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 be triggered by 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.

Medications Linked to Sleep Apnea

Both over-the-counter and prescription medications can bring on apnea episodes. Here's an overview of the most common medications linked to the condition.

Over-The-Counter Medications

Antihistamines

Antihistamines are a class of drugs commonly used to treat allergy symptoms. The immune system releases the chemical histamine to help get rid of foreign invaders that find their way into the body.

Allergy symptoms occur when histamine is released in response to exposure to harmless allergens. Antihistamines work to lessen these effects. Some common antihistamine medications include:

• Diphenhydramine (brand name Benadryl)
• Loratadine (brand name Claritin)
• Fexofenadine (brand name Allegra)
• Cetirizine (brand name Zyrtec)

Antihistamines 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 Medications

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 (brand name Xanax)
• Chlordiazepoxide
• Clonazepam (brand name KIonopin)
• Clorazepate
• Diazepam (brand name Valium)
• Lorazepam (brand name Ativan)
• Quazepam
• Midazolam
• Estazolam
• Flurazepam
• Temazepam (brand name 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. These effects can depress breathing, worsening sleep apnea.

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. Opiates can cause sleepiness but also affect 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.

Dangers of Anxiety Meds and Opioids in Sleep Apnea

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 reduce 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.

Finally, these medications may have different effects on your sleep architecture, leading to disrupted sleep.

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

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.

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. Alcohol also relaxes airway muscles, potentially triggering an apnea episode.

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 increases by 25% with high alcohol consumption. It is generally best to avoid alcohol consumption at least four hours before bedtime to ensure it does not affect sleep quality.

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. 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.