Medications that can make snoring and sleep apnea worse

Some medications can make snoring and sleep apnea worse, mostly ones that make you drowsy or relax your muscles. Sleeping pills, opioid pain medicines, sedating antihistamines and muscle relaxants are the main groups to know about, and alcohol on top of any of them adds to the effect.

That doesn't mean you should stop taking anything. Many of these medicines are important, some are risky to stop suddenly, and there are usually safer ways to adjust them. The goal of this article is to help you have a better conversation with your prescriber.

Which medications can make snoring worse?

The medications most likely to make snoring worse are those that sedate you or relax the muscles of your throat. Cleveland Clinic explains that alcohol, sedatives and even lack of sleep can relax the muscles of the upper airway once you fall asleep, which limits airflow and leads to snoring.

The NHS says the same in plain terms. Its advice for snorers includes not drinking too much alcohol and not taking sleeping pills, because these can sometimes cause snoring. AASM Sleep Education adds a second concern for people with sleep apnea: medication or alcohol can interfere with your ability to wake up from sleep and can lengthen periods of apnea.

That second point matters. Your brain normally rouses you just enough to reopen the airway after a pause in breathing. Anything that dulls that wake-up response can make each pause last longer.

The main groups are:

• sleeping pills, including benzodiazepines and the newer "Z-drug" sleep medicines
• opioid pain medicines
• sedating antihistamines, such as diphenhydramine
• muscle relaxants, such as cyclobenzaprine
• alcohol, which isn't a medicine but adds to the effect of all of the above

Do sleeping pills make sleep apnea worse?

Sleeping pills can make sleep apnea worse in some people, which is why the NHS advises people with sleep apnoea not to take them unless a doctor recommends them. But the research is more mixed than many people expect, and some newer sleep medicines look safer than older ones.

A 2015 Cochrane review looked at 14 randomized trials with 293 people who had confirmed obstructive sleep apnea. The trials tested sleeping pills and sedatives including zolpidem, eszopiclone, temazepam, triazolam, flurazepam and others. None of the drugs significantly increased AHI or the oxygen desaturation index. Some did lower the lowest oxygen level reached overnight, including zolpidem at 20 mg, flurazepam at 30 mg and triazolam at 0.25 mg.

The reviewers were cautious about what this means. Most trials lasted only one to three nights, most participants had mild to moderate sleep apnea, and only two trials included people with severe sleep apnea. They concluded that caution is still needed when prescribing these drugs to people with sleep apnea, especially at higher doses or in more severe disease.

So the honest summary is this. In short trials, the sleeping pills studied didn't clearly increase the number of breathing pauses, but some lowered oxygen levels. Nobody knows much about long-term nightly use in people with severe sleep apnea. If you have insomnia and sleep apnea together, our guide to sleep apnea and insomnia covers options that don't rely on pills.

How do opioids affect breathing during sleep?

Opioids affect breathing during sleep in more than one way, and the American Academy of Sleep Medicine takes this seriously. Its 2019 position statement says opioids are associated with several types of sleep-disordered breathing, including sleep-related hypoventilation (breathing too shallowly), central sleep apnea and obstructive sleep apnea.

The NHLBI says that long-term use of prescribed opioid pain medicines, or opioid use disorder, can cause problems with how the brain controls breathing during sleep. That's a different problem from a floppy airway. In central sleep apnea, the brain briefly stops sending the signal to breathe. Our guide to central sleep apnea explains how it differs from the obstructive kind.

The AASM statement also says chronic opioid therapy can change sleep structure and quality and contribute to daytime sleepiness. The encouraging part is that it says testing is available for opioid-related breathing problems, and that screening, testing and treatment can improve health and quality of life. It encourages pain doctors and sleep doctors to work together.

The NHLBI says that when someone is being evaluated for sleep apnea, a provider will ask whether they use medicines such as opioids. Mention them even if you've taken them for years and feel used to them.

Can antihistamines or muscle relaxants make you snore?

Sedating antihistamines and muscle relaxants can make you drowsy, but there's very little direct research on whether they make snoring worse. We couldn't find a study that tested either group's effect on snoring, so it's fair to call this a reasonable concern rather than a proven effect.

What we do know comes from the drug information. MedlinePlus says diphenhydramine, an older antihistamine sold for allergies and as a sleep aid, may make you drowsy, and that alcohol adds to that drowsiness. It also says diphenhydramine generally shouldn't be used in older adults, except for serious allergic reactions, because it isn't as safe or effective as other options.

MedlinePlus says cyclobenzaprine, a common skeletal muscle relaxant, works by acting on the brain and nervous system to let muscles relax. It may make you drowsy, and it can make the effects of alcohol worse. Like diphenhydramine, it's usually not recommended for older adults.

There's a flip side with antihistamines. If your snoring comes from a blocked nose, Cleveland Clinic says cold and allergy medicines can relieve nasal congestion and help you breathe more freely. Non-drowsy options may suit night-time allergy symptoms better than sedating ones, and a pharmacist can help you choose. Our guide to anti-snoring sprays and pills covers what's sold specifically for snoring.

How do the main medication groups compare?

The main medication groups differ in how strong the evidence is and in what they seem to do to breathing at night. This table sums up what the sources in this article say.

Why shouldn't you stop a medication on your own?

You shouldn't stop a medication on your own because some can cause serious problems if they're stopped suddenly, and the condition they treat can come back. The FDA warns that people taking benzodiazepines should not suddenly stop them without first agreeing a plan with their health care professional to lower the dose slowly.

The FDA explains why. Physical dependence can develop when benzodiazepines are taken steadily for several days to weeks, even as prescribed. Stopping abruptly or cutting the dose too quickly can cause withdrawal reactions, including seizures, which can be life-threatening. Even a gradual taper can bring symptoms like anxiety, insomnia, muscle pain and tremors, so it's something to do with support.

Opioids also need a careful plan, and the AASM encourages pain and sleep doctors to work together rather than make sudden changes. The same principle applies to everything in this article. Your prescriber knows why you take the medicine and what the alternatives are. Snoring is a good reason to ask questions, not to quit on your own.

What should you ask your prescriber or pharmacist?

The most useful thing to ask your prescriber or pharmacist is whether any of your medicines could be affecting your breathing at night, and what your options are. Bring a full list, including over-the-counter sleep aids, allergy tablets and supplements, because sedating antihistamines are easy to forget.

Other questions worth asking:

• Could this medicine be making my snoring or sleepiness worse?
• Is there a lower dose, a different time of day or a less sedating alternative?
• Is it safe to drink alcohol while I take this?
• Should I have a sleep study before or while I take it?
• If we change anything, how should I taper, and what should I watch for?

If you've been diagnosed with sleep apnea, tell every doctor who prescribes for you, including surgeons and dentists. Our list of questions to ask your doctor about snoring has more ideas for the appointment.

What if you use CPAP?

If you use CPAP, keep using it every night, and especially on any night you've taken a sedating medicine. The Cochrane review included some trials in people already using CPAP or a mouthpiece, but the evidence is too thin to say any particular medicine is safe for everyone with sleep apnea.

If you notice your machine reporting more events, feel sleepier than usual, or a bed partner hears more pauses after starting a new medicine, tell your sleep doctor. Our guides to snoring with CPAP and getting used to CPAP cover the other common reasons a good setup stops working.

When should you see a doctor about snoring?

You should see a doctor if your snoring comes with pauses in breathing, choking or gasping, or heavy daytime sleepiness, whether or not you take any of these medicines. Those are sleep apnea warning signs, and the NHS says many people with sleep apnoea need a CPAP machine.

It's also worth booking a review if your snoring started or got louder around the time you began a new medication. Our article on why you might start snoring suddenly covers other common causes.

This article is general information, not medical advice. Don't start, stop or change a prescribed medicine without talking to your prescriber.

Read next

• Why alcohol makes snoring worse
• Snoring vs sleep apnea
• Central sleep apnea

* This content is for informational and educational purposes only and is not medical advice. It is not intended to diagnose, treat, cure or prevent any disease or health condition. Talk to a qualified healthcare provider about your health.