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ASK THE DOCTORS: Readers ask about melatonin, sodium intake

Posted Dec 9, 2018 at 4:26 PM Updated Dec 9, 2018 at 4:26 PM

Hello, dear readers! Once again, you’ve filled our overflowing mailbox with questions, concerns and some kind words:

• “I’m in my mid-50s and am having trouble sleeping. Melatonin was effective, but only for a short time. A friend suggested taking ibuprofen p.m.; it works very well, but I’m concerned about taking it on a daily basis. Is it safe to take each night?”

Pain relievers targeted for nighttime use can be helpful with sleep issues because many of them contain diphenhydramine, an antihistamine also called Benadryl. Drowsiness is one of the drug’s side effects, which is why it’s used in over-the-counter sleep aids. While it’s a useful fix for the short-term, like for sleeping through a long flight, it’s not a great long-term solution. If you want to use Benadryl, we recommend you opt for the sleep aid rather than the pain reliever, which contains medication you don’t need.

However, the quality of sleep from Benadryl use is generally not very good. For our own patients, our preference for insomnia supplements is melatonin or magnesium. When supplements aren’t effective, then we suggest the prescription medication trazodone.

• “I’ve been hearing a lot about cherry complex, which is supposed to be good for you. But what’s in it? What does it actually do?”

You’re referring to a supplement derived from either the fruit or the bark of black cherries, which are believed to have antioxidant properties. According to some studies, antioxidants may be a hedge against inflammation, which plays a role in disease. Black cherry, also known as wild cherry, has long been an ingredient in herbal medicine and home remedies. In colonial times, it was used in cough syrups, as a sedative and for pain relief. The makers of various cherry complex products claim it is useful for cough, chest congestion and diarrhea. Due to certain chemical properties of wild cherry, however, it should not be used by women who are pregnant or breastfeeding. Those chemicals can also change the rate at which the liver breaks down certain medications. Due to a lack of studies into the use of wild cherry, dosage is basically guesswork. We recommend talking to your family doctor before using cherry complex to be sure it’s right for you.

• “When we perspire, do we lose sodium that we can (or perhaps should) then restore by taking in more sodium than we otherwise would? If so, how can we tell how much sodium we can safely add? Let’s assume that our regular diet keeps us at an acceptable sodium level.”

It’s the job of our kidneys to regulate sodium and water balance, and when they’re healthy, they do it extremely well. The sodium we lose when we sweat is replenished via the foods we eat. If for any reason there is either a deficiency or an excess of sodium, the kidneys will correct the imbalance. For most of us, the teaspoon or so of salt that we consume each day is adequate. Elite or endurance athletes may occasionally require more, but they are the exception.

Eve Glazier, M.D., MBA, is an internist and associate professor of medicine at UCLA Health. Elizabeth Ko, M.D., is an internist and assistant professor of medicine at UCLA Health. Send your questions to askthedoctors@mednet.ucla.edu.