Medications That Cause Insomnia

Insomnia, characterized by difficulty in falling asleep, staying asleep, or experiencing non-refreshing sleep, can be exacerbated by various medications. Understanding which medications contribute to sleep disturbances is crucial for managing and mitigating insomnia.

Antidepressants and Insomnia

Selective Serotonin Reuptake Inhibitors (SSRIs)

SSRIs, commonly prescribed for depression and anxiety, are frequently associated with sleep disturbances. Studies have shown that SSRIs like paroxetine can improve subjective sleep measures in some cases, but the overall evidence is mixed and often of low quality. Additionally, SSRIs are among the drug classes most significantly associated with sleep disturbances.

Tricyclic Antidepressants (TCAs)

TCAs, such as doxepin and trimipramine, have shown moderate improvements in sleep quality over placebo. However, their impact on sleep latency is minimal, and they may cause adverse effects like morning grogginess and dry mouth. Despite their potential benefits, the safety and tolerability of TCAs for insomnia remain uncertain due to limited reporting of adverse events.

Other Antidepressants

Trazodone, another antidepressant, has been found to moderately improve subjective sleep outcomes but also comes with side effects such as morning grogginess and increased dry mouth. Mianserin, although less commonly used, has shown some effectiveness in treating insomnia related to opiate withdrawal.

Benzodiazepines and Non-Benzodiazepine Hypnotics

Benzodiazepines

Benzodiazepines, such as nitrazepam and midazolam, are effective in inducing sleep but are no longer recommended as first-line treatments due to their potential for dependence, tolerance, and rebound insomnia. They are particularly discouraged in older adults due to risks of cognitive impairment, falls, and accidents.

Non-Benzodiazepine Receptor Agonists (Non-BzRAs)

Non-BzRAs like zolpidem and eszopiclone are preferred over benzodiazepines due to a better safety profile. However, they still pose risks such as dementia, serious injury, and fractures, especially in the elderly. Zolpidem has shown effectiveness in both sleep induction and maintenance, but its use should be limited to avoid long-term side effects.

Other Medications

Acetylcholinesterase Inhibitors and Dopamine Agonists

These medications, often used for conditions like Alzheimer's disease and Parkinson's disease, are significantly associated with sleep disturbances. Their impact on sleep can exacerbate insomnia symptoms, making it essential to monitor patients closely.

Antipsychotics

Second-generation antipsychotics, such as quetiapine and olanzapine, are increasingly used off-label for insomnia despite limited evidence of their efficacy. These drugs may improve sleep while treating comorbid conditions but come with a different side effect profile compared to traditional hypnotics.

Antihistamines

Sedating antihistamines like diphenhydramine are commonly used for their sleep-inducing properties. However, they are not recommended for older adults due to the risk of residual sedation and cognitive impairment.

Conclusion

Several medications, including SSRIs, TCAs, benzodiazepines, non-BzRAs, acetylcholinesterase inhibitors, dopamine agonists, antipsychotics, and antihistamines, can contribute to insomnia. While some of these drugs may improve sleep in the short term, their long-term use is often associated with significant side effects and risks. Clinicians should carefully consider these factors when prescribing medications to patients with insomnia and explore non-pharmacologic treatments as first-line options.

Medications that cause insomnia

Summary

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