Medications and depression
How they disrupt sleep: Medications sometimes have side effects that trigger sleeplessness or interfere with deep sleep. Most common culprits: asthma medications, corticosteroids, blood pressure medications, and antidepressants.
Also, many ingredients in common medications act as stimulants. They may cause jitteriness during the day and trigger sleeplessness or prevent deep sleep at night. Example: Bronchodilators like albuterol and salmeterol, commonly used to treat asthma, bronchitis, and COPD, can amp you up and interfere with sleep, yet patients are often directed to use them at the end of the day. Other common medications that can interfere with sleep include SSRIs, such as Prozac and Paxil, and beta-blockers taken for high blood pressure and heart disease.
Sometimes medications sabotage your sleep indirectly. Diuretics, for example, can interfere with sleep by causing you to use the bathroom at night. Tagamet (generic name cimetidine), taken to control reflux and ulcers, can cause sleeplessness, especially when combined with caffeine or other medications. Like many side effects, sleeplessness from medications can affect some people but not others; Propecia, used to treat hair loss, and the antihistamine loratadine (brand name Claritin) are both known to cause sleeplessness in a percentage of those who take them. Some people react to opioid pain medications with rebound sleeplessness, feeling sleepy at first but then waking up and being unable to get back to sleep.
The evidence: Although every medication is tested for side effects during the FDA approval process, in many cases evidence of side effects mounts over time as a drug enters more widespread use. Albuterol has been widely reported to cause restlessness, nervousness, and sleeplessness. An article in the European Journal of Clinical Pharmacology also found that beta-blockers interfere with melatonin release.
Recent studies have found that Prozac, Zoloft, Celexa, and other SSRIs affect sleep in a significant number of patients. If you're using an antidepressant, be sure to talk to your psychiatrist about any possible sleep problems and ask about alternative antidepressants if this is an issue.
Who's at risk: Those taking regular medication for a chronic condition such as asthma, depression, high blood pressure, or pain. A medication that you take once is less likely to cause an ongoing sleep issue because you take it for a short period of time and are more likely to notice the side effect. When you have a chronic condition, you're more likely to attribute any sleep problems to the condition rather than the treatment.
What to do: Any time you're prescribed a new medication, ask the doctor to discuss in detail all side effects you should be alert to. It's always a good idea to ask both the doctor and the pharmacist, "How will this medication affect my sleep?" Because some medications cause sleepiness, some interfere with sleep, and some do both, asking the question in an open-ended way will get you the most information.
How it disrupts sleep: Fatigue is one of the most prevalent symptoms of depression, yet many people don't realize how closely related depression and poor sleep can be. Depression wreaks havoc with your natural biological rhythms; many people with depression have trouble getting out of bed in the morning, and they oversleep or get fatigued and nap during the day. Yet their sleep is fitful and of poor quality, so despite spending more hours ostensibly sleeping or trying to sleep, they don't feel well rested. Then at night, depression sufferers often have trouble maintaining a regular bedtime routine. Having slept late in the morning or napped late in the day, they may not feel sleepy. Anxiety, which often accompanies depression, may cause excessive late-night worry that contributes to sleeplessness.
The evidence: Because the relationship between depression and insomnia is a chicken-and-egg cycle, experts have studied it from both directions. Psychological studies have found that a high proportion of those with depression suffer from either sleeplessness or disrupted sleep, and a recent study by the University of Maryland found that 40 to 60 percent of people with sleeplessness show signs of depression.
Who's at risk: Those with a history of mood disorders such as depression and anxiety, or anyone who has recently undergone a stressful life event likely to trigger depression.
What to do: One of the most effective steps you can take in this situation is to exercise vigorously during the day. According to experts at the University of Maryland, exercise combats depression by increasing serotonin levels in the brain. It's also one of the best ways to get your sleep-wake cycle back on track. Do 45 minutes to an hour of physical activity before dinner, and you'll feel tired earlier and sleep more deeply. If your low mood persists, consult a therapist or ask your doctor for a referral to a psychologist or psychiatrist.