persuaded me to stick it out and sure enough the chronic drowsiness went away by the following week, leaving only the potent sleep induction that encouraged an increase to 30mg.

But this thread terrifies me now, finding it's also a dementia-inducer. Is there any literature I can review to either allay or justify the fear? Additional horrifying fact from same physician: Chronic benzo use also linked to dementia?

Gauche to follow up on my own post but the mirtazapine-dementia link is strong in this study https://www.health.harvard.edu/mind-and-mood/two-types-of-dr... but rather weak, and correlative rather than causative if my reading of this study https://www.ehealthme.com/ds/mirtazapine/dementia/ is correct (in that roughly half of the demented patients were co-dosed with an antipsychotic, presumably to help manage the agitation that can accompany dementia) . So now I feel I really need someone much better versed in medicine to advise.

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I used to react strongly to antihistamines, even weak ones, that are not supposed to induce sleep (levocetirizine would knock me off), but after mirtazapine I got a semi-permanent tolerance to other antihistamines sleep inducing properties -- so if other antihistamines cause dementia, I'd expect mirtazapine to do so as well.

It's also a pity because I used to feel quite well rested and clear headed the day after antihistamines.

Lack of sleep is also terrible for your health in so many ways though, and is also associated with Alzheimers. Of course antihistamines decreases your sleep quality but if it helps you get through rough patches I think it's a good alternative.

Taking it every day for years though is probably not a good idea.

I have this exact same pattern, where the effectiveness lasts for 1-3 days then stops. This is regardless of whether the dosage is 10 mg or 1 mg (Ive never tried 0.3 mg because I never bothered to crush the pills and weigh). The reset period seems to be on the order of 4-8 weeks before its effective again.

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