If you have heart or circulatory conditions like arrhythmia, angina (chest pain), coronary artery disease, heart failure, or high blood pressure, you could be on beta blockers, a class of medications that works by blocking the release of stress hormones adrenaline and noradrenaline. They cause your heart to reduce its activity speed and strength which helps lower blood pressure. They also improve blood flow by helping to widen your arteries.
Cold hands and feet, dizziness, weight gain, and fatigue are common side effects of beta blockers, also known as beta-adrenergic blocking agents, but did you know that they could be one of the things you didn’t realize were ruining your sleep? Turns out, beta blockers were found to be related to unusual dreams, insomnia, and sleep disorders in a 2024 study published in the journal Hypertension. The study was actually researching the common idea that this type of heart medication could cause mental health concerns like depression in those who take them.
“We found no indication of an association between beta-blocker use and depression … However, sleep-related symptoms such as unusual dreams or insomnia did emerge during beta-blocker therapy for some patients,” explained Dr. Reinhold Kreutz, a professor at the Berlin Institute of Health, Institute of Clinical Pharmacology and Toxicology and the study’s supervising and corresponding author (via American Heart Association).
How do beta blockers cause disruptions in sleep?
According to experts, there are a few things that happen with beta blockers that cause sleep disruptions. Firstly, this widely used class of medications lowers your melatonin levels. Melatonin is called a sleep hormone for a reason. Produced by your brain’s pineal gland in response to darkness, melatonin helps synchronize circadian rhythms in your body — like your sleep-wake cycle. Higher levels of this hormone are associated with better sleep.
“Sleep is regulated by two fundamental mechanisms — the circadian clock, which impacts the timing and organization of sleep, and by what we call the sleep homeostat, which is related to the amount of time you have been awake, meaning your brain needs to be awake for a certain period of time before it can get sleepy,” explained the assistant director of the Wisconsin Institute for Sleep and Consciousness at the University of Wisconsin School of Medicine and Public Health in Madison, Stephanie Jones (via Everyday Health). Beta blockers affect both of these mechanisms, according to the expert. In fact, a 2024 study published in the journal Sleep found that three weeks of nightly melatonin supplementation improved sleep quality in patients with hypertension.
It is unclear how exactly beta blockers trigger nightmares in people, but a 2024 study published in the journal Medicina seemed to link changes in REM sleep time with this particular nighttime side effect of the medication. Nightmares typically occur during REM sleep, when more time is spent in this stage of sleep. Sleep disruptions or insomnia caused by low melatonin levels could lead to nightmares too.
How to handle sleep disturbances caused by beta blockers
It goes without saying that you shouldn’t stop taking your tablets without consulting your doctor, even if sleep disruption becomes a part of your life. Your heart health is just as important as anything else. Plus, your body gets used to functioning with the medication, so abruptly stopping beta blockers can lead to palpitations, return of chest pain, or an increase in blood pressure.
However, it is definitely important to discuss your sleep concerns with your healthcare provider. Sometimes, it might be a simple case of putting you on a different drug to fix the problem, explained associate professor of neurology at Duke University School of Medicine in Durham, North Carolina, Dr. Andrew Spector, to Everyday Health. “Beta-blockers can disrupt sleep, but only certain beta-blockers tend to do it and it has to do with how well that particular beta-blocker crosses the blood-brain barrier. Metoprolol, propranolol, and atenolol tend to be more problematic than, say, labetalol.”
Simply put, do your own research and be your own advocate, but also listen to the advice of your healthcare provider before choosing a different route that will prioritize your sleep as well. What you practice as sleep hygiene matters too. A lot happens to your body when you switch off from technology, draw a warm bath before bed, or simply engage in journaling or meditation to shed anxious thoughts. Taking a holistic approach to your sleep troubles can be effective.
