Drugs That Negatively Affect Sleep

Abstract

Getting adequate sleep is a healthy lifestyle activity that is important for the body to function optimally both physically and mentally. Unfortunately, 70 million Americans suffer from chronic sleep loss or sleep disorders. Secondary causes of sleep disorders are often overlooked and can occur from the consumption of social or medicinal drugs. Common social drugs that can disrupt sleep include alcohol, caffeine, and nicotine. Certain medications can also have side-effects that can induce sleep disruptions. This article briefly reviews common social drugs and prescription medications that can negatively impact sleep.

‘It is estimated that as many as 70 million Americans may be affected by chronic sleep loss or sleep disorders.’

Out of all the lifestyle medicine activities that are important to healthy living, one is so important that we are advised to devote one third of each day doing this activity. ¹ This activity, of course, is sleep. Most people think of sleep as a time when our bodies and minds simply shut down and relax. On the contrary, when we sleep our bodies and minds are very active carrying out a number of vital tasks that keep us healthy and allow us to function at our best when we are awake.

The prevalence of sleep loss is significant among American adults. It is estimated that as many as 70 million Americans may be affected by chronic sleep loss or sleep disorders. ¹ More than one third of American adults report that sleep loss adversely effects their work performance and social life at least a few days each month. ¹ It is estimated that inadequate sleep costs the United States approximately $16 billion in direct health care expenditures and $50 billion in lost productivity each year. ¹

There are many reasons why 70 million Americans are not getting adequate sleep. ¹ At least 40 million are affected by a sleep disorder. ¹ The 4 most common sleep disorders are insomnia, sleep apnea, restless leg syndrome, and narcolepsy. ¹ Secondary causes of sleep disorders can be easily overlooked. Medications can be a secondary culprit for some sleep disorders and should be evaluated in patients suffering from sleep loss. The purpose of this article is to briefly discuss common drug related causes of sleep loss.

Alcohol and Sleep

Although alcohol is not classified as an over-the-counter or prescription medication, it is certainly classified as a social drug. In the United States, approximately 50% of adults drink alcohol on a regular basis and another 14% drink occasionally. ² Alcohol has been shown to have both a positive effect and a negative effect on health, depending on amount consumed and the timing of the consumption. Sleep has been shown to be negatively affected by alcohol consumption. ¹

Consuming an alcoholic drink prior to bedtime, or “having a nightcap,” is a solution that some individuals use to solve sleep disorders. A cocktail or glass of wine may help some to relax and fall asleep more easily. However, alcohol has been shown to disrupt sleep a few hours later. ¹

Alcohol can disrupt certain stages in the sleep cycle (specifically non–rapid eye movement [REM] Stage 3 and REM stage) that are necessary for “restorative” sleep. ¹ This often results in keeping these individuals in the “lighter” stages of sleep with more frequent awakenings during the night to urinate. Additionally, an overconsumption of alcohol prior to bedtime can result in excessive muscle relaxation, including those muscles in the pharynx. This can exacerbate snoring and increase the risk for sleep apnea. ¹ As a result, individuals who have a “nightcap” prior to bedtime generally do not wake in the morning fully rested.

Caffeine and Sleep

Caffeine acts as a stimulant that can increase heart rate, blood pressure, mental alertness, and temporarily reduce fatigue. Caffeine can be found in many items that we consume on a daily basis. Some of the most common sources of caffeine include coffee, tea, and soda. Caffeine is also commonly found in chocolate, energy drinks, herbal products, and in over-the-counter and prescription medications. People vary widely on their sensitivity to the stimulant effects of caffeine, which can begin within 15 minutes and last up to 7 hours. ³

The amount of caffeine in the average 8 ounce cup of coffee is about 133 mg. The caffeine content in 8 ounces of tea and 12 ounces soda can range from 40 to 120 mg and 35 to 72 mg, respectively. ³ Chocolate can contain about 9 to 33 mg of caffeine depending on serving size and energy drinks can contain up to 300 mg of caffeine in a 20 ounce serving. Additionally, herbal products can contain varying amounts of caffeine based on the product and quantity in which it is sold.

Caffeine is also included in many over-the-counter and prescription pain relievers, especially those targeted toward headache relief. Caffeine has been shown to speed the absorption of analgesics like aspirin and as a result provide quicker headache relief. The amount of caffeine included in pain relievers can range from 16 to 65 mg per dosage form (pill). The dosing regimen for many pain relievers suggests that patients take 2 pills per episode (eg, headache). This can result in as much as 130 mg of caffeine and, in turn, induce sleep disorders in some patients.

Nicotine and Sleep

Nicotine is a stimulant similar to caffeine. Nicotine consumption, regardless of route, can result in increased heart rate, blood pressure, and respiratory rate. The stimulant effects from nicotine can last for several hours and can affect an individual’s ability to fall asleep and/or stay asleep. Additionally, withdrawal symptoms from nicotine can begin within a few hours of the last cigarette. Nicotine withdrawal symptoms can include restlessness, irritability, headache, lighter sleep, and frequent nighttime awakenings. Individuals who use nicotine often experience poor sleep quality and suffer from daily fatigue. ¹

Prescription Medications

Similar to over-the-counter medications, certain prescription pain medications can contain caffeine. Two such products, Fioricet and Fiorinal, each contain 40 mg of caffeine per tablet. Depending on patient sensitivity, this amount of caffeine may adversely affect sleep in some individuals.

There are several other common prescription medications that induce sleep disorders that are unrelated to the stimulant effects of caffeine. The specific cause(s) for this in many medications is largely unknown and the degree to which patients experience these side effects varies widely. The following is a brief list of common drug classes and their potential sleep disruptive symptoms. ¹

Selective Serotonin Reuptake Inhibitors (SSRIs)

Studies have shown that patients taking SSRIs can experience sleep disorder symptoms such as restless leg syndrome, insomnia, nonrestorative sleep, and daytime sleepiness. Examples of medications in this drug class are citalopram (Celexa), escitalopram (Lexapro), and fluoxetine (Prozac).

Tricyclic Antidepressants

Medications in this class of drugs have shown to disrupt sleep by increasing the potential for restless leg syndrome and insomnia. They have also been shown to increase daytime sleepiness and morning grogginess, most likely due to their negative effects on restorative sleep patterns. Examples of tricyclic antidepressants include amitriptyline, amoxapine, and clomipramine.

Angiotensin-Converting Enzyme (ACE) Inhibitors

A well-known class side-effect of ACE inhibitors is cough. For many patients, the “ACE cough” worsens at nighttime. This side effect can make it difficult to sleep and may also worsen sleep apnea. Examples of ACE inhibitors include benazepril (Lotensin), captopril (Capoten), and lisinopril (Prinivil).

Corticosteroids

Oral corticosteroids have been linked to sleep disorders such as sleep onset insomnia (difficulty falling asleep), sleep maintenance insomnia (difficulty staying asleep), and abnormal dreams. Examples of oral corticosteroids include methylprednisolone (Medrol), prednisolone, and prednisone.

Statins

The sleep disorders linked with statin medications include sleep onset insomnia, frequent awakening at night, and daytime fatigue. The muscle soreness that can occur with taking a statin medication has also been reported to disrupt sleep. Examples of statin medications include atorvastatin (Lipitor), rosuvastatin (Crestor), and simvastatin (Zocor).

Conclusion

Restorative sleep is an important lifestyle activity. Sleep loss affects many Americans and can lead to negative health consequences. Certain social and medicinal drugs have been shown to secondarily cause disruptive sleep in certain individuals. Health care providers should be advised to check for drugs that negatively affect sleep when talking with patients about sleep disorders.