Can Medication Cause Sleep Apnea?

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 over-the-counter medications like Benadryl and certain prescription drugs such as 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.

A woman taking medication, France
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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 antidepressants, possibly making sleep apnea worse. However, mirtazapine and trazodone are 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:

  • 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.

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

Benzodiazepines work by stimulating production of gamma-aminobutyric acid (GABA), which 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. This can make throat muscles even more relaxed, leading to a blocked airway.

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 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.

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.

Most research into baclofen and sleep apnea has been limited to small case studies. However, some researchers have recommended that people with obstructive sleep apnea avoid using 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.

Anxiety medications and opioids are frequently implicated in overdose deaths.

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.

19 Sources
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.
  1. American Medical Association. What doctors wish patients knew about sleep apnea.

  2. Medline Plus. Obstructive sleep apnea - adults.

  3. Robillard R, Saad M, Ray LB, et al. Selective serotonin reuptake inhibitor use is associated with worse sleep-related breathing disturbances in individuals with depressive disorders and sleep complaints: a retrospective studyJ Clin Sleep Med. 2021;17(3):505-513. doi:10.5664/jcsm.8942

  4. AbdelFattah MR, Jung SW, Greenspan MA, Padilla M, Enciso R. Efficacy of antidepressants in the treatment of obstructive sleep apnea compared to placebo. A systematic review with meta-analysesSleep Breath. 2020;24(2):443-453. doi:10.1007/s11325-019-01954-9

  5. MedlinePlus. Antihistamines for allergies.

  6. American Academy of Family Physicians. Anti-histamines: Understanding your OTC options.

  7. Harvard Health Publishing. Drugstore sleep aids may bring more risks than benefits.

  8. Jullian‐Desayes I, Revol B, Chareyre E, et al. Impact of concomitant medications on obstructive sleep apnoea. British Journal of Clinical Pharmacology. 2016;83(4):688-708. doi:10.1111/bcp.13153

  9. Atkin T, Comai S, Gobbi G. Drugs for insomnia beyond benzodiazepines: pharmacology, clinical applications, and discoveryPharmacol Rev. 2018;70(2):197-245. doi:10.1124/pr.117.014381

  10. Department of Justice Drug Enforcement Administration. Benzodiazepines.

  11. National Institute on Drug Abuse. What are prescription opioids.

  12. Centers for Disease Control and Prevention. Prescription opioids: The basics.

  13. Correa D, Farney RJ, Chung F, Prasad A, Lam D, Wong J. Chronic opioid use and central sleep apnea: a review of the prevalence, mechanisms, and perioperative considerationsAnesth Analg. 2015;120(6):1273-85. doi:10.1213/ANE.0000000000000672

  14. European Monitoring Centre for Drugs and Drug Addiction. Barbiturates drug profile.

  15. Heck T, Zolezzi M. Obstructive sleep apnea: management considerations in psychiatric patientsNeuropsychiatr Dis Treat. 2015;11:2691–2698. doi:10.2147/NDT.S90521

  16. Locatelli F, Formica F, Galbiati S, et al. Polysomnographic analysis of a pediatric case of baclofen-induced central sleep apnea. Journal of Clinical Sleep Medicine. 2019;15(02):351-354. doi:10.5664/jcsm.7644

  17. Cole AP, Hanske J, Jiang W, et al. Impact of testosterone replacement therapy on thromboembolism, heart disease and obstructive sleep apnoea in men. BJU International. 2018;121(5):811-818. doi:10.1111/bju.14149

  18. La Vignera S, Calogero AE, Cannarella R, Condorelli RA, Magagnini C, Aversa A. Obstructive sleep apnea and testosterone replacement therapy. Androgens: Clinical Research and Therapeutics. 2020;1(1):10-14. doi:10.1089/andro.2020.0001

  19. Simou E, Britton J, Leonardi-bee J. Alcohol and the risk of sleep apnoea: a systematic review and meta-analysisSleep Med. 2018;42:38-46. doi:10.1016/j.sleep.2017.12.005.

By Brandon Peters, MD
Brandon Peters, MD, is a board-certified neurologist and sleep medicine specialist.