Can Medication Cause Sleep Apnea?

Around 22 million Americans have sleep apnea, a disorder in which interruptions in breathing occur during sleep. These breathing interruptions happen due to a blockage in the upper airway or the brain not sending signals correctly to the breathing muscles.

While factors like obesity and age can play roles in the development of sleep apnea, the condition may develop for those at risk or worsen with the use of over-the-counter medications like Benadryl and certain prescription drugs such as benzodiazepines. Such medications can impact sleep architecture, muscle tone, and breathing and contribute to the effects of sleep apnea.

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Medications That Cause Sleep Apnea

Over-The-Counter

Antihistamines

Antihistamines are a class of drugs commonly used to treat allergy symptoms. Our immune system creates chemicals known as histamines that help get rid of foreign invaders that find their way into the body.

While the production of histamines is great for keeping the body safe, histamines are sometimes released when typically harmless substances or allergens find their way into the body, causing bothersome symptoms. This is where antihistamines work to lessen the effect. Some common antihistamine medications include:

  • Diphenhydramine (Benadryl)
  • Loratadine (Claratin)
  • Fexofenadine (Allegra)
  • Cetirizine (Zyrtec)

While antihistamines can help treat allergy symptoms, they are also sometimes used as sleeping aids. These drugs affect a histamine receptor that helps you stay awake. Taking antihistamines can induce sleepiness and relax breathing muscles, possibly making untreated sleep apnea worse or increasing the chance of developing sleep apnea if you are at risk.

Antihistamines are also known to cause weight gain, which can lead to obesity—a notable risk factor for sleep apnea.

Prescription

Benzodiazepines

Benzodiazepines are a class of medications used to relieve anxiety. Some work as muscle relaxants or are used as anticonvulsants to treat seizures. As these medications can also cause sleepiness, they have sometimes been used over the short term to aid sleep. However, chronic use for this purpose is discouraged due to their high risk of dependency. Some of the benzodiazepine medications include:

  • Alprazolam (Xanax)
  • Chlordiazepoxide
  • Clonazepam (KIonopin)
  • Clorazepate
  • Diazepam (Valium)
  • Lorazepam (Ativan)
  • Quazepam
  • Midazolam
  • Estazolam
  • Flurazepam
  • Temazepam (Restoril)
  • Triazolam

Gamma-aminobutyric acid (GABA) is a chemical in the body that works as an inhibitory neurotransmitter that blocks nerve signals, notably signals that induce feelings like anxiety and fear. Benzodiazepines work by stimulating GABA receptors, causing sedation, decreased anxiety, muscle relaxation, and retrograde amnesia.

Due to their muscle-relaxing and neurological effects and high risk of dependency, benzodiazepines have largely been replaced by safer classes of drugs such as selective serotonin reuptake inhibitors (SSRIs). Such medications do not increase the risk of breathing disturbances that may cause or worsen sleep apnea as benzodiazepines do.

Opiates

Opiates (sometimes called opioids or narcotics) are a class of medications often used to treat pain and sometimes diarrhea or cough. As opiates can cause sleepiness as a side effect, they can have important effects on breathing during sleep. Some of the common opiates include:

  • Hydrocodone
  • Oxycodone
  • Fentanyl
  • Meperidine
  • Methadone
  • Morphine
  • Sufentanil
  • Codeine
  • Propoxyphene
  • Buprenorphine
  • Pentazocine

These opiates bind to various opioid receptors within the nervous system and elsewhere in the body, resulting in increased respiratory pauses, irregular breathing, and shallow breaths. Research suggests opiates may cause central sleep apnea due to their effects.

Barbiturates

Barbiturates are a class of medications formerly used for sedation. But because of serious side effects, including the risk for dependence, withdrawal, and coma, they have largely been phased out as sleep aids. Some of the barbiturates include:

  • Amobarbital
  • Phenobarbital
  • Pentobarbital
  • Secobarbital
  • Thiopental

Barbiturates act at the sodium and potassium transporters in cells, inhibiting the reticular activating system in the brainstem—a system responsible for regulating sleep-wake transitions. This can produce sedation and even coma and has significant effects on breathing.

Anxiety Meds and Opioids Affect Breathing in Sleep

Anxiety medications and opioids can suppress your breathing and make your upper airway more collapsible. This may worsen sleep-disordered breathing, such as sleep apnea. As these medications also suppress your level of consciousness, you may not be able to protect your airway adequately, which may lead to disrupted breathing, suffocation or asphyxiation, and even death.

Anxiety medications are frequently implicated in overdose deaths, including among celebrities.

Finally, these medications may have different effects on your sleep architecture, leading to disrupted sleep even while you remain unconscious.

If you have sleep apnea, you should have a polysomnogram (PSG) performed when using any of these medications to monitor for side effects. It is important to discuss these risks with your healthcare provider to determine if the benefits of the medication outweigh the potential for harm in your situation.

Sleep Aids and Sleep Apnea Patients

Many people have trouble sleeping and rely on sleeping aid medications to get quality sleep. These types of drugs are either prescribed or found over the counter. As mentioned before, sleep aids like antihistamines that induce sleepiness and muscle relaxation may make untreated sleep apnea worse or make you more susceptible to developing the condition if you are at risk.

Before taking sleeping aids, it is important to know if you have sleep apnea or are at risk of developing sleep apnea. Treating sleep apnea or improving upon the factors that put you at risk may enhance sleep quality and curb the need for sleeping aids.

If you have sleep apnea and still find it hard to fall or stay asleep with the treatment you are receiving, make an appointment with your doctor to discuss different and emerging therapies and medications that are available that may help.

For example, one study published in the European Respiratory Journal found that cognitive-behavioral therapy (CBT) for insomnia reduced the severity of obstructive sleep apnea (OSA) in patients dealing with the condition.

Alcohol and Sleep Apnea

Alcohol's sedative properties lead many to use it as a way to self-medicate, as they feel it helps them relax and fall asleep. However, research has shown that drinking alcohol before bed can negatively impact your natural sleeping cycle.

Upon drinking, especially in large amounts, the substance is absorbed into the bloodstream and impacts the body physically and neurologically, causing effects such as increased blood pressure changes, slow reflexes, and mood swings.

Alcohol can disrupt sleep quality if taken before bed as the liver slowly metabolizes it during the night, meaning that the substance is still circulating in the body, increasing the chance of experiencing sleep disruptions.

In addition, research has shown that the risk of developing sleep apnea can increase by 25% with high alcohol consumption. Alcohol's sedative nature can relax the airway muscles, potentially increasing the chance of developing OSA or worsening the condition. It is generally best to avoid alcohol consumption at least four hours before bedtime to ensure it does not affect sleep quality.

Coping With Anxiety and Sleep Stress

Anxiety is the body's natural response to stress and can actually be beneficial in some situations. However, when this response becomes excessive or somewhat exaggerated, it can greatly affect one's well-being.

Studies have shown an association between anxiety and lack of proper sleep. A state of mental hyperarousal, usually caused by worry, can be a key risk factor for insomnia.

Being anxious can make it more difficult to fall and stay asleep, while a lack of sleep can negatively impact mood and mental and physical well-being. Those who cannot get adequate sleep may even start to become fearful and anxious about falling or staying asleep—a form of anxiety known as sleep anxiety.

If you have anxiety that is causing you to lose sleep and affecting your well-being, seeking the help of a mental health professional should be your first action. They can help identify what may be causing your anxiety and give you the proper therapy that may help. Also, there are things you can do that may help you cope better with anxiety and sleep stress:

  • Improve sleep hygiene: Sleep hygiene refers to the behaviors and habits you practice before bed that can affect the way you sleep. Turning off electronics at least 30 minutes before bed, avoiding caffeine or alcohol intake before bedtime, creating a relaxing and comfortable sleep environment, and avoiding large meals before bed are all examples of good sleeping habits that may improve your sleep quality.
  • Redirect your focus: If you deal with anxiety, you may notice that you focus too much on the anxiety itself or the triggers that cause them. Doing activities such as writing, exercising, listening to music, or watching a funny TV show can redirect your focus and may help alleviate your anxiety.
  • Practice breathing techniques: Research shows that practicing deep breathing may trigger body responses in your body that relax you.

Summary

Sleep apnea is a sleeping disorder marked by interruptions in breathing during sleep. Certain medications, notably antihistamines, benzodiazepines, barbiturates, and opiates, can impact your natural sleeping cycle and breathing, increasing your risk for developing sleep apnea or worsening the condition if you have it.

A Word from Verywell

If you have sleep apnea or are at risk for developing the condition, talk thoroughly with your doctor about any medications you wish to take to ensure it will not affect your sleep health. For many sleep apnea patients, standard treatment methods such as using a continuous positive airway pressure (CPAP) machine or an oral appliance have proven to be effective methods for getting quality sleep.

Frequently Asked Questions

  • How do you know if you have sleep apnea?

    It can be difficult to know if you have sleep apnea; a professional diagnosis is the surest way to know. However, common signs may include:

    • Loud snoring
    • Gasping for air while sleeping
    • Waking up from sleep constantly
    • Constant feeling of tiredness during the day
  • Should sleep apnea patients take antidepressants?

    Research suggests that there may be an association between impaired breathing and inadequate nighttime oxygen saturation and antidepressants, possibly making sleep apnea worse. However, mirtazapine and trazodone are two antidepressants that research suggests may reduce sleep apnea severity.

    If a sleep apnea patient is dealing with depression, mirtazapine or trazodone are two possible antidepressants that may be suitable if their doctor feels that medication is needed. But more research is needed in this area to conclude if and which antidepressants make sleep apnea worse.

  • How do you cope with anxiety without prescription medication?

    There are strategies that do not involve medications that you can do to cope with anxiety, such as practicing breathing techniques, engaging in fun activities, and writing down your thoughts.

    However, if you have an anxiety disorder, it is best to seek treatment from a mental health professional, as they can provide the best possible therapy options for you.

  • What else makes sleep apnea worse?

    Some things that can make sleep apnea worse include:

    • Weight gain
    • Old age
    • Smoking
    • Respiratory conditions
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Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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