10 Common Medications That Can Affect Sleep

3. Blood pressure medications

Class of medications and common names:

• Angiotensin-converting enzyme (ACE) inhibitors: benazepril (Lotensin), enalapril (Vasotec), lisinopril (Prinivil), quinapril (Accupril), ramipril (Altace) and many others in this family
• Beta-blockers: Propranolol (Inderal), nadolol (CorGard), pindolol (Visken), labetalol (Normodyne), penbutolol (Levatol), sotalol (Betapace) and carvedilol (Coreg) are all considered nonselective for the heart and can lead to more associated sleep disturbances.

How they affect sleep:

• ACE inhibitors do not directly cause insomnia. However, some side effects, such as a dry, persistent cough (from the buildup of an inflammation-causing protein in the body), may affect sleep. 
• Beta-blockers may reduce your natural levels of melatonin, which helps with your sleep cycles, and some, such as carvedilol, can cause nightmares. The drugs metoprolol (Lopressor) and propranolol (Inderal XL) can cross the blood-brain barrier into the brain, reducing sleep quality and causing you to wake up more often after you fall asleep. These beta-blockers are linked to nightmares, insomnia and daytime sleepiness. Beta-blockers may also affect your slumber by suppressing REM sleep (the stage when rapid eye movements and dreaming occur). Atenolol (Tenormin) and bisoprolol may be less likely to cause insomnia than other beta-blockers.

What to do: Do not stop taking these without talking to your doctor. These medications are not only used for blood pressure; they may also protect your kidneys and heart from more severe problems. Your doctor may lower the dose of your medication or recommend an alternative therapy that causes fewer changes in sleep.

4. Diabetes medications

Class of medications: sulfonylureas, meglitinides, antihyperglycemics, hormones

Common names: glipizide (Glucotrol), glimepiride (Amaryl), repaglinide (Prandin), nateglinide (Starlix), insulin

How they affect sleep: People with diabetes who take insulin or certain oral medications that lower blood glucose may experience nocturnal hypoglycemia, when blood glucose levels fall below 70 mg/dl at night. Low blood sugar can cause restless and irritable sleep, along with symptoms such as night sweats, shaking, changes in breathing, nightmares and a racing heartbeat.

What to do: Talk to your doctor if you are having sleep issues. If you’re dealing with nocturnal hypoglycemia, your doctor may change the dose or timing of your insulin or other medications, monitor your glucose levels with scheduled testing, or use a continuous monitor that wakes you if levels drop too low. Other factors like sleep apnea or poor sleep hygiene may also need an evaluation.

5. Dementia medications

Class of medications: acetylcholinesterase inhibitors

Common names: donepezil (Aricept), galantamine (Razadyne), rivastigmine (Exelon)

How they affect sleep: People with dementia and those experiencing changes in memory often have disrupted sleep cycles. To add to it, medications used to treat these conditions often have “wake-promoting” effects meant to help improve alertness. Side effects of these medications, such as pain, muscle cramps, increased blood pressure, agitation and lack of appetite (which can cause low blood sugar), can also disrupt sleep.

What to do: Talk to your doctor about the pros and cons before stopping or changing these treatments, which help many people manage the symptoms of dementia. Also, make sure no other causes of sleeplessness are to blame, such as infections, pain or poor sleep hygiene.  

6. Mood and anxiety medications

Class of medications and common names:

• Selective serotonin reuptake inhibitors: fluoxetine (Prozac), citalopram (Celexa), escitalopram (Lexapro), sertraline (Zoloft), paroxetine (Paxil), fluvoxamine (Luvox)
• Serotonin norepinephrine reuptake inhibitors: venlafaxine (Effexor), desvenlafaxine (Pristiq), milnacipran (Savella), levomilnacipran (Fetzima), duloxetine (Cymbalta)
• Norepinephrine and dopamine reuptake inhibitors (NDRIs): bupropion (Wellbutrin, Zyban, Aplenzin)

How they affect sleep: Depression, anxiety and other mental health conditions often cause sleep problems if not treated with medication. These medications can improve baseline sleep, but occasionally their actions on common neurotransmitters (serotonin, dopamine and norepinephrine) can worsen sleep. Typically, the worsened symptoms are continuity of sleep, delayed REM (rapid eye movement, the sleep phase when most dreams occur) and less REM sleep. The antidepressant medication Wellbutrin can also keep you awake. “Wellbutrin is a very stimulating medication that can cause insomnia for some people,” says Michael Breus, a clinical psychologist and sleep specialist practicing in Los Angeles.

What to do: Take these medicines in the morning, rather than at night. Stop or change one of these medications only after talking to a doctor, since stopping abruptly can cause adverse effects. A lower dose may help improve sleep; alternative therapies in other drug classes may also be available.  

7. Pain medications

Class of medications: opioid pain relievers

Common names: fentanyl (Duragesic), morphine (Avinza), hydrocodone (Norco), oxycodone (OxyContin), oxymorphone (Opana) and tramadol (Ultram) 

How they affect sleep: Pain can make it difficult to fall asleep and stay asleep. In some people, opioid pain medications, which are sometimes prescribed to treat moderate to severe pain following surgery or an injury, can contribute to sleep issues by causing altered sleep cycles and even apnea, which is when breathing stops and restarts throughout the sleep cycle.

What to do: If you were prescribed opioids for short-term pain relief, talk to your doctor about alternating the prescribed opioid with acetaminophen (Tylenol) or ibuprofen (Motrin) to minimize the opioid use. Some prescription pain relievers already contain ibuprofen or acetaminophen, so check with your pharmacist before using multiple medications at the same time. Additionally, lifestyle changes (like exercise and weight loss), behavioral treatment (cognitive behavioral therapy), physical therapy, complementary medicine (like acupuncture) and alternative medicine therapies can help improve quality of life in people suffering from pain.

8. Prostate medications

Class of medications: alpha-blockers

Common names: alfuzosin (Uroxatral), doxazosin (Cardura), prazosin (Minipress), silodosin (Rapaflo), terazosin (Hytrin) and tamsulosin (Flomax)

How they affect sleep: Alpha-blockers usually don’t cause sleep problems, but they can reduce REM sleep. REM is a critical component of the sleep cycle because, in addition to its role in dreaming, it’s also involved in memory, emotional processing and healthy brain development.

What to do: If you are using an alpha-blocking medication for the treatment of prostate symptoms and are experiencing sleep problems including insomnia, talk to your doctor about using the lowest effective dose or changing to another family of drugs, such as a 5-alpha-reductase inhibitor like dutasteride (Avodart) or finasteride (Proscar). These are safer and generally better tolerated by older adults.  

9. Stimulants

Class of medications: Stimulants work in the central nervous system and increase alertness, attention and energy. Although commonly used for attention-deficit/hyperactivity disorder (ADHD), these medications are also used to treat conditions affecting alertness and concentration, especially in older adults.

Common names: amphetamine-dextroamphetamine (Adderall), methylphenidate (Concerta), dextroamphetamine (Dexedrine), dexmethylphenidate (Focalin), methylphenidate (Ritalin), lisdexamfetamine (Vyvanse) and many other formulations

How they affect sleep: Stimulants can make it take longer for a person to fall asleep (this is called sleep onset latency) and are associated with insomnia and disruptions to a person’s internal sleep clock.

What to do: Talk to your doctor about the benefits and drawbacks of using a stimulant medication. Ask about adjusting the dose or changing the time you take it to improve your sleep. Additionally, non-stimulants — such as atomoxetine (Strattera), clonidine (Kapvay), viloxazine (Qelbree) and guanfacine (Intuniv) — could be effective, depending on the condition being treated.  

10. Steroids

Class of medications: Glucocorticoids, or steroids, are used as short-term anti-inflammatory medications or long-term immunosuppressive agents for conditions including rheumatoid arthritis, multiple sclerosis, leukemia, lymphoma and systemic lupus.

Common names: prednisone (Deltasone), methyl-prednisolone (Medrol), dexamethasone (Decadron)

How they affect sleep: With steroids, changes in sleep may be due to restlessness caused by the medications, along with decreased natural melatonin levels and disruption of sleep cycles.

What to do: In drug studies, insomnia associated with the use of these medications was considered mild; however, symptoms can be made worse with high doses and long-term use. Only use these medications if needed, in the lowest possible amount, and as your doctor prescribes. If your condition worsens and you need additional steroid symptom relief, talk to your doctor about maintenance medications to treat those symptoms.   

How do you know whether your medicine, or something else, is disrupting your sleep?

Timing is everything, experts say. “It helps to look at when the sleep trouble began and see if it correlates with the start of a particular medication,” Dimitriu says. You might also try taking your medicine in the morning rather than at night to see if that makes a difference.

If you’re having trouble sleeping and are taking any of these medications, it’s important that you don’t stop taking them. Talk to your health care provider, who may be able to adjust your dose or recommend a different medication that can achieve the same results. There are also lifestyle changes that can help improve underlying conditions, as well as cognitive behavioral therapy, which is the first-line treatment for insomnia.

Editor's note: This story, originally published April 8, 2013, has been updated to reflect new information and a new author.