July 8, 2013

July 8, 2013
10 Types of Meds That Can Cause Insomnia


Welcome to another day in my life. Today is Monday and I hope you had a beary safe and great weekend. It is another busy week for Dab the AIDS Bear and me as we are still in Washington, DC meeting with our elected officials about the Ryan White Care Act.

Speaking about dealing with elected officials, the stress from doing so sometimes gives me insomnia. At times, it is all I can do to fall asleep. But did you know that besides stress that some medications can also cause insomnia? Well I will blog about some of those today and tomorrow.

Insomnia not only saps your energy and affects your mood, but also can put your health, work performance and quality of life on a downward spiral. Insomnia can be short-term (up to three weeks) or long-term (four weeks or more). Sleep deprivation can lead to irritability, depression, and memory and attention problems. It also has been linked with diabetes, obesity and heart disease, in addition to increased risk of automobile-related accidents and falls.

The Top 10

Here are 10 types of medications that can cause insomnia. If you're taking any of them and having sleep problems, you should talk with your doctor or pharmacist about adjusting the dosage, changing to another type of medication, or trying an alternative treatment or therapy.

1. Alpha-blockers

Why they're prescribed: Alpha-blockers are used to treat a variety of conditions, including high blood pressure (hypertension), benign prostatic hyperplasia (BPH) and Raynaud's disease. These drugs relax certain muscles and help keep small blood vessels open. By keeping the hormone norepinephrine (noradrenaline) from tightening the muscles in the walls of smaller arteries and veins, they improve blood flow and lower blood pressure. Because alpha-blockers also relax other muscles throughout the body, they can help improve urine flow in older men with prostate problems.

Examples: alfuzosin (Uroxatral), doxazosin (Cardura), prazosin (Minipress), silodosin (Rapaflo), terazosin (Hytrin) and tamsulosin (Flomax).

How they can cause insomnia: Alpha-blockers are linked to decreased REM (rapid eye movement) sleep — the stage of sleep when people dream — and daytime sedation or sleepiness. The proportion of REM sleep drops markedly in old age, and people deprived of REM sleep can experience memory problems.

Alternatives: For older people, benzothiazepine calcium channel blockers, another form of blood pressure medication, are often safer and more effective than alpha-blockers. If the alpha-blocker has been prescribed to treat BPH, talk with your doctor about the possibility of switching to a 5-alpha-reductase inhibitor such as dutasteride (Avodart) or finasteride (Proscar), which are safer and generally better tolerated by older patients.

2. Beta-blockers

Why they're prescribed: Beta-blockers are typically prescribed to treat hypertension (high blood pressure) and arrhythmias (abnormal heart rhythms). These drugs slow the heart rate and lower blood pressure by blocking the effect of the hormone adrenaline. Beta-blockers are also used to treat angina, migraines, tremors and, in eyedrop form, certain kinds of glaucoma.

Examples: atenolol (Tenormin), carvedilol (Coreg), metoprolol (Lopressor, Toprol), propranolol (Inderal), sotalol (Betapace), timolol (Timoptic) and some other drugs whose chemical names end with "-olol."

How they can cause insomnia: Beta-blockers have long been associated with sleep disturbances, including awakenings at night and nightmares. They are thought to do this by inhibiting the nighttime secretion of melatonin, a hormone involved in regulating both sleep and the body's circadian clock. Low levels of melatonin have sometimes been observed in chronic insomnia.

Alternatives: For older people, benzothiazepine calcium channel blockers, another form of blood pressure medication, are often safer and more effective than beta-blockers.

A nightly dose of melatonin may also help. A small study published in the journal Sleep in 2012 found that patients on beta-blockers who also took melatonin fell asleep sooner, had more restful sleep, and slept longer — an extra 36 minutes a night, on average — than patients taking an inactive placebo. (This was determined with polysomnography, an overnight sleep test that records brain waves, muscle tone, heart rate and eye movements.)

3. Corticosteroids

Why they're prescribed: Corticosteroids are used to treat inflammation of the blood vessels and muscles as well as rheumatoid arthritis, lupus, Sjögren's syndrome, gout and allergic reactions.

Examples: cortisone, methylprednisolone (Medrol), prednisone (sold under many brand names, such as Deltasone and Sterapred) and triamcinolone.

How they can cause insomnia: People often ask why a drug that reduces inflammation would keep them awake. The answer lies in the adrenal glands, which are responsible for regulating the body's fight-or-flight response. Too much stress can keep the body awake and the mind stimulated by exhausting the adrenal glands; corticosteroids can do the same thing, wreaking havoc on all the systems that allow you to relax and sleep, causing insomnia and unpleasant dreams.

Alternatives: Ask your doctor or pharmacist whether you can take your medication in a single dose early in the day.

4. SSRI antidepressants

Why they're prescribed: SSRIs (selective serotonin-reuptake inhibitors) are used to treat symptoms of moderate to severe depression. SSRIs block the reabsorption (reuptake) of the neurotransmitter serotonin in the brain, which may help brain cells send and receive chemical messages, easing depression. They're called selective because they seem to primarily affect serotonin, not other neurotransmitters.

Examples: citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac, Sarafem), fluvoxamine (Luvox), paroxetine (Paxil, Pexeva) and sertraline (Zoloft).

How they can cause insomnia: Just as it isn't known exactly how SSRIs work, it isn't known exactly how these drugs interfere with sleep. Studies have shown, however, that SSRIs cause agitation, insomnia, mild tremor and impulsivity in 10 percent to 20 percent of the people who take them.

Although about half of people who take SSRIs say that the drugs make them feel better, many continue to struggle with symptoms that can make life miserable, especially insomnia. We know this from researchers at the University of Texas Southwestern Medical Center in Dallas, who combed through data from the STAR*D trial, the largest and longest study ever done on depression treatment, and published their findings in 2011. Almost all of the subjects in the Star*D trial, which was funded by the National Institute of Mental Health, said they continued to have problems with insomnia, with 81 percent reporting being unable to sleep in the middle of the night.

Alternatives: If you are experiencing anxiety or insomnia while on an SSRI (or any other antidepressant, for that matter), it's important to tell your prescribing doctor right away. Sleeplessness — in itself a marker of depression — can make you even more depressed.

Because antidepressants vary in their side effects, a change in dosage or switching to another medication may help you feel better without causing insomnia or other sleep disturbances. A selective serotonin/norepinephrine reuptake inhibitor (SSRI/SNRI), a newer-generation antidepressant, offers some advantages in improving relaxation and sleep. Of the three drugs in this category (clomipramine, duloxetine and venlafaxine), I find venlafaxine to have the least adverse side effects in older patients and to be easier to dose to a therapeutic level.

5. ACE inhibitors

Why they're prescribed: Angiotensin-converting enzyme (ACE) inhibitors are used to treat high blood pressure, congestive heart failure and other conditions. These drugs help relax blood vessels by preventing the body from producing angiotensin II, a hormone that causes blood vessels to narrow and, in turn, blood pressure to rise.

Examples of ACE inhibitors include: benazepril (Lotensin), captopril (Capoten), enalapril (Vasotec), fosinopril (Monopril), lisinopril (Prinivil, Zestril), moexipril (Univasc), perindopril (Aceon), quinapril (Accupril), ramipril (Altace) and trandolapril (Mavik).

How they can cause insomnia: ACE inhibitors boost the body's levels of bradykinin, a peptide that enlarges blood vessels. Bradykinin is thought to be the cause of the hacking, dry cough that up to a third of all patients who take an ACE inhibitor develop. This chronic, round-the-clock cough can be severe enough to keep anyone awake. ACE inhibitors can also cause potassium to build up in the body (another type of electrolyte imbalance) and lead to diarrhea, as well as leg cramps and achy joints, bones and muscles — all of which can disturb normal sleep.

Alternatives: If you're taking an ACE inhibitor for a cardiovascular problem, talk with your doctor or pharmacist about possibly switching to a benzothiazepine calcium channel blocker, another form of blood-pressure medication that is often better tolerated by older adults. This is especially important for African Americans and Asian Americans, who, because of differences in their renin-angiotensin systems, have much higher incidences of adverse side effects.

If your condition is accompanied by fluid retention, your doctor may consider adding a low dose of a long-acting loop diuretic, such as torsemide.

Many people find that cognitive behavior therapy works just as well as medication. (Cognitive therapy aims to help people overcome their difficulties by changing their thinking, behavior and emotional responses.) Others report success with such approaches as acupuncture, exercise, changes in diet, meditation, relaxation therapy and the like.

Tomorrow I will blog about the rest on my list. Hope you have a beary safe and great Monday!

Until we meet again; here's wishing you health, hope, happiness and just enough.

big bear hug,



Daddy Dab