If you’re experiencing frequent unsettling dreams without a clear connection to your daily life, your medication might be the cause. Many individuals are unaware that common drugs can negatively impact their dream experiences.
Specific antidepressants, beta-blockers for high blood pressure, statins for cholesterol issues, psychostimulants for ADHD, dopamine agonists for Parkinson’s disease, and acetylcholinesterase inhibitors for neurodegenerative conditions such as Alzheimer’s and Parkinson’s are all medications identified as potentially causing or worsening disturbing dreams.
Exceptionally vivid dreams and nightmares are also recognized as adverse effects of various other prescription drugs, and even certain over-the-counter remedies like sedating antihistamines.
“Many medications have the potential to induce nightmares or unpleasant dreams,” states Dr. Clete Kushida, division chief and medical director of Stanford Sleep Medicine. “Even sleep aids and short-term insomnia treatments like Ambien, Sonata, and Lunesta can be linked to an increase in bad dreams, though the underlying mechanisms remain unclear.” Kushida also notes that newer weight-loss medications (such as Ozempic and Mounjaro) used for Type 2 diabetes or to aid weight loss have been associated with unsettling dream experiences.
Why do some medications affect dreams?
The exact reason why some medications lead to an uptick in disturbing dreams or nightmares isn’t always evident. For certain drugs, such as selective serotonin reuptake inhibitor (SSRI) antidepressants, the medications might alter brain neurotransmitter levels, like serotonin, thereby influencing dreams and nightmares. “SSRIs prevent the reabsorption of serotonin, a neurotransmitter crucial for sleep regulation, resulting in higher levels circulating in the brain,” explains Kushida.
Research indicates that while older tricyclic antidepressants tend to “elicit more positive dream emotions,” the use of SSRIs and serotonin-norepinephrine reuptake inhibitors (SNRIs) is linked to more vivid dreaming and potentially more frequent nightmares. Discontinuing tricyclic antidepressants can also trigger nightmares, whereas withdrawing from SSRIs and SNRIs appears to heighten dream intensity.
In contrast, “dopamine agonists are believed to influence nightmares directly via their action on dopamine receptors,” clarifies Dr. Swetha Gogineni, a sleep specialist and pulmonary physician at UCLA Health.
Some other medications might more directly affect sleep architecture, which refers to the organization of various sleep stages throughout the night. For instance, drugs prescribed for Alzheimer’s (like Aricept) can induce REM sleep behavior disorder, potentially resulting in intense, often distressing dreams, and might even cause individuals to physically act out their dreams, according to Kushida.
Conversely, beta-blocker medications generally decrease REM sleep, the stage where most dreaming takes place, yet studies have revealed an association between their use and an increase in nightmares. The use of certain antibiotics, like ciprofloxacin and levofloxacin, has also been connected to an elevated risk of nightmares.
Occasionally, the precise trigger for troubling dreams remains ambiguous. For instance, an unaddressed sleep disorder, such as sleep apnea, might be influencing an individual’s dreams while they are on a dream-impacting medication like an antidepressant. “Many individuals with depression experience disturbing dreams,” notes Dr. Barry Krakow, a sleep medicine specialist in Savannah, Georgia, who operates a sleep-health coaching service. “Many people suffering from depression require a sleep study due to the presence of a sleep disorder like sleep apnea.” Obstructive sleep apnea itself is associated with an increase in nightmares; treating it with continuous positive airway pressure (CPAP) has demonstrated a reduction in these unpleasant dreams.
How to handle nightmarish side effects
When individuals encounter dream-related adverse effects from medications, their reactions can differ considerably. Some merely observe heightened dream intensity and dismiss it. “Others describe fragmented sleep, heart palpitations, and a sense of panic upon waking,” Gogineni states. “Certain individuals might develop sleep anxiety stemming from fears about sleeping and nightmares. For some, these nightmares can progress to interfere with their professional or social functioning.”
So, what steps should you take if you suspect a medication is disrupting your dreams? The initial action involves discussing your symptoms and worries with your primary care physician. “Nightmares can considerably affect an individual’s sleep and general quality of life,” Gogineni emphasizes. “It is crucial that your doctor is aware if this is occurring.”
It is essential not to discontinue medication without prior consultation with your doctor, as doing so could negatively impact the underlying health condition. Additionally, “suddenly stopping these medications can occasionally result in an intensification of nightmares,” Gogineni cautions.
Various solutions may be effective, depending on both the medical condition and the specific medication involved. “Your physician might recommend adjusting the dosage or the timing of when the medication is taken,” Kushida suggests.
In certain cases, your doctor might propose trying a different medication from the same class, or an entirely different type of drug to manage your health condition, Gogineni notes.
This is a crucial discussion to initiate with your primary doctor—and if further assistance is needed, with a sleep specialist. The standard of your rest, including your dreams, impacts your overall well-being around the clock, making it worthwhile to pursue measures for peaceful sleep.