If you’ve been having frequent disturbing dreams and there isn’t an obvious link to what’s happening in your waking life, it may be time to check your medicine cabinet. Many people aren’t aware that common medications can have a negative influence on their dreams.
Certain antidepressants, beta blockers to treat high blood pressure, statins to treat cholesterol abnormalities, psychostimulants for attention deficit hyperactivity disorder, dopamine agonists for Parkinson’s disease, and acetylcholinesterase inhibitors to treat neurodegenerative diseases like Alzheimer’s and Parkinson’s are all among the medications that have been linked to causing or aggravating distressing dreams.
Unusually vivid dreams and nightmares are also recognized side effects of other prescription medications and even some over-the-counter drugs such as sedating antihistamines.
“There are a lot of medications that can cause nightmares or bad dreams,” says Dr. Clete Kushida, division chief and medical director of Stanford Sleep Medicine. “Even melatonin and medications that are used for short-term insomnia such as Ambien, Sonata, and Lunesta can be associated with more bad dreams, but we don’t know the mechanisms.” The newer GLP-1 drugs (like Ozempic and Mounjaro) that are used to treat Type 2 diabetes or promote weight loss have also been linked to disturbing dream content, Kushida adds.
Why do some medications affect dreams?
When medications are associated with an increase in bad dreams or nightmares, the cause isn’t always clear. In the case of some drugs like selective serotonin reuptake inhibitor (SSRI) antidepressants, the medications may change the levels of neurotransmitters, such as serotonin, in the brain, which can affect dreams and nightmares. “SSRIs inhibit the reuptake of serotonin, a neurotransmitter that’s involved in sleep regulation, so more serotonin is floating around [in the brain],” Kushida says.
Research has found that while older tricyclic antidepressants “induce more positive dream emotions,” use of SSRIs and serotonin norepinephrine reuptake inhibitors (SNRIs) is associated with more intense dreaming and the possibility of more frequent nightmares. Withdrawal from tricyclic antidepressants may also lead to nightmares, while withdrawal from SSRIs and SNRIs seems to intensify dreaming.
By contrast, “dopamine agonists are thought to impact nightmares directly through their activity on dopamine receptors,” explains Dr. Swetha Gogineni, a sleep specialist and pulmonary physician at UCLA Health.
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Other drugs may have a more direct impact on sleep architecture, the structure of different sleep stages during the night. For example, drugs that are used to treat Alzheimer’s (such as Aricept) can lead to REM sleep behavior disorder, which can cause intense, often bad dreams and may even lead people to act out their dreams, Kushida says.
Meanwhile, beta blocker medications tend to reduce REM sleep, which is when most dreaming occurs, but research has found that they are associated with an increase in nightmares. Use of some fluoroquinolone antibiotics, such as ciprofloxacin and levofloxacin, has also been linked with a higher risk of nightmares.
Sometimes it’s not entirely clear what’s triggering the bad dreams. For example, an underlying sleep disorder like sleep apnea could be affecting someone’s dreams when they are taking a dream-affecting drug such as an antidepressant. “Many people who have depression suffer disturbing dreams,” says Dr. Barry Krakow, a sleep medicine specialist in Savannah, Georgia, who runs a sleep-health coaching service. “Many people with depression need a sleep study because they have a sleep disorder like sleep apnea.” Obstructive sleep apnea on its own is associated with increased nightmares; treating it with continuous positive airway pressure (CPAP) has been shown to reduce bad dreams.
How to handle nightmarish side effects
When people experience dream-related side effects from medications, their responses can vary significantly. Some people simply notice that their dreams are more intense and shrug them off. “Others report sleep fragmentation, palpitations, and a panicked sensation upon awakening,” says Gogineni. “Some individuals can develop insomnia due to fears regarding sleeping and nightmares. For some, the nightmares can go on to impact their ability to function at work or in different social settings.”
So what should you do if you suspect a medication is wreaking havoc on your dreams? The first step is to discuss your symptoms and concerns with your primary care physician. “Nightmares can significantly impact someone’s sleep and overall quality of life,” says Gogineni. “It is vital that [your] physician know if this is happening.”
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It’s important not to just stop taking a medication without first talking to your doctor, because that could have negative effects on the health condition being treated. Also, “an abrupt discontinuation of these medications can sometimes lead to worsening of nightmares,” Gogineni says.
Depending on both the medical condition and the medicine, several solutions may help. “Your doctor may suggest altering the dose or the time of day the medication is being taken,” Kushida says.
In some instances, your doctor may suggest trying a different medication in the same class or a different type of drug altogether to treat your health condition, says Gogineni.
It’s an important conversation to have, starting with your primary doctor—and if that isn’t sufficiently helpful, with a sleep specialist. The quality of your rest, including your dreams, can affect your well-being day and night, so it’s worth taking steps to sleep peacefully.
