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10 Common Medications That Can Affect Sleep

Trouble catching z’s? Your prescription and over-the-counter meds may be to blame

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Just as our bodies and minds change throughout life, so does our ability to get the recommended seven-plus hours of good, quality sleep each night. In fact, it’s estimated that 40 to 70 percent of older adults routinely experience sleep problems, like difficulty falling asleep or staying asleep.

Insufficient sleep doesn’t just wreck your mind and mood the next day; it’s been linked to a number of chronic health conditions, including type 2 diabetes, cardiovascular disease, obesity and depression. What’s more, lack of sleep can increase your risk of accidents and falls.

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Poor sleep can be traced back to a number of causes, from stress to screen time to health-related issues like heartburn. Commonly used prescription and over-the-counter medications can also contribute.

What is Insomnia?

Insomnia is a common sleep disorder, characterized by trouble falling asleep, staying asleep or getting good-quality sleep. Short-term insomnia can be caused by stress or changes in your schedule or environment; chronic insomnia occurs at least three nights a week and lasts more than three months.

Insomnia is the most common sleep problem in adults 60 and older.

Source: National Heart, Lung and Blood Institute

Here are 10 sleep-disrupting drugs commonly used by older adults.  

1. Cold and allergy decongestants

Class of medications: alpha-/beta-agonist; decongestants commonly used for runny nose and nasal congestion

Common names: phenylephrine (Sudafed PE), pseudoephedrine (Sudafed) and various other combinations. Always check the active ingredients on the product’s label.

How they affect sleep: These drugs increase heart rate and heart muscle contractions, which can stir up heart palpitations, anxiety, blood pressure and excitability that prevents sleep or deep sleep. 

What to do: Because these medications can affect the heart, check with your doctor or pharmacist before reaching for one — an alternative such as a steroid nasal spray may be recommended. If you get the OK from your health care provider and find you need a decongestant for more than seven days, or if your symptoms are worsening during use, contact your doctor to make sure there’s not another issue causing your symptoms, like an infection.    

2. Asthma medications

Common medications: short-acting beta 2-agonists (bronchodilators), commonly called “rescue” medications or inhalers for quick symptom relief

Common names: pirbuterol (Maxair Autohaler), albuterol (Proventil HFA, ProAir and Ventolin HFA), levalbuterol (Xopenex)

How they affect sleep: These medications have data showing that only 1 to 3.1 percent of users experience true insomnia. However, other side effects such as excitability, headache, heart palpitations and tremors may be the bigger culprits for the sleep troubles, especially with frequent use.

What to do: If you use your rescue asthma inhaler or nebulizer more than twice a week and have trouble sleeping when you do, contact your physician and consider using a preventive medication or long-acting therapy.  

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 have more associated sleep disturbances.

How they affect sleep:

  • ACE inhibitors do not directly cause insomnia. However, side effects, such as a dry, persistent cough (from the buildup of an inflammation-causing protein in the body) and muscle aches (from changes in potassium), 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. 

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: biguanides

Common names: best known as metformin (Glucophage)


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How they affect sleep: Metformin has been linked to sleep disturbances and even nightmares. Insomnia is less frequent with metformin; however, diabetes is linked to sleep apnea and low blood sugar at night.

What to do: Talk to your doctor if you are taking metformin and having sleep issues. Other factors may be at play, such as low blood sugar at night (also known as nocturnal hypoglycemia), sleep apnea or poor sleep hygiene.

5. Memory 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. Add to it, medications used to treat these conditions often have “wake-promoting” effects that can 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 ever 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 and poor sleep hygiene.  

6. Mood and anxiety medications

Class of medications and common names:

  • Selective serotonin reuptake inhibitor: fluoxetine (Prozac), citalopram (Celexa), escitalopram (Lexapro), sertraline (Zoloft), paroxetine (Paxil), fluvoxamine (Luvox)
  • Serotonin norepinephrine reuptake inhibitor: venlafaxine (Effexor), desvenlafaxine (Pristiq), milnacipran (Savella), levomilnacipran (Fetzima), duloxetine (Cymbalta)

How they affect sleep: Depression, anxiety and other mental health conditions often cause sleep problems without 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 (which stands for rapid eye movement, a phase in sleep when most dreams occur), and less REM sleep.

What to do: Only stop or change one of these medications 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 pain reliever with acetaminophen (Tylenol) or ibuprofen (Motrin) to help relieve pain and minimize the opioid use. Some prescription pain relievers already contain ibuprofen or acetaminophen, so check with your pharmacist before using any 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.

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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 are linked to decreased 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), which 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 among 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 and ask about taking the lowest effective dose. Additionally, non-stimulant drugs — 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 like 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: Insomnia with these medications is considered mild in drug studies; however, these symptoms can be worsened with high doses and long-term use. Only use these medications if needed, at 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 for symptom relief.   

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.

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