AARP Eye Center
l The older you are, the more likely you are to have insomnia — a disorder that can make it hard to fall asleep, stay asleep or both. Older adults wake up more frequently during the night, wake up earlier and are more likely to report feeling unrested on awakening.
Older people are also more likely to have medical conditions that can cause pain or discomfort that disturbs their sleep. (Some studies, in fact, have found no significant increase in insomnia in older adults who are healthy.) These conditions include gastrointestinal distress, frequent urination, lung disease and heart conditions. Neurological disorders, such as restless legs syndrome (RLS), Parkinson's disease and Alzheimer's disease, can also affect sleep patterns.
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Insomnia not only saps your energy and affects your mood, but also can put your health, work performance and quality of life on a downward spiral. Insomnia can be short-term (up to three weeks) or long-term (four weeks or more). Sleep deprivation can lead to irritability, depression, and memory and attention problems. It also has been linked with diabetes, obesity and heart disease, in addition to increased risk of automobile-related accidents and falls.
The Top 10
Here are 10 types of medications that can cause insomnia. If you're taking any of them and having sleep problems, you should talk with your doctor or pharmacist about adjusting the dosage, changing to another type of medication, or trying an alternative treatment or therapy.
Why they're prescribed: Alpha-blockers are used to treat a variety of conditions, including high blood pressure (hypertension), benign prostatic hyperplasia (BPH) and Raynaud's disease. These drugs relax certain muscles and help keep small blood vessels open. By keeping the hormone norepinephrine (noradrenaline) from tightening the muscles in the walls of smaller arteries and veins, they improve blood flow and lower blood pressure. Because alpha-blockers also relax other muscles throughout the body, they can help improve urine flow in older men with prostate problems.
Examples: alfuzosin (Uroxatral), doxazosin (Cardura), prazosin (Minipress), silodosin (Rapaflo), terazosin (Hytrin) and tamsulosin (Flomax).
How they can cause insomnia: Alpha-blockers are linked to decreased REM (rapid eye movement) sleep — the stage of sleep when people dream — and daytime sedation or sleepiness. The proportion of REM sleep drops markedly in old age, and people deprived of REM sleep can experience memory problems.
Alternatives: For older people, benzothiazepine calcium channel blockers, another form of blood pressure medication, are often safer and more effective than alpha-blockers. If the alpha-blocker has been prescribed to treat BPH, talk with your doctor about the possibility of switching to a 5-alpha-reductase inhibitor such as dutasteride (Avodart) or finasteride (Proscar), which are safer and generally better tolerated by older patients.
Meds That May Cause Insomnia
4. SSRI antidepressants
5. ACE inhibitors
7. Cholinesterase inhibitors
8. H1 antagonists
Why they're prescribed: Beta-blockers are typically prescribed to treat hypertension (high blood pressure) and arrhythmias (abnormal heart rhythms). These drugs slow the heart rate and lower blood pressure by blocking the effect of the hormone adrenaline. Beta-blockers are also used to treat angina, migraines, tremors and, in eyedrop form, certain kinds of glaucoma.
Examples: atenolol (Tenormin), carvedilol (Coreg), metoprolol (Lopressor, Toprol), propranolol (Inderal), sotalol (Betapace), timolol (Timoptic) and some other drugs whose chemical names end with "-olol."
How they can cause insomnia: Beta-blockers have long been associated with sleep disturbances, including awakenings at night and nightmares. They are thought to do this by inhibiting the nighttime secretion of melatonin, a hormone involved in regulating both sleep and the body's circadian clock. Low levels of melatonin have sometimes been observed in chronic insomnia.
Alternatives: For older people, benzothiazepine calcium channel blockers, another form of blood pressure medication, are often safer and more effective than beta-blockers.
A nightly dose of melatonin may also help. A small study published in the journal Sleep in 2012 found that patients on beta-blockers who also took melatonin fell asleep sooner, had more restful sleep, and slept longer — an extra 36 minutes a night, on average — than patients taking an inactive placebo. (This was determined with polysomnography, an overnight sleep test that records brain waves, muscle tone, heart rate and eye movements.)
Why they're prescribed: Corticosteroids are used to treat inflammation of the blood vessels and muscles as well as rheumatoid arthritis, lupus, Sjögren's syndrome, gout and allergic reactions.
Examples: cortisone, methylprednisolone (Medrol), prednisone (sold under many brand names, such as Deltasone and Sterapred) and triamcinolone.