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Medicines can sometimes cause sleep-associated side effects that may worsen the condition or exacerbate symptoms. It is important to intervene wherever necessary and ensure that patients are getting the most from their treatments.
Many different medicines and medical conditions can cause sleep issues.
Click through the carousel for some common examples:13,14
NICOTINE REPLACEMENT THERAPY (NRT)
Nicotine is known to increase alertness and can raise blood pressure and heart rate
The impact on sleep often depends on the formulation and dosage of the NRT format used. Inhalers tend not to cause sleep disturbances, whereas long-acting patches may do so
CUSTOMER ADVICE: All smokers should be encouraged to quit smoking, and using NRT is a good way to stop. It can be difficult to determine if the sleep difficulties are due to nicotine withdrawal or the product alone; however, customers should be encouraged to stick with their NRT and try different formats if they are struggling. Alternative non nicotine-based products can be offered by a GP if they prefer.
PAINKILLERS
Pain is well-known to impact sleep, so it’s important that pain is appropriately managed at bedtime to help prevent this
Opioids such as codeine and morphine can affect sleep. Although they commonly cause drowsiness, some people find they disrupt sleep. Their use is also associated with sleep apnoea, which causes poor sleep and daytime sleepiness
CUSTOMER ADVICE: Pain can be extremely distressing and although in some people it can resolve quickly, others may suffer long term. Opioids can cause complications when used for long periods and are therefore typically only recommended for short-term use; however, they should not be stopped suddenly. Other painkillers such as NSAIDs, which have limited effects on sleep, may be more appropriate.
COUGH AND COLD REMEDIES
Cough or cold symptoms can often keep people awake
Decongestants such as pseudoephedrine may cause sleep disturbances as well as an increased chance of restless legs syndrome
Promethazine or diphenhydramine are commonly found in cold and flu medicines. The effects of promethazine can last up to 12 hours whereas diphenhydramine typically lasts about 8 hours, meaning the former may make customers feel drowsy into the next day
CUSTOMER ADVICE: If customers are struggling to sleep because of their cough and cold symptoms you could recommend a combination product that contains a sedating antihistamine. As these conditions are often viral, symptoms usually resolve on their own; however, good sleep and rest can help to aid recovery.
CARDIOVASCULAR MEDICINES
Beta blockers can affect sleep. Although water soluble beta-blockers (atenolol and sotalol) are less likely to affect sleep, fat soluble options (propranolol and metoprolol) have been found to worsen the ability to fall and stay asleep
Alpha blockers such as tamsulosin, doxazosin and prazosin are sometimes used to treat hypertension and also an enlarged prostate. They are found to cause sleep disturbances, but these usually settle. Patients with an enlarged prostate often experience nocturia, which can affect the quality of sleep
Angiotensin-converting enzyme (ACE) inhibitors such as ramipril, lisinopril and enalapril are commonly used to treat hypertension. Side effects can include sleep disorders, in addition to cough or aches and pains that may also affect sleep
CUSTOMER ADVICE: If medication is affecting their sleep, they may need to have their medication reviewed by their GP, particularly if the lack of sleep is causing stress and affecting their blood pressure or overall health.
ANTIDEPRESSANTS
Selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine, sertraline, paroxetine and citalopram can negatively affect sleep
Serotonin and norepinephrine reuptake inhibitors (SNRIs) such as venlafaxine are used to treat depression, anxiety disorders and chronic pain, especially nerve pain; however, they can cause sleep disturbances
Other types including serotonin antagonist reuptake inhibitors (SARIs), tricyclic antidepressants, tetracyclic antidepressants and monoamine oxidase inhibitors (MAOIs) can all affect sleep, some increasing drowsiness
CUSTOMER ADVICE: As depression and anxiety can affect sleep quality, it can be difficult to determine whether the medicine or the condition are causing the issues. During the first 2 weeks’ use, some antidepressants can interfere with sleep; however, as they start to work and improve mood, sleep also starts to improve. These medicines should not be abruptly stopped without speaking to a GP first.
NICOTINE REPLACEMENT THERAPY (NRT)
Nicotine is known to increase alertness and can raise blood pressure and heart rate
The impact on sleep often depends on the formulation and dosage of the NRT format used. Inhalers tend not to cause sleep disturbances, whereas long-acting patches may do so
CUSTOMER ADVICE: All smokers should be encouraged to quit smoking, and using NRT is a good way to stop. It can be difficult to determine if the sleep difficulties are due to nicotine withdrawal or the product alone; however, customers should be encouraged to stick with their NRT and try different formats if they are struggling. Alternative non nicotine-based products can be offered by a GP if they prefer.
PAINKILLERS
Pain is well-known to impact sleep, so it’s important that pain is appropriately managed at bedtime to help prevent this
Opioids such as codeine and morphine can affect sleep. Although they commonly cause drowsiness, some people find they disrupt sleep. Their use is also associated with sleep apnoea, which causes poor sleep and daytime sleepiness
CUSTOMER ADVICE: Pain can be extremely distressing and although in some people it can resolve quickly, others may suffer long term. Opioids can cause complications when used for long periods and are therefore typically only recommended for short-term use; however, they should not be stopped suddenly. Other painkillers such as NSAIDs, which have limited effects on sleep, may be more appropriate.
COUGH AND COLD REMEDIES
Cough or cold symptoms can often keep people awake
Decongestants such as pseudoephedrine may cause sleep disturbances as well as an increased chance of restless legs syndrome
Promethazine or diphenhydramine are commonly found in cold and flu medicines. The effects of promethazine can last up to 12 hours whereas diphenhydramine typically lasts about 8 hours, meaning the former may make customers feel drowsy into the next day
CUSTOMER ADVICE: If customers are struggling to sleep because of their cough and cold symptoms you could recommend a combination product that contains a sedating antihistamine. As these conditions are often viral, symptoms usually resolve on their own; however, good sleep and rest can help to aid recovery.
CARDIOVASCULAR MEDICINES
Beta blockers can affect sleep. Although water soluble beta-blockers (atenolol and sotalol) are less likely to affect sleep, fat soluble options (propranolol and metoprolol) have been found to worsen the ability to fall and stay asleep
Alpha blockers such as tamsulosin, doxazosin and prazosin are sometimes used to treat hypertension and also an enlarged prostate. They are found to cause sleep disturbances, but these usually settle. Patients with an enlarged prostate often experience nocturia, which can affect the quality of sleep
Angiotensin-converting enzyme (ACE) inhibitors such as ramipril, lisinopril and enalapril are commonly used to treat hypertension. Side effects can include sleep disorders, in addition to cough or aches and pains that may also affect sleep
CUSTOMER ADVICE: If medication is affecting their sleep, they may need to have their medication reviewed by their GP, particularly if the lack of sleep is causing stress and affecting their blood pressure or overall health.
ANTIDEPRESSANTS
Selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine, sertraline, paroxetine and citalopram can negatively affect sleep
Serotonin and norepinephrine reuptake inhibitors (SNRIs) such as venlafaxine are used to treat depression, anxiety disorders and chronic pain, especially nerve pain; however, they can cause sleep disturbances
Other types including serotonin antagonist reuptake inhibitors (SARIs), tricyclic antidepressants, tetracyclic antidepressants and monoamine oxidase inhibitors (MAOIs) can all affect sleep, some increasing drowsiness
CUSTOMER ADVICE: As depression and anxiety can affect sleep quality, it can be difficult to determine whether the medicine or the condition are causing the issues. During the first 2 weeks’ use, some antidepressants can interfere with sleep; however, as they start to work and improve mood, sleep also starts to improve. These medicines should not be abruptly stopped without speaking to a GP first.
NICOTINE REPLACEMENT THERAPY (NRT)
Nicotine is known to increase alertness and can raise blood pressure and heart rate
The impact on sleep often depends on the formulation and dosage of the NRT format used. Inhalers tend not to cause sleep disturbances, whereas long-acting patches may do so
CUSTOMER ADVICE: All smokers should be encouraged to quit smoking, and using NRT is a good way to stop. It can be difficult to determine if the sleep difficulties are due to nicotine withdrawal or the product alone; however, customers should be encouraged to stick with their NRT and try different formats if they are struggling. Alternative non nicotine-based products can be offered by a GP if they prefer.
WHEN TO REFER TO THE GP
Often, poor sleep and stress can exacerbate symptoms and so by having important sleep and stress conversations, you could in turn improve the management of some of these conditions. It is important to collaborate with other HCPs in order to help improve patient outcomes.
Click each customer profile to find out more
CUSTOMER FINDS THAT THEIR SLEEP HAS WORSENED DUE TO THE MEDICATION THEY HAVE BEEN PRESCRIBED
They may require a medication review due to the negative effect it is having on sleep, which may also affect how the condition is being managed
CUSTOMER FINDS THAT THEIR SLEEP HAS WORSENED DUE TO THE MEDICATION THEY HAVE BEEN PRESCRIBED
It is important to keep an eye out for red flags that may indicate this, e.g. severe pain that is affecting sleep could be undiagnosed arthritis that could be better managed with other forms of therapy or medication
THE CUSTOMER HAS TRIED OTC MEDICATIONS AND TRIED SLEEP HYGIENE FOR 2 CONSECUTIVE WEEKS, HOWEVER IT IS NOT EFFECTIVELY MANAGING THEIR SLEEP OR STRESS
There may be some underlying stress-related issues. Other forms of therapy can help to manage stress, such as cognitive behavioural therapy
THE CUSTOMER MAY NOT BE ELIGIBLE FOR OTC TREATMENT DUE TO A MEDICAL CONDITION, MEDICINE INTERACTIONS, AGE RESTRICTIONS OR IF THEY ARE PREGNANT OR BREASTFEEDING
There may be alternative forms of therapy or prescription medicines that might work better for short term sleep and stress management
THE CUSTOMER APPEARS TO HAVE BECOME TOLERANT, DEPENDENT OR ADDICTED TO OTC SLEEP AIDS
The risks associated with some sleep aids may require management from the GP so that the customer can still get help but also reduce the risks of harm associated with these products
Which medicines can cause sleep issues?
