Prescription Medications and the Risk of Sleep Apnea (2024)

Around 30 million people in the United States 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 caused by relaxed throat muscles. It can also happen when the brain isn't sending signals correctly to the breathing muscles.

While factors like obesity and age can play a role in the development of sleep apnea, the condition may be triggered by the use of medications including muscle relaxants and benzodiazepines. Such medications can impact muscle tone, breathing, and sleep architecture (your normal sleep pattern) and contribute to the development of sleep apnea.

This article will discuss the medications that can affect sleep apnea and which ones to avoid to prevent worsening the condition.

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.

Antidepressants

Research suggests that there may be an association between impaired breathing and inadequate nighttime oxygen saturation and selective serotonin reuptake inhibitors (SSRIs), a type of antidepressants that may possibly make sleep apnea symptoms worse.

However, mirtazapine and trazodoneare two antidepressants that research suggests may reduce sleep apnea severity. More research is needed in this area to conclude whether and which antidepressants make sleep apnea worse.

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 such as coughing and sneezing occur when histamine is released in response to exposure to harmless allergens. Antihistamines, which can be bought over the counter, work to lessen these effects. Some common antihistamine medications include:

• Benadryl (diphenhydramine)
• Claritin (loratadine)
• Allegra (fexofenadine)
• Zyrtec (cetirizine)

Antihistamines are also sometimes used as sleeping aids. However, American Academy of Sleep Medicine guidelines note there is limited evidence of their benefit and they may present risks when used as sleep aids. There is no clear evidence of their effects in people with obstructive sleep apnea, although they may contribute to weight gain, a known risk factor for sleep apnea.

Benzodiazepines

Benzodiazepines are a class of prescription 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.

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

Two of these drugs, flurazepam and triazolam, lowered oxygen saturation at night during research studies. However, other studies of benzodiazepine drugs have not found significant effects. While there may be a relationship between the drugs and sleep apnea symptoms, more data is needed.

Opiates

Opiates(sometimes called opioids or narcotics) are a class of prescription 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
  
• 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. Like benzodiazepines, opiates may relax the muscles in the upper airway, leading to a blockage. They also may interfere with signals to the muscles that involve breathing.

People who are taking opioids for chronic conditions, like cancer or chronic obstructive pulmonary disease (COPD), may be more at risk of sleep apnea complications. More research is needed to understand opiate effects and the type of sleep apnea that may be at work.

Barbiturates

Barbiturates are a class of prescription medications that cause sedation. They used to be used as a sleep aid, but have been largely phased out because of serious side effects, including the risk for dependence, withdrawal, and coma. Today they're largely used to treat seizures. Some barbiturates include:

• Amobarbital
• Phenobarbital
• Pentobarbital

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.

Baclofen

Baclofen, a myorelaxant (skeletal muscle relaxant), is used to treat spasticity in conditions like multiple sclerosis and spinal cord conditions. These relaxant properties are thought to cause upper airway collapse during sleep, increasing the incidence of sleep apnea.

Studies have found that central sleep apnea (not obstructive) has been reported with long-term use of baclofen at high doses in people diagnosed with alcohol use disorder. There's also some evidence of central sleep apnea at normal doses in people who have had a previous stroke. However, a single 25-milligram dose had no effect in studies of people with moderate obstructive sleep apnea.

Some researchers have recommended that people with obstructive sleep apnea avoid using baclofen. However, more data is needed to support conclusions about sleep apnea and the use of baclofen.

Testosterone

Research has found some evidence that testosterone can increase the cases of sleep apnea. In a 2018 study, the risk of sleep apnea was higher in patients taking testosterone replacement therapy.

A 2020 review of studies concluded that testosterone replacement therapy is a risk factor for developing sleep apnea. It recommended that those receiving the therapy should be monitored for the condition, particularly in obese patients.

Medications Causing Weight Gain

Certain medications can contribute to weight gain, increasing the risk for sleep apnea. About 70% of those with sleep apnea are obese. This can be the result of extra tissue blocking the upper airways.

Medications that can cause weight gain include antidepressants, anticonvulsants, alpha- and beta‐adrenergic blockers, diabetes medications, and antihistamines.

Alcohol

Alcohol's sedative properties lead many to use it as a way to 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.

Research has shown that the risk of developing sleep apnea increases by 25% with high alcohol consumption. It is best to avoid alcohol consumption at least four hours before bedtime to ensure it does not affect sleep quality.

What to Consider Before Taking These Drugs

Before taking these medications, it is important to know if you have sleep apnea or are at risk of developing sleep apnea. Common risk factors include:

• Obesity
• A large tongue or neck circumference
• A lower jaw that's shorter than the upper jaw
• Large tonsils

Talking to a healthcare provider can help you determine if the benefits of the medication outweigh the potential for harm in your situation. They may decide to treat the underlying causes of your sleep apnea, which may help you sleep better and eliminate the need for you to take some of the medications described above.

If you decide to take any of the medications described above, the effects can be monitored with a polysomnogram (PSG), also called a sleep study. During the study, electrodes placed on your body monitor your brain waves, breathing patterns, blood oxygen levels, and more.

Summary

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