Are some of your medications impacting your sleep? – Dr Wendy Davis ND

Are some of your medications impacting your sleep?

Certain medications have the potential to negatively affect a person’s sleep. Many medications, from cold and flu remedies to cancer treatments, can cause insomnia, making it hard to either fall or stay asleep.

Adding insult to injury, some people develop insomnia after they start a medication or during the withdrawal period after they stop taking a drug. One study reported at least 17% of North American adults reported taking at least one drug that listed sleep disturbances as a side effect.

In addition to causing insomnia, some medications affect sleep architecture, or how the sleep cycle is structured. During healthy sleep, people cycle through three stages of non-rapid eye movement sleep and one stage of rapid eye movement (REM) sleep multiple times each night. Disrupted sleep architecture is often associated with sleep disorders and health problems.

Cold and Allergy Medications

Over-the-counter cold medications often contain a decongestant drug called pseudoephedrine, used to reduce nasal congestion. Pseudoephedrine is known to cause insomnia.

Some antihistamine medications promote sleep, so pseudoephedrine may be added to them to prevent drowsiness. As a result, antihistamines that are marketed as “non-drowsy” or containing a decongestant may interfere with sleep, but these can wreak havoc on a healthy sleep cycle.

Occasionally steroid medications called corticosteroids are given to individuals with severe allergies. Corticosteroid inhalers and nasal sprays are less likely to affect sleep, but many oral steroid drugs are known to keep those who take them awake at night.

Additionally, the cough suppressant dextromethorphan can trigger restlessness and agitation. Some people may experience trouble sleeping as a result.

SSRI Medications (Antidepressants)

Causing both drowsiness or insomnia, most antidepressants affect sleep, but ironically some doctors may prescribe a type of antidepressant, called a selective serotonin reuptake inhibitor (SSRI), for insomnia. However, it is not clear how effective these medications are at helping people sleep.

Like other types of antidepressants, SSRIs lengthen stage 1 sleep and reduce REM sleep. Stage 1 is the lightest phase of the sleep cycle, when the sleeper is easiest to wake. This may be why SSRIs cause some people to wake frequently in the night and sleep for fewer hours in total.

While a few studies suggest that SSRIs might help some people sleep better, real life reactions appear to be mixed and depend on which drug the individual is taking. Certain SSRIs such as ​​fluoxetine and paroxetine seem more likely to cause insomnia than others. People may also experience sleep issues if they abruptly stop taking an SSRI without tapering off their dosage.

Beta Blockers (Blood Pressure Medications)

Beta blockers treat high blood pressure by slowing the heart rate. Some beta blockers are fat soluble, which means that they are stored in the body’s fats and tissues. Others are water soluble and stay within the blood and surrounding fluids. Water-soluble beta blockers do not affect sleep, but fat-soluble beta blockers can interfere with sleep, examples of these are; labetalol, metoprolol, pindolol and propranolol.

People who take fat-soluble beta blockers may wake up frequently at night, experience more nightmares, and struggle to fall back asleep. Both types of beta blockers reduce the amount of time spent in REM sleep. Independent of their effect on sleep, beta blockers may also cause daytime sleepiness.

Anti-Inflammatory Corticosteroids

Corticosteroids, particularly glucocorticoids, are often used to treat a variety of health conditions, including lung diseases, allergies, inflammatory disorders, autoimmune conditions, and some cancers. Common steroid drugs, such as prednisone and prednisolone, may be taken orally, injected, inhaled, or applied to the skin.

Sleep problems are common among people who take corticosteroids, especially those who take their medication twice a day or at night. Sleep troubles may happen because steroid drugs disrupt the body’s hormone production patterns and decrease melatonin production.

People who take steroids often report waking up frequently at night. Corticosteroids may also trigger mania, a mood condition that causes a person to require less sleep.

Dopamine Agonists (Parkinson's Disease Medications)

Dopamine agonists are used to treat mild or moderate Parkinson’s disease and certain mental health conditions. These medications activate dopamine receptors in the brain.

Dopamine agonists can cause daytime sleepiness and help people fall asleep faster. Some may alter sleep architecture by preventing REM sleep and lengthening the amount of time spent in stage 3 sleep.

Although dopamine agonists make many people feel more tired, these drugs are also associated with insomnia in some studies. Also, dopamine agonists can cause side effects, like nausea, vomiting, and dizziness, that may keep a person up at night.

Nicotine Replacement Treatments

Nicotine replacement therapy helps people quit smoking. Nicotine replacement aids come in many forms such as gum, a patch, an inhaler, lozenges, or nasal spray to help prevent cravings and withdrawal symptoms.

Nicotine is known to make people more alert. Nicotine also increases blood pressure and heart rate. Some kinds of nicotine replacement aids can also make it harder to fall asleep.

A nicotine replacement treatment’s side effects depend on how it delivers nicotine, the dosage, and the formulation. Inhalers, for example, do not usually cause sleep disturbances. Other forms, such as the patch or gum, may cause sleep problems, vivid dreams, and nightmares.

Additionally, some nicotine replacement treatments also have side effects that may keep a person awake, including nasal congestion, heartburn, and headaches.

Sleeping Pills

You might be surprised to find sleeping pills on a list of medications that cause insomnia. But some drugs that are intended to treat sleeplessness can cause unwanted side effects.

These sleep medications may complicate sleep for some individuals. For example, benzodiazepines can worsen symptoms of obstructive sleep apnea or cause  sleepwalking or performing actions like driving, talking, and eating while they are not fully awake. Researchers estimate that up to 25% of people who use nonbenzodiazepines experience these behaviors, particularly those who take higher doses of a medication.

People who stop taking prescription sleeping pills may experience rebound insomnia. Rebound insomnia causes a person to have more difficulty falling or staying asleep after going off of a medication than they did before taking it.