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What Medications Cause Insomnia

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What Should I Do If I Experience Side Effects

5 Medications That Can Cause Insomnia | Insomnia

If you notice severe or dangerous side effects, consult your doctor immediately.

If you notice more mild side effects, you should still speak to your doctor as soon as possible. They may be able to suggest a lower dose, a different medication, or a plan for slowly weaning off the medication.

Know that rebound insomnia can occur when you stop using prescription sleep aids, especially if you stop cold-turkey. It can also happen as youre gradually lowering your dosage. Rebound insomnia can feel even more frustrating than your original insomnia, as you may experience vivid dreams, nightmares, and anxiety. If you experience this, talk to your doctor. They may suggest lowering your dose more gradually.

How Soon After Taking The Drug Can A Sleep Disorder Be Induced

In some cases, a sleep disorder can be induced almost immediately after taking a drug or medication. According to diagnostic guidelines for physicians and other healthcare professionals who assess sleep disorders, there is even a category “with onset during intoxication,” which means that the sleep disturbance actually begins when the individual was under the influence of alcohol, a recreational drug, or medication.

It can also occur during withdrawal. Sleep problems are a very common withdrawal symptom, and, like other withdrawal symptoms, will often resolve themselves within days or weeks of discontinuing alcohol, drugs, or medications. So time is needed to determine whether sleep problems are simply a symptom of withdrawal, which becomes clear if the person’s sleep improves within a few days or weeks of ceasing to take the drug.

In contrast, with a substance-induced sleep disorder, problems with sleep can start during withdrawal, and continue or get worse as the person moves through the detox process, and into the post-withdrawal phase of recovery. Sometimes, sleep problems are part of a larger cluster of longer-term withdrawal symptoms, known as post-acute withdrawal syndrome .

Treatment Of Chronic Insomnia

A number of at-home and professional treatment options are available for chronic insomnia. Treatment will depend on the cause of your insomnia and may involve medication or therapy to address an underlying condition.

Along with treating any existing conditions, your doctor may recommend one or a combination of treatment options for chronic insomnia.

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Insomnia And Specific Sleep Disorders

Specific sleep disorders can be a cause of insomnia. Obstructive sleep apnea, which causes numerous breathing lapses and temporary sleep interruptions, affects up to 20% of people and can be an underlying factor causing insomnia and daytime sleepiness.

Restless Leg Syndrome detracts from sleep by causing a powerful urge to move the legs. Abnormal behaviors during sleep, known as parasomnias, can interfere with sleep. Some well-known examples of parasomnias include sleepwalking, nightmares, and sleep paralysis.

Becoming Aware Of Your Sleep Problem

Benzodiazepine Drugs Approved for Insomnia

It can take months or even years to become aware of a substance- or medication-induced sleep disorder. As drugs tend to affect feelings of alertness and relaxation, people expect their sleep to be affected to some extent and anticipate a rebound effect afterward. Then, it can seem like just a series of bad nights, rather than a disorder that is not going away on its own.

The irony of substance-induced sleep disorder is that many people affected by it drink, take drugs, or use medications to try and get to sleep, yet those same drugs actually interfere with getting a good night’s sleep afterward. For this reason, people often don’t realize that it is alcohol, drugs or medications that are causing the sleep problems, because they associate those substances with inducing sleep.

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Restless Legs Syndrome And Periodic Limb Movement Disorder

Symptoms of restless legs syndrome include uncomfortable limb sensations at sleep onset and motor restlessness exacerbated by relaxation. Periodic limb movement disorder is characterized by repetitive, stereotypic limb movements occurring in 15- to 40-second cycles in NREM sleep and often leading to recurrent arousals from sleep. These disorders are quite common, occurring in up to 15% of the population and increasing in frequency with age.

Historically, both periodic limb movement disorder and restless legs syndrome have been treated with benzodiazepines, particularly clonazepam. Low dosages of dopamine precursors and dopamine receptor agonists at bedtime have been demonstrated to be efficacious in these disorders. Possible side effects from these medications, which include carbidopa/levodopa, pergolide, pramipexole, selegiline, and ropinirole, are nausea, headache, and occasional augmentation of symptoms.

Is It Safe To Take Medication To Treat Insomnia

The cornerstone of therapy for insomnia involves a treatment called cognitive behavioral therapy . This form of therapy provides techniques to help the body relax and develop habits to improve sleep. Its performed by a medical professional with specialized training.

Medications are typically used as add-on therapy when general sleep hygiene and CBT do not work. Thats because there are risks that come along with taking any medications, especially in older adults.

Important considerations when considering a sleeping medication include:

  • how long it stays in your body
  • what side effects it may have
  • the level of dependency it may cause

Its critical to review medications with your physician. Some medications may have secondary side effects, such as daytime sleepiness.

Always take medications as prescribed by your doctor. There should be a timeline and goal for when to start decreasing and stop taking the medication.

I wouldnt say that I never use medications to treat insomnia. However, I am very conservative and considerate of medication side effects.

Most people typically improve with CBT alone. But some of my patients have persistent insomnia and frequent recurrence. Their condition may require both CBT and medication so they can get adequate sleep at night.

Doctors may recommend several medications to treat insomnia.

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What Are The Causes Of Insomnia During Pregnancy

Multiple factors can cause insomnia during pregnancy:

  • Discomfort: Increased weight and changed body composition can affect positioning and comfort in bed.
  • Disrupted Breathing: Growth of the uterus places pressure on the lungs, creating potential for breathing problems during sleep. Hormonal changes can increase snoring and the risk of central sleep apnea, which involves brief lapses in breath.
  • Reflux: Slower digestion can prompt disruptive gastroesophageal reflux in the evening.
  • Nocturia: Greater urinary frequency can create the need to get out of bed to go to the bathroom.
  • Restless Leg Syndrome: The exact cause is unknown, but pregnant women have a greater risk of RLS even if they have never had symptoms before becoming pregnant.

Studies have found that more than half of pregnant women report sleeping problems consistent with insomnia. In the first trimester, pregnant women frequently sleep more total hours, but the quality of their sleep decreases. After the first trimester, total sleep time decreases, with the most significant sleeping problems occurring during the third trimester.

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What Does Fatal Familial Insomnia Mean

What about medications for insomnia?

Fatal Familial Insomnia is a rare genetic neurological disorder that causes chronic insomnia. FFI typically starts mild but eventually becomes worse, resulting in death. Fatal Familial Insomnia is different from traditional insomnia in several ways.

First, FFI is an inherited disorder. Research has found that some people may be genetically predisposed to developing insomnia, but there is no evidence that its directly inherited like FFI. Second, Fatal Familial Insomnia is a direct cause of death in patients. Insomnia can cause long-term health issues that could be fatal later, but it is not directly linked to mortality.

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When To See Your Gp

Make an appointment to see your GP if you’re finding it difficult to get to sleep or stay asleep and it’s affecting your daily life particularly if it has been a problem for a month or more and the above measures have not helped.

Your GP may ask you about your sleeping routines, your daily alcohol and caffeine consumption, and your general lifestyle habits, such as diet and exercise.

They will also check your medical history for any illness or medication that may be contributing to your insomnia.

Your GP may suggest keeping a sleep diary for a couple of weeks to help them gain a better understanding of your sleep patterns.

Each day, make a note of things such as the time you went to bed and woke up, how long it took you to fall asleep, and the number of times you woke up during the night.

Insomnia Causes Due To Psychiatric Issues

Psychiatric disorders or issues are the most commonly known cause of insomnia.

These include:

Anxiety. Many people with an anxiety disorder have trouble with their own thoughts and worries keeping them up at night. When they finally do get to sleep, they often wake up and the anxiety keeps them from being able to fall back asleep.

Unfortunately, not only can anxiety cause insomnia, but insomnia can also cause anxiety. This makes it important to find the root cause of whats going on so the cycle can be stopped.

Depression. Depression is not the same thing as anxiety. But like anxiety, depression can also lead to insomnia. This can be an ongoing, chronic problem for someone thats chronically depressed. It may also be a seasonal condition in someone with seasonal affective disorder , which happens in the dark, gloomy, winter months.

Post-Traumatic Stress Disorder . For someone with PTSD, being in the dark can bring on flashbacks and feelings of fear and anxiety. If theyre able to fall asleep, they may sometimes awaken with nightmares.

Stress and worry. You dont have to have a diagnosed with a mental disorder to have stress or worry keep you up at night. Often times people have insomnia while going through some kind of stressful life event, such as loss of a loved one, loss of a job, or a divorce, for example.

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Precautions If You Take Trazodone

  • Because trazodone might not work well to treat insomnia after a few weeks, check in with your doctor periodically to discuss how its going or whether its still working.
  • If you have trouble getting to sleep, take it several hours before you go to bed. If you have trouble staying asleep, take it within 30 minutes of bedtime.
  • Avoid trazodone if youre recovering from a heart attack. Inform your doctor if you have abnormal heart rhythms, weakened immunity, an active infection, or liver or kidney disease. Use it cautiously if you have heart disease.
  • Watch for adverse effects. Thats especially important for people older than 55 or so because theyre more susceptible to abnormal heart rhythms and falls caused by dizziness or drowsiness. Close monitoring is also crucial if youre taking trazodone with another antidepressant.
  • As with any sleep medication, never mix trazodone with alcohol, and use it cautiously if youre taking other sedating medications or anti-hypertensive drugs. Ask your doctor or pharmacist about other possible drug interactions.
  • If you develop an erection thats unusually prolonged or occurs without stimulation, discontinue the drug and contact your physician. Also call your doctor if you develop a fever or sore throat, or other signs of infection while taking trazodone.

Additional reporting by Chris Hendel and Ronald Buchheim

Some Medicines Cause Insomnia:

Classes of Major Anti

Amphetamines are an easy target. But many other medicine cause insomnia. Here is just one example:

Q. When I was working, I got up at 6 am to leave for work at 7 and went to bed around 11:30 pm. Now that Im retired, I have gotten used to going to bed later and waking up later, but thats getting out of hand. I now rise between 9 and 11 am or sometimes even later, since I dont get to sleep until 2 or 3 am. Id like to get out of this vicious cycle.

I was on trazadone for a while but still had trouble falling asleep. Then I was drowsy the next day unless I had several cups of coffee. How can I fix my current dilemma without taking sleeping pills?

I take glipizide for type 2 diabetes, Lasix and lisinopril for high blood pressure, simvastatin for high cholesterol and gabapentin for spinal stenosis pain. I also take oxybutynin for overactive bladder, so I dont want to add more meds.

A. Some of your medications may be contributing to your sleeping problems. Please ask your doctor to check oxybutynin and simvastatin.

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What Are The Risks And Complications Of Insomnia

The risks and complications of insomnia include worse job or school performance, increased risk for accidents, bad personal and professional relationships, long-term health problems, and less physical energy.

  • Worse Job or School Performance: Insomnia can diminish job or school performance. A lack of sleep can impair your ability to learn new information, make it harder to concentrate, and elevate your risk of errors. These factors can cause you to do worse in your academic or professional career.
  • Higher Risk for Accidents: Sleep deprivation associated with insomnia can cause you to feel tired during the day, increasing the risk of motor vehicle accidents. The National Highway Traffic Safety Administration reports 697 drowsy-driving deaths in 2019.
  • Bad Personal and Professional Relationships: Insomnia can cause you to exhibit more negative moods, which may harm your personal and professional relationships. Insomnia in kids could impair their social skills with peers as well.
  • Long-Term Health Problems: Chronic insomnia can lead to long-term health problems. Long-term complications associated with insomnia include hypertension, heart attacks, strokes, obesity, and diabetes.
  • Less Physical Energy: Not getting enough rest due to insomnia can reduce physical energy during the day. Less energy may mean you avoid working out or attending social outings with friends or family.
  • How Common Is Insomnia With Stimulant Medications

    A review in the journal Neurotherapeutics was quite clear:

    Insomnia or delayed SOL greater than 30 minutes is one of the most common adverse events associated with stimulant medications.

    If you check out the official prescribing information for Adderall XR you discover that in one clinical trial 27% of adults reported insomnia as a side effect of the drug. Interestingly, the official prescribing information for Vyvanse also reports an incidence of insomnia of 27% associated with this stimulant medication.

    One would hope that a health professional would mention a common side effect such as trouble sleeping when prescribing a stimulant medication.

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    Approach To The Patient

    Behavioral interventions are the mainstay of treatment for insomnia. If pharmacologic intervention becomes necessary, a tailored approach based on the type of insomnia is suggested . If the initial intervention is ineffective, a different agent in the same class or a different class of medication should be considered. Although some persons can tolerate multiple sedating agents, such as a sedating tricyclic antidepressant and a z-drug, extreme caution should be used when prescribing such combinations. Because of the risk of respiratory depression, patients at risk of sleep apnea or nocturnal hypoxia due to lung disease should be evaluated by a sleep specialist before sedating medication is prescribed. Benzodiazepines are generally not recommended because of their high risk of abuse. If benzodiazepines are prescribed, they should be used for the shortest possible time at the lowest possible dose. Benzodiazepines, z-drugs, atypical antipsychotics, and tricyclic antidepressants should be avoided in older adults, patients with untreated sleep apnea, and those with chronic nocturnal hypoxia. Herbal medications have not been proven effective for the treatment of insomnia.13

    Recommended treatment algorithm for insomnia.

    Treatment of Insomnia

    Figure 1.

    Recommended treatment algorithm for insomnia.

    This article updates previous articles on this topic by Ramakrishnan and Scheid54 Rajput and Bromley55 and Eddy and Walbroehl.56

    Read the full article.

    How Can I Sleep Better Without Sleeping Pills

    Medication Induced Insomnia

    Cognitive behavioral therapy is an effective tool for improving sleep and curing insomnia. Behavioral changes often improve sleep without the need for medications.

    You may want to:

    • Avoid large meals and alcohol before bed.
    • Cut back on caffeine, including coffee, sodas and chocolate, throughout the day and especially before bedtime.
    • Relax with soothing music, a good book or meditation.
    • Shut off electronic devices at least 30 minutes before bedtime.
    • Stay physically active during the day. Try to get outside, if possible.
    • Stick to a sleep schedule even on weekends.
    • Turn your bedroom into a dark, quiet and cool sanctuary.

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    What Are Causes Of Insomnia In The Elderly

    Insomnia occurs in 30-48% of older adults, who often have particular struggles with sleep maintenance.

    As in people of a younger age, stress, physical ailments, mental health problems, and poor sleep habits can cause insomnia in the elderly. However, elderly people are often more sensitive to these causes because of higher levels of chronic health conditions, social isolation, and an increased use of multiple prescription drugs that may affect sleep.

    Research indicates that people over age 60 have less sleep efficiency. They spend less time in deep sleep and REM sleep, which makes it easier for their sleep to be disturbed. A decrease in daylight exposure and reduced environmental cues for sleep and wakefulness can affect circadian rhythm, especially for elderly people in managed care settings.

    Is There Any Reason I Might Not Be Able To Take Sleep Medication

    Always consider the current medications that you are taking for any drug interactions. Look at the individual ingredients and make sure you have no allergies to contents of the medication.

    Any medications that can make you drowsy should typically not be taken when drinking or driving and should be avoided by older adults.

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    Take Your Medication At A Different Time

    Sometimes timing can make all the difference. If theres flexibility in when you take your medications, taking them at a different time can make all the difference in your sleep quality. This is especially true for medications that contain stimulants you dont want to be taking something thats supposed to keep you awake close to bedtime.

    However, if you need to take your prescription on a set schedule, talk to your doctor before you do anything.

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