There are a multitude of medical conditions that primarily involve sleep. To list all of these conditions on this website would be a challenging task that would potentially lead to unneeded confusion on the reader’s part.
In addition, many substances we ingest produce sleep difficulties or symptoms. A well-known example is caffeine. Medications often affect sleep and those effects can be under appreciated.
Other Sleep Disorders
A national association of sleep physicians periodically releases a listing of all recognized disorders of sleep. In recent issues the separate diagnoses that can be established number greater than 70. Each has its own specific symptom profile and clinical findings.
These problems range from specific types of insomnias and circadian rhythm changes to multiple types of breathing disturbances and movement issues during sleep. The common feature of most of these disorders is their uncommon occurrences.
The common disorders of sleep are covered elsewhere on these pages.
You should always seek professional help when concerned about your sleep health. If these pages do not give you any help understanding your situation, that is reason enough to seek professional help.
Do not be put off by the provider’s concern about the potential for obstructive apnea. The condition is extremely common and more so as we age. It has major long-term health consequences. In most cases, both the provider and your insurance company will want to be sure that you don’t have obstructive apnea as a cause of your symptoms.
Medications as a Cause of Sleepiness and Sleep Problems
What we ingest can have effects on our sleep. Medications represent a specific example of some of those effects. We are blessed with having many agents for the treatment of the ills of mankind, but those agents may come with side effects and changes to our sleep or how rested we feel. This is a brief summary of what you should consider when you have sleep problems and take medication.
Many factors need to be considered when reviewing the effects of medications. For each recognized drug, effects can vary depending upon the manufacturer’s preparation, the dose, the time and how taken. The complexities can be huge. The side effects discussed here will be for standard doses taken at recommended times for approve indications. Even when standard doses are considered, the range of doses may be quite large and side effects may be higher as the dose level increases.
Another factor playing a significant role in the side effects is the individual. We are all unique. A medication that one person can tolerate well may lead to many side effects in another. Some may improve with a small dose while others need a higher dose. An individual’s handling and processing of each medication is unique. We all do not respond the same. For example, some medications are known for their ability to cause sleepiness in one person and insomnia in the next.
Certain medications are designed to either help you sleep or stay awake. The side effects of excessive sleepiness or insomnia for those agents occur when they last too long or work too well. An agent to help you sleep would be considered to have a side effect of excessive sleepiness if you remained sleepy the next day.
How should we approach this complex problem? There are hundreds of agents and several pages could be written on each. I have chosen to review them based on the symptoms or problems they cause; excessive sleepiness, difficulty going to or staying asleep and movements during sleep.
Excessive Daytime Sleepiness
SYMPTOMS: Being tired and sleepy during the day is not normal. Certainly a night of bad sleep will result in those feelings. However, having those symptoms day after day following normal nights of sleep is not. The symptoms produced by medication can occur just after it’s taken, hours later, or after days, weeks or months of treatment. The symptoms may last just a few hours or all day and are there most every day.
PRESCRIPTION AGENTS AND SLEEPINESS: Classes of medications highly associated with excessive sleepiness during the waking hours include anti-anxiety, antidepressants, anti-psychotic, anti-seizure, muscle relaxants and neuropathy agents.
Side effects of pharmacologic agents are published by several sources. Often older medications known to have side effects such as sleepiness will not have published numbers as shown on the chart below. Such information was not required when they were approved. This is a list of some of the agents when used in usual dosages that are to be considered when excessive sleepiness is a problem.
| Brand Name | Generic Name | Users with Sleepiness |
| Xanax | Alprazolam | 60% |
| Remeron | Mirtazapine | 54% |
| Anafranil | Clomipramine | 50% |
| Klonopin | Clonazepam | 50% |
| Prosom | Extazolam | 42% |
| Seroquel | Quetiapine | 38% |
| Zpyrexa | Olanzapine | 38% |
| Lyrica | Pregablain | 36% |
| Desyrel | Trazodone | 31% |
| Catapres | Clonidine | 30% |
| Mirapex | Pramipexole | 28% |
| Spravato | Esketamine | 25% |
| Valium | Diazepam | 23% |
| Serzone | Nefazodone | 22% |
| Flexeril | Cyclobenzaprime | 20% |
| Horizant | Gabapentin enacarbil | 20% |
| Neurontin | Gabapentin | 20% |
| Depakote | Valproic acid | 19% |
| Brand Name | Generic Name | Users with Sleepiness |
| Gabitril | Tiagabine | 19% |
| Geodon | Ziprasidone | 19% |
| Celexa | Citalopram | 18% |
| Neupro | Rotigotin trans derm | 18% |
| RisperDAL | Risperidone | 18% |
| Effexor | Venlafaxine | 15% |
| Asendin | Amoxapine | 14% |
| Luvox | Fluvoxamine | 14% |
| Paxil | Paroxetine | 14% |
| Requip | Ropinirole | 12% |
| Zyrtec | Cetirizine | 12% |
| Proszc | Fluoxetine | 11% |
| Zoloft | Sertaline | 11% |
| Ativan | Lorazepam | 10% |
| Buspirone | Buspirone | 10% |
| Cymbalta | Duloxetine | 10% |
| Stattera | Atomoxetime | 10% |
If your medicine appears on this list or other lists of agents that might cause sleepiness, consult your doctor before making any changes. When excessive daytime sleepiness is present, it is best to review all your medications with your doctor.
NON-PRESCRIPTION (OVER THE COUNTER) MEDICATIONS AND SLEEPINESS: Many over the counter (OTC) medications can be associated with sleepiness. These most often are with allergy or cough and cold medications. Diphenhydramine (Benadryl brand name) is an antihistamine used for all three types of conditions. It is significantly associated with sleepiness and is used in many of the OTC sleep aid preparations. Other antihistamines are also used in these medications and can have similar side effects.
Difficulty Going to Sleep and Staying Asleep
SYMPTOMS: These problems are extremely common and fortunately, self-limited and not a prolonged issue. When they are persistent, the role of medications needs to be considered. It may surprise you to know that some of the same agents listed above can produce the opposite effect in certain individuals.
These medications can make sleep onset difficult. They can make the sleep quality poor with broken up sleep and frequent awakenings. Often, they can do both.
PRESCRIPTION AGENTS AND INSOMNIA: Classes of medications highly associated with difficulty going to sleep or staying asleep (DIMS) during the appropriate sleep times include antidepressants, anti-psychotic, anti-seizure and stimulating agents.
As previously noted, side effects of pharmacologic agents are published by several sources. Often older medications known to have side effects such as DIMS will not have published numbers las shown on the chart below. This is a list of some of the agents when used in usual dosage that are to be considered when DIMS is a problem.
|
Brand Name |
Generic Name |
Users with Insomnia |
|
Luvox |
Fluvoxamine |
28% |
|
RisperDAL |
Risperidone |
28% |
|
Wellbutrin |
Bupropion |
28% |
|
Proszc |
Fluoxetine |
21% |
|
Adderall |
Dextroamphetamine/Amphetamine |
20% |
|
Effexor |
Venlafaxine |
20% |
|
Zoloft |
Sertaline |
20% |
|
Paxil |
Paroxetine |
16% |
|
Celexa |
Citalopram |
15% |
|
Methylphenidate |
15% |
|
|
Depakote |
Valproic acid |
12% |
|
Mirapex |
Pramipexole |
12% |
|
Dexmethyphenidate |
11% |
|
|
Asendin |
Amoxapine |
10% |
|
Cymbalta |
Duloxetine |
10% |
|
Lexapro |
Escitalopram |
10% |
|
Pristiq |
Desvenlafaxine |
10% |
|
Stattera |
Atomoxetime |
10% |
If your medicine appears on this list or other lists of agents that might cause DIMS, consult your doctor before making any changes. When experiencing these problems, it is best to review all your medications with your doctor.
NON-PRESCRIPTION MEDICATIONS AND INSOMNIA: A few over the counter (OTC) medications can be associated with DIMS. These most often are with allergy or cough and cold medications. It is best to review all of these with your doctor.
Movement While You Sleep
We all toss and turn in our sleep on occasions. There are other types of movements that can affect the quality of our sleep. Two types are not unusual: Rapid Eye Movement Sleep Behavior Disorder (REMB) and Periodic Limb Movements (PLMs). Medications should be reviewed in the presence of either of these problems.
SYMPTOMS: REMB is characterized by episodes of physical actions such as walking, shouting, hitting, kicking or thrashing. When awakened, the person is almost always experiencing a threatening physically active dream. REMB can result in personal injury. Many sufferers are unaware of the episodes.
PLMs are repeated muscular contractions with or without muscle twitches. They last up to 10 seconds and occur in groups of at least 4 movements less than 90 seconds apart. They can occur in single or multiple groups. They can be brief or last the entire night of sleep. There may or may not be associated visible movements. Generally PLMs are not bothersome to the sufferer. However, there are those who have significant numbers of them or significant movements when they occur that affect their sleep quality.
Prescription Agents and Movements
REMB can be caused or aggravated by medications. The primary agents are the serotonergic antidepressant medications. Other agents reported to very rarely cause REMB include beta-blockers and cholinesterase inhibitors.
PLMS can be aggravated or caused by antidepressant therapy and drugs with antihistamine properties. The information is at best fragmented but if a problem with PLMs is the apparent cause of a sleep issue, a review of medications is very important.
Summary
This is an extremely brief review of the subject. There is extensive material available on every prescription medication. As a patient you should always ask if a medication you are taking could cause your problems.
Last updated: 6/2024