7:  MEDICATIONS AS A CAUSE OF INSOMNIA                [Rev 12-21-2017]

          This is one of the general issues addressed in Step C

All medications have side effects – effects on organs or experiences in addition to the targeted effect. Some have common effects on people’s ability to sleep. Some may not have the effect that the person intends, and some may interact with others. This area is beyond the training and expertise of most of us, but we can gather some data and make some guesses about consequences of the person’s medication choices.

It is a good idea to gather information about all the person’s medications at this point. For each one, ask…

  • The name of the medication.
  • The dosage, and when it is taken. Some patients may take medications on their own schedules. It may be helpful to learn what they do, the regimen prescribed, and any differences. If the patient is not following the prescribed plan, he/she should probably return for another medical consultation.
  • When it was started, and why.
  • The name of the prescribing physician. If it could be a source of insomnia, you may want to get the physician’s telephone number and a release to talk to him/her.
  • How effective it is.
  • Whether the person is aware of any side effects.
  • Specifically, whether the patient thinks it could be affecting sleep.

Many people take over-the-counter drugs in addition to, or instead of prescription medications. Ask about these as well.

Often people are not consciously aware of some medication side effects, especially when the drug relieves a targeted symptom. It can be helpful to ask about the timing of any changes in the person’s life. Then if the person began having insomnia about the same time as starting with a new medication, there is the possibility of a connection.

There are far too many drugs available for us to keep a list of them all and their possible effect on sleep. Also, a given patient may have an idiosyncratic reaction to a medication or be responding to a drug interaction. Some general considerations about suspect medications and a general list of types can be found in Hauri and Linde, pp.170-172. Another list of types of medications reported to cause insomnia can be found in Reite, Weissberg and Ruddy,Table 3-1, p. 52. Information about individual medications can be found online at drugs.com and Right Diagnosis.

 

TIMING OF ADMINISTRATION

A person may use a side effect to help sleep. If the drug is known to be sedating, taking it in the evening or before bed can promote sleep. If it is generally energizing, then taking it in the morning may help a person remain alert during the day, and indirectly contribute to sleeping at night.

INTERACTIONS

Any time that a person is taking two or more medications – including over-the-counter medications – they may compound in the person’s body to produce unintended effects. This could include insomnia. It may pay to check with the person’s physician about this interaction possibility. An interaction checker can be found online at drugs.com. To use it, you will need to know the names of the medications the person is taking.

This problem is more likely when the person is being treated by more than one physician, or when the physician is unaware of the person’s over-the-counter treatments. Some patients may not reveal their use of recreational drugs or alcohol to their physicians, and some combinations can be lethal. Here again, communication with the person’s physician can be very important.

ALTERNATIVE TREATMENTS

Any medication needs to be matched to the reactions of the patient. If a drug has a side effect on the person’s ability to sleep, it may be possible for his/her prescriber to adjust the dose or find an alternative medication with different side effects.