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Insomnia is the most common sleep disorder in adults and leads to more than 5 million outpatient medical visits in the U.S. per year.[1] The condition is characterized by difficulty falling asleep or maintaining sleep. Insomnia can cause significant daytime symptoms, including fatigue, sleepiness, mood disturbances and functional impairment.[2]
Insomnia generally is divided into two types: short-term or acute insomnia, which usually lasts a few days to weeks and typically is due to a...
Insomnia is the most common sleep disorder in adults and leads to more than 5 million outpatient medical visits in the U.S. per year.[1] The condition is characterized by difficulty falling asleep or maintaining sleep. Insomnia can cause significant daytime symptoms, including fatigue, sleepiness, mood disturbances and functional impairment.[2]
Insomnia generally is divided into two types: short-term or acute insomnia, which usually lasts a few days to weeks and typically is due to a stressor such as job loss or death of a loved one; and chronic insomnia, which is defined as insomnia symptoms occurring at least three times per week for at least three months.[3]
Importantly, numerous prescription and over-the-counter medications can cause or exacerbate insomnia. Knowing which medications prescribed or recommended by your doctor cause insomnia will allow you to take steps to avoid or minimize this common, troubling adverse drug effect.
Drugs that cause insomnia while being used
Numerous oral medications have effects that can cause insomnia while the drugs are being used (see Table, below, for a list of examples; note that this list is not all-inclusive). The list of such drugs includes the following:
- appetite suppressants for weight reduction
- beta blockers used to treat hypertension (high blood pressure) as well as other conditions like angina, heart failure or abnormal heart rhythms
- central nervous system stimulants, such as amphetamines for treating attention deficit hyperactivity disorder or narcolepsy (a sleep disorder characterized by marked daytime drowsiness and episodes of sudden falling asleep)
- diuretics (water pills)
- certain drugs for treating infections
- glucocorticosteroids (alsoknown as corticosteroids) usedto treat inflammation andnumerous autoimmune diseases,among other things
- monoamine oxidase (MAO)inhibitors used to treat depression or Parkinson’s disease
- over-the-counter nasal decongestants and cold medicines
- selective serotonin reuptakeinhibitors (SSRIs) used to treatdepression or other psychiatricdisorders
- serotonin and norepinephrinereuptake inhibitors for treatingdepression or other conditions[4]
The manner in which these drugs cause insomnia varies. For example, appetite suppressants and central nervous system stimulants promote wakefulness through their direct effects on the brain, whereas diuretics (water pills) can cause nocturia (waking up at night to urinate), thus interrupting sleep and promoting insomnia.
For many of these drugs, the proportion of patients who experience insomnia can be quite high. For example, insomnia has been reported to occur in nearly 70% of patients taking MAO inhibitors (for example, phenelzine [NARDIL]) for depression, 50–70% of patients taking the glucocorticosteroid prednisone (RAYOS) and 5–35% of patients taking SSRIs (for example, fluoxetine [PROZAC, SYMBYAX]).[5]
Examples of Oral Drugs That Cause Insomnia While Being Used
| Drug Category | Generic Drug Name (Brand Name[s]) |
|---|---|
| Appetite suppressants |
|
| Beta blockers |
|
| Central nervous system stimulants |
|
| Diuretics |
|
| Drugs for treating infections | |
| Glucocorticosteroids |
|
| Monoamine oxidase inhibitors |
|
| Nasal decongestants and cold medicines |
|
| Selective serotonin reuptake inhibitors |
|
| Serotonin and norepinephrine reuptake inhibitors |
|
†Combination brand-name drug that contains one or more other active ingredients
*Designated as Do Not Use by Worst Pills, Best Pills News
**Designated as Limited Use by Worst Pills, Best Pills News
Drugs that cause rebound insomnia when stopped
There are numerous drugs that, when discontinued, can lead to a condition known as rebound insomnia.
Examples of such drugs include the following:
- certain benzodiazepines, particularly those that are cleared quickly from the body, such as flurazepam (available in genericonly), temazepam (RESTORIL)and triazolam (HALCION),[11],[12] all of which Public Citizen’s Health Research Group has designated as Do Not Use
- glucocorticosteroids (see Table, above)[13]
- the seizure and neuropathic pain drug gabapentin (GRALISE, HORIZANT, NEURONTIN)[14]
What You Can Do
If you experience insomnia, review all of your prescription and over-the-counter medications (and any recently discontinued medications) with your doctor to determine whether any of them may be contributing to your sleep problems. Do not stop taking any prescription medication without first talking to your doctor. Be aware that other drugs not listed in this article can cause insomnia.
References
[1] Ford ES, Wheaton AG, Cunningham TJ, et al. Trends in outpatient visits for insomnia, sleep apnea, and prescriptions for sleep medications among US adults: findings from the National Ambulatory Medical Care survey 1999-2010. Sleep. 2014;37(8):1283-1293.
[2] Bonnet MH, Arand DL. Risk factors, comorbidities, and consequences of insomnia in adults. UpToDate. April 15, 2022.
[3] Bonnet MH, Arand DL. Evaluation and diagnosis of insomnia in adults. UpToDate. October 4, 2022.
[4] Bonnet MH, Arand DL. Risk factors, comorbidities, and consequences of insomnia in adults. UpToDate. April 15, 2022.
[5] Ibid.
[6] Bayer HealthCare Pharmaceuticals Inc. Label: ciprofloxacin (CIPRO). November 2021. https://www.accessdata.fda.gov/drugsatfda_docs/label/2021/019537s092lbl.pdf. Accessed January 11, 2023.
[7] ANI Pharmaceuticals, Inc. Label: dapsone. March 2022. https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=57a47368-d1f6-4d61-a2ee-c5f1fe7ff690&type=display. Accessed January 11, 2023.
[8] Janssen Pharmaceutical Companies. Label: levofloxacin (LEVAQUIN). June 2020. https://www.accessdata.fda.gov/drugsatfda_docs/label/2020/020634s073lbl.pdf. Accessed January 11, 2023.
[9] Breckenridge Pharmaceutical, Inc. Label: moxifloxacin. January 2021. https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=4bcacdca-c1cf-234c-e054-00144ff8d46c&type=display. Accessed January 11, 2023.
[10] Label: rimantadine (FLUMADINE). https://www.accessdata.fda.gov/drugsatfda_docs/label/2010/019649s015lbl.pdf. Accessed January 11, 2023.
[11] Bonnet MH, Arand DL. Risk factors, comorbidities, and consequences of insomnia in adults. UpToDate. April 15, 2022.
[12] Gillin JC, Spinweber CK, Johnson LC. Rebound insomnia: a critical review. J Clin Psychopharmacol. 1989;9(3):161-172.
[13] Bonnet MH, Arand DL. Risk factors, comorbidities, and consequences of insomnia in adults. UpToDate. April 15, 2022.
[14] Finch CK, Eason J, Usery JB. Gabapentin Withdrawal Syndrome in a Post–Liver Transplant Patient. J Pain Palliat Care Pharmacother. 2010;24(3):236-238.
