Are common medications interrupting your sleep?

 

The reasons we might experience insomnia or sleep fragmentation are varied.

Emotional stress, pain, sleep disorders, medical conditions, and poor sleep hygiene are the most talked about root causes for sleeplessness.

But what about your prescriptions? Might they be contributing to poor sleep? 

Yes. As a matter of fact, there are several common classes of drugs that can cause insomnia. Below, we discuss ten of them.

Ten common medications that can cause insomnia

Many more drugs than these have been shown to lead to sleep deprivation, but these are among the most commonly prescribed.

1. Alpha blockers 

Common examples: doxazosin (Cardura), prazosin (Minipress), tamsulosin (Flomax)

Purpose: Controlling high blood pressure and treating Raynaud's disease and benign prostatic hyperplasia. Alpha blockers relax certain muscles and keep the walls of small blood vessels loose and open.

Impact on sleep: Alpha-blockers have been shown to reduce REM (rapid eye movement) sleep. For older people, there is a higher risk for memory problems related to loss of critical REM sleep, a key stage in healthy sleep architecture

2. Angiotensin-convertingenzyne (ACE) inhibitors

Common examples: benazepril (Lotensin), enalapril (Vasotec), lisinopril (Prinivil, Zestril)

Purpose: Controlling high blood pressure and treating congestive heart failure. ACE inhibitors relax the blood vessels and prevent the production of the hormone that narrows blood vessels, angiotensin II.

Impact on sleep: ACE inhibitors have other side effects which might lead to interrupted sleep, such as dry hacking cough; nocturnal leg cramps; achy joints, bones, and muscles; and diarrhea.

3. Angiotensin-II receptor blockers

Common examples: candesartan (Atacand), irbesartan (Avapro), losartan (Cozaar)

Purpose: Treating coronary artery disease or heart failure for patients who have type II diabetes or kidney disease associated with diabetes, or for those who cannot tolerate ACE inhibitors.

Impact on sleep: Like ACE inhibitors, these drugs has side effects like nocturnal leg cramps; achy joints, bones, and muscles; and diarrhea—all of which can lead to disrupted sleep.

4. Antidepressants (SSRIs)

Common examples: citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac, Sarafem), paroxetine (Paxil, Pexeva) and sertraline (Zoloft)

Purpose: SSRI stands for selective serotonin-reuptake inhibitor. These drugs may ease the impact of depression by possibly preventing the brain from reabsorbing (or reuptaking) a specific substance known as serotonin; doing so may help the brain more effectively send and receive other chemical messages.

Impact on sleep: SSRIs may cause insomnia and agitation in 1 in 5 people who take them. In the STAR*D trial published in 2011, it was shown that as many as 8 out of 10 SSRI users struggled specifically with being unable to sleep in the middle of the night. This is significant since the associations between depression and sleep disorders like insomnia are considerable.

5. Antihistamines

Common examples: cetirizine (Zyrtec), fexofenadine (Allegra), loratadine (Claritin)

Purpose: Specifically, antihistamines classified as H1 antagonists are used to inhibit the body's ability to produce histamine, the chemical released during an allergic reaction, in order to prevent allergy symptoms such as sneezing, watery eyes, itching, runny nose, hives, and congestion. 

Impact on sleep: Using antihistamines can block the presence of an important neurotransmitter, acetylcholine, which leads to insomnia. 

6. Beta blockers

Common examples: metoprolol (Lopressor, Toprol), propranolol (Inderal), sotalol (Betapace), timolol (Timoptic) 

Purpose: Controlling high blood pressure and treating cardiac arrhythmias, angina, migraine, certain kinds of glaucoma, and tremor. Beta blockers slow the pulse and control the effect of adrenaline in the bloodstream.

Impact on sleep: Beta-blockers are know to cause frequent nocturnal arousals and nightmares due to their inhibition of the important sleep-regulating hormone, melatonin.  

7. Cholinesterase inhibitors

Common examples: donepezil (Aricept), galantamine (Razadyne) and rivastigmine (Exelon)

Purpose: Treating memory loss and cognitive dysfunction in those with Alzheimer's disease and other forms of dementia.

Impact on sleep: Cholinesterase inhibitors break down an important neurotransmitter known as acetylcholine, which can cause sleep-disrupting side effects such as diarrhea, nausea, heart rhythm changes, muscle spasticity, and vomiting, as well as abnormal dreams. 

8. Corticosteroids

Common examples: cortisone, methylprednisolone (Medrol), prednisone (Deltasone and Sterapred)

Purpose: Treating inflammation of the muscles and the blood vessels; also a common treatment for allergic reactions, gout, lupus, multiple sclerosis flareups, rheumatoid arthritis, and Sjögren's syndrome.

Impact on sleep: Corticosteroids can fatigue the adrenal glands, which are responsible for regulating stress responses. Unchecked stress leads to an overstimulated mind and an inability to relax so you can fall asleep, leading to both insomnia and nightmares.

9. Glucosamine and chondroitin

Purpose: These common over-the-counter dietary supplements are taken for arthritis to relieve joint pain, improve joint function, and reduce joint inflammation. 

Impact on sleep: Side effects include nausea, diarrhea, and headaches, which can cause sleep disturbance, as well as insomnia.

10. Statins

Common examples: atorvastatin (Lipitor), lovastatin (Mevacor), rosuvastatin (Crestor) and simvastatin (Zocor).

Purpose: Reducing high cholesterol.

Impact on sleep: Statins most commonly cause muscle pain that can disrupt sleep. Also, some statins are more likely to cause insomnia and nightmares because they are fat soluble and more easily absorbed by cells, especially across the blood-brain barrier, which exists to keep out potentially damaging chemicals. 

Other considerations regarding sleep and prescription drugs

Interactions

When you take multiple medications, you increase your chances for drug interactions, which can cause, among other things, impaired sleep. Always make sure that every doctor you see has a complete list of all the medications you are taking. They don't want to make the mistake of prescribing a new medication for you that leads to a problematic, even dangerous interaction with something you are already taking. 

Making and keeping an updated medications list should include:

Aging

The older you get, the more likely you will be taking more medications. Aside from problematic drug interactions, aging alone can make it more difficult to get good sleep.

It's important to make sure you have an open dialog with your doctors at all times regarding symptoms like insomnia because these may also be symptoms of another emerging health concern and not just a side effect of medication or the result of a drug interaction.

Only your doctor can know for sure; please don't self diagnose that you are sleep deprived because of your medications or make assumptions linking prescriptions and sleep without first running your concerns by your doctor.

What to do if you suspect your medications are causing insomnia

First things first: never stop taking a medication without first asking the prescribing physician about doing so. Some medications cannot be stopped without "tapering" off safely, and you could do more harm than good.

Doctors generally have a list of medications they routinely prescribe for certain conditions which includes alternatives for those who do not respond to their first choices.

It should not be a problem to tell your doctor you suspect your medication is keeping you awake at night and ask for an alternative prescription.

When you receive new medications, make sure you read all the labels and packaging information provided to you by the pharmacy. You can also take labeled medications to your local pharmacist to ask them if insomnia or fragmented sleep is a common side effect.

The United States Food and Drug Administration also curates a drug website you can search for information about any given prescription (found here). If you believe you are experiencing sleep problems previously documented as side effects for a medication you're taking, you can also report your experience at their MedWatch drug safety database


Sources:

AARP ("Ask the Pharmacist" columnist Armon B. Neel Jr., PharmD, CGP)
Mayo Clinic
National Sleep Foundation
SleepDex
United States Food and Drug Administration

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