What Medications Cause Insomnia? 10 Medication Types That Can Interfere With Sleep
Quick Summary
Many common prescription medications - taken for conditions like depression, high blood pressure, allergies, and pain - can significantly interfere with your ability to fall asleep and stay asleep.
These drugs can cause insomnia because the brain chemicals they influence to treat a health condition, such as serotonin and norepinephrine, also play a fundamental role in regulating your sleep-wake cycle.
Beyond general insomnia, some medications can trigger more specific sleep problems, including distressing nightmares or the uncomfortable sensations of Restless Legs Syndrome (RLS).
If you suspect a medication is affecting your sleep, it is critical to speak with your doctor before making any changes. They can often adjust the timing, dosage, or type of medication to protect your sleep.
Prescription Medications That Cause Insomnia
You follow a consistent sleep schedule, your bedroom is a dark and quiet sanctuary, and you avoid caffeine in the afternoon. Yet, you still find yourself staring at the ceiling at 2 a.m. or waking up feeling as if you haven't slept at all. While many factors can disrupt sleep, the reason for your nightly struggles could be hiding in plain sight: your medicine cabinet.
Turns out, many medications prescribed for common health issues have the unintended side effect of disrupting sleep. This happens because the chemical pathways these drugs use to manage conditions like depression or high blood pressure are often the very same pathways your brain uses to control sleep and wakefulness. A drug designed to lift your mood or lower your blood pressure can inadvertently flip the "on" switch in your brain right when you want it to power down (Schweitzer & Malhotra, 2022).
So what common categories of medications can cause insomnia and other sleep disturbances? But first, let’s take a closer look at why this happens?
Why Do Some Medications Cause Insomnia?
Some medications cause insomnia because they alter the balance of your brain's chemical messengers, known as neurotransmitters, which are responsible for controlling when you feel awake and when you feel sleepy. The brain's systems for mood, focus, and alertness are closely linked to the systems that control sleep, so a drug targeting one area can easily affect the other.
Your brain relies on a delicate balance of "go" signals and "stop" signals to manage your day. Wake-promoting neurotransmitters like dopamine, norepinephrine, histamine, and acetylcholine keep you alert and focused. In contrast, sleep-promoting messengers like GABA, the brain's primary inhibitory neurotransmitter, and adenosine help you wind down and fall asleep. Because many medications work by increasing or decreasing the activity of these very chemicals, they can unintentionally disrupt this natural rhythm (Schweitzer & Malhotra, 2022).
Think of your brain's neurochemical system as a complex electrical grid. A single neurotransmitter, like serotonin, might help regulate mood, appetite, and sleep. A medication designed to increase serotonin to treat depression is like a power surge sent to improve the function of one part of the city, say the business district. While it might achieve its intended goal, that extra electrical activity can also cause the lights to stay on all night in the residential areas, keeping the entire city awake.
This interference can show up in several ways. Some drugs increase the activity of wake-promoting neurotransmitters, making it difficult to fall asleep. Others can disrupt the natural sleep cycle leaving you waking during the night, reduce deep sleep, or trigger other conditions like nightmares or restless legs that break up your sleep (Schweitzer & Malhotra, 2022).
But which specific medications are most often responsible for this?
Can Antidepressants Keep You Awake at Night?
Yes, while some antidepressants are sedating, many of the most widely prescribed antidepressants today can cause insomnia by increasing the levels of stimulating neurotransmitters in the brain. This is one of the most common medication-related causes of sleep problems.
How do modern antidepressants like SSRIs and SNRIs affect sleep?
Modern antidepressants, including selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs), frequently cause insomnia because they boost brain chemicals that promote alertness.
SSRIs work by increasing the amount of available serotonin, while SNRIs increase both serotonin and norepinephrine. While this action is effective for treating depression, norepinephrine in particular is a powerful chemical involved in the body's stress and "fight-or-flight" response, making it a strong signal to stay awake (Shelton, 2019).
Common antidepressants in these classes that are associated with insomnia include:
SSRIs: Fluoxetine, sertraline, and paroxetine.
SNRIs: Venlafaxine, desvenlafaxine, and duloxetine.
Polysomnography studies, which use electrodes to measure brain activity during sleep, confirm that these medications can break up your sleep and suppress rapid eye movement (REM) sleep, the stage associated with dreaming (Oberndorfer et al., 2000).
What about other types of antidepressants and sleep?
Other antidepressants that work through different mechanisms can also lead to sleeplessness. Bupropion, which is a norepinephrine and dopamine reuptake inhibitor, is another common cause of insomnia due to its stimulating effects. Unlike most other antidepressants, however, bupropion does not typically suppress REM sleep and may even increase it in some individuals, a finding confirmed in a study of depressed men (Nofzinger et al., 1995).
Even some older tricyclic antidepressants, which are often known for being highly sedating, can cause insomnia. Those that have a stronger effect on norepinephrine reuptake, such as desipramine and nortriptyline, are more likely to be activating and interfere with sleep (Schweitzer & Malhotra, 2022).
Can Heart and Blood Pressure Medications Cause Insomnia?
Yes, certain medications used to treat hypertension and other cardiovascular conditions can disrupt sleep, most notably a class of drugs called beta-blockers. While they are very effective at protecting the heart, the way they work can have a big impact on your sleep.
How do beta-blockers interfere with sleep?
Some beta-blockers can cause insomnia and vivid nightmares primarily by blocking your brain from making melatonin at night. Melatonin, often called the "hormone of darkness," is the key signal your body uses to prepare for sleep. By blocking the sympathetic nerve signals that trigger melatonin release from the pineal gland, a small endocrine gland in your brain, these drugs can effectively remove one of your body's most important cues for sleep (Stoschitzky et al., 1999).
The likelihood of a beta-blocker causing sleep problems often depends on whether it is lipophilic, meaning it is fat-soluble and can easily cross the blood-brain barrier to act directly on the central nervous system. Beta-blockers that are 'lipophilic' are the ones most often linked to sleep problems.
Examples include:
Propranolol: High lipid solubility and strongly linked to insomnia and nightmares.
Metoprolol: Also has high lipid solubility and a high risk for sleep disruption.
A randomized controlled trial found that when hypertensive patients taking beta-blockers were given melatonin supplements, their sleep quality improved, confirming the connection between these drugs and lower melatonin levels (Scheer et al., 2012).
Do other heart medications cause sleep problems?
Angiotensin-converting enzyme (ACE) inhibitors, another common class of blood pressure medication, can also indirectly lead to insomnia. These drugs, such as captopril and lisinopril, are known to cause a nagging, dry cough in many people who take them. This cough can be severe enough to repeatedly wake a person up during the night, leading to fragmented sleep and next-day fatigue (Israili & Hall, 1992).
Can Stimulants and Decongestants Disrupt Sleep?
Yes, any medication that has a stimulating effect on the central nervous system has the potential to cause insomnia, particularly stimulants used for Attention-Deficit/Hyperactivity Disorder (ADHD) and common over-the-counter decongestants.
How do ADHD medications impact sleep?
Stimulant medications are the first-line treatment for ADHD because they improve focus and reduce hyperactivity by increasing the levels of dopamine and norepinephrine in the brain. As these are two of the most important neurotransmitters for promoting wakefulness, it is no surprise that insomnia is one of their most common side effects (Schweitzer & Malhotra, 2022).
If these medications are taken too late in the day, their stimulating effects can persist well into the evening, making it very difficult to fall asleep at a normal bedtime. Common examples include amphetamine-based drugs and methylphenidate.
Can my cold medicine keep me up at night?
The active ingredient in many over-the-counter oral decongestants is pseudoephedrine, a compound that works by constricting blood vessels in the nasal passages. However, pseudoephedrine is also an adrenergic agonist, meaning it stimulates the same receptors as adrenaline. This activates your sympathetic nervous system - the body's alertness system - which can lead to feelings of restlessness and an inability to sleep (Schweitzer & Malhotra, 2022).
What Other Common Medications Can Cause Insomnia?
Beyond the major categories, several other widely used medications are known to interfere with sleep.
Can steroids cause insomnia?
Yes, corticosteroids like prednisone are well-known for causing sleep problems, including severe insomnia. These powerful anti-inflammatory drugs mimic the effects of cortisol, a natural hormone that plays a central role in regulating the body's stress response and sleep-wake cycle.
Cortisol levels are naturally highest in the morning to promote wakefulness and lowest at night to allow for sleep. Taking corticosteroids can disrupt this rhythm, leading to a state of being overly alert that makes sleep feel nearly impossible (Schweitzer & Malhotra, 202)2.
Do cholinesterase inhibitors affect sleep?
Cholinesterase inhibitors, a class of drugs used to manage the symptoms of Alzheimer's disease, can also cause insomnia and nightmares. Medications like donepezil and rivastigmine work by increasing the amount of acetylcholine in the brain, a neurotransmitter important for memory and cognition. However, acetylcholine is also a key player in promoting REM sleep and wakefulness. Elevated levels at night can disrupt the sleep cycle and lead to more frequent awakenings. In one large study, insomnia was reported in 13-14% of users of donepezil and rivastigmine, with nightmares being a notable side effect of donepezil (Campbell et al., 2017).
Can pain relievers like NSAIDs interfere with sleep?
Surprisingly, yes. Some research suggests that nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and diclofenac (Voltaren) may disrupt sleep. There are two main ways this might happen.
First, NSAIDs work by blocking the production of prostaglandins, which are compounds involved in inflammation. However, one specific type, prostaglandin D2, also helps you fall asleep.
Second, some studies suggest that NSAIDs may slightly suppress the normal nighttime surge in melatonin. One study confirmed that NSAIDs can affect normal sleep patterns in humans (Murphy et al., 1994).
Are There Other Surprising Sleep Disrupting Drugs?
Beyond the usual suspects, there are a few common medications that people rarely associate with sleep problems, yet they can be significant disruptors.
Can antibiotics affect sleep?
Yes, even a short course of antibiotics can sometimes lead to sleep issues. Certain types of antibiotics, specifically fluoroquinolones (like ciprofloxacin and levofloxacin) and macrolides (like clarithromycin and erythromycin), have been linked to insomnia, nightmares, and feeling "wired" or anxious.
This happens because these drugs can block the activity of GABA, the brain neurotransmitter responsible for calming down nerve activity. Without enough "calming" signals, the brain can remain in a state of over-excitement, making it hard to drift off (Zareifopoulos & Panayiotakopoulos, 2017).
Does the nicotine patch cause vivid dreams?
Quitting smoking is one of the best things you can do for your health, but using a nicotine patch overnight can sometimes lead to intense, vivid dreams or insomnia. Nicotine is a stimulant that mimics acetylcholine, a chemical that promotes wakefulness and brain activity.
When you wear a patch 24 hours a day, your brain receives a steady stream of this stimulant even while you are trying to sleep. This can disrupt deep sleep and cause you to wake up too early in the morning (Gillin et al., 1994). If this happens to you, ask your doctor if it is safe to remove the patch before bed.
Do cholesterol medications (statins) interfere with sleep?
Statins are among the most widely prescribed drugs in the world. While most people take them without issue, research suggests that for some "susceptible individuals," they can cause sleep disturbances. The key factor appears to be whether the medication is lipophilic (fat-soluble) or hydrophilic (water-soluble).
Lipophilic statins - such as atorvastatin, lovastatin, and simvastatin - are fat-soluble, which allows them to cross the blood-brain barrier more easily. Some data mining studies suggest these are more likely to be associated with insomnia and parasomnias (Takada et al., 2014).
In contrast, hydrophilic statins (like pravastatin) do not enter the brain as easily. While clinical trials have shown mixed results regarding how much statins truly affect sleep, if you are taking a fat-soluble statin and experiencing sleep issues, it may be worth discussing with your doctor whether a switch to a water-soluble option is appropriate (Tuccori et al., 2014; Eckernäs et al., 1993).
Can Medications Trigger Nightmares or Restless Legs Syndrome?
Yes, in addition to causing general insomnia, some medications can trigger more specific and disruptive sleep disorders like nightmares or Restless Legs Syndrome (RLS).
Which drugs are linked to vivid dreams and nightmares?
The exact reason why some drugs cause nightmares is not completely clear, but it often involves medications that have strong effects on neurotransmitters like dopamine, serotonin, and norepinephrine (Pagel & Helfter, 2003). The drugs most often linked to this include:
Beta-blockers: Lipophilic beta-blockers like propranolol are frequently reported to cause vivid dreams and nightmares.
Antidepressants: While many antidepressants suppress REM sleep and dream recall, bupropion is one that does not and is more frequently associated with nightmares.
Dopaminergic Drugs: Medications used to treat Parkinson's disease that increase dopamine can also trigger intense dreams.
Cholinesterase Inhibitors: Drugs like donepezil, which increase acetylcholine, are also linked to an increase in nightmares (Campbell et al., 2017).
Additionally, withdrawing from medications that suppress REM sleep, such as many antidepressants and benzodiazepines (used to treat insomnia and/or anxiety), can cause a phenomenon known as "REM rebound." This is a period where the brain tries to "catch up" on lost REM sleep, often resulting in unusually intense and vivid dreams or nightmares (Schweitzer & Malhotra, n.d.).
Can my medication be causing Restless Legs Syndrome (RLS)?
Yes, a number of common medications can either cause RLS—an uncomfortable urge to move the legs, usually at night—or make its symptoms worse in people who already have the condition (Patatanian & Claborn, 2018). The mechanism is thought to be related to the drugs' effects on the dopamine and serotonin systems in the brain.
Medications most frequently associated with triggering or exacerbating RLS include:
Antidepressants: A systematic review concluded that mirtazapine carries a high risk, while SSRIs, most SNRIs, and tricyclic antidepressants slightly increase the risk (Kolla et al., 2018).
Antipsychotics: Certain antipsychotics, particularly olanzapine and quetiapine, are also linked to RLS.
Antihistamines: The sedating effects of first-generation antihistamines like diphenhydramine can, for some people, paradoxically worsen RLS symptoms (Schweitzer & Malhotra, n.d.).
It is worth noting that the antidepressant bupropion appears to be an exception. A randomized controlled trial found that it does not exacerbate RLS and may even improve symptoms in some individuals, likely due to its dopamine-enhancing effects (Bayard et al., 2011).
What Should I Do If I Suspect a Medication Is Harming My Sleep?
If you believe a prescription or over-the-counter medication is disrupting your sleep, the most important first step is to consult with your prescribing doctor or a pharmacist. It is essential that you do not stop taking any prescribed medication on your own, as this can be dangerous to your health.
Here are some practical steps you can take:
Do Not Stop a Medication Abruptly. Suddenly discontinuing a medication can lead to withdrawal symptoms or the return of the illness it was treating. Always seek medical guidance first.
Keep a Detailed Sleep Log. For a week or two, track when you take your medications, when you go to bed, how long it takes you to fall asleep, how many times you wake up, and how you feel the next day. This information is extremely valuable for your doctor.
Ask About Changing the Timing. In many cases, a simple adjustment can make a big difference. For example, a stimulating medication could be taken earlier in the morning, while a mildly sedating one could be moved to the evening.
Inquire About a Dosage Adjustment. Your doctor might determine that a lower dose could still be effective for your primary condition while having less of an impact on your sleep (but do be careful for non-linear dosage effects).
Discuss Alternative Medications. For many conditions, there are multiple classes of drugs available. Your doctor may be able to switch you to an alternative medication that is known to be less disruptive to sleep.
Your medicine cabinet can be a health ally, but it's important to be aware of its potential impact on all aspects of your health, including your sleep. By being an informed and proactive patient, you can work with your healthcare provider to find a treatment plan that allows you to feel your best - both day and night.
Concerned about your sleep? We always advocate talking to your primary care health provider in the first instance.
You can also talk to a NZ sleep clinic like The Better Sleep Clinic for sleep help. Whether it’s an Auckland sleep clinic, Wellington sleep clinic, Christchurch sleep clinic, Hamilton sleep clinic or anywhere in NZ, we can help. We specialise in the recommended insomnia treatment - CBT for insomnia as well as treatments for other
Ask for a free chat below or book an assessment (no referral required) and get started addressing your sleep problems today.
Frequently Asked Questions: Medications That Cause Insomnia
Q1: Which antidepressants are most likely to cause insomnia?
A1: Antidepressants that increase stimulating brain chemicals like norepinephrine and dopamine are the most likely to cause insomnia. This includes many common selective serotonin reuptake inhibitors (SSRIs) like fluoxetine and sertraline, as well as serotonin-norepinephrine reuptake inhibitors (SNRIs) like venlafaxine and duloxetine (Shelton, 2019). The antidepressant bupropion is also frequently linked to insomnia because of its specific effects on norepinephrine and dopamine (Schweitzer & Malhotra, 2022).
Q2: Can antibiotics make it hard to sleep?
A2: Yes, certain antibiotics can disrupt sleep. Specifically, fluoroquinolones (like ciprofloxacin) and macrolides (like clarithromycin) have been linked to insomnia and nightmares. These drugs can block GABA receptors in the brain—the chemical "brakes" that help you relax—leading to a state of over-excitement that makes falling asleep difficult (Zareifopoulos & Panayiotakopoulos, 2017).
Q3: Do cholesterol medications (statins) cause sleep problems?
A3: Statins can disrupt sleep for some people, particularly if the statin is "lipophilic" (fat-soluble). Fat-soluble statins like atorvastatin, lovastatin, and simvastatin can cross the blood-brain barrier more easily than water-soluble ones. Some studies suggest these are more likely to be associated with insomnia and restless sleep (Takada et al., 2014). If you suspect this is happening to you, discuss with your doctor whether a hydrophilic (water-soluble) statin might be a better option.
Q4: Can my blood pressure medication give me nightmares?
A4: Certain blood pressure medications, specifically lipophilic beta-blockers like propranolol and metoprolol, are known to cause vivid dreams and nightmares. This happens because they can suppress the body's natural release of melatonin, the hormone that signals darkness and sleep to the brain (Stoschitzky et al., 1999)
Q5: Can the nicotine patch cause insomnia?
A5: Yes, using a nicotine patch, especially overnight, can cause insomnia and intense, vivid dreams. Nicotine acts as a stimulant that mimics acetylcholine, a brain chemical involved in wakefulness. Receiving a steady dose of nicotine while you sleep can disrupt your deep sleep cycles (Gillin et al., 1994).
Q6: Which medications can make Restless Legs Syndrome (RLS) worse?
A6: Several common medications can trigger or worsen RLS, most notably certain antidepressants (like mirtazapine and SSRIs) and some antipsychotics (like olanzapine). This effect is thought to be related to how these drugs alter the brain's dopamine and serotonin pathways (Patatanian & Claborn, 2018; Kolla et al., 2018). Interestingly, the antidepressant bupropion is an exception and does not typically worsen RLS (Bayard et al., 2011).
Q7: What should I do if I think my prescription medication is ruining my sleep?
A7: If you suspect your medication is the cause of your sleep problems, talk to your doctor before making any changes. Do not stop taking a prescribed drug on your own, as this can be dangerous. Your doctor may suggest adjusting the dosage, changing the time of day you take the medication (e.g., moving a stimulating drug to the morning), or switching to an alternative medication that is less likely to disrupt your sleep.
References
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Written By The Better Sleep Clinic
Reviewed By Dan Ford, Sleep Psychologist
