7 Drugs That Can Cause Obstructive Sleep Apnea

A psychologist colleague of mine once told me that at the hospital where he works, many of his patients are on antipsychotic and antidepressant medications. A significant number of these patients will go on to gain significant weight, snore heavily, and end up dying of heart attacks or strokes. While this is purely anecdotal, based on what we know about the side effects of commonly prescribed prescription medications, it’s not too far fetched for the following reason: Any medication that causes weight gain can potentially aggravate or uncover obstructive sleep apnea.

I’ve written extensively in the past how obstructive sleep apnea is mainly a structural problem with narrow jaws and upper airways, but if you add fat in the throat due to being overweight, it just makes things much worse. Here are 7 commonly prescribed prescription medications that can aggravate obstructive sleep apnea due to their ability to put on weight:

1. 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 these type of medications 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. 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.

2. 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.

3. Atypical anti-psychotics (Risperdal, Seroquel, Zyprexa, Abilify, and others) are known to cause significant weight gain (7% or more in original body weight) in up to 30% of patients. There’s also some evidence that these medications may also cause insulin resistance and potentially lead to diabetes. A study published in Obesity found that men who took Zyprexa for only 2 weeks increased their food intake by 17%. Another 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.

4. Prednisone, one of many corticosteroids to control inflammation, is one of the most commonly prescribed medications. Chronic, long-term use is given for asthma, inflammatory bowel disease, rheumatoid arthritis, and various other autoimmune conditions. One study found that 70% of people on chronic steroid use reported significant weight gain.

5. Antihistamines such as Allegra and Zyrtec, are also associated with being overweight. This study found that patients on these medications were 55% more likely to be overweight compared to those not taking the medications.

6. Insulin. You’d think that with better sugar control, there would be weight loss, but the findings are the reverse. Here’s a study showing that insulin alone promotes weight gain.

7. The older beta-blockers such as atenolol, metoprolol and propranolol are also associated with significant weight gain. One possible mechanism is that any drug that lowers sympathetic activity will block the brain pathway that stimulates 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 alter melatonin production.

As I was doing research for this blog post, I kept getting led down more rabbit holes with studies detailing potentially serious side effects with all these medications. I only listed 7 medications, but there are many more. It’s clear that most if not all prescription medications will have various side effects, with many causing sleep or weight disturbances. This is something that all physician must think about when prescribing any of these medications.

I can’t tell you to stop taking your medications, but one thing you can do is to incorporate habits from this list of 20 Quick Daily Health Tips.

If you started taking any of the above mentioned medications, did you notice any significant weight gain?

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18 thoughts on “7 Drugs That Can Cause Obstructive Sleep Apnea

  1. This is a great article for the people I know with sleep apnea. Perfect for sharing. Thank you so much. I’m going to share this with all my social media contacts.

  2. My body weight increased by not seven, but thirty percent (from 120lbs to 160lbs) in a very short period of time after starting Paxil/remeron combo. I had a narrow airway and snored some, but after the meds I began what my respiratory therapist dubbed “jack hammer” snoring. Lovely! On my sleep study at times the line went off the chart. In spite of the weight gain, I still was not overweight since I was so very thin before taking the meds. Chest pains that began after starting the meds went away very soon after starting cpap. Every time my paxil dosage increased my cpap pressure had to be increased to overcome the increase in apnea. Hope that helps your research some. Tomorrow’s doctors will be saying,” okay here’s a paxil script and while your at the pharmacy go ahead and grab a cpap over by the breathe rite strips cause you’re gonna need it! And get some earplugs for your spouse cause their gonna feel like they are sleeping next to the subway!” (And you might wanna get your fat pants out of storage too. Just saying.)

  3. I read with interest your article about medications which cause weight gain.
    I suffer from cfs and was prescribed propranolol and mirtazapine. I had a sleep study which showed mild apnea, but struggled with cpap. Instead I have opted for a jaw advancement device, provided by a very good orthodontist who commented on my large tongue, small airway and loss of back molars.
    The device plus mirtazapine has helped me sleep, but I am now 21 lb heavier than 2 years ago and cannot shift the weight. I have a pulse oximeter and see that my oxygen levels are often on the low side. Any suggestions?

  4. I started taking Remeron/mirtazapine for insomnia in 2014. I was having another bout of delayed-onset insomnia, and all the medications I’d tried before had stopped working. The Remeron made me hungry, but I was so desperate for sleep that I continued taking it anyway. Dr. Park, you can probably guess where this story is going. About a year later, I had a sleep study and was diagnosed with severe obstructive sleep apnea plus 20 RERA events/hour. I am now on CPAP therapy. When I started trying to taper down the Remeron a few months ago, I discovered to my dismay that it has a severe discontinuation syndrome. I am still tapering down my Remeron dosage. I hope to be completely off it soon. I have gained 30 lbs. since beginning the Remeron. I learned recently that there are studies showing that Remeron decreases the severity of obstructive sleep apnea. I wish my doctor would have made the connection that, if Remeron helped me to sleep when Ambien no longer did, that I very likely had sleep apnea.

  5. I’m being woke up to loud ear ringing in left ear and also heat waves in my stomach intestines area like a menthol kind of heat and also I take atenolol 25 before bed and just have started on Paxil 20 mg but just before that it was celexsa 20 mg

  6. I found some much need info in this article. I was recently put on depakote and while I didn’t experience weight gain, I did notice fat building around my neck. My family has a history of sleep apnea, and every morning for the past few weeks I’ve been jolted awake with symptoms that resemble my fathers behavior when he’s awoken from his apnea. I really hope these are just hypnic jerks, but I’m going to a doctor to get it checked out. Sadly I don’t trust doctors very much. Doctors got me hooked on clonazepam and now this. I don’t know where to turn except for the internet, which is very sad.

  7. I use a dental sleep appliance for my sleep apnea. I used Cpap for quite a few years but when my shoulder and neck pain got so bad from having the air set so high, I went to a dental appliance which I had to pay for. I have been using for maybe 7 years. I lost weight and am not overweight but I sleep with my mouth open and sometimes snore. I have a watch that monitors how many times I wake or move which is a lot. I worry how much I am stopping breathing. Any suggestions

  8. Hello Dr Park,
    I have been prescribed Seroquel up to 400mg and gabapentin 800mg for PTSD. I am sure it has made my apnea worse or even caused it. I have severe > 70 obstructive sleep apnea. I have come off both these medications and my new doctor has prescribed melatonin x2 at night and an ssri in the morning. I knew my life was at risk on the previous medication because of my apnea. I use a resmed apap machine. If I could have an operation that would cure my apnea I would, but because my apnea is so bad it is very dangerous for me to have an anaesthetic. I am also now trying to lose weight. Do you have any advice? Warm regards Anne

  9. I have noticed since being on amitriptyline that I have been waking up during night not breathing and gasping for breath,also I have had to cough up fluid which felt like it had gone down the wrong way.I’m only on 10mg of amitriptyline as a migraine preventer.I’m a 42 year old of normal weight.I did’nt have these symptoms until I started taking amitriptyline i’m currently reducing my dose.Once i’m off of amitriptyline completely I’m hoping this symptom will stop.

  10. What would you think if someone was requesting a CNS stimulant (methylphenidate product) for a patient with obstructive sleep apnea, where you see the patient currently taking diazepam, clonazepam, clonidine, gabapentin and trazodone? Wouldn’t this drug regimen be fairly dangerous for a patient with OSA (due to long half life of diazepam, and multiple sedating medications being used concurrently)?

  11. Seroquel has destroyed me and has contributed to a lot more than 7 percent weight gain. On it for 6 and a half years. Going to get tested for apnea. Have taken it, ironically, for severe insomnia. Take other drugs with it now that we’re supposed to help me get off of it but am hooked on now too. Our health system has failed people like me and other people leaving these comments.

  12. Yes! Started taking Metoprolol and within 3 months I have gained 15lbs. Stomach bloating, mild swelling in lower legs and feet and my husband says I now snore!

  13. i was on propranolol for anxiety but never gained any weight. but it did cause me to have sleep apnea. ive since stopped propranolol because sleep apnea can be very frightening if you never had it before.

  14. This information is interesting. I’m glad I was able to read it for additional knowledge. Thank you for sharing this!

  15. Yes I have gained 30 lbs on metoprolol and am experiencing severe insomnia, and started having sleep apnea symptoms of waking up gasping for air numerous times per night. I feel like I am running on fumes. I’m a single mom with a 3 year old. I am 40 years old.

  16. I have hard to treat depression and anxiety. Was hospitalized for 4 months even had 9 etc treatments. My pulmonary dr believes I have sleep apnea. I take maoi parnate, valuim during the day. Ambein at bedtime even 100 milligrams of seraquil.I’m doing good on these medications I don’t want to stop them. Can I take with sleep apnea