10 Common Medications That Can Affect Sleep

4. Diabetes medications

Class of medications: sulfonylureas, meglitinides, antihyperglycemics, hormones

Common names: glipizide (Glucotrol), glyburide (Diabeta, Glycron, Micronase), 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 milligrams per deciliter (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’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 improve alertness. Side effects of these medications can also disrupt sleep; they include pain, muscle cramps, increased blood pressure, agitation and lack of appetite (which can cause low blood sugar).

What to do: Talk to your doctor about the pros and cons before stopping or changing these treatments. And make sure nothing else is causing your sleeplessness, such as infections, pain or poor sleep hygiene. 

6. Mood and anxiety medications

Class of medications and common names:

• Selective serotonin reuptake inhibitors (SSRIs): fluoxetine (Prozac, Sarafem, Selfemra), citalopram (Celexa), escitalopram (Lexapro), sertraline (Zoloft), paroxetine (Paxil, Brisdelle, Pexeva), fluvoxamine (Luvox)
• Serotonin and norepinephrine reuptake inhibitors (SNRIs): venlafaxine (Effexor), desvenlafaxine (Pristiq, Khedezla)), milnacipran (Savella), levomilnacipran (Fetzima), duloxetine (Cymbalta, Drizalma , Irenka)
• Norepinephrine and dopamine reuptake inhibitors (NDRIs): bupropion (Wellbutrin, Zyban, Aplenzin, among others)

How they affect sleep: Depression, anxiety and other mental health conditions often cause sleep problems. These medications can improve baseline sleep, but occasionally their effects on common neurotransmitters (serotonin, dopamine and norepinephrine) can worsen sleep. A 2023 analysis of 216 trials found that about half of the 21 antidepressants evaluated were more likely than a placebo to cause insomnia. 

SSRI depression medications “have been known to lessen slow-wave sleep and suppress REM a little bit,” Dimitriu says. But he adds that in his experience, “the overall benefit greatly outweighs costs.”

The antidepressant Wellbutrin can also keep you awake, says Michael Breus, a clinical psychologist and sleep specialist practicing in Los Angeles: “Wellbutrin is a very stimulating medication that can cause insomnia for some people.”

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, because stopping abruptly can cause adverse effects. A lower dose may help improve sleep. You can also ask your doctor if you can try a medication in a different drug class. 

7. Pain medications

Class of medications: opioid pain relievers

Common names: fentanyl (Duragesic, Ionsys), morphine (Avinza, Kadian, MS Contin, among others), hydrocodone (Norco, Lortab, among others), oxycodone (OxyContin, Roxicodone, among others), oxymorphone (Opana) and tramadol (Ultram, ConZip, among others) 

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 sleep 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, Tezruly) 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 to treat 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 (Ritalin, Concerta, among others), dextroamphetamine (Dexedrine, ProCentra, Zenzedi, among others,), dexmethylphenidate (Focalin), methylphenidate (Ritalin), lisdexamfetamine (Vyvanse, Arynta) 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, nonstimulants — such as atomoxetine (Strattera), clonidine (Kapvay, Catapres, Nexiclon XR), viloxazine (Qelbree) and guanfacine (Intuniv, Tenex) — 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, among others), methylprednisolone (Medrol), dexamethasone (Decadron among others)

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, but 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.  

Can antibiotics keep you awake?

One class of antibiotics, called fluoroquinolones, is strongly linked to sleep disorders, vivid nightmares and anxiety, Dimitriu says. Examples include ciprofloxacin (Cipro), levofloxacin (Levaquin) and moxifloxacin (Avelox). Most other antibiotics aren’t known to cause insomnia, he says. But side effects such as nausea and dizziness can make it harder to sleep, as can the illness being treated.

Can medications cause sleep apnea?

Some medications can worsen sleep apnea or contribute to breathing problems during sleep, Dimitriu says. Common culprits are opioids, benzodiazepines and sleep aides such as Ambien. “Anything that has a sedating effect” or a muscle-relaxing effect can cause sleep apnea, Dimitriu says.

Opioids are especially dangerous for older adults, he says, particularly when combined with other sedatives, because they can cause respiratory issues: Breathing may get slower, shallower and less effective or even stop altogether.

Can medications cause non-REM parasomnias like sleepwalking and sleep talking?

Nonrapid eye movement (non-REM) parasomnias are actions you do during the early stages of sleep, including sleepwalking, sleep talking, sleep eating and night terrors. Though you’re not awake and may not remember them, they can disrupt your sleep.

A number of medications can cause these sleep-related disorders, including antianxiety drugs like benzodiazepines, certain antidepressants, high blood pressure medicines, antipsychotic drugs, antiseizure medications, and asthma or allergy medicines.

What drugs cause REM sleep behavior disorder?

Certain antidepressants have been linked to REM sleep behavior disorder, a condition in which you act out your dreams during the REM stage of sleep. This includes talking, yelling, kicking, punching or even jumping out of bed in response to what’s happening in your dream.

Antidepressants may cause REM sleep behavior disorder by altering levels of the brain chemicals dopamine and serotonin, which play a role in REM sleep. The association has been reported with several common SSRIs, such as sertraline (Zoloft) and fluoxetine (Prozac), although researchers are still studying whether the medications directly trigger the condition or simply unmask it in people who are prone to it.

Other medications linked to the disorder include sleep medicines like zolpidem (Ambien) and eszopiclone (Lunesta).

How do you know whether your pills are 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.

What to do if you think your medication is affecting your sleep

If you’re having trouble sleeping and you think it’s being caused by a medication, don’t stop taking it on your own. Instead, talk to your health care provider, who may adjust your dose, have you take it earlier in the day or recommend a different medication that can achieve the same results with fewer sleep-related side effects. 

Lifestyle changes can also make a big difference, he says. Try to manage stress, limit naps, skip caffeine after noon and avoid stimulating activities (like scrolling on your phone) right before bed. If those changes don’t work, you can try cognitive behavioral therapy, which is the first-line treatment for insomnia.

“In my own practice, oftentimes just having those healthy habits in place will override any insomnia effect of pill,” Dimitriu says.