5. ACE inhibitors
Why they're prescribed: Angiotensin-converting enzyme (ACE) inhibitors are used to treat high blood pressure, congestive heart failure and other conditions. These drugs help relax blood vessels by preventing the body from producing angiotensin II, a hormone that causes blood vessels to narrow and, in turn, blood pressure to rise.
Examples of ACE inhibitors include: benazepril (Lotensin), captopril (Capoten), enalapril (Vasotec), fosinopril (Monopril), lisinopril (Prinivil, Zestril), moexipril (Univasc), perindopril (Aceon), quinapril (Accupril), ramipril (Altace) and trandolapril (Mavik).
How they can cause insomnia: ACE inhibitors boost the body's levels of bradykinin, a peptide that enlarges blood vessels. Bradykinin is thought to be the cause of the hacking, dry cough that up to a third of all patients who take an ACE inhibitor develop. This chronic, round-the-clock cough can be severe enough to keep anyone awake. ACE inhibitors can also cause potassium to build up in the body (another type of electrolyte imbalance) and lead to diarrhea, as well as leg cramps and achy joints, bones and muscles — all of which can disturb normal sleep.
Alternatives: If you're taking an ACE inhibitor for a cardiovascular problem, talk with your doctor or pharmacist about possibly switching to a benzothiazepine calcium channel blocker, another form of blood-pressure medication that is often better tolerated by older adults. This is especially important for African Americans and Asian Americans, who, because of differences in their renin-angiotensin systems, have much higher incidences of adverse side effects.
If your condition is accompanied by fluid retention, your doctor may consider adding a low dose of a long-acting loop diuretic, such as torsemide.
6. Angiotensin II-receptor blockers (ARBs)
Why they're prescribed: ARBs are often used to treat coronary artery disease or heart failure in patients who can't tolerate ACE inhibitors or who have type 2 diabetes or kidney disease from diabetes. Instead of blocking the body's production of angiotensin II, ARBs prevent it from exerting its blood vessel-constricting effects.
Examples of ARBs include: candesartan (Atacand), irbesartan (Avapro), losartan (Cozaar), telmisartan (Micardis) and valsartan (Diovan).
How they can cause insomnia: Like ACE inhibitors, ARBs frequently lead to potassium overload in the body, causing diarrhea as well as leg cramps and achy joints, bones and muscles — all of which can disturb normal sleep.
Alternatives: As with ACE inhibitors, I'd recommend you consult with your health care provider about the advisability of switching to a benzothiazepine calcium channel blocker, which is often better tolerated by older adults. This is especially important for African Americans and Asian Americans, who because of differences in their renin-angiotensin systems, have much higher incidences of adverse side effects.
A low dose of a long-acting loop diuretic such as torsemide may also be desirable.
Next page: Cholinesterase inhibitors and (nonsedating) H1 antagonists. »