Can lisinopril cause insomnia

The secret to a better night’s rest could be changing or reducing the dosage of your medication. Doctors prescribe medications with the best intentions, but many common medications can interfere with sleep as a side effect. Certain over-the-counter ones can, too.

For example, some medications, including those for high blood pressure and asthma, can keep you up all night with insomnia, while others, like cough, cold, and flu medications, can disrupt sleep. And certain medications, such as antihistamines, can cause daytime drowsiness. In fact, sleepiness is one of the most common side effects of medications.

Medications that can affect sleep include:

  • Anti-arrhythmics (for heart rhythm problems)
  • Beta blockers (for high blood pressure)
  • Clonidine (for high blood pressure)
  • Corticosteroids (for inflammation or asthma)
  • Diuretics (for high blood pressure)
  • Cough, cold, and flu medications that contain alcohol
  • Headache and pain medications that contain caffeine
  • Nicotine replacement products
  • Sedating antihistamines (for colds and allergies)
  • SSRIs (for depression or anxiety)
  • Sympathomimetic stimulants (for attention deficit disorder)
  • Theophylline (for asthma)
  • Thyroid hormone (for hypothyroidism)

If you suspect that a medication is disrupting your sleep or causing you to feel drowsy during the day, talk to your doctor. He or she may be able to switch you to a different one that has a different side effect profile, reduce the dosage of your current prescription, or suggest a different type of treatment altogether so that your sleep isn’t affected. For example, if you’re taking a medication to lower your blood pressure and it’s negatively affecting your sleep somehow, you might consider asking your doctor whether you can drop the medication and replace it with lifestyle changes, such as losing weight, exercising regularly, eating more nutritious foods, reducing your intake of sodium, alcohol, and caffeine, quitting smoking, and/or lowering your stress.

What you shouldn’t do is attempt to solve the problem on your own. Always discuss the situation in depth with your doctor first, and don’t stop taking the medication until you have decided on an alternative treatment. Otherwise, you may experience dangerous side effects (such as uncontrolled asthma, ADD, depression, or anxiety). A physician’s guidance can help you evaluate the risks and benefits of a medication.

Contents

Beta Blockers: How Can These Common Medications Impact Your Sleep?

What are Beta Blockers?

Beta blockers are a class of medication used to treat a variety of heart and blood pressure conditions including: heart failure, high blood pressure, angina, atrial fibrillation, and others.

Beta blockers are prescribed for these conditions because they regulate the receptors that control heart rate. Decreasing your heart rate in these conditions works to improve your blood pressure while also decreasing the amount of work your heart has to do on a daily basis.

Although this is extremely helpful for the conditions mentioned above, the receptors beta blockers block are also located in the brain, specifically in the pineal gland that controls the release of melatonin.

What is Melatonin?

Melatonin is a hormone closely tied to sleep. It is released from the pineal gland in the brain.

The release of melatonin is controlled by a variety of factors including: your sleep-wake cycle, the time that you get up, the time you go to bed, and the amount of light you are exposed to.

On a normal day, a person’s melatonin levels will be low during the day (when they are typically awake, as well as when it is brightest) and will gradually climb in the evening. The melatonin levels will stay elevated throughout the night and will drop as the sun rises.

What Does This Mean For Me?

Individuals who take beta blockers can have less melatonin than needed, therefore making it difficult to sleep.

Many beta blockers can decrease the amount of melatonin by up to 80% (with the exception of carvedilol and Bystolic®).

A clinical study conducted with patients taking beta blockers showed significant improvement in people’s quality of sleep when they continually took a 2.5mg melatonin supplement one hour prior to going to sleep.

The results from taking this supplement showed that patients fell sleep approximately 10 minutes faster and progressed into deeper stages of sleep more quickly.

No adverse reactions were seen from taking this melatonin supplement.

These improvements began after 1 week of taking the supplement and lasted for up to two weeks after individuals stopped taking it.

Is a Melatonin Supplement Something I Should Consider Taking?

For individuals who take beta blockers and experience trouble sleeping, taking extra melatonin could help improve their quality of sleep.

If you are curious if melatonin could help you, please stop by Sona Pharmacy (or call (828) 298-3636) and speak with one of our pharmacists.

We are more than happy to help talk with you to determine the best options for your personal needs!

What is melatonin. Sleep.org. https://sleep.org/articles/melatonin/. Accessed online 8/16/18.

Frank A.J.L. Scheer et al. Repeated Melatonin Supplementation Improves Sleep in Hypertensive Patients Treated with Beta-Blockers: A Randomized Controlled Trial. Sleep. Oct. 2012 35(10):1395-1402. Accessed online 8/16/18.

CV Drugs That Negatively Affect Sleep Quality

Sleep-disordered breathing (SDB), including both Cheyne-Stokes Breathing-Central Sleep Apnea (CSB-CSA) and Obstructive Sleep Apnea Hypoapnea Syndrome (OSAHS), occurs frequently as a co-morbid condition in patients with heart failure (HF).1 Although both conditions may be present, CSB-CSA is generally thought to be a consequence of HF, while OSAHS may actually be a causative factor as a result of its effect on hypertension. Newer data also suggests that patients with OSAHS are more than twice as likely to have a family history of premature death due to coronary artery disease (CAD), regardless of whether the patient has CAD.2 While the association between cardiovascular conditions such as CHF and now CAD and their negative effects on sleep is known, questions remain regarding how and to what extent various cardiovascular medications may negatively affect sleep quality in patients with other co-morbidities. This article will focus on the effects of cardiovascular medications on sleep quality and strategies that clinicians may use to identify and minimize negative effects.

Alpha Adrenergic Agonists
Data is inconsistent regarding the effects of centrally acting alpha adrenergic agents on sleep quality; one study in hypertensive patients found that clonidine decreased total sleep time, however another study in healthy patients showed that clonidine increased total sleep time.3,4 However, another study reported that clonidine suppressed rapid eye movement (REM) sleep and the apneas occurring during REM, which decreased nocturnal hypoxemia.5 Despite the inconsistent data on the effects of the alpha adrenergic agonists on sleep quality it is clear that the class exhibits a high degree of CNS effects. As such, these agents probably should not be considered preferred agents for hypertension, particularly in the geriatric population.

Antiarrhythmics
Class I
There is little data and few published studies showing any negative effects of the Class I antiarrhythmics on sleep quality. Of note, the package labeling for propafenone states that insomnia occurs in 1-2% of patients, with fatigue occurring in 2-6% and drowsiness occurring in 1% of patients. Adverse effects are considered dose related; however, blockade of beta adrenergic receptors as well as the blockade of fast inward sodium channels may be partially responsible for the CNS effects.6 Similarly, the labeling for flecainide describes a high level of CNS adverse effects including dizziness (19-30%), visual disturbances (16%), fatigue (8%) and somnolence and insomnia at a frequency between 1% and 3%. Despite the relative paucity of clear association between the Class I antiarrhythmics and sleep quality, it seems prudent to discuss these potential adverse reactions with patients and perhaps with the geriatric subset of patients in particular, since they are known to have increased levels of sleep disturbance at baseline.

Class II Beta Blockers
Beta blockers exist as hydrophilic and lipophilic moieties and their effects on sleep are related to their ability to cross the blood brain barrier (BBB). The lipophilic agents include metoprolol, pindolol and propranolol. These three agents readily cross the BBB and affect sleep quality by increasing the number of awakenings as well as the amount of awake time after onset of sleep.7 Furthermore, the lipophilic type have been associated with daytime somnolence, insomnia, nightmares and hallucinations. This effect is observed even after daytime administration and appears to be independent of their effect on nighttime sleep.8 Finally, both lipophilic and hydrophilic beta blockers may negatively affect sleep architecture by suppressing REM sleep.7,8 More recent data published in 2007 support a hypothesis that carvedilol, an agent with mixed beta blocker and alpha adrenergic blocker activity, may affect CSA severity by normalizing enhanced central chemosensitivity to CO2.9 In the small study, patients taking carvedilol had a lower apnea-hypoapnea index (AHI) and central apnea index (CAI) than the cohort not taking the drug. Furthermore, the indices appeared to be negatively associated with the dose; patients receiving the highest doses had the lowest index scores. It is unclear whether the data can be extrapolated to all beta blockers; however, if a beta blocker is indicated, perhaps carvedilol may offer benefit over the other agents in the patient with concomitant OSAHA or CSA.

Class III

Amiodarone
This agent is known to have a plethora of adverse reactions, many of them serious. CNS effects, including insomnia, fatigue and other sleep disturbances are described as occurring in 3% to 40% of patients in the package labeling and neurologic side effects were reported in the literature in 20-40% of patients.10
Dronedarone
This is the newest agent of the class and while it has decreased efficacy over amiodarone, it also has decreased adverse reactions, including no known adverse effects on sleep quality or architecture.
Dofetilide
There are no published studies detailing any association between dofetilide and negative sleep quality; however, the package labeling states that insomnia occurs in 4% of treated patients.
Sotalol
The package labeling for this agent indicates an 8% occurrence of undefined sleep problems; however a very small published study which evaluated the effects of sotalol 320mg or 960mg on the CNS via sleep, EEG, and psychophysiological parameters showed no difference between the two treated groups.11

The Class III agents, although similarly classed, have vastly different associations with sleep disturbance and sleep quality. Clinically, based upon individual factors, one agent may be preferred over another for treatment of specific arrhythmia; however, the clinician must be vigilant to the occurrence of CNS effects and their adverse effect on sleep quality and architecture.

Class IV: Non-dihydropyridine Calcium Channel Blockers

Diltiazem and Verapamil There is no data indicating an association between diltiazem and sleep disturbance and although sleep disturbance is listed as a potential adverse effect in the product labeling of verapamil, it is not known to be a common side effect, occurring in less than 1% of patients treated.

Angiotensin Converting Enzyme (ACE) Inhibitors
ACE inhibitors are thought to negatively affect sleep in some patients by increasing the amount of circulating bradykinin. The associated cough and rhinopharyngeal inflammation induced by the bradykinin may worsen the AHI.12 Additionally, ACE inhibitors may affect potassium levels, potentially leading to leg cramps as well as painful joints and muscles in some patients. Since these side effects do not affect all patients, clinicians should discuss them with patients and adjust therapy accordingly if necessary, to avoid sleep disturbances.

Angiotensin Receptor Antagonists (ARBs)
Although ARBs do not cause the bradykinin induced cough that is associated with ACE inhibitors, they may affect potassium levels, potentially leading to disturbances in sleep quality by causing painful joints and muscles and causing or worsening existing leg cramps. As previously discussed, clinicians should inquire about adverse reactions and adjust therapy if needed to optimize overall outcomes and minimize adverse effects.

HMG Co-A Reductase Inhibitors
These agents are known to cause muscle pain which may affect sleep quality by not allowing patients to fall asleep and stay asleep. It has been hypothesized that the lipophilic type HMG Co-A reductase inhibitors may cause a disturbance in sleep architecture and cause insomnia or nightmares via their increased penetration of the blood-brain barrier. However, a study comparing simvastatin (a lipophilic agent) and pravastatin (a hydrophilic agent) via objective and subjective measures of sleep, found no differences between the two agents.13 It is generally thought that the lipophilic agents may cause more adverse reactions than their hydrophilic siblings; therefore, if the clinician feels that the patient is exhibiting side effects such as increased muscle aches or complains of difficulties with sleeping, it may be prudent to switch to a hydrophilic agent preferentially.

Many cardiovascular medications have been shown to be associated with negative changes in sleep quality and sleep architecture. The high variability of association may be due in part to the wide variety of patient specific factors including patient age, race, sleep habits or sleep disturbance at baseline, co-morbidities leading to increased sleep disturbance at baseline, variability in clinical dosing, and other unknown factors. It is clear that although more research is needed to fully elucidate the association between cardiovascular medications and sleep quality, clinicians should actively question their patients about sleep quality upon initiation of and periodically throughout medication therapy.

  1. Lanfranchi PA, Somers VK. Sleep-disordered breathing in heart failure: Characteristics and implications. Respir Physiol Neurobiol 2003;136:153-165.
  2. Gami AS, Olson EJ, Shen WK, et al. Obstructive Sleep Apnea and the Risk of Sudden Cardiac Death: A Longitudinal Study of 10,701 Adults. J Am Coll Cardiol 2013;62:610-616.
  3. Kostis JB, Rosen RC, Holzer BC, et al. CNS side effects of centrally-active antihypertensive agents: a prospective, placebo-controlled study of sleep, mood state, and cognitive and sexual function in hypertensive males. Psychopharmacology (Berl) 1990;102:163-70.
  4. Kanno, O, Clarebach, P. Effect of clonidine and yohimbine on sleep in man: polygraphic study and EEG analysis by normalized slope descriptors. Electroencephalogr Clin Neurophysiol 1985;60:478-84.
  5. Issa FG. Effect of clonidine in obstructive sleep apnea. Am Rev Respir Dis 1992;145:435-439.
  6. Stavens CS, McGovern B, Garan H, Ruskin JN. Aggravation of electrically provoked ventricular tachycardia during treatment with propafenone. Am Heart J 1985;110:24-9
  7. Rosen RC, Kostis JB. Biobehavioral sequelae associated with adrenergic-inhibiting antihypertensive agents: a critical review. Health Psychol 1985;4:579.
  8. Schweitzer PK. Drugs that Disturb Sleep and Wakefulness. In: Principles and Practices of Sleep Medicine., Fifth, Kryger MH, Roth, T, Dement WC.. (Eds), Elsevier Saunders, St. Louis, MO. 2011. p. 542.
  9. Tamura A, et. al. Carvedilol suppresses sleep apnea. Chest. 2007; 131: 118-121, 130-135.
  10. Hilleman, D., Miller, M. A., Parker, R., Doering, P. and Pieper, J. A. Optimal Management of Amiodarone Therapy: Efficacy and Side Effects. Pharmacotherapy 1998, 18:138S–145S.
  11. Bender W, Greil W, Ruther E, Schnelle K. Effects of the beta-adrenoceptor blocking agent sotalol on CNS: sleep, EEG and psychophysiological parameters. J Clin Pharmacol 1979;19:505-12.
  12. Cicolin A, Mangiardi L, Mutani R, Bucca C. Angiotensin-converting enzyme inhibitors and obstructive sleep apnea. Mayo Clin Proc 2006;81:53-55.
  13. Eckernas SA, Roos BE, Kvidal P, Eriksson LO, Block GA, Neafus RP, Haigh, JRM. The effects of simvastatin and pravastatin on objective and subjective measures of nocturnal sleep: a comparison of two structurally different HMG CoA reductase inhibitors in patients with primary moderate hypercholesterolaemia. Br J Clin Pharmacol 1993;35:284-289.

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Clinical Topics: Heart Failure and Cardiomyopathies, Prevention, Atherosclerotic Disease (CAD/PAD), Acute Heart Failure, Hypertension, Sleep Apnea

Keywords: Cardiovascular Agents, Cheyne-Stokes Respiration, Coronary Artery Disease, Heart Failure, Hypertension, Mortality, Premature, Sleep Apnea Syndromes, Sleep Apnea, Obstructive, Sleep Apnea, Central

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Zyrtec Side Effects

Generic Name: cetirizine

Medically reviewed by Drugs.com. Last updated on Jan 22, 2020.

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Note: This document contains side effect information about cetirizine. Some of the dosage forms listed on this page may not apply to the brand name Zyrtec.

For the Consumer

Applies to cetirizine: oral solution, oral tablets and chewable tablets

Side effects include:

Adults and children ≥12 years of age: Somnolence, fatigue, dry mouth. Insomnia reported with cetirizine (the active ingredient contained in Zyrtec) hydrochloride-pseudoephedrine hydrochloride fixed combination.

Children 2–11 years of age: Headache, pharyngitis, abdominal pain.

Children 6 months to 2 years of age: Irritability, fussiness, insomnia, fatigue, malaise.

For Healthcare Professionals

Applies to cetirizine: oral capsule, oral liquid, oral syrup, oral tablet, oral tablet chewable, oral tablet dispersible

General

The most commonly reported side effects include somnolence, dizziness, and headache.

Nervous system

Very common (10% or more): Somnolence (up to 14.3%), headache (up to 14%)

Common (1% to 10%): Dizziness

Frequency not reported: Altered sense of taste, paresthesia, hypertonia, tremor, abnormal coordination/incoordination, ataxia, hyperesthesia, hyperkinesia, hypoesthesia, migraine, paralysis, twitching, parosmia, taste loss/perversion

Postmarketing reports: Convulsions, dysgeusia, dyskinesia, dystonia, syncope, amnesia, vertigo, memory impairment

Gastrointestinal

Common (1% to 10%): Dry mouth, nausea, diarrhea, vomiting, abdominal pain

Uncommon (0.1% to 1%): Dyspepsia

Frequency not reported: Tongue disorder, constipation, flatulence, increased salivation, aggravated tooth caries, eructation, gastritis, hemorrhoids, melena, rectal hemorrhage, stomatitis/ulcerative stomatitis, tongue discoloration/edema, enlarged abdomen

Respiratory

Common (1% to 10%): Pharyngitis, rhinitis, coughing, epistaxis

Frequency not reported: Dyspnea, respiratory disorder, bronchospasm, upper respiratory tract infection, dysphonia, bronchitis, hyperventilation, increased sputum, pneumonia, sinusitis, nasal polyp

Other

Common (1% to 10%): Fatigue

Postmarketing reports: Asthenia, stillbirth

Psychiatric

Common (1% to 10%): Insomnia

Frequency not reported: Nervousness, impaired concentration, confusion, decreased libido, abnormal thinking, anxiety, depersonalization, emotional lability, euphoria, paroniria, sleep disorder

Postmarketing reports: Agitation, aggression/aggressive reaction, depression, hallucination, tic, suicidal ideation/suicide

Musculoskeletal

Very rare (less than 0.01%): Myelitis

Dermatologic

Frequency not reported: Pruritus/intense itching, increased sweating, acne, alopecia, bullous eruption, dermatitis, dry skin, eczema, erythematous rash, furunculosis, hyperkeratosis, hypertrichosis, maculopapular rash, photosensitivity/photosensitivity toxic reaction, purpura, seborrhea, skin disorder/nodule

Postmarketing reports: Rash, urticaria, angioneurotic edema, fixed drug eruption, acute generalized exanthematous pustulosis (AGEP)

Ocular

Frequency not reported: Eye abnormality, periorbital edema, abnormal vision, eye pain, conjunctivitis, ptosis, visual field defects, blindness, glaucoma, ocular hemorrhage, xerophthalmia, periorbital edema/eye swelling

Postmarketing reports: Accommodation disorder/loss of accommodation, blurred vision, oculogyration, orofacial dyskinesia

Genitourinary

Frequency not reported: Polyuria, urinary retention, urinary tract infection, dysmenorrhea, hematuria, micturition frequency, urinary incontinence, female breast pain, intermenstrual bleeding, leukorrhea, menorrhagia, vaginitis

Postmarketing reports: Dysuria, enuresis

Cardiovascular

Frequency not reported: Flushing, palpitations, tachycardia, edema/general edema, chest pain, cardiac failure, hypertension, hot flashes, peripheral edema, pallor

Postmarketing reports: Severe hypotension

Metabolic

Frequency not reported: Increased appetite, anorexia, increased weight, dehydration, diabetes mellitus

Hepatic

Frequency not reported: Reversible transaminase elevations

Postmarketing reports: Abnormal hepatic function (increased transaminases, alkaline phosphatase, GGT, bilirubin), cholestasis, hepatitis

Hypersensitivity

Frequency not reported: Allergic reactions/delayed allergic reactions

Postmarketing reports: Hypersensitivity, anaphylactic shock

Hematologic

Frequency not reported: Lymphadenopathy

Postmarketing reports: Thrombocytopenia, hemolytic anemia

Renal

Frequency not reported: Cystitis

Postmarketing reports: Glomerulonephritis

1. Cerner Multum, Inc. “UK Summary of Product Characteristics.” O 0

2. “Product Information. Zyrtec (cetirizine).” Pfizer US Pharmaceuticals, New York, NY.

3. Cerner Multum, Inc. “Australian Product Information.” O 0

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Some side effects may not be reported. You may report them to the FDA.

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Impaired sleep (insomnia) is a major complaint from patients in my practice, with huge personal and economic costs. When it comes to treatments for either difficulty going to sleep or staying asleep, looking for an easily reversible cause is the first step.

One of the first places to look: many drugs may affect the quality and duration of sleep. These 18 meds have been shown in studies to do just that. If you are struggling with insomnia and take one of these medications, asking your doctor to try an alternative may allow you to get some zzz’s.

  1. Prednisone. A steroid given for asthma or COPD, hives, and other skin conditions, prednisone has been shown to disrupt your sleep.
  2. Sertraline (Zoloft). Studies show sertraline is a significant disruptor of sleep. Sertraline is a selective serotonin reuptake inhibitor (SSRI) prescribed for depression and obsessive compulsive disorder—if you are struggling with sleep disturbance after starting sertraline, ask your doctor about another option in the same class of meds.
  3. Paroxetine (Paxil). An SSRI used for anxiety, depression, and OCD, studies reveal that paroxetine significantly affects sleep.
  4. Fluoxetine (Prozac). Another well known SSRI used for depression, panic disorder, OCD, and premenstrual dysphoric disorder, fluoxetine has also been shown in studies to contribute to insomnia.
  5. Citalopram (Celexa). Another SSRI that may disrupt sleep.
  6. Fluvoxamine (Luvox). Yet another old school SSRI, this antidepressant may disrupt your sleep.
  7. Donepezil (Aricept). Donepezil is indicated for the treatment of dementia, specifically Alzheimer’s, and may cause disrupted sleep in folks taking it.
  8. Venlafaxine (Effexor). Slightly different from SSRIs, this SNRI (serotonin, norepinephrine reuptake inhibitor) is prescribed for generalized anxiety disorder and depression. Studies show it significantly contributes to insomnia.
  9. Pramipexole (Mirapex and Mirapex ER). These medications are used for restless leg syndrome (RLS) and Parkinson’s disease. Studies show they may contribute to sleep disturbance.
  10. Rotigotine (Neupro). Neupro is a brand-name-only patch prescribed for restless leg syndrome and Parkinson’s disease, and it may cause insomnia.
  11. Ropinirole (Requip). Another medication used for the treatment of restless leg syndrome, ropinirole may contribute to insomnia.
  12. Varenicline (Chantix). Prescribed for folks who want to quit smoking, studies reveal that Chantix may disrupt your sleep.
  13. Rivastigmine (Exelon). This patch is used for the treatment of dementia and has been shown in studies to affect sleep.
  14. Naltrexone (Revia). Naltrexone is an opioid receptor antagonist used for alcohol dependence. It’s also part of the new weight loss medication Contrave (a combination of naltrexone and bupropion). Naltrexone can negatively affect sleep.
  15. Olanzapine (Zyprexa). Olanzapine is used for bipolar disorder and psychosis associated with dementia and studies show it may contribute to insomnia.
  16. Levodopa. Part of Sinemet (a combination of levodopa and carbidopa), it’s used for restless leg syndrome as well as Parkinson’s disease and may cause insomnia.
  17. Amantadine (Symmetrel). Amantadine is an antiviral medication that also happens to be used for Parkinson’s disease and schizophrenia, and it may negatively impact sleep.
  18. Cabergoline (Dostinex). Cabergoline is a medication that’s effective both for restless leg syndrome and for lowering levels of prolactin in those with prolactin-producing pituitary tumors. Studies show cabergoline may cause insomnia.

Hope this helps.

Dr O.

Ref: Doufas A, Panagioutou O. Insomnia From Drug Treatments: Evidence From Meta-analyses of Randomized Trials and Concordance With Prescribing Information. Mayo Clin. Proc Jan 2017: 92(1): 72-87.

  • Among the signs that may indicate a need for a sleep disorders center are:

    • Insomnia due to psychologic disorders
    • Sleeping problems due to substance abuse
    • Snoring and sudden awakening with gasping for breath (possible sleep apnea)
    • Severe restless legs syndrome
    • Persistent daytime sleepiness
    • Sudden episodes of falling asleep during the day (possible narcolepsy)

    Most sleep disorders centers perform an in-depth analysis, which includes polysomnography.

    Polysomnography is the technical term for an overnight sleep study that involves recording brain waves and other sleep-related activity. Its primary role is in diagnosing obstructive sleep apnea, restless leg syndrome/periodic limb movement disorder, or other abnormal sleep behaviors called parasomnias, such as nightmares, sleep walking, and acting out dreams. If obstructive sleep apnea is the most likely problem, a sleep device called a home sleep test may be provided for you to sleep with in your home.

    Treatment

    The American Academy of Sleep Medicine (AASM) recommends a number of behavioral methods and prescription medications as the main treatments for insomnia. According to the AASM, these treatment options can improve both quality and quantity of sleep for people with insomnia.

    Doctors agree that behavioral therapies should be the first-line treatment for insomnia. For children in particular, medications should rarely be used as initial treatment.

    Behavioral Therapy

    Various approaches are available to help people learn how to relax and sleep well. Although medications can help people with insomnia to sleep, they cannot cure the condition. Behavioral techniques can dramatically improve chronic insomnia in many cases, and the benefits of psychological and behavioral therapy are long lasting. Behavioral methods work for all age groups, including children and older adults.

    Sleep hygiene practices, tips and techniques for ensuring a good night’s sleep, should accompany any behavioral method. (For more on sleep hygiene, see the Lifestyle Changes section of this report.)

    Behavioral methods include:

    • Stimulus control
    • Cognitive behavioral therapy
    • Relaxation training and biofeedback
    • Sleep restriction

    All behavioral approaches have the same basic goals:

    • To reduce the time it takes to go to sleep to less than 30 minutes
    • To reduce the frequency and length of wake periods during the night

    Studies report that the majority of people who are treated with non-drug methods experience improved sleep. Furthermore, most of those who have been taking sleep medications are able to stop or reduce their use.

    Stimulus Control

    Stimulus control is considered the standard treatment for primary chronic insomnia and may also be helpful for some people with secondary insomnia. The primary goal of stimulus control is to regain the idea that the bed is for sleeping. It involves the following:

    • Use the bed only for sleep and sex.
    • Go to bed only when ready to sleep.
    • If unable to sleep within 15 to 20 minutes, get up and go into another room. (People who find it physically difficult to get out of bed should sit up and do something relatively arousing, like reading a book.)
    • Maintain a regular wake-up time no matter how few hours you actually sleep.
    • Avoid naps.

    Cognitive-Behavioral Therapy

    Cognitive behavioral therapy (CBT) is a form of therapy that emphasizes observing and changing negative thoughts about sleep such as, “I’ll never fall asleep.” It uses actions intended to change behavior. The goal is to change or correct misconceptions about the ability to fall and stay asleep. Emphasis is on reinforcing the need for 7 to 8 hours of sleep each night and addressing the anxiety that people with insomnia often develop around sleep. Many studies have shown CBT to work as well or better than drugs. According to several studies, adding medication to CBT does not provide additional benefit.

    Relaxation Training and Biofeedback

    Relaxation training includes breathing and guided imagery techniques. Progressive muscle relaxation is another technique for inducing sleep that works well for many people. It takes about 10 minutes to perform and involves the following:

    • Focus on one specific muscle group at a time. Most people start with the muscles in one foot. Inhale and tense the foot muscles for about 8 seconds. (Do this gently. It is not intended to cause severe pain or muscle contractions.)
    • Relax the foot, and let it become loose and limp. Stay relaxed for 15 seconds, and then repeat with the other foot.
    • Move up to the next muscle group and repeat the sequence, doing one side of the body at a time. Move progressively from each foot and leg, up through the abdomen and chest, to each hand and arm, then to the neck, shoulders, and face.

    Biofeedback may be combined with relaxation techniques. Biofeedback involves being monitored with an electroencephalogram (EEG), a device that measures brain waves. People are given feedback to recognize certain states of tension or sleep stages so that they can either avoid or repeat them voluntarily.

    Paradoxical Intention and Sleep Restriction Therapies

    Paradoxical intention is a type of cognitive technique that aims to conquer anxiety about insomnia by forcing the patient to stay awake. Not trying to fall asleep may help relieve performance anxiety associated with sleep.

    Sleep restriction therapy is similar to paradoxical intention. It involves limiting the time spent in bed to the number of hours that are actually spent asleep. Eventually, the sleep loss helps some people fall asleep faster and spend more time asleep. As sleep improves, the hours spent in bed are increased.

    Treatment of Underlying Mental Health Problems

    Disruption in sleep is commonly present in those with mental health problems, such as certain types of depression, bipolar disorder, anxiety disorders, attention deficit disorders, alcohol and substance abuse, psychosis and others.

    When a sleep problem accompanies any of these disorders, it is important that the underlying mental health problem is treated also.

    Drug Therapy

    Unlike behavioral treatment, which can cure insomnia, sleeping pills produce only temporary improvement. Medications for insomnia can also have some serious side effects and risks, especially for older people. In general, the following considerations are important when using medications for the treatment of insomnia:

    • Non-benzodiazepine and other newer sedative hypnotics are the preferred medications for insomnia and have less risk for dependency than other drugs, such as benzodiazepines. However, these drugs may cause hazardous or strange sleep-related behaviors. They can also impair driving and mental alertness the next day. If you need to take one of these prescription drugs, start with as low a dose as possible.
    • For adults over age 60 years, the risks for sedative hypnotics may far outweigh their benefits. Sleep medications increase the risks for falls, depression, and memory loss in older people. Older people should generally start sleep medications at lower doses than younger people.
    • As a general rule, do not take either prescription or nonprescription sleeping pills on consecutive days or for more than 2 to 4 days a week.
    • Medication should be withdrawn gradually, and the person should be aware of the possibility of rebound insomnia after stopping medication. Rebound insomnia is the return of insomnia after medication is discontinued. It usually lasts for several days and can be more severe than the original insomnia.
    • If insomnia is still a problem after stopping the medication and continuing with good sleep hygiene, this pattern can be repeated again, but for only up to 4 weeks.
    • Alcohol intensifies the side effects of all sleeping medication and should be avoided.
    • If chronic insomnia is accompanied by depression or anxiety, treating these problems first may be the best approach.

    Lifestyle Changes

    Sleep Hygiene Tips

    Proper sleep hygiene should accompany any behavioral method. The term sleep hygiene is used to describe simple behaviors that may help everyone improve their sleep.

    During the day:

    • Avoid naps, especially in the evening.
    • Exercise before dinner. Stimulation from exercise drops to a low point a few hours after exercise, making sleep easier.
    • Exercising close to bedtime may increase alertness.
    • Eat light meals, and schedule dinner 4 to 5 hours before bedtime. A light snack before bedtime can help sleep, but a large meal may have the opposite effect.
    • Spend at least half an hour in daylight every day. The best time is early in the day.

    Before and at bedtime:

    • Establish a regular time for going to bed and getting up in the morning. Stick to this schedule even on weekends and during vacations.
    • Use the bed for sleep and sexual relations only, and not for reading, watching television, or working. Excessive time in bed disrupts sleep.
    • Take a hot bath about 1.5 to 2 hours before bedtime to help fall asleep.
    • Do something quiet and relaxing in the 30 minutes before bedtime. Reading, meditating, or a leisurely walk are all appropriate activities.
    • Keep the bedroom relatively cool and well ventilated.
    • Avoid fluids just before bedtime so that sleep is not disturbed by the need to urinate.
    • Avoid stimulants such as caffeine or nicotine in the hours before sleep.
    • Avoid alcohol in the hours before bedtime. While alcohol may help you fall asleep quickly, it can cause you to wake up in the middle of the night.

    If you are having problems falling asleep:

    • Do not look at the clock. Obsessing over time will just make it more difficult to sleep.
    • If still awake after 15 to 20 minutes, go into another room, read or do a quiet activity using dim lighting until feeling very sleepy. Do not watch television or use bright lights.
    • If distracted by a sleeping bed partner, moving to the couch or a spare bed for a couple of nights might be helpful.
    • If a specific worry is keeping you awake, thinking of the problem in terms of images rather than in words may help you to fall asleep more quickly and to wake up with less anxiety.

    Medications

    Many Americans use some form of herbal, over the counter, or prescription sleep aid pill. Over-the-counter (nonprescription) medications make use of the drowsiness caused by some common medications. Prescription drugs used specifically for improving sleeping are called sedative hypnotics.

    Herbs and Supplements

    More than 1.5 million Americans use complementary and alternative therapies to treat insomnia. Valerian and melatonin are among the most popular herbal and supplement remedies for insomnia. Chamomile tea and lemon balm are also popular. These substances are generally harmless for most people. However, other herbs and supplements have more serious side effects and interactions.

    The American Academy of Sleep Medicine (AASM) advises that there is only limited scientific evidence to show that herbal and dietary supplements are effective sleep aids. The AASM recommends that these products should be taken only if approved by a doctor. Be sure to talk to your doctor if you are considering taking any herbal or dietary supplement. Some of these products can interact with prescription medications.

    Generally, manufacturers of herbal remedies and dietary supplements do not need FDA approval to sell their products. Just like a drug, herbs and supplements can affect the body’s chemistry, and therefore have the potential to produce side effects that may be harmful. There have been a number of reported cases of serious and even lethal side effects from herbal products. People should always check with their doctors before using any herbal remedies or dietary supplements.

    Melatonin

    Melatonin is the most studied dietary supplement for insomnia. It appears to reduce the time to fall asleep (sleep onset) and may be effective in treating delayed sleep phase syndrome. However current evidence does not support the use of melatonin for primary or secondary insomnia. There are no consistent standards on melatonin doses and its safety has only been assessed for short-term use. General recommendations are to take 0.3 mg to 1 mg about 90 minutes before going to sleep. Taking higher doses may disrupt sleep and may cause daytime sleepiness, headaches, dizziness, nausea, and stomach cramps.

    Valerian root

    Valerian is an herb that has sedative qualities and is commonly used by people with insomnia. Some studies have indicated that it may help improve the quality of sleep, but there have been few rigorous and well-conducted trials to prove it is effective.

    Kava

    Kava has been used to relieve anxiety and improve sleep. It is dangerous and associated with reports of liver failure and death, with highest risk in those with liver disease. Kava can interact dangerously with certain medications, including alprazolam, an anti-anxiety drug. Kava also increases the strength of certain other drugs, including other sleep medications, alcohol, and antidepressants. Do not use this herb.

    Tryptophan and 5-hydroxy-L-tryptophan (5-HTP)

    Tryptophan is an amino acid used in the formation of the neurotransmitter serotonin, which is associated with healthy sleep. L-tryptophan used to be marketed for insomnia and other disorders but was withdrawn after contaminated batches caused a rare but serious, and even fatal, disorder called eosinophilia myalgia syndrome. A byproduct of tryptophan, 5-HTP, is still available as a supplement. There is little evidence that 5-HTP relieves insomnia.

    Sleep Medications

    Certain Nonprescription Antihistamines

    Many over-the-counter sleeping medications use antihistamines, which cause drowsiness. Diphenhydramine (Benadryl, generic) is the most common antihistamine used in non-prescription sleep aids.

    Some drugs marketed as sleep aids contain diphenhydramine alone, while others contain combinations of diphenhydramine with pain relievers (such as Tylenol PM and its generic forms). Doxylamine (Unison, generic) is another antihistamine used in sleep medications. Certain antihistamines indicated only for allergies, such as chlorpheniramine (Chlor-Trimeton, generic) or hydroxyzine (Atarax, Vistaril, generic) may also be used as mild sleep-inducers.

    Unfortunately, most of these drugs leave people feeling drowsy the next day and may not be very effective in providing restful sleep. Side effects include:

    • Daytime sleepiness
    • Cognitive impairment
    • Dizziness
    • Drunken movements
    • Blurred vision
    • Dry mouth and throat

    In general, people with angina, heart arrhythmias, glaucoma, or problems urinating should avoid these drugs. They should not be used at the same time as medications that prevent nausea or motion sickness. People with chronic lung disease should also avoid some nonprescription sleeping aids, such as those containing doxylamine.

    Nonprescription Pain Relievers

    When sleeplessness is caused by minor pain, simply taking acetaminophen (Tylenol, generic) or a non-steroidal anti-inflammatory drug (NSAID) such as ibuprofen (Advil, Motrin, generic), can be very helpful without causing any daytime sleepiness. The extra “P.M.” antihistamine found in combination products is simply an extra, needless chemical in these situations.

    Sedative hypnotics

    Sedative hypnotics include benzodiazepines and non-benzodiazepines, which enhance the effects of the brain chemical (neurotransmitter) GABA. When GABA binds to GABA receptors, brain activity slows down, inducing calm and relaxation. There are also new types of sedative hypnotics that work in a different way by targeting receptors for melatonin or orexin.

    Sedative hypnotics carry risks for dependence, tolerance, and rebound insomnia:

    • Dependence means relying on a drug for falling asleep and having difficulty falling asleep or achieving restful sleep without it.
    • Tolerance is being unable to fall asleep using the original dose and needing to take progressively higher doses of medication.
    • Rebound insomnia can occur after stopping the drug. It typically causes 1 to 2 nights of sleep disturbance, daytime sleepiness, and anxiety. In some cases, people may experience a temporary worsening of long-term insomnia.

    Non-Benzodiazepine Hypnotics

    Non-benzodiazepines (also called “Z” drugs) are the preferred sedative hypnotic drugs for the treatment of insomnia. In general, non-benzodiazepine hypnotics are recommended for short-term use (7 to 10 days), and treatment should not exceed 4 weeks.

    Non-benzodiazepine hypnotics currently approved in the United States are:

    • Zolpidem (Ambien, Ambien CR, generic) is the most commonly prescribed drugs for insomnia. Because it is long-lasting, people should not take it unless they plan on getting at least 7 to 8 hours of sleep. A lower-dose, sublingual (under-the-tongue) formulation of zolpidem (Intermezzo) is approved for people who wake up abruptly in the middle of the night and have trouble falling back asleep. People take it as needed when they awaken in the night but must be able to get at least 4 hours of sleep after taking.
    • Zaleplon (Sonata, generic) is the shortest-acting hypnotic available. Because it is rapidly eliminated from the body it may be best for people who have difficulty falling asleep, not those who wake up often throughout the night. The drug takes effect within 30 minutes and may be taken at bedtime or later as long as the patient can sleep for at least 4 hours.
    • Eszopiclone (Lunesta, generic) is related to zopiclone (Imovane), which has been used for many years in Europe. Unlike other sleep medications, eszopiclone was the first sleep medication approved to be taken on a long-term basis.

    Dosage

    For all sleeping pills, the lowest dose that achieves symptom relief should be the chosen dose.

    Recommended dosage for zolpidem products:

    • All zolpidem products now have lower recommended bedtime dosages.
    • Women have lower recommended dosages than men (women metabolize zolpidem more slowly than men and are more susceptible to next-day mental impairment).
    • Use of higher doses increases the risk for next-day impairment of driving. In addition, the FDA warns people to refrain from next-day driving or activities involving mental alertness if they take the extended-release form of zolpidem (Ambien CR, generic).

    Lower dose recommendations are also in place for eszopiclone, which can cause impairment in driving and cognitive skills for up to 11 hours after an evening dose. The FDA is currently reviewing all sleep medications to evaluate how they affect next-day mental alertness.

    Side Effects

    Non-benzodiazepines tend to have fewer side effects than benzodiazepines because they target the GABA receptor in a more specific way. However, these drugs can still cause residual morning sedation even if you are feeling fully awake. When people first start taking any of these drugs, they should use caution during morning activities until they are sure how the drug affects them.

    General side effects may include:

    • Drowsiness
    • Dizziness
    • Fatigue
    • Headache
    • Diarrhea or constipation

    All non-benzodiazepine drugs carry labels warning that these drugs can cause strange sleep-related behavior, including driving, making phone calls, and preparing and eating food while asleep. Most cases of sleepwalking and sleep driving likely occur when people use the drug along with alcohol or other drugs or take more than the recommended dose.

    Anyone who receives a prescription for these medicines will get a patient medication guide explaining the risks for the drugs and the precautions to take. Talk to your doctor if you have any questions concerning these drugs or their potential side effects.

    Carefully read the information labels for all drugs and follow the directions. Some sleeping pills take 30 to 60 minutes to take effect, while others (such as zolpidem) act quickly. For zolpidem, people should:

    • Take zolpidem immediately before going to sleep
    • Take zolpidem only when able to get a full night’s sleep (7 to 8 hours)
    • Not drink alcohol the same evening
    • Not take more than the prescribed dose
    • Use caution in the morning when getting out of bed, driving, or operating heavy machinery

    Interactions

    As with any hypnotic, alcohol increases the sedative effects of these drugs. These hypnotics also interact with other drugs. Inform your doctor of all your medications.

    Rebound Insomnia, Dependence, and Tolerance

    The risk for rebound insomnia, dependence, and tolerance is lower with non-benzodiazepine hypnotics than with benzodiazepine drugs. These drugs are still subject to abuse. In any case, no hypnotic should be taken for more than 7 to 10 days in a row or at higher than the recommended dose without a doctor’s approval.

    Benzodiazepine Hypnotics

    Benzodiazepines used to be the most commonly prescribed sedative hypnotics. These drugs were originally developed in the 1960s to treat anxiety.

    Commonly prescribed benzodiazepines are:

    Side Effects

    Older people are more susceptible to side effects and should usually start at half the dose prescribed for younger people. They should not take long-acting forms.

    Side effects may differ depending on whether the benzodiazepine is long- or short-acting. They include:

    • Respiratory problems (especially reducing how often or how deeply one breathes), which may occur with overuse or in people with pre-existing respiratory illness.
    • Worsening of depression, a common condition in many people with insomnia.
    • Residual daytime drowsiness, which is common with benzodiazepines. Long-acting benzodiazepines pose a higher risk than shorter-acting benzodiazepines.
    • Memory loss, sleepwalking, sleep driving, eating while asleep, and other odd mood states may occur. These effects are enhanced by alcohol.
    • Urinary incontinence may occur, particularly in older people and when taking long-acting formulations.
    • In pregnant and nursing women, birth defects are a risk because these drugs cross the placenta and enter breast milk. Pregnant women or nursing mothers should not use these medications. Benzodiazepine use in the first trimester of pregnancy may be associated with the development of cleft lip in newborns.
    • Although rare, fatal overdoses can occur.

    Interactions

    Benzodiazepines are potentially dangerous when combined with alcohol. Some medications, like ulcer and acid reflux medications in the histamine receptor-2 blocker class (such as cimetidine, Tagamet), can slow the metabolism of the benzodiazepine.

    Withdrawal Symptoms

    Withdrawal symptoms usually occur after prolonged use and indicate dependence. They can last 1 to 3 weeks after stopping the drug and may include:

    • Gastrointestinal distress
    • Sweating
    • Disturbed heart rhythm
    • Rebound insomnia (the risk is higher with short-acting benzodiazepines than with long-acting ones)
    • In severe cases, hallucinations or seizures

    Other Types of Sedative Hypnotics

    Ramelteon (Rozerem, generic)

    Ramelteon is a type of sedative hypnotic called a melatonin receptor agonist. Unlike non-benzodiazepines or benzodiazepines, which target GABA receptors, ramelteon works by targeting melatonin receptors. Ramelteon is not habit forming and is the first sleep drug that is not designated as a controlled substance. A related melatonin receptor agonist, tasimelteon (Hetlioz), is approved for treating circadian rhythm disorders in people who are blind.

    Suvorexant (Belsomra)

    In 2014, the FDA approved suvorexant (Belsomra), the first orexin receptor antagonist sleep drug. Suvorexant targets and blocks the action of orexin. Orexin (also called hypocretin) is a chemical produced in the hypothalamus part of the brain, which is involved in regulating the sleep-wake cycle and keeping people awake. Suvorexant is a controlled substance, which means it can potentially be abused or cause dependence. Like other sleep medications, suvorexant may cause sleep-related behaviors such as sleep driving. The FDA approved four different dose strengths for suvorexant and advises people to use the lowest effective dose.

    Antidepressants

    Antidepressants are often helpful in treating insomnia even when anxiety or major depression are not present. Certain types of antidepressants with sedating properties are prescribed for the treatment of primary insomnia, generally in lower doses than used to treat depression.

    For example, the antidepressant trazodone (Desyrel, generic) is prescribed in low doses as a hypnotic to help induce sleep. A very low dose formulation of the tricyclic antidepressant doxepin (Silenor) is approved for treatment of insomnia. Other antidepressants used for insomnia include the tricyclics trimipramine (Surmontil, generic) and amitriptyline (Elavil, generic) and the tetracyclic antidepressant mirtazapine (Remeron, generic).

    Precautions should be taken in the use of trazodone and other sedating antidepressants in older people, due to the risk for side effects (daytime sleepiness, dizziness, priapism, and increased risk of falls) and drug interactions.

    Barbiturates

    Similarly to benzodiazepines, barbiturates are central nervous system depressants that stimulate GABA receptors and thus inhibit nerve cells. Barbiturates were commonly used for insomnia treatment in the past, as well as for epilepsy, anxiety, and anesthesia, but have now been almost entirely replaced by newer, safer drugs in most regions of the world. A few barbiturates that are FDA-approved for the short treatment of insomnia are still marketed in the United States, including secobarbital (Seconal) and butabarbital (Butisol). These drugs are controlled substances and are rarely used today.

    Resources

    • American Academy of Sleep Medicine — aasm.org
    • National Center for Sleep Disorders Research — www.nhlbi.nih.gov/about/scienfic-divisions/national-center-sleep-disorders-research
    • National Sleep Foundation — sleepfoundation.org
    • American Alliance for Healthy Sleep — sleepeducation.org

    Hammerschlag AR, Stringer S, de Leeuw CA, et al. Genome-wide association analysis of insomnia complaints identifies risk genes and genetic overlap with psychiatric and metabolic traits. Nat Genet. 2017;49(11):1584-1592. PMID: 28604731 www.ncbi.nlm.nih.gov/pubmed/28604731.

    Huedo-Medina TB, Kirsch I, Middlemass J, Klonizakis M, Siriwardena AN. Effectiveness of non-benzodiazepine hypnotics in treatment of adult insomnia: meta-analysis of data submitted to the Food and Drug Administration. BMJ. 2012;345:e8343. PMID: 23248080 www.ncbi.nlm.nih.gov/pubmed/23248080.

    Masters PA. In the clinic. Insomnia. Ann intern med. 2014;161(7):ITC1-15. PMID: 25285559 www.ncbi.nlm.nih.gov/pubmed/25285559.

    Morin CM, Benca R. Chronic insomnia. Lancet. 2012;379(9821):1129-1141. PMID: 22265700 www.ncbi.nlm.nih.gov/pubmed/22265700.

    Posner D. Insomnia. In: Ferri FF, ed. Ferri’s Clinical Advisor 2018. Philadelphia, PA: Elsevier; 2018:710-712.

    Qaseem A, Kansagara D, Forciea MA, Cooke M, Denberg TD; Clinical Guidelines Committee of the American College of Physicians. Management of chronic insomnia disorder in adults: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2016;165(2):125-133. PMID: 27136449 www.ncbi.nlm.nih.gov/pubmed/27136449.

    Sateia MJ, Buysse DJ, Krystal AD, Neubauer DN, Heald JL. Clinical practice guideline for the pharmacologic treatment of chronic insomnia in adults: an American Academy of Sleep Medicine clinical practice guideline. J Clin Sleep Med. 2017;13(2):307-349. PMID: 27998379 www.ncbi.nlm.nih.gov/pubmed/27998379.

    Review Date: 1/15/2018
    Reviewed By: Allen J. Blaivas, DO, Division of Pulmonary, Critical Care, and Sleep Medicine, VA New Jersey Health Care System, Clinical Assistant Professor, Rutgers New Jersey Medical School, East Orange, NJ. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

    The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only — they do not constitute endorsements of those other sites. © 1997- A.D.A.M., a business unit of Ebix, Inc. Any duplication or distribution of the information contained herein is strictly prohibited.

    Lisinipril

    Lisinipril is a common misspelling of lisinopril.

    What is lisinopril (lisinipril)?

    Lisinopril (lisinipril) is an angiotensin-converting enzyme (ACE) inhibitor. Angiotensin is a chemical that is made by the body that narrows blood vessels and maintains blood pressure. When the enzyme is blocked by lisinopril (lisinipril), angiotensin cannot be converted into its active form. As a result, blood vessels dilate and blood pressure falls.

    Lisinopril (lisinipril) is used in the treatment of high blood pressure, alone or with other medicines. Lisinopril (lisinipril) is also used along with other medicines to manage congestive heart failure. It may also be given within 24 hours of a heart attack to improve chances of survival.

    The first doses of lisinopril (lisinipril) can cause dizziness due to a drop in blood pressure. Lisinopril (lisinipril) can cause nausea, headaches, anxiety, insomnia, drowsiness, nasal congestion and sexual dysfunction. Lisinopril (lisinipril) should be stopped if there are symptoms or signs of an allergic reaction including feelings of swelling of the face, lips, tongue or throat.

    Click for more information on Lisinipril (lisinopril)

    Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

    • Can I just stop taking lisinopril?
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    Medical Disclaimer

    The Complete Guide to Insomnia for Aging Adults + How to Get More Sleep

    Seniors need just as much sleep as younger adults, according to numbers from the National Sleep Foundation. However, the prevalence of sleep disorders like insomnia among older adults is a growing concern for the medical community. In fact, some studies have found that around 50% of seniors report difficulty falling and staying asleep.

    This comprehensive guide outlines the causes and symptoms of insomnia, as well as common treatments. Jump to a specific topic using the links below or keep reading to learn more about insomnia in seniors and adults.

    Table of Contents

    • The Causes of Insomnia in Older Adults
    • Symptoms of Insomnia
    • Types of Insomnia
    • How to Fall Asleep
    • How to Restructure Your Daily Routine for Better Sleep

    The Causes of Insomnia in Older Adults

    As people age, changes to normal sleep patterns may occur. Seniors may produce less melatonin, the hormone that regulates sleep cycles and circadian rhythms. This often results in lighter, more fragmented sleep during the night.

    While the normal aging process can cause symptoms of insomnia, there are other factors that may result in an inability to fall asleep naturally.

    Physical Conditions

    Many common health conditions are correlated with insomnia. Examples of conditions linked to insomnia include:

    Chronic pain: Pain can make falling asleep difficult. Common conditions like arthritis, fibromyalgia and obesity can result in chronic pain, making nightly movements and adjustments painful.

    Diabetes: Uncontrolled blood sugar levels caused by diabetes may lead to sleep problems. Symptoms of irregular blood sugar include night sweats, frequent urination and hypoglycemia. For those who have nerve damage as a result of diabetes, nighttime movement may cause leg pain.

    Heart disease: Heart conditions can lead to a number of symptoms that may make sleep difficult. Some heart problems can lead to a buildup of fluid in the lungs, which may cause shortness of breath or sleep apnea. For those living with coronary artery disease, the natural pattern of circadian rhythms during the night may lead to chest pain, irregular heartbeat and, in extreme cases, heart attack.

    Asthma: The natural circadian rhythms can cause small movements in the muscles around the airways, potentially making breathing difficult. This constriction can cause nocturnal asthma attacks and shortness of breath that may wake the sleeper up immediately.

    Alzheimer’s Disease and Dementia: Memory loss conditions can disrupt normal brain function and sleep regulation. For those who experience nightly wandering, disorientation and agitation, falling asleep can be difficult as a result.

    Some medications list insomnia and sleeplessness as side effects. The main types of medications that may cause insomnia include:

    • Alpha-blockers: Alpha-blockers have been linked to decreased REM sleep and increased daytime sleepiness. These effects can cause nighttime sleeplessness.
    • Beta-blockers: This type of medication has been linked to sleep disturbances and nightmares. They are also known to reduce the production of melatonin.
    • Corticosteroids: Corticosteroids can mimic the effects of the adrenal glands, which regulate stress and relaxation.
    • SSRI antidepressants: While it’s not clear exactly how these medications cause insomnia, research has linked SSRI antidepressants with agitation, sleeplessness and mild tremors in some individuals.
    • ACE inhibitors: These medications have been correlated with frequent coughing that can keep people awake at night. ACE inhibitors can also cause an increase in the production of potassium, which sometimes leads to diarrhea, cramps and pain in the joints, bones and muscles. This pain can make it difficult to fall asleep.
    • ARBs: Like ACE inhibitors, ARBs cause a buildup of potassium which can trigger pain.
    • Cholinesterase inhibitors: These medications inhibit the enzyme that breaks down acetylcholine, the neurotransmitter related to alertness and memory. Interference with this breakdown can affect involuntary body processes, including sleep regulation.
    • H1 antagonists: H1 antagonists block a neurotransmitter called acetylcholine, which can cause anxiety and insomnia.
    • Specific supplements: Supplements glucosamine and chondroitin have been found to cause nausea, diarrhea, headaches and insomnia in some studies.
    • Statins: A common side effect of statin drugs that can make it difficult to sleep is muscle pain. Fat-soluble statins like Lipitor, Mevacor, Vytorin and Zocor often cause insomnia and nightmares. This is because they penetrate cell membranes and move across the blood-brain barrier, which protects the brain from chemicals traveling through the blood.

    Be sure to consult a doctor before taking or changing any medication.

    Medication Type Common Drugs Used to Treat
    Alpha-blockers
    • Alfuzosin (Uroxatral)
    • Doxazosin (Cardura)
    • Prazosin (Minipress)
    • Silodosin (Rapaflo)
    • Terazosin (Hytrin)
    • Tamsulosin (Flomax)
    • High blood pressure
    • Benign prostatic hyperplasia (BPH)
    • Raynaud’s disease
    • Male urinary difficulty
    Beta-blockers
    • Atenolol (Tenormin)
    • Carvedilol (Coreg)
    • Metoprolol (Lopressor, Toprol)
    • Propranolol (Inderal)
    • Sotalol (Betapace)
    • Timolol (Timoptic)
    • High blood pressure
    • Arrhythmia
    • Angina
    • Migraines
    • Tremors
    • Glaucoma
    Corticosteroids
    • Cortisone
    • Methylprednisolone (Medrol)
    • Prednisone
    • Triamcinolone
    • Inflammation
    • Rheumatoid arthritis
    • Lupus
    • Sjögren’s syndrome
    • Gout
    • Allergic reactions
    SSRI antidepressants
    • Citalopram (Celexa)
    • Escitalopram (Lexapro)
    • Fluoxetine (Prozac, Sarafem)
    • Fluvoxamine (Luvox)
    • Paroxetine (Paxil, Pexeva)
    • Sertraline (Zoloft)
    • Moderate to severe depression
    ACE inhibitors
    • Benazepril (Lotensin)
    • Captopril (Capoten)
    • Enalapril (Vasotec)
    • Fosinopril (Monopril)
    • Lisinopril (Prinivil, Zestril)
    • Moexipril (Univasc)
    • Perindopril (Aceon)
    • Quinapril (Accupril)
    • Ramipril (Altace)
    • Trandolapril (Mavik)
    • High blood pressure
    • Congestive heart failure
    ARBs
    • Candesartan (Atacand)
    • Irbesartan (Avapro)
    • Losartan (Cozaar)
    • Telmisartan (Micardis)
    • Valsartan (Diovan)
    • Coronary artery disease
    • Heart failure
    Cholinesterase inhibitors
    • Donepezil (Aricept)
    • Galantamine (Razadyne)
    • Rivastigmine (Exelon)
    • Alzheimer’s Disease
    • Dementia
    H1 antagonists
    • Azelastine (Astelin)
    • Cetirizine (Zyrtec)
    • Desloratadine (Clarinex)
    • Fexofenadine (Allegra)
    • Levocetirizine (Xyzal)
    • Loratadine (Claritin)
    • Allergic reactions
    • Seasonal allergies
    Supplements
    • Glucosamine
    • Chondroitin
    • Joint pain
    • Joint function
    • Inflammation
    • Arthritis
    Statins
    • Atorvastatin (Lipitor)
    • Lovastatin (Mevacor)
    • Rosuvastatin (Crestor)
    • Simvastatin (Zocor)
    • High cholesterol

    A doctor or pharmacist may have recommendations for alternative medications. If a prescription causes insomnia or other symptoms that make it challenging to fall and stay asleep, consult a professional before stopping or changing the medication.

    Stress and Mental Health

    Mental health plays a significant role in sleeping ability. In addition, stress caused by life events and mental health conditions like anxiety have been closely linked to the development of insomnia.

    Research shows that insomnia is more frequent in those with psychiatric conditions such as major depression disorder, bipolar disorder and cyclothymic disorder, as well as most anxiety disorders and substance abuse disorders. These conditions, especially depression, are common in older adults and seniors, meaning they are also more likely to experience symptoms of insomnia.

    Lifestyle

    In addition to medical conditions and medications, lifestyle factors and environment can affect sleep regulation.

    • Sunlight: Getting enough sunshine can help regulate sleep cycles. Exposure to bright sunlight early in the day helps regulate circadian rhythms and melatonin production. Dark rooms and excessive time spent indoors can negatively affect one’s ability to sleep well at night.
    • Social time: Interacting with others, from family members to senior community residents, can help keep the brain active and engaged during normal daytime hours. In turn, this can help seniors fall asleep more easily at the end of the day.
    • Exercise: Regular exercise and physical activity promotes healthier sleep. While research hasn’t pinpointed exactly why exercise is good for sleep, moderate aerobic exercise has been correlated with increased deep sleep.
      Unhealthy habits: Focusing on healthy lifestyle habits can make a difference in sleep quality. Irregular sleeping hours, excessive screen time and consuming alcohol or sugar before bedtime can all hinder healthy sleep.
    • Significant stress: Managing stress is an important part of healthy sleep. Major life events like the loss of a loved one or a sudden move can affect sleep habits and can cause insomnia if not handled appropriately.

    Symptoms of Insomnia

    While insomnia can manifest in many ways, there are three telltale signs of the sleep disorder. Struggling to fall asleep, stay asleep and feeling unrested after sleep are all warning signs of insomnia.

    According to the National Sleep Foundation, those living with insomnia may experience one or more of these symptoms:

    • Difficulty falling asleep at night
    • Difficulty maintaining sleep (waking up during the night)
    • Difficulty sleeping long enough (waking up too early)
    • Sleep that does not feel restful
    • General fatigue and low energy
    • Daytime sleepiness
    • Excessive napping
    • Difficulty concentrating
    • Agitation and irritability
    • Impulsivity and aggression
    • Difficulty in personal relationships

    Any of these symptoms could be caused by acute or chronic insomnia and should be discussed with a medical professional.

    Types of Insomnia

    While there are many kinds of insomnia (listed below), most forms fall into two main categories:

    1. Primary insomnia: This type of insomnia occurs when sleep problems are not a result of another health condition.
    2. Secondary (comorbid) insomnia: This type of insomnia occurs when sleep problems are caused by another medical condition, such as arthritis, heart disease or mood disorders. Secondary insomnia can also be caused by pain, medication, life changes and substance abuse.

    Acute Insomnia

    This is a type of secondary insomnia that usually occurs as a result of a stressful life event or sudden change in medication. Acute insomnia can last from a single night to several weeks, but can usually be resolved with medical treatment.

    Chronic Insomnia

    Chronic insomnia can be primary or secondary and is characterized by long-term sleep problems. Insomnia is classified as chronic if sleep difficulty lasts more than three nights per week for three months or more.

    Onset Insomnia

    The Journal of Sleep Medicine describes onset insomnia as difficulty initiating sleep. This type of insomnia is typically secondary to another health condition or medication. Onset insomnia can also be caused by behavioral habits like drinking caffeine before bedtime, lack of exercise and a bedroom environment not conducive to healthy sleep.

    Maintenance Insomnia

    Sleep-maintenance insomnia makes it difficult to stay asleep at night. Similar to onset insomnia, this form of sleep difficulty is usually secondary to another condition or sleep disorder like sleep apnea and Restless Leg Syndrome.

    How to Fall Asleep

    With many seniors experiencing symptoms of insomnia and other sleep disturbances, learning how to effectively manage sleep disorders is important to other areas of health.

    While insomnia can negatively affect an individual’s quality of life, there are ways to manage and treat the sleep condition that can make sleep a more restful experience.

    Medication for Sleep

    More than 30% of seniors aged 65 and older take some type of medication for sleep, from prescription pills to supplements like melatonin.

    There are hundreds of medications and supplements that can help treat sleep disorders. Here are some of the more common medical treatments for insomnia:

    • Antidepressants: Some antidepressant medications like trazodone (Desyrel) can help treat sleeplessness and anxiety.
      • Antidepressants have a range of side effects from weight gain to blurred vision. Always consult with a medical professional before and while taking antidepressants.
    • Benzodiazepines: These medications, like temazepam (Restoril) and triazolam (Halcion) are older forms of sleep treatments and can effectively treat sleepwalking and night terrors.
      • Consult a doctor before taking a benzodiazepine medication, as some may cause dependence and daytime sleepiness.
    • Doxepin (Silenor): This drug is approved for sleep-maintenance insomnia and can help individuals stay asleep by blocking histamine receptors.
      • This medication should only be taken if seven to eight hours can be dedicated to sleep, as it can cause drowsiness.
    • Eszopiclone (Lunesta): Lunesta is an effective treatment for onset insomnia.
      • The FDA recommends starting with a dosage of one milligram to avoid next-day grogginess or impairment.
    • Ramelteon (Rozerem): Prescribed to those who have trouble falling asleep, Rozerem works by targeting the sleep-wake cycle. It can be used long term and has no evidence of dependence or abuse.
      • Side effects include dizziness, fatigue and in some cases, worsening sleeping problems.
    • Zolpidem (Ambien, Edluar, Intermezzo): This type of medication is prescribed for onset insomnia and can help ease the process of falling asleep.
      • The FDA warns that because Ambien has long-lasting effects on the body, users should avoid driving or operating machinery.
    • Over-the-counter treatments: Sleep aids like Advil PM, ZzzQuil, Unisom and melatonin can all be used to help regulate sleep, though they are not official insomnia medications.
      • Most over-the-counter sleep aids contain antihistamines, which should not be taken in conjunction with other drugs containing antihistamines like cold or allergy medication.

    It’s important to speak to a doctor or pharmacist before taking any medication for sleep. Some medications come with serious side effects that can be dangerous for seniors. For example, a study found that people taking sleep medications like Ambien or Lunesta fell asleep only eight to 20 minutes faster than people taking a placebo.

    Common side effects of typical sleep medications include:

    • Drowsiness
    • Headache
    • Muscle pain and stiffness
    • Constipation
    • Trouble concentrating
    • Dizziness

    For those taking prescription sleep medication, risks include:

    • Eventual tolerance to medication
    • Drug dependence
    • Symptoms of withdrawal
    • Interaction with other medications

    In addition to these risks, taking sleeping medication may mask an underlying condition causing insomnia – physical or mental disorders that cause insomnia can’t be treated with sleeping pills.

    Cognitive Behavioral Therapy for Insomnia

    Often referred to as CBT-I, cognitive behavioral therapy for insomnia can be an effective alternative to medication.

    CBT-I involves regular visits to a certified therapist who assesses sleep patterns and helps adjust behaviors to achieve better sleep. Specifically, CBT-I works to change sleep hygiene and habits, as well as mitigate anxieties around sleep that may cause disturbances in normal sleep patterns.

    CBT-I techniques include:

    • Stimulus control therapy: This technique removes factors that condition the mind to resist sleep. For example, the therapist may recommend leaving the bedroom if sleep does not come within 20 minutes.
    • Sleep restriction: Reducing the amount of time spent in bed can lead to increased feelings of sleepiness, which can help insomniacs fall asleep the next night.
    • Sleep hygiene: Lifestyle habits like drinking caffeine and alcohol, smoking and limited exercise can negatively affect sleep. The therapist will recommend lifestyle changes to make it easier to fall asleep.
    • Remaining passively awake: Also known as paradoxical intention, this technique involves trying to avoid sleep. Worrying about being unable to fall asleep can prevent sleep, so focusing on avoiding sleep can act as reverse psychology and trick the brain into sleeping.

    While sleeping pills treat symptoms of insomnia, cognitive behavioral therapy targets the underlying cause. CBT-I may be a good option for seniors living with long-term sleep concerns or other health conditions, as well as those taking certain medications that may interact with sleeping pills.

    Natural Solutions to Insomnia

    While medical treatment is often the most effective way to manage insomnia, there are natural treatments and lifestyle changes that can be implemented in addition to medication or therapy.

    Incorporate these things into a daily routine to improve sleep quality:

    • Exercise: A study found that people who get 60 minutes of exercise five days per week have more normal REM sleep than those who don’t exercise.
    • Natural light: Exposure to sunlight during daytime hours can actually help improve sleep quality at night. This exposure helps the body determine when to produce melatonin, the hormone that causes sleepiness.
    • Yoga or meditation: A 2013 study found that 40% of people report feeling tired as a result of stress. Because stress plays a significant role in sleep disorders like insomnia, it’s important to manage stress proactively. Yoga has been found to lower stress hormones in the blood.
    • Nutrition: Certain foods – like fruit, cottage cheese, almonds and whole grains – can promote sleep. For example, almonds contain melatonin, the sleep hormone. In addition, chamomile is thought to function like a Benzodiazepine, a drug that induces sleep.

    There are many ways to combat symptoms of insomnia and encourage a healthier sleep pattern. Check out the infographic below for more ways to manage insomnia and improve quality of life.

    Whether it’s the sounds of the city, stress or another health condition that’s preventing sleep, it’s important to be proactive about insomnia. Promote better sleep by making healthy lifestyle changes, consulting a doctor and keeping your living environment clean and comfortable.

    Sources

    Common use
    Lisinopril is used to treat high blood pressure (hypertension) in adults and children 6 years and older, including renovascular, acute myocardial infarction in clinically stable condition of the patients, heart failure (adjuvant treatment), diabetic nephropathy. The principle of this drug is to relax blood vessels, causing them to expand, it can lead to prevention of occurrence of strokes, heart attacks and kidney problems. Lisinopril is also used after acute myocardial recovery, and is used with other drugs (eg, “water pills” / diuretics, digoxin) to treat heart failure. This drug belongs to a class of medications called ACE inhibitors.
    Dosage and direction
    Take medicine for adults 1 time per day. The dose is determined individually, depending on the evidence, the state of renal function and concomitant therapy. Typically, the initial dose is 2,5-5 mg, the average maintenance dose – 5-20 mg, the maximum daily – 80 mg.
    Precautions
    Treatment is carried out under regular medical supervision (water-electrolyte balance). During treatment requires monitoring of blood pressure, protein level and plasma potassium, urea nitrogen, creatinine, renal function, blood picture, body weight and dieting. You have to be careful during surgery (including dental), especially when using general anesthetics that have a hypotensive effect.
    Contraindications
    Hypersensitivity, pregnancy, breast-feeding.
    Possible side effects
    You can feel headache, dizziness, nervousness, fainting, drowsiness, insomnia, tremors, convulsions, visual disturbances, palpitations, chest pain, hypotension, arrhythmia, dry cough and malignant tumors of the lung, hemoptysis, pain when breathing, bronchitis, dry mouth, indigestion, heartburn, vomiting, diarrhea / constipation, bloating, abdominal pain, renal failure, weakening of libido, impotence, arthritis, neck pain, back pain, rash, urticaria, and syndrome of Stevens – Johnson.
    Drug interactions
    List of the drugs that can interact with Lisinopril: gold injections to treat arthritis, lithium (Lithobid, Eskalith), a potassium supplement such as K-Dur, Klor-Con, salt substitutes that contain potassium, insulin or diabetes medication you take by mouth, aspirin or other NSAIDs (non-steroidal anti-inflammatory drugs) such as ibuprofen (Motrin, Advil), diclofenac (Voltaren), etodolac (Lodine), indomethacin (Indocin), ketoprofen (Orudis), naproxen (Aleve, Naprosyn), and others, or a diuretic (water pill).
    Missed dose
    Take the missed dose as soon as you remember. If it is almost time for your next dose, skip the missed dose and take the medicine at the next regularly scheduled time. Do not take extra medicine to make up the missed dose.
    Overdose
    Seek emergency medical attention if you think you have used too much of this medicine. Lisinopril overdose symptoms may include feeling extremely dizzy or light-headed, or fainting.
    Storage
    Store Lisinopril at room temperature away from moisture and heat.
    Disclaimer
    We provide only general information about medications which does not cover all directions, possible drug integrations, or precautions. Information at the site cannot be used for self-treatment and self-diagnosis. Any specific instructions for a particular patient should be agreed with your health care adviser or doctor in charge of the case. We disclaim reliability of this information and mistakes it could contain. We are not responsible for any direct, indirect, special or other indirect damage as a result of any use of the information on this site and also for consequences of self-treatment.

    Is Your Medication Making You Lose Sleep?

    If you rely on medications for a chronic condition or even minor ailments, you may find yourself sleep-deprived or battling daytime drowsiness.

    “Certain heart, blood pressure, and asthma drugs, as well as over-the-counter medicines for colds, allergies, and headaches, can interrupt normal sleep patterns,” says James Wellman, MD, medical director of the Sleep Disorders Center of Georgia in Augusta.

    In fact, a number of common medications can prevent you from falling asleep or staying asleep; others can make you groggy or sleepy during the day. Chemicals work differently on everyone, so a given medication may not affect you and your best friend the same way, but the following drugs could cause sleep problems for most people.

    Sleep: Prescription Medication Side Effects

    These drugs can affect both the quality and quantity of your sleep:

    • Heart medications. Anti-arrhythmic drugs used to treat heart rhythm problems can cause insomnia and other sleep difficulties. Beta blockers, used for high blood pressure, arrhythmias, and angina, increase the chance of insomnia, awakenings at night, and nightmares. Additionally, some cholesterol-lowering drugs have been linked to poor sleep. “There have been some reports of people on statins, such as Zocor, having insomnia and nightmares,” says Dr. Wellman.
    • Asthma medications. Theophylline, an asthma medication that is sometimes used to ease inflammation and help clear airways, can cause insomnia, as well as daytime jitters. “The chemicals in this medication are related to caffeine,” explains Wellman. Corticosteroids, such as prednisone, are frequently prescribed for asthma and can cause similar medication side effects.
    • Depression medications. About 10 to 20 percent of people who take a class of antidepressants known as selective serotonin reuptake inhibitors, or SSRIs, such as fluoxetine (Prozac), sertraline (Zoloft), and paroxetine (Paxil), experience sleep problems. “Insomnia is one of the common medication side effects of SSRIs,” says Wellman.
    • Anti-smoking medications. Nicotine patches used to help people quit smoking work by delivering small doses of nicotine into the bloodstream 24/7, and one common medication side effect is insomnia. Some people using the patches have also reported nightmares.
    • ADHD medications. Attention-deficit hyperactivity disorder (ADHD) is usually treated with stimulant-like medicines that boost alertness, but can lead to insomnia. “People taking these medicines may have trouble falling asleep,” says Wellman. “And once they’re able to get to sleep, they may spend more time in non-REM sleep.” REM sleep refers to the stage of sleep accompanied by rapid eye movements and is a deeper level of sleep. Examples of medications with these side effects include methylphenidate (Ritalin) and dextroamphetamine (Dexedrine).
    • Thyroid medications. An underactive thyroid gland (hypothyroidism) can cause extreme sleepiness during the day, but some drugs used to treat the condition can result in insomnia. However, this side effect usually only occurs at higher doses, says Wellman.

    Sleep: Over-the-Counter Medications

    Sleep problems aren’t limited to prescription drugs. These common medications can also affect sleep:

    • Medications for colds and allergies. Antihistamines used to treat colds and allergies cause drowsiness in most people. Worse, this medication side effect can be long-lasting. “Antihistamines can continue to cause drowsiness six to eight hours after taking them,” notes Wellman. Decongestants have the opposite effect, causing insomnia. Be aware of cough medicines, too. They often contain alcohol, which can prevent deep REM sleep and cause you to wake frequently throughout the night.
    • Pain-relief medications. Over-the-counter painkillers sometimes contain caffeine, which can stimulate the brain and drive away sleep. Pain relievers with caffeine include the brands Excedrin, Anacin, and Motrin Complete. “The effects of caffeine can last six to eight hours in some people,” says Wellman. To avoid this medication side effect, scan the label before purchasing a pain reliever to see if it contains caffeine — not all pain relievers do.
    • Herbal medications. “Natural” medications can still interfere with sleep. “Some people taking St. John’s wort for depression have reported overstimulation and insomnia,” says Sheila Kingsbury, ND, a naturopathic physician and chair of the botanical medicine department at Bastyr University in Seattle. Sam-e (S-adenosylmethionine, a dietary supplement that is sometimes used as an antidepressant, can also cause sleep difficulties, says Dr. Kingsbury. Insomnia is a common side effect of the Chinese herb ginseng as well.

    How to Take Your Medicine and Get Some Sleep

    Discuss your sleep problems with your doctor, health care practitioner, or pharmacist. There may be other medications that can treat your ailment or health condition without disrupting sleep. Switching medications or lowering dosages with your doctor’s guidance may help ease insomnia that’s due to medication side effects. Likewise, changing the time of day at which you take your medication may help. Restful sleep is important for feeling well and recovering from health problems, so don’t lose sleep over medication side effects. Changing your medication could be the perfect prescription for a good night’s sleep.

    In addition to dream-related changes, antidepressants can affect your sleep in all sorts of ways, both good and bad.

    Before you even add medication, depression and sleep issues are often linked.

    People usually think of depression as causing symptoms like persistent sadness and feelings of worthlessness, but it can also lead to fatigue, insomnia, and consistently waking up too early or sleeping too late. And, of course, sleep issues can have a negative impact on your mental health, leading to a vicious cycle.

    When you loop in drugs meant to combat depression, your sleep habits can change even more. “It depends on the antidepressant—some can be alerting, while some can be sedating,” Breus says.

    Although different people can react to the same medication in different ways, there are some basic rules for how various antidepressants might influence your sleep.

    “Generally speaking, these medications affect neurotransmitters like serotonin, dopamine, and norepinephrine,” which are important for regulating your emotions, board-certified sleep medicine doctor and neurologist W. Chris Winter, M.D., of Charlottesville Neurology and Sleep Medicine and author of The Sleep Solution, tells SELF.

    These neurotransmitters play another role as well. “All of these chemicals are big players in the pathways of maintaining or initiating sleep, or chemicals that help you feel awake during the day,” Winter says.

    Take selective serotonin reuptake inhibitors (SSRIs), like sertraline (Zoloft) and paroxetine (Paxil). “Serotonin is a calming hormone,” Breus says. “When somebody is taking an SSRI, they have more serotonin in their system for longer, which can have a sedating effect,” leading to sleepiness.

    On the other side of the spectrum, norepinephrine and dopamine reuptake inhibitors, like the popular drug bupropion (Wellbutrin), increase the levels of those two neurotransmitters in the brain. That can result in feeling extra-energized, potentially causing insomnia, Breus says.

    Other types of antidepressants can bring about either fatigue or insomnia as side effects.

    Antidepressants have the ability to change how you dream because they affect your REM sleep.

    “Depending on the antidepressant, you may find the medication enhances dreaming or your memory of dreams and nightmares,” Winter says. But other medications can suppress your dreaming or ability to remember your dreams. And until you try a certain antidepressant, there’s no way to know how it will affect your dreams—it could go either way.

    This phenomenon likely centers around rapid eye movement (REM) sleep, the mentally restorative sleep cycle in which dreams occur.

    Many antidepressants suppress REM sleep. Escitalopram (Lexapro), sertraline (Zoloft), duloxetine (Cymbalta), and paroxetine (Paxil) have all been shown to have this effect.

    Does Zoloft Cause Insomnia?

    Zoloft’s Connection to Insomnia

    Zoloft’s connection to insomnia is inherent in its design. As a selective serotonin reuptake inhibitor, Zoloft influences nerves in the brain and alters perceptions and moods. Since serotonin is often linked to inciting sleep in the body, its effect on sleep can vary wildly.

    In short—Zoloft, like all antidepressants, can cause insomnia as a side effect. This is reported both by the Food and Drug Administration (FDA), as well as from reputable organizations like Mayo Clinic and the United States Library of Medicine.

    Adjusting to any mood-altering drug is going to take some time, and antidepressants are no different. For those who may be suffering from insomnia as a side effect of Zoloft, the effects may be short-lived.

    For others, a foggy disposition and increased lethargy may soon become normal—much like how a lack of constant sleep due to insomnia can. While some can cope with this reality and prefer it to the alternative, others may experience worse mental health symptoms on Zoloft.

    Whether Zoloft and insomnia go hand-in-hand will depend upon the individual as well as their experience. Insomnia is not always a side effect of Zoloft, so many can treat their depression symptoms without such side effects.

    However, for those who need Zoloft to maintain a standard of living but are unable to sleep at night, there are several home remedies that can help.

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