Substances and Sleep: How Prescription Drugs and Stimulants Disrupt Your Sleep

Key Takeaways

• More than 35% of Americans report sleeping less than 7 hours in a 24-hour period.
• On average, 66% of Americans use prescription medications.
• It’s important to check medications’ side effects for drowsiness or daytime sleepiness (among other possible side effects).
• On average, 25.5% of women and 22.6% of men 65 and older sleep less than seven hours per night.
• Prescription and over-the-counter (OTC) medications, sugar, caffeine, and other substances can impact sleep quality and quantity.

All adults require an average of seven to nine hours of sleep each night, but a common misconception is that we need less sleep as we age. Getting adequate sleep is vital for maintaining your overall health. Not only does sleep regulate hormones that tell your body when you’re hungry or full, but not getting enough sleep can make daily stressors harder to handle, increase your risk of depression, and reduce the effectiveness of your immune system.Communications Biology. Nov. 18, 2021. Role of Sleep Deprivation in Immune-Related Disease Risk and Outcomes. Found on the internet at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8602722

Since sleep is so important, it’s important to understand that substances like marijuana, medication, food, and dietary supplements can negatively impact sleep.Sejbuk, Monika. Nutrients. May 2, 2022. Sleep Quality: A Narrative Review on Nutrition, Stimulants, and Physical Activity as Important Factors. Found on the internet at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9103473

This guide discusses how certain substances can impact sleep quality and provides tips on getting the rest your body needs.

The importance of sleep as we age

With its restorative powers and ability to boost the immune system, sleep is a critical component of our overall health. While the recommended amount of sleep for adults is between seven and nine hours per night, 25.5% of women and 22.6% of men 65 and older sleep less than seven hours per night. It’s important to consider the substances we expose ourselves to daily, as many of these can negatively impact our sleep.

Ryan Sultan, MD, a board-certified psychiatrist, substance use disorder therapist, and assistant professor at Columbia University, shared, “The significance of sleep and its multifaceted relationship with various substances, especially in older adults, is a growing concern and interest. The twilight years can be fraught with sleep disturbances, often exacerbated by substances, like medications and dietary supplements.”

Sleep often gets worse with age

As we age, our sleep patterns change, resulting in difficulty falling or staying asleep and decreased periods of deep restorative sleep. In addition, chronic illnesses and issues, like back pain, heartburn, diabetes, and hypertension, can interfere with sleep, as can changes in our social life. Koyanagi, Ai, et al. PLOS ONE. Dec. 5, 2014. Chronic Conditions and Sleep Problems Among Adults Aged 50 Years or Over in Nine Countries: A Multi-Country Study. Found on the internet at https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0114742Habits, like consuming caffeine too late in the day, can also disrupt sleep.

Poor sleep negatively impacts your health

Insomnia, which is trouble falling and staying asleep, is the most common sleep problem for adults 60 and older. National Institute on Aging. A Good Night’s Sleep. Nov. 3, 2020. Found on the internet at https://www.nia.nih.gov/health/good-nights-sleep

Sleep apnea, a disorder characterized by halted breathing for short periods while you sleep, may lead to high blood pressure, stroke, or memory loss. Other common sleep disorders involve involuntary body movements, including restless leg syndrome, periodic limb movement disorder, and rapid eye movement (REM) sleep behavior disorder. The right mattress can often help with some of these conditions, like sleeping on an adjustable bed can reduce heartburn and even some sleep apnea symptoms, or finding the best mattress for back pain can help alleviate disruptive aches and pains.

“Poor sleep patterns have been linked to cognitive impairments, exacerbating memory issues and potentially accelerating conditions, like Alzheimer’s disease,” said Sultan.

Lack of sleep can be a hazard during the daytime

Excessive daytime sleepiness (EDS) is common as we age, with roughly 15% of adults 60 and older affected. EDS is associated with depression, cognitive deficits, and doubling falls risks. Lack of sleep can lead to problems with balance, coordination, and attention, and it also increases the risk of falls, accidents, and injury.Morelhão, Priscila K, et al. Journal of Clinical Sleep Medicine. Oct. 15, 2018. Can Sleep Problems Have a Negative Impact on Falls in Older People? Found on the internet at https://jcsm.aasm.org/doi/10.5664/jcsm.7418

How medicine can impact sleep

Common medicines that affect sleep

Many medications impact the central nervous system and can affect your sleep. Drowsiness is one of the most reported side effects of these medications. Medication classes commonly associated with daytime sleepiness and other side effects that negatively affect sleep include^:Pagel, J.F. American Family Physician. March 1, 2009. Excessive Daytime Sleepiness. Found on the internet at https://www.aafp.org/pubs/afp/issues/2009/0301/p391.html

• Alpha-adrenergic blocking agents (e.g., Cardura, Minipress): Often used to treat blood pressure or prostate problems, these medications can decrease REM sleep.
• Anticonvulsants (e.g., Clonazepam, Gabapentin): This class of medication is used to treat epilepsy (seizures) and can negatively impact the sleep-wake cycle.
• Antidepressants (e.g., Celexa, Prozac): Many of these medications impact serotonin, dopamine, and norepinephrine, which can worsen sleep in some people.
• Antidiarrheal agents (e.g., Imodium): Many diarrhea medications slow down the muscle contractions in the gastrointestinal system and commonly cause drowsiness.
• Antiemetics (e.g., Phenergan, Zofran): Medications for nausea and vomiting can impact serotonin and dopamine, resulting in dizziness or drowsiness.
• Antihistamines (e.g., Benadryl): Unless these medications contain a non-drowsy label, they can cause drowsiness and potentially serve as sleep aids.
• Antipsychotics (e.g., Seroquel): Due to the sedating effects of these medications, off-label brands have served as a treatment for insomnia.
• Antitussives (e.g., Codeine, Dextromethorphan): Cough suppressants may affect the central nervous system, resulting in sedation and drowsiness.
• Benzodiazepines and sedative-hypnotics (e.g., Valium, Xanax): This class of medication affects your central nervous system, leading to calming and sedating effects. Studies have suggested these are not good medications for treating insomnia due to daytime drowsiness, increased risk for falls, and memory issues.AGS Health in Aging Foundation. Ask The Expert: Sedative-Hypnotic Drugs And Related Medications. July 2019. Found on the internet at https://www.healthinaging.org/tools-and-tips/ask-expert-sedative-hypnotic-drugs-and-related-medications
• Beta-adrenergic blocking agents (e.g., Metoprolol, Propranolol): These medications can negatively affect your melatonin levels, impacting your sleep-wake cycle.
• Decongestants (e.g., Phenylephrine, Pseudoephedrine): Many decongestants are alpha- and beta-agonists and can cause heart palpitations and anxiety, adversely affecting the quantity or quality of sleep. Pseudoephedrine is also a stimulant and can impact sleep if taken around bedtime. It should be taken several hours before bedtime. Phenylephrine is no longer available due to FDA removal because of ineffectiveness, but some people may still have it in their medicine cabinets.
• Diuretics (e.g., Lasix, Spironolactone): Commonly referred to as fluid or water pills, taking these medications too close to bedtime can lead to frequent nighttime urination.
• Nicotine (e.g., cigarettes, cigars, patches, gum): Nicotine acts on the neurotransmitter systems and can impact sleep by causing insomnia, increasing sleep onset time, and daytime sleepiness.
• Supplements (e.g., St. John’s wort): Supplements marketed as sleep aids, like St. John’s wort, have been shown to increase REM sleep.
• Marijuana and cannabidiol (CBD): Medicinal marijuana and CBD product use may improve sleep quality and reduce the use of prescription sleep medications. But chronic use may lead to less REM sleep, so moderation and guidance from a health professional is essential.Vaillancourt, Régis. Canadian Pharmacists Journal. April 15, 2022. Cannabis Use in Patients With Insomnia and Sleep Disorders: Retrospective chart review. Found on the internet at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9067069

Download our PDF Common Medicines and How They Impact Sleep below.

Understanding medications and side effects

When taking prescription or OTC medications, it’s crucial to understand potential side effects and interactions. Side effects are undesirable effects caused by medication. For instance, nausea, vomiting, and diarrhea are common side effects of many medications. Medicine can also have more severe side effects, like heart palpitations or shortness of breath. Anytime you experience side effects, you should consult your health provider to see if they advise continuing the medication.

Drug interactions occur when medicines are taken with other medicines, supplements, or food and can have different and potentially undesirable effects on you. For example, taking prescription blood thinners, like Coumadin and over-the-counter aspirin, can increase your chances of bleeding. Eating grapefruit can interact with certain statin cholesterol medications, like Zocor. Many supplements also have interactions with medications. An example of this would be taking St. John’s wort with heart or lung medications, like digoxin and theophylline, which can decrease the effectiveness of these medicines.

Medications that impact your central nervous system and cause drowsiness can have an increased impact on sleep when combined with pain medications, antidepressants, or antihistamines. Your primary care provider or pharmacist can help you determine if the combination of your prescription and over-the-counter medications can impact your sleep. You can also do your research online. Consider using MedlinePlus as a free resource available through the National Library of Medicine.MedlinePlus. Drug Reactions. Found on the internet at https://medlineplus.gov/drugreactions.html

Managing medication for better sleep

As we grow older, we may experience increased difficulty sleeping due to medical issues or hormonal changes, which include insomnia, pain, sleep apnea, or menopause for women. These coexisting factors make treating sleep disorders more challenging.

Additionally, the body changes as we age, and we may absorb medications less quickly and effectively. It may also take the body longer to eliminate medication, prolonging its intended effects. As many medications impact sleep, it can be challenging to identify which medication may be causing your sleep problems. Monitoring and adjusting your medications over time can help you ensure they are effective and avoid potential adverse effects. Be sure to discuss any sleep problems with your health care provider and review your medications and any supplements you take with them at each visit.

Download our PDF Sleep Diary and Substance Tracker below to track your sleep.

Dietary stimulants that affect sleep

Proper nutrition is critical to maintaining overall health and well-being. In fact, nutrition has a significant impact on quality of sleep and daytime alertness. Eating too little protein can impact sleep quality, and eating too much can result in difficulty staying asleep.

Sugar and caffeine

Studies show a significant relationship between consuming added sugars in your diet and poor sleep quality. High sugar consumption can lead to blood sugar spikes, which may wake you up at night. After the spike, you can experience a blood sugar crash that will cause you to wake up feeling hungry or thirsty. Sugar also stimulates brain activity and can impair your ability to fall and stay asleep. Studies have related high-sugar diets with decreased restorative and dream (REM) sleep phases.Sejbuk, Monika. Nutrients. May 2, 2022. Sleep Quality: A Narrative Review on Nutrition, Stimulants, and Physical Activity as Important Factors. Found on the internet at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9103473

Caffeine is a stimulant in coffee, tea, chocolate, energy, and soft drinks. It’s commonly used to relieve tiredness and fatigue but can actually harm sleep. Once consumed, caffeine can continue to impact your body for up to 10 or more hours. Caffeine affects the central nervous system and can cause shortened or poor-quality sleep and daytime sleepiness.

Other ingredients that may affect you at night

Foods high in tryptophan, melatonin, and serotonin can make you sleepy. Some over-the-counter supplements with these ingredients are marketed as sleep aids. On the other hand, food with high glycemic indexes, like refined grains and starches, can increase the risk of insomnia. Furthermore, food additives, like dyes and preservatives, might impact sleep quality, and some believe there is a link between food additives and hyperactivity in children.Kemp, Andrew. The BMJ. May 24, 2008. Food Additives and Hyperactivity. Found on the internet at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2394588/

Adjusting your diet for better sleep

Choosing foods that promote better sleep and avoiding those that impair sleep can help you meet your rest goals. Here are some diet tips for better sleep:

• Avoid eating foods high in sugar late in the day.
• Stop your caffeine intake at least six hours before going to bed. Some people may need to stop around noon if they experience the effects of caffeine for longer periods.
• Choose snacks that are high in melatonin, like walnuts or kiwis.
• Drink chamomile tea before bed. Antioxidants in this tea can help promote sleepiness.
• Dairy products, like milk, contain tryptophan, which can help you sleep better.

Lindsey DeSoto, RDN, LD, a renal dietitian at Fresenius Medical Care North America in Waltham, Massachusetts, added, “Studies have shown that diets low in saturated fat and high in fiber, fruit, vegetables, and seafood seem to be beneficial for improving sleep. A balanced diet can also help you achieve and maintain a moderate weight, which can also help improve sleep quality.”

Tips for healthy sleep among older adults

Getting a good night’s sleep is an important goal. Take action to get a better night’s sleep by following these tips:

• Establish and maintain a bedtime routine. Go to bed and get up at the same time every day, including weekends.
• Find ways to relax before bed. Do something calming before you head to bed. Reading, taking a warm shower or bath, deep breathing, or drinking chamomile tea (which has antioxidants that promote sleepiness) can help you fall asleep.
• Keep cellphone, computer, and television use out of the bedroom.
• Exercise daily, but ensure it’s at least three hours before bedtime.
• Limit naps to 30 minutes or less and not late in the day.
• Keep your bedroom quiet and comfortable by eliminating background noise, adjusting your thermostat, and finding the right sleep position and mattress, such as the best mattress for side sleepers.
• Avoid substances that may negatively impact your sleep or use only in moderation.
• Consult your health care provider, pharmacist, or sleep specialist if you’re consistently having difficulty sleeping.
• Explore relaxation techniques such as meditation.
• Consider cognitive behavior therapy (CBT), specifically for insomnia, to help treat prolonged sleep problems.
• Use the best mattress type for your sleep needs.

“Sleep is not just a restorative process for the body; it’s a cornerstone for overall well-being,” said Sultan. “Adequate sleep aids in memory consolidation, physical restoration, and emotional well-being. There are a number of things that can be done to achieve quality sleep, such as keeping a consistent schedule by going to bed and waking up at the same time daily” to help set a regular sleep rhythm. He added that you can also “ensure the bedroom is dark, quiet, and cool. Consider using earplugs, eye shades, or white noise machines if needed.”

Why you should avoid OTC sleep aids

Many older adults may turn to over-the-counter substances such as Tylenol PM, Excedrin PM, or ZzzQuil to help them fall asleep and stay asleep. Although these products are available without a prescription, they should be avoided or used cautiously. Speaking with a doctor or pharmacist about side effects and other concerns before taking these medications is sound advice.

Many OTC sleep aids contain diphenhydramine, an antihistamine and active ingredient in Benadryl. Diphenhydramine should be avoided by older adults because as we age, our metabolism slows down, which increases the amount of the medication that stays in our bodies, prolonging the medication’s effects.

Diphenhydramine causes many side effects in older adults like dizziness, daytime drowsiness (even when taken at bedtime), confusion, constipation, low blood pressure, blurry vision, and increased risk of falls. People with Alzheimer’s disease or other types of dementia should not take diphenhydramine because it can make symptoms of dementia worse.

Download our PDF Healthy Sleep Hygiene Tracker below to track your sleep.

Bottom line

Sleep is a critical component of our overall health, and many substances can impact our quality or quantity of sleep. Understanding how various substances may affect sleep is important to achieving the best sleep quality. Start by considering the potential downsides of consuming substances, like prescription and OTC medications, stimulants, and supplements. Then, talk to your doctor about the changes you can make on a daily basis to improve your sleep quality. While there’s no one-size-fits-all solution to achieving optimal sleep, an individualized approach may include adjustments to medication, supplements, daily routines, and sleep hygiene. By following this approach, you may be able to help improve your sleep quality and overall well-being.

Have questions about this review? Email us at reviewsteam@ncoa.org.

Sources

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5. Communications Biology. Role of Sleep Deprivation in Immune-Related Disease Risk and Outcomes. Nov. 18, 2021. Found on the internet at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8602722
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13. Vaillancourt, Régis. Cannabis Use in Patients With Insomnia and Sleep Disorders: Retrospective Chart Review. Canadian Pharmacists Journal. April 15, 2022. Found on the internet at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9067069
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Steven Marshall Author

Steve Marshall has more than 35 years of clinical and leadership experience in health care. He has worked in various settings, including emergency departments, intensive care units, air and ground transport, oncology, infectious disease, and infusion services.  He founded See Doc Nurse Write LLC in 2023 to expand the reach of his clinical knowledge and expertise.

Chester Wu Medical Reviewer

Dr. Chester Wu is board certified in Psychiatry and Sleep Medicine, training at Baylor College of Medicine and Stanford University School of Medicine, respectively. He has since established his own private practice in Houston, TX where he provides psychiatric and sleep medicine services.

Kathleen Cameron Reviewer

Kathleen Cameron, BSPharm, MPH, has more than 25 years of experience in the health care field as a pharmacist, researcher, and program director focusing on falls prevention, geriatric pharmacotherapy, mental health, long-term services and supports, and caregiving. Cameron is Senior Director of the NCOA Center for Healthy Aging, where she provides subject matter expertise on health care programmatic and policy related issues and oversees the Modernizing Senior Center Resource Center.