Effects of Commonly Prescribed Medications on Sleep: A Review of the Literature

This review synthesizes literature on how commonly prescribed medications-antihypertensives, statins, antidepressants, levothyroxine, proton pump inhibitors, phosphodiesterase type 5 inhibitors, and metformin-affect sleep. With many primary care patients reporting sleep issues and more than half of American adults using prescription medications, understanding these effects is essential. Methods included a comprehensive PubMed search of the past decade using relevant medication and sleep-related terms. A review of additional relevant references was also conducted. Our findings indicate that beta blockers are often linked to increased fatigue and somnolence, whereas diuretics may benefit patients with obstructive sleep apnea alongside an increased risk of nocturia. Statins appear to have minimal impact on sleep, although rare cases of insomnia or nightmares are reported. Antidepressants have mixed effects; some increase somnolence (trazodone, amitriptyline), whereas others are associated with insomnia (bupropion) and may worsen restless legs syndrome (mirtazapine). Levothyroxine does not significantly disrupt sleep, and evening administration may enhance hypothyroidism management. Proton pump inhibitors are found to improve sleep quality in patients with gastroesophageal reflux disease. Phosphodiesterase type 5 inhibitors like sildenafil may exacerbate severe obstructive sleep apnea, warranting caution. Metformin does not appear to interfere with sleep, with some studies suggesting a limited benefit. Clinicians should carefully consider these medication effects to balance therapeutic benefits with potential sleep-related adverse effects.