Key takeaways
Propranolol is a beta blocker that’s used to treat heart conditions, migraines, essential tremors, and kidney tumors.
Beta blockers like propranolol can impact sleep in various ways, including triggering insomnia, unusual dreams, and sleep disorders in certain individuals.
If you are experiencing insomnia while taking propranolol, talk to a healthcare provider about changing the time of day to take your medication, changing your dose, or exploring alternative medications.
Propranolol, sold under the brand name Inderal, is a type of beta blocker medication approved to treat high blood pressure, chest pain (angina), irregular heart rhythms, and heart muscle enlargement. It’s also approved to prevent migraines, manage essential tremors, and treat symptoms from pheochromocytoma, a kind of adrenal gland tumor. Off-label uses include the treatment of anxiety, panic attacks, agitation, and hemangiomas.
If you are taking propranolol, you may have heard of propranolol insomnia, which describes the phenomenon of experiencing sleep issues while taking it. While propranolol insomnia happens to some individuals, it’s not very common. We’ll cover why it happens, what to do if you experience it, and when to see your healthcare provider to discuss it.
Does propranolol make you sleepy?
Fatigue and sleepiness are well-known side effects of propranolol. People prescribed propranolol should avoid operating machinery until they know how the medication affects them.
“Fatigue occurs because propranolol slows the heart rate and decreases sympathetic nervous system activity,” explains Lizzie Benge, MD, sleep medicine physician with Brigham and Women’s Hospital and instructor at Harvard Medical School. This often leaves people feeling sleepy or lethargic.
Can propranolol cause insomnia?
But despite the symptoms of fatigue that propranolol can cause, propranolol can paradoxically cause both drowsiness and insomnia, according to Dr. Benge. “Propranolol may interfere with normal sleep patterns by reducing melatonin levels and altering REM sleep, preventing restful sleep,” she says. So someone may feel drowsy while taking propranolol but struggle to get a good night’s sleep as well.
“Propranolol can cause insomnia for some people, but it’s not something everyone experiences. If it does cause sleep issues, the problem might get better over time as your body adjusts to the medication,” says Raj Dasgupta, MD, a quadruple board-certified physician specializing in internal medicine, pulmonology, critical care, and sleep medicine.
Research supports this potential occurrence as well. For instance, a 2021 systematic review and meta-analysis published in the American Heart Association’s Hypertension found that insomnia, unusual dreams, and sleep disorders occur at times in people taking beta blockers like propranolol. As the researchers point out, beta blockers have also been linked to nightmares, hallucinations, and anxiety.
As for how long insomnia can last while taking propranolol, that also varies between one individual and another. “The duration of insomnia varies depending on the individual, the dosage, and how the body adapts to the medication,” says Dr. Benge. “In some cases, insomnia subsides after a few days to weeks as the body adjusts.”
Why does propranolol cause insomnia?
It’s not known why propranolol causes insomnia. But research has found that propranolol crosses the blood-brain barrier. In doing so, propranolol “may interfere with neurotransmitters such as norepinephrine, which play a role in regulating the sleep-wake cycle,” Dr. Benge says. Additionally, propranolol can reduce nocturnal melatonin production, making it more difficult for people to fall asleep and stay asleep.
Other factors may impact your sleeping experience while taking propranolol. Dr. Benge says the risk of insomnia may increase if propranolol is taken with other medications that affect sleep, such as central nervous system (CNS) stimulants. “Factors such as stress, which often leads to propranolol use, or the timing of medication administration may also contribute to sleep disturbances.”
How to prevent propranolol insomnia
If you are experiencing propranolol insomnia, there are several strategies you can consider. Here are some tips from Dr. Benge:
- Take propranolol earlier in the day to reduce its impact on sleep.
- Avoid doses closer to bedtime.
- Consider melatonin supplementation, with healthcare provider approval.
- Ask your healthcare provider about lowering the dose of propranolol to decrease CNS-related side effects like insomnia.
- Ask your provider about switching to a long-acting or extended-release formulation of propranolol, and take it in the morning.
Are there any propranolol alternatives that won’t cause insomnia?
According to Dr. Rabii, finding a viable alternative depends in part on the reason you were prescribed propranolol. “In most cases, if you have to be on a beta blocker specifically, they can all potentially cause insomnia,” says Kevin Rabii, DO, a cardiologist with Memorial Hermann. As such, you should ask your healthcare provider if there is a medication in a different drug class that is appropriate to treat your condition.
However, when beta blockers are the only option, keep in mind that some people might experience fewer side effects with certain beta blockers over others. “Discussing alternative medications with your healthcare provider, such as selective beta blockers that do not cross the blood-brain barrier (e.g., atenolol), might be a viable option,” Dr. Benge says.
Other propranolol side effects
Sleepiness, sleep disturbances, and insomnia aren’t the only potential side effects of propranolol. Other common side effects include:
- Lightheadedness
- Fatigue
- Nausea
- Dizziness
- Lowered sex drive
- Stomach pain
- GI symptoms like constipation or diarrhea
Serious side effects are possible with propranolol. Definitely reach out to your healthcare provider or get an urgent evaluation in the emergency department if you experience any of the following:
- Shortness of breath or trouble breathing
- Difficulty swallowing
- A new rash
- Hives
- Peeling, blistering skin
- Swelling of your face, lips, tongue, or throat
- Feeling like you are going to faint
- Atypical weight gain
- Irregular heartbeat
When to see your healthcare provider about propranolol insomnia
Not everyone will get insomnia with propranolol. When they do, it’s usually temporary, and subsides after a few days, as their body gets used to the medication. If that doesn’t happen, it might be time to seek medical advice. If propranolol insomnia persists, “consulting a healthcare provider to explore alternative treatments or dosing adjustments is essential,” Dr. Benge says.
It’s also vital to discuss any changes to your medication routine with your healthcare provider, as well as any supplements you are considering, such as melatonin. “It’s best to have a conversation with your healthcare provider to figure out which medication is most likely to work for you and your underlying condition without interfering with your sleep,” Dr. Dasgupta emphasizes.
- Do β-blockers cause depression?: Systematic review and meta-analysis of psychiatric adverse events during β-blocker therapy, Hypertension (2021)
- The association between beta blocker therapy and daytime sleepiness in obstructive sleep apnoea, Sleep and Biological Rhythms (2021)
- Effects of prolonged use of β-adrenoblockers on melatonin secretion, sleep quality, and vascular brain damage, Neuroscience and Behavioral Physiology (2022)
- Propranolol (cardiovascular), MedlinePlus (2023)