Modern prescription medications are touted as a major advance in promoting health and keeping us alive longer. I beg to differ. What I observe instead is that in many cases, commonly prescribed prescription medications can wreak your sleep or make you fat, or both. As I have stated many times on this blog and in my book, Sleep, Interrupted, poor sleep promotes weight gain, and weight gain promotes sleep related breathing problems. Nasal congestion from medications may also ruin your sleep.
For example, Jane is a 51 year old woman who came to see me for her recurrent sinus infections and headaches. She took 5 courses of antibiotics this past year. Her doctor ordered a sinus CT which revealed that her sinuses were clear with no evidence of infection, except for a deviated nasal septum. Upon further questioning, she admitted that about 2 years ago, she gained about 15 pounds. Around the same time period, she was placed on a medication for high blood pressure, and was given another medication for chronic migraine headaches. She also started taking sleeping pills occasionally for insomnia. As expected, she admitted that her sleep quality had worsened and now wakes up to urinate about 2 times every night.
Looking back on Jane’s medical history, I noted four risk factors for weight gain and sleep loss. Besides the fact that she is in her pre-menopausal years (lower progesterone with lower tongue muscle tone), she was exposed to three medications which likely contributed to her weight gain in the past few years. What most patients (and many doctors) don’t realize is that a high number of prescription medications have the potential to cause weight gain, ruin your sleep, or both. If you’re taking a prescription medication, take a look at your package insert or look online for potential side effects. It’s more than likely that insomnia or weight gain will be on the list.
Here are 12 of the most commonly prescribed medications that can ruin your sleep or make you fat:
1. High Blood Pressure Medications and Weight Gain
Beta-blockers (such as atenolol, metoprolol, nadolol, propranolol) lower the effects of the hormone epinephrine, which constricts blood vessels. Alpha-blockers (prazocin, doxazocin or terazocin) help to relax muscles in the small vessels by blocking norepinephrine. Both of these classes of medications are known to promote weight gain. Other classes of antihypertensives including ACE inhibitors do not have this effect.
Another way that high blood pressure medications can ruin your sleep is by blocking the pathway for making your sleep hormone, melatonin. Light stimulates receptors in the eye that stimulate nerves in the suprachiasmatic nucleus (near the optic nerve), which then connects to the thalamus then drops down to the spinal cord, connecting with the superior cervical ganglion, and then back up to the pineal gland, which makes melatonin. Light suppresses melatonin, whereas darkness enhances melatonin. Since the superior cervical ganglion is part of the sympathetic nervous system, taking beta blockers can potentially lower melatonin levels.
Medications that lower sympathetic tone can also cause nasal congestion. Since blood flow in your nose is regulated by a delicate balance between the sympathetic (fight or flight response) and parasympathetic (rest, digestion and reproduction) nervous systems, lowering sympathetic tone can cause pooling of blood in your nasal tissues. Nasal congestion can aggravate sleep-breathing problems. Viagra is one medication that’s known to cause nasal congestion and has been suggested to make OSA worse. Viagra and other similar medications relax blood vessels in the penis, but also does the same in the nose as well.
2. Proton Pump Inhibitors (PPIs)
It’s not an understatement to say that many Americans suffer from reflux disease. Despite the fact that the most commonly prescribed anti-reflux medications don’t address reflux at all, proton pump inhibitors (such as omeprazole/Prilosec and esomeprazole/Nexium) are promoted to treat gastro-esophageal reflux disease (GERD). In our field (ENT), it’s commonly given for laryngo-pharyngeal reflux disease (LPRD). Although seemingly safe when first introduced, there are now a number of troubling long-term findings. This includes higher risk of dementia, pneumonia, C. difficile infection, iron/B12/magnesium deficiency, bony fractures, liver problems, and chronic kidney disease.
Basically, PPIs lower acid secretion in the stomach, with a wide range of potential consequences mentioned in the above referenced article. As I mentioned in my book, the presence of apneas can lead to severe negative forces that suction up your normal stomach juices into your esophagus, throat, and sometimes even into your ears, sinuses and lungs. Disappointingly, the rate of esophageal cancer from Barrett’s esophagitis has continued to increase significantly over the past few decades (0.13/100K in the 70s and 80s to 4.3/100K in recent years). Additionally, PPI use was not found to help lower esophageal adenocarcinoma in a recent meta-analysis.
3. Medications for Anxiety, Depression, and Bipolar Disease
It saddens me to see so many of my patients on medications for anxiety or depression. Quite often, there is a direct correlation of weight gain after starting to take one of these medications. The most common offenders include paroxetine (Paxil), sertraline (Zolft), fluoxetine (Prozac; short term weight loss, long term weight gain), and the atypical antipsychotics, such as olanzapine (Zyprexa) and clozapine (Clozaril). A study published in the Journal of the American Medical Association reported that 10 to 36% of children and teens became overweight or obese after 12 weeks taking atypical antipsychotics for the first time. Many other medications given for anxiety, depression, or bipolar disorder can cause weight gain.
Many of the antidepressants, especially the tricyclic antidepressants (TCAs) are known to stimulate appetite. Two examples of brand names are Pamelor and Elavil. The newer class of antidepressants called selective serotonin repute inhibitors (SSRIs) don’t generally cause weight gain, except for Paxil. One interesting known side effect of this medication class is that they suppress REM sleep. Perhaps by limiting REM sleep, you’re prevented from having as much apneas since you’re kept out of REM sleep. REM sleep is when your throat muscles are most relaxed. This can be one way that these medications may help with depression. However, there’s a cost to not getting enough REM sleep: Your nervous system gets more excitable, with lowered pain thresholds, and you’ll have more problems with learning and memory.
Depakote (valproic acid) is a common mood stabilizer to treat bipolar disease and seizures. It’s also used to prevent migraines. One study found that 44% of women and 24% of men gained about 11 pounds on average over one year. Lithium can also cause weight gain due to altering a person’s appetite and metabolism.
4. Diabetes Medications and Weight Gain
Insulin is commonly known to potentially cause weight gain. Non-insulin antidiabetic drugs such as thiazolidinediones, sulfonylureas, chlorpropamide, and glinides are also associated with weight gain.
Antibiotics can also cause weight gain. Exposure to antibiotics during infancy was also shown to correlate with risk of being overweight later in life. Antibiotics not only kill what’s causing your ear infection or pneumonia, it can also kill the good bacteria in your gut. It’s thought this occurs by altering your gut microbiome. Having the right balance of various species is essential to maintaining a healthy weight. This is why it’s important to take probiotics if you’re ever given antibiotics. Ideally, you should not have to take antibiotics, which was greatly overprescribed in this country.
6. Pain and Seizures
Neurontin is a commonly prescribed medication for pain, seizures and headaches. One study found that daily use was associated with a 10% increase in body weight.
7. Cholesterol Medications
Cholesterol lowering medications called statins are associated with weight gain Here’s another study showing weight gain and increased blood sugar levels. Other documented sides effects include muscle pain, liver damage and memory loss.
8. Steroids and Weight Gain
Long-term oral steroids are a common reason for weight gain. They are often given for severe asthma, arthritis and various autoimmune conditions.I
9. ADHD Medications and Sleep
It’s estimated that over 10% of children and teens in the US have an ADHD diagnosis. About 2/3 are on medications. Common brand names include Ritalin, Aderall, and Concerta, which are variations of amphetamines. Since they are stimulants, expected side effects include insomnia, weight loss, headaches, high blood pressure, and moodiness. Long-term side effects include heart rhythm problems, addiction, and rarely psychosis. One concerning finding is that these class of medications can alter areas of the brain that control motivation. Dr. Leonard Sax, a prominent child psychologist, warns that long-term use may damage the nucleus accumbens in the brain, which is regulates motivation through the neurotransmitter dopamine.
10. Sleeping Pills
It’s ironic that many sleep aids can cause more sleep problems in the long term. One of the known side effects of Ambien is that it can motivate hunger and food seeking activity, even during sleep. This can potentially lead to weight gain.
Millions of people suffer from allergies every spring and fall. Over-the-counter allergy pills such as Allegra or Zyrtec are associated with increased weight. It’s thought that blocking the H1 histamine receptor in the brain, your appetite is enhanced and potentially lead to weight gain.
12. Birth Control Pills
This one is a double edged sword. While there are many benefits of synthetic hormones such as pregnancy prevention, as well as to regulate menstrual cycles or have better skin, there may be a potential down-side. Synthetic estrogens and progesterones are biologically much stronger than what your body normally makes, overdriving your hormones. Add to this the concept of estrogen dominance due to multiple toxic environmental sources of estrogen, and you have what’s called estrogen dominance. Too much estrogen suppresses progesterone, which help to increase tongue muscle tone and drive respiration. Prolonged estrogen exposure is also thought to increase your risk of breast cancer. Post-menopausal women who are given progesterone are found to have increased tongue muscle tone and better sleep.
Should I Stop Taking These Medications?
This list may seem daunting, but the scary thing is that it’s only an abbreviated list. Sleep problems and weight gain are only two out of many other potentially serious side effects from all these medications. On the other hand, the overall rate of side effects is relatively small. Just because you’re taking any of these medications doesn’t mean that you’ll suffer sleep problems or gain weight. Unfortunately, for many of you, changing or stopping medications is not an option. Whether or not to come off medications is a decision you have to make with your doctor. However, if you’re gaining significant weight, or if your sleep is severely disrupted (which can cause weight gain), it’s important to come up with a different strategy. I will talk about these strategies in an upcoming podcast. Stay tuned.