Medications can disrupt your sleep

When I’ve had insomnia in the past, I usually know what is causing it, be it a particularly stressful week or a time change due to cross-country flight. But sometimes the cause of sleep troubles isn’t so easy to pinpoint. According to the Special Health Report titled Improving Sleep: A guide to a good night’s rest, you may need to look in your medicine cabinet to find the cause of your sleep woes. Here’s what the report has to say on the subject:

Often, medication rather than illness is the culprit behind sleep problems. A number of drugs steal sleep, while others may cause unwanted drowsiness. Your doctor may be able to suggest alternatives that do not disrupt sleep.

Antidepressants. The selective serotonin reuptake inhibitors (SSRIs) — such as fluoxetine (Prozac), sertraline (Zoloft), and paroxetine (Paxil) — disrupt sleep or produce daytime fatigue in about 10% to 20% of those who take them.

Anti-arrhythmics. These drugs, used to treat heart rhythm problems, may cause daytime fatigue and nighttime sleep difficulties. Such medications include procainamide (Procanbid), quinidine (Cardioquin, others), and disopyramide (Norpace).

Sedating antihistamines. These medications, commonly taken to relieve cold or allergy symptoms, also cause drowsiness in most people. They are also the active ingredients in most over-the-counter sleep aids and motion sickness pills (see “Antihistamines”). To find out if a medication might cause unwelcome drowsiness, check with a pharmacist. If you are taking a sedating antihistamine and are bothered by drowsiness, your physician may recommend a non-sedating alternative that does not readily enter the brain and affect wakefulness and sleep.

Beta blockers. Beta blockers are used to treat high blood pressure, arrhythmias, and angina. These drugs can promote insomnia, awakenings in the night, and nightmares.

Medications containing caffeine. Caffeine, found in some over-the-counter painkillers and appetite suppressants, stimulates the nervous system and can induce insomnia. Caffeine makes people feel alert by blocking the action of adenosine, a substance that promotes drowsiness. Caffeine’s direct effects gradually diminish but may linger for six or seven hours or even longer in some people.

Medications containing alcohol. Cough medicines often contain alcohol, which can suppress REM sleep and break up nighttime sleep.

Clonidine. This medication, which acts on nerve cells that respond to the neurotransmitter norepinephrine, is used to treat hypertension and occasionally to curb nicotine craving in people who are quitting smoking. The drug can cause daytime drowsiness and fatigue; it also may interfere with REM sleep. Some people report no problems with clonidine, but others note restlessness, early morning awakening, and nightmares.

Corticosteroids. Corticosteroids such as prednisone, used to suppress inflammation and asthma, often cause daytime jitters and nighttime insomnia.

Diuretics. Diuretics, which rid the body of excess sodium and water, can interfere with sleep by inducing urination throughout the night. Potassium deficiency, a common side effect of some diuretics, can cause painful nocturnal cramping of calf muscles during sleep.

Nicotine patches. Patches used to curb smoking deliver small doses of nicotine into the bloodstream around the clock. People who use them often suffer insomnia or experience disturbing dreams.

Sympathomimetic stimulants. Sympathomimetic stimulants — such as dextroamphetamine (Dexedrine), methamphetamine (Desoxyn), and methylphenidate (Ritalin) — are powerful central nervous system stimulants that enhance the effect of brain chemicals involved in wakefulness. People taking these agents have difficulty falling asleep; once asleep, they spend less time in REM sleep and non-REM deep sleep. When the drug is discontinued, extreme sleepiness and a craving for REM sleep may follow.

Theophylline. This respiratory stimulant, used to treat asthma, is chemically related to caffeine. Many people who use it require doses that are high enough to disrupt sleep.

Thyroid hormone. Thyroid hormone taken to counteract the effects of an underactive gland may cause sleeping difficulties at higher doses.

Have you found that any medications affect your sleep? Which ones? Were you able to find alternative medications to treat your medical problem without impacting your sleep

Julie K. Silver, M.D., is an assistant professor in the Department of Physical Medicine and Rehabilitation at Harvard Medical School. She is also the Chief Editor of Books for Harvard Health Publications.

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