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If you have difficulty going to sleep, staying asleep, or find that you wake up too early, you may have insomnia. Trying to figure out the cause of these sleepless nights can be tiresome (no pun intended!), but sometimes, it’s as simple as reading the labels on your prescription medications.
Sleep deprivation can wreak havoc on your physical and mental well-being. That’s why it’s critical to understand how drug-induced insomnia impacts your health and what you can do to get a better night’s sleep.
What is drug-induced insomnia?
“Drug-induced insomnia is just what it sounds like—insomnia, or difficulty sleeping, caused by taking certain medications,” says Brynna Connor, MD, a family medicine specialist.
Difficulty falling or staying asleep, or getting good quality sleep is considered insomnia, according to the National Heart, Lung, and Blood Institute. If it occurs for less than three months, it’s called short-term insomnia. Chronic, or long-term, insomnia, occurs three or more nights a week and lasts for 3 months or longer. Drug-induced insomnia can be either short-term or chronic.
While drug-induced insomnia is sometimes caused by a straightforward causal relationship between the interactions of a specific drug with your body’s neurotransmitters or receptors that control your sleep, the relationship between a drug and the side effect of insomnia is often a bit more complex.
“Factors beyond the chemical components of a specific drug and their known side effects that can contribute to drug-induced insomnia include pre-existing conditions or diseases, sleep disorders, sleep patterns, and other indirect effects from medications,” Dr. Connor explains.
What’s more, this condition is commonly observed in people with chronic conditions such as cardiovascular disorders, diabetes, and pulmonary diseases, as some of the therapeutics to treat those chronic diseases can cause insomnia, says Carleara Weiss, Ph.D,, MS, RN, Aeroflow Sleep’s sleep science adviser and a postdoctoral fellow in sleep and circadian rhythms.
9 types of medications that cause insomnia
According to the U.S. Department of Health and Human Services, insomnia is one of the most commonly reported sleep problems. Because a wide variety of medications can cause insomnia, drug-induced insomnia can be quite common. In SingleCare’s sleep survey, 5% of respondents reported insomnia is a side effect of their medication.
“Drug-induced insomnia can be a consequence of stimulants and certain classes of medications,” Weiss says. These drugs cause insomnia for different reasons including their mechanism of action, dose timing, and length of treatment.
Here are some of the more common medications that cause insomnia.
- Cold and allergy medicine
- Blood pressure medications
- Pain relievers
- Antidepressants
- Smoking cessation drugs
- Corticosteroids
- Asthma and COPD medicines
- Stimulants
- Dopamine agonists
1. Cold and allergy drugs
Over-the-counter (OTC) decongestants and allergy medications work wonders to help reduce the sniffles, sneezing, and a runny nose. But the main ingredients in some of these formulas can also cause jitteriness and insomnia. This includes phenylephrine and pseudoephedrine, according to the American Academy of Family Physicians.
Examples of cold and allergy treatments that might contain these medications include DayQuil, Sudafed, Claritin-D, and Allegra-D. If you’re taking cold or allergy meds on a short-term basis, you can probably get by with a few restless nights. But if you take decongestants regularly, talk with your provider about a different medicine that may make it easier to sleep. If possible, avoid taking decongestants close to bedtime.
2. Blood pressure medications
Blood pressure medications like beta blockers and ACE inhibitors are prescribed to treat hypertension and congestive heart failure. Additionally, beta blockers can also be used in the treatment of tremors and angina (and prevention of migraine).
Beta blockers lower blood pressure by blocking the hormone adrenaline. Examples of beta blockers include acebutolol, Tenormin (atenolol), Zebeta (bisoprolol), Toprol XL (metoprolol), Corgard (nadolol), Bystolic (nebivolol), and Inderal (propranolol). According to research from the American Heart Association, beta blockers may be linked to unusual dreams, insomnia, and sleep disorders.
ACE inhibitors relax blood vessels by preventing the body from producing angiotensin. This helps the blood vessels open up, according to the American Heart Association. Examples of ACE inhibitors include Lotensin (benazepril), Zestril (lisinopril), captopril, Vasotec (enalapril), trandolapril, and Altace (ramipril). Dr. Connor says blood pressure drugs like ACE inhibitors might cause insomnia because they induce dry cough, leg cramps, restless leg syndrome, and other symptoms that in many people can interrupt sleep. Talk to your provider if you’re experiencing sleep disturbances from taking a beta blocker or ACE inhibitor.
3. Pain medicines
Over-the-counter (OTC) pain medicines mostly fall into two categories: nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen. Examples of NSAIDs include Advil/Motrin (ibuprofen), Bayer (aspirin), and Aleve (naproxen). The most common acetaminophen drug is Tylenol.
NSAIDs, especially in higher doses, can cause stomach irritation, abdominal pain, acid, bloating, diarrhea, and other gastrointestinal problems. Because of this, some people experience disrupted sleep when taking NSAIDs. If you’re taking an NSAID, consider a lower dose or taking the medicine with a meal. Also, talk to your doctor about other OTC pain relievers that may not cause GI issues.
Excedrin, which is used for headaches, contains acetaminophen, aspirin, and caffeine. This combination does an excellent job of stopping headaches, but the addition of 65 mg of caffeine, can wreak havoc on your sleep if you take it too close to bedtime. Avoid taking Excedrin too close to bedtime, and if you’re dealing with headaches at night, opt for ibuprofen or naproxen or consult your healthcare provider for a plan.
4. Antidepressant drugs
Selective serotonin reuptake inhibitors (SSRIs) are one of the most commonly prescribed drug classes for treating depression. Insomnia is one of the common side effects of these medications. Examples of SSRIs include Zoloft (sertraline), Prozac (fluoxetine), Celexa (citalopram), Paxil (paroxetine), Lexapro (escitalopram), and Luvox (fluvoxamine).
Wellbutrin (bupropion) is a norepinephrine and dopamine reuptake inhibitor (NDRI). It works by keeping the neurotransmitters norepinephrine and dopamine available to the brain’s neurons for longer, according to the U.S. Food and Drug Administration (FDA). One of the main side effects is insomnia—even more than SSRIs—due to increased levels of dopamine and norepinephrine. Talk to your provider if you’re experiencing sleep disturbances from taking antidepressant medicines.
5. Smoking cessation drugs
Nicotine replacement treatments are helpful when you’re trying to quit smoking, but they may also be interfering with your sleep. Smoking cessation drugs, also called nicotine replacement therapy, include patches, gum, inhaler, nasal spray, and lozenges. Examples of smoking cessation drugs that may cause sleep issues include Nicotrol Inhaler, Nicotrol NS, NicoDerm CQ, and Nicorette. They all contain nicotine, which can disrupt sleep. If possible, avoid wearing a nicotine patch while you sleep, or close to bedtime.
Additionally, your doctor may recommend an oral medication for smoking cessation. According to the American Cancer Society, trouble sleeping is a common side effect of Zyban (bupropion). Talk to your provider if you’re experiencing sleep disturbances from smoking cessation treatments.
6. Corticosteroids
Corticosteroids like prednisone and Medrol (methylprednisolone) are anti-inflammatory drugs. They are prescribed for various conditions that involve inflammation of the muscles and blood vessels, such as rheumatoid arthritis, vasculitis, lupus, and allergic reactions.
Unfortunately, because corticosteroids closely resemble cortisol, they can impair your ability to fall asleep, especially if you take them at night. Cortisol is a hormone produced naturally by your adrenal glands that functions as your main stress hormone.
One way to get around interrupted sleep is to talk to your doctor about taking the entire dose in the morning or using the smallest dose possible. Side effects like insomnia are more common in prolonged use and at higher doses, according to the Cleveland Clinic.
7. Asthma and COPD medicines
Chronic obstructive pulmonary disease (COPD) refers to a group of lung diseases (including emphysema and chronic bronchitis) that cause obstructed airflow from the lungs. Another chronic lung condition that causes breathing problems is asthma. Symptoms of both conditions are often treated with prescription medications.
Some of the medications used to treat COPD and asthma, such as albuterol and prednisone, can cause sleep problems, according to Johns Hopkins Medicine. Examples of COPD and asthma drugs include bronchodilators like albuterol, ipratropium, and levalbuterol, among others. Side effects from these medications include nervousness, insomnia, and a rapid heart rate.
If first-line treatments do not work, your doctor may recommend theophylline, a COPD and asthma medication that helps control inflammation in the lungs to ease symptoms. According to the National Library of Medicine, theophylline has stimulating properties similar to caffeine, causing irritability, difficulty falling or staying asleep, and restlessness.
Talk with your provider if your asthma or COPD medications are causing insomnia. They may recommend changing the delivery method or reducing the dose to minimize side effects.
8. Stimulant medications
Stimulants like Ritalin (methylphenidate) and Adderall (amphetamine and dextroamphetamine) are central nervous stimulants prescribed for attention deficit hyperactivity disorder (ADHD) and narcolepsy, according to the National Institute on Drug Abuse. Both are known to increase alertness, energy, and attention. However, this may cause insomnia, especially if the dose is too high or you take them too late in the evening.
9. Dopamine agonists
Additionally, Dr. Connor says dopamine agonists, which are medications that work on dopamine, can cause insomnia. This includes medicines for Parkinson’s disease like Sinemet (carbidopa-levodopa) and restless leg syndrome medication such as Mirapex (pramipexole).
Treatment options for drug-induced insomnia
Talk to your physician if you have developed new sleep patterns or lack of sleep with any new medications. One simple adjustment, if possible, is to take your medicines at a different time of the day, especially if you’ve been taking it in the late afternoon or evening hours. Taking them in the morning instead of the end of the day allows for the adverse effects on sleep to wear off throughout the day.
In partnership with your healthcare team, treatment options for drug-induced insomnia include reducing your dosage or changing medications if possible. “You should always talk with your physician if you think medication is affecting your sleep as there are so many different medications for various medical conditions,” Dr. Connor says. “Your provider may be able to prescribe you a different medication that will alleviate your insomnia.”
Dr. Connor often talks with patients about how to “start low and go slow” as they titrate up on medication dosages in order to use the lowest amount possible while still getting the desired effect of the medication.
