Whenever Dr. David Neubauer sees patients with sleep complaints, his first question is about whether they are taking any prescription or over-the-counter medications.
Dr. Neubauer, a psychiatrist and sleep specialist at Johns Hopkins Medicine, said that in many cases, he can quickly figure out which drug is causing the issue — whether it’s trouble falling or staying asleep, or feeling drowsy during the day.
There are many medications that can disrupt sleep, Dr. Neubauer said, including those for colds, allergies, high blood pressure, mental health issues and more.
Here are some of the most common medications that can keep you awake — and what to do if you’re struggling with sleep while taking them.
1. Certain A.D.H.D. Drugs
There are two main categories of medication that treat attention deficit hyperactivity disorder: stimulants and nonstimulants. The stimulants, which include Adderall, Vyvanse, Ritalin and Concerta, are very good at improving focus, said Julie Dopheide, a professor of clinical pharmacy at the University of Southern California. But they are notoriously disruptive to sleep, she said.
Stimulant medications increase dopamine and norepinephrine levels in the brain, causing many people to feel alert. The drugs are so good at keeping people awake that they are sometimes prescribed for narcolepsy, a sleep disorder that causes extreme daytime sleepiness.
Not everyone who takes a stimulant has trouble sleeping. But if you’re struggling, it’s best to take it early in the day so that any induced alertness can wear off by bedtime, Dr. Neubauer said. Some people, especially those taking extended-release versions, may still feel energized late into the evening.
2. Sudafed and Other Decongestants
Over-the-counter decongestants that contain pseudoephedrine, like Sudafed, may disrupt sleep too, Dr. Dopheide said. The active ingredient is also found in many cold and allergy drugs like Advil Cold & Sinus, Zyrtec-D and Claritin-D.
Pseudoephedrine works by stimulating the release of norepinephrine, which binds to receptors that cause your blood vessels to shrink. When this happens in your nasal passages, it creates more space for air to flow. Although this can help you breathe more easily, norepinephrine can also have an adrenaline-like effect. And because pseudoephedrine can temporarily raise blood pressure, some people feel like their hearts are pounding when they try to sleep.
If a decongestant makes sleep challenging, try taking it in the morning, Dr. Neubauer said. Or consider other cold and allergy medications that do not contain pseudoephedrine, said C. Michael White, a professor of pharmacy at the UConn School of Pharmacy and Pharmaceutical Sciences. Some nasal sprays are also useful for congestion, he said, and aren’t likely to disrupt sleep.
3. Anti-Smoking Aids
When you quit smoking, sleeping may become difficult as your body adjusts to the lack of nicotine. Paradoxically, some smoking-cessation products including patches, gums and lozenges that contain nicotine can also have a similar effect. The nicotine in them increases norepinephrine and dopamine in the brain, Dr. White said. As a stimulant, nicotine can also increase heart rate and blood pressure.
It can help to consult a doctor or a smoking-addiction coach if these products disrupt your sleep. A professional may adjust the timing or dose of the products or recommend other strategies to quit smoking.
4. Some Antidepressants
Selective serotonin reuptake inhibitors (like Prozac and Zoloft) and serotonin-norepinephrine reuptake inhibitors (like Cymbalta and Effexor) are among the most popular antidepressants, said Dr. Bhanu Kolla, a psychiatrist who specializes in sleep medicine and addiction psychiatry at the Mayo Clinic in Minnesota.
Their side effects can widely vary, he said. Some people may feel too alert to sleep, and others too drowsy to stay awake.
Wellbutrin, another type of antidepressant, may also disrupt sleep because it has stimulating properties, Dr. Dopheide said. If an antidepressant is messing with your sleep, your doctor can adjust the dose or the time you take it, or suggest an alternative.
5. Diuretics
Diuretics, often called “water pills,” are essential for managing conditions like high blood pressure, heart failure, kidney disease and liver disease. But they can indirectly disturb sleep by increasing the need to urinate at night, Dr. Dopheide said.
These drugs work to prevent stress on your heart by removing extra salt and water from your blood through increased urination. Many diuretics are available via prescription, but some options, like Diurex, are offered over-the-counter. Midol, which relieves bloating and other menstrual symptoms, is another nonprescription drug that contains a diuretic.
Taking the medications earlier in the day and drinking less fluids near bedtime may help reduce middle-of-the night bathroom trips, Dr. Kolla said.
The Bottom Line
Any sleep disruptions that result from taking a medication should be discussed with a doctor, Dr. Neubauer said.
Adopting healthy sleep habits could also help counter the medication’s side effects, Dr. White added. Try to avoid consuming caffeine after around 2 p.m., don’t drink alcohol just before bed, keep your bedroom dark and cool and maintain a consistent sleep schedule.