How Different Blood Pressure Medications Affect Sleep Quality

August 27, 2025/Andrew Le

Having trouble sleeping at night? Your blood pressure medication could be the reason. You may not be aware of it, but your medications can be the culprit behind your sleepless nights.

Blood pressure medication and sleep quality may be associated with each other. While not all may have the same impact, understanding the differences between these medications can help you decide on which one to get. 

Want to know which medications affect sleep quality the most? Keep reading to learn more. 

🔑 Key takeaways

➤ Blood pressure medication and sleep problems usually go hand in hand, but the effects vary depending on the type of medication. 

➤ Diuretics may indirectly affect sleep by causing nocturia, or frequent urination during nighttime.

➤ Beta blockers, particularly the lipophilic types, can contribute to sleep disturbances and frequent nighttime awakenings. 

➤ ACE inhibitors may impair sleep quality by worsening obstructive sleep apnea (OSA).

➤ ARBs can worsen sleep quality as they cause insomnia and alter potassium levels, which may result in leg cramps, aching joints, and muscles. 

➤ CCBs can reduce overall sleep duration but may improve insomnia symptoms when replacing certain diuretics.

➤ Central-acting agents and vasodilators have limited direct evidence on their impact on sleep quality, but adverse effects, such as sedation or tachycardia, may indirectly disrupt sleep. 

The relationship between sleep and blood pressure

Poor sleep habits are strongly associated with an increased risk of hypertension, as shown in a study involving 12,166 adults. 

Experts say that sleep helps regulate hormones in the body that control stress and metabolism. Sleep deprivation may result in hormonal fluctuations, which may cause hypertension and other risk factors for heart disease. 

This finding is supported by another study confirming that having a short sleep duration is a risk factor for developing hypertension. In fact, increasing sleep time for just 1 hour reduces the risk of hypertension by 0.3207%. This shows the importance of sleep in maintaining cardiovascular health. 

However, even having a long sleep duration of more than 9 hours has also been linked to hypertension, particularly in young and middle-aged individuals.

In relation to these findings, the Academy of Sleep Medicine and the Society for Sleep Research advise that individuals should get 7 to 9 hours of sleep per day, as poor sleep habits can increase the risk of hypertension by disrupting blood pressure regulation.  

Blood pressure medications and sleep quality effects

This section discusses the study findings on the association between blood pressure medication and sleep. 

Such blood pressure medications are diuretics, beta blockers, angiotensin-converting enzyme (ACE) inhibitors, calcium channel blockers (CCBs), angiotensin II receptor blockers (ARBs), alpha blockers, central-acting agents, and vasodilators.

Diuretics

According to an article in Harvard Health Publishing, while diuretics don’t directly affect sleep, they can cause nocturia, disrupting sleep as you may need to wake up at night to pee. 

In a study of 203 patients with hypertension, those who took diuretics at bedtime reported nocturia as a significant burden more often (15.6%) compared to when they took their medications in the morning (1.5%). Because of this, non-adherence among diuretic users reached 22.7%, mostly because of reports of nocturia.

In contrast, patients taking other types of blood pressure medications did not experience an increase in nocturia when they switched from morning to bedtime dosing. 

A systematic review also reported that the use of diuretics was strongly associated with frequent nighttime urination of at least three times a night, with women experiencing it more often than men. Among the different diuretic types, loop diuretics are the ones that worsen nocturia symptoms.  

Beta blockers

Some beta blockers may affect sleep quality. 

A study on lipophilic and hydrophilic beta blockers found that lipophilic beta blockers such as propranolol, pindolol, and metoprolol were associated with more sleep disturbances and increased nighttime awakenings. 

Atenolol, the only hydrophilic beta blocker in the study, had less impact on sleep quality. Despite these differences, all four beta blockers were found to reduce rapid eye movement (REM) sleep. 

Another study compared the effect of two lipophilic beta blockers, nebivolol and metoprolol succinate (extended release), on the sleep quality of 39 patients with stage 1 hypertension. 

After 6 weeks of treatment, it was found that the Pittsburgh Sleep Quality Index (PSQI) score of patients who took nebivolol improved significantly. Meanwhile, the PSQI score of those who took metoprolol worsened, showing that the drug negatively affects sleep quality. 

In addition to affecting REM sleep, beta blockers are linked to other sleep-related side effects, such as nightmares and insomnia. This results from their ability to lower melatonin levels in the body, which plays a role in sleep regulation. In fact, a systematic review found that one-third of participants reporting nightmares were taking beta-blockers. 

💡 Did you know?

REM sleep plays an essential role in cognitive function and emotional regulation. 
According to The Sleep Foundation, a lack of REM sleep may contribute to troubles in focusing, excessive daytime drowsiness, forgetfulness, irritability, and increased risk of accidents. 

ACE inhibitors 

ACE inhibitors may impair sleep quality by worsening OSA and developing the bradykinin-induced cough. 

In one study, a patient treated with enalapril developed:

  • Increased daytime sleepiness
  • More frequent obstructive apnea-hypopnea episodes
  • Increased apnea-hypopnea index (AHI)
  • Upper airway symptoms and cough

However, the patient’s symptoms improved a month after discontinuing the medication. 

Further evidence from a polysomnography-based analysis found that ACE inhibitor use was associated with increased sleep latency, increased AHI, and decreased sleep efficiency.  

Taking ACE inhibitors also results in increased levels of bradykinin, which can cause a dry cough and a scratchy feeling in the throat. Bradykinin-induced cough is associated with up to 35% of individuals taking ACE inhibitors, and can be chronic enough to keep anyone awake. 

CCBs

In a study involving hypertensive patients with OSA, it was found that CCBs were associated with a reduction in total sleep duration and lower sleep efficiency. Compared to other blood pressure medications, only CCBs were found to be associated with sleep impairments in the study. 

However, when compared to diuretics, CCBs appear to be more effective in reducing insomnia. 

Another study comparing indapamide (a thiazide diuretic) and amlodipine (CCB) found that replacing indapamide with amlodipine resulted in improved sleep quality and fewer manifestations of insomnia in patients with hypertension and type 2 diabetes. 

ARBs

In a study comparing ARBs, ACE inhibitors, and CCBs, it was found that patients taking losartan, an ARB, experienced more adverse effects, including insomnia, than those taking the other medications. 

This finding is supported by a cross-sectional analysis, which found that hypertensive patients taking ARBs were associated with a higher likelihood of developing insomnia. 

Furthermore, taking ARBs may alter potassium levels in the body, which could worsen sleep quality by causing diarrhea, aching joints and muscles, as well as leg cramps. 

Alpha-blockers

Alpha-blockers can affect sleep quality by causing sleep deprivation and worsening sleep apnea episodes. 

A study observing sleep patterns in rats found that giving phenoxybenzamine, an alpha-blocker, resulted in an increase in the number of desynchronized sleep periods and sleep time.  

Meanwhile, a retrospective cohort study between the years 2000 and 2012 found that patients with hypertension who take the alpha-blockers have a higher risk of developing sleep apnea. The same study found that the incidence of sleep apnea in males with hypertension was twice as high as that of females, and may be associated with a relatively weak genioglossus response in males. 

A more recent case study showed how tamsulosin, an alpha-blocker, worsened sleep apnea episodes. A 67-year-old patient with OSA experienced poorer sleep quality after starting tamsulosin and had more episodes of apnea. Once tamsulosin was discontinued, the patient’s sleep quality returned to its baseline value within 10 days. 

💡 Did you know?

The genioglossus muscle, a fan-shaped muscle that forms the majority of the tongue’s mass, is abnormal in patients with OSA. 

A study conducted on 27 subjects found that individuals with OSA exhibited greater fatigability of the genioglossus muscle compared to control subjects. However, this abnormality is corrected by treatment with continuous positive airway pressure (CPAP). 

Central-acting agents 

There is limited research on the impact of central-acting agents on sleep quality. 

However, both methyldopa and clonidine are known to cause sedation, affecting more than one-third of patients in a study. 

On the other hand, guanfacine has been identified as a potential alternative for patients intolerant to other central-acting agents due to excessive sedation. 

Vasodilators

While there are limited studies on the direct effect of vasodilators on sleep quality, their side effects may influence it. 

Minoxidil, for example, may cause fluid retention and tachycardia as adverse effects, which can indirectly disrupt sleep. Conversely, the most frequent side effects of hydralazine include tachycardia, palpitations, and sleep disturbances. 

Wrap up

Blood pressure medication and sleep quality may be closely linked, but this depends on the specific medication being taken. While some may affect sleep quality, others help improve sleep outcomes. 

If you notice changes in your sleep after starting or changing your medication, it’s advisable to discuss this with your healthcare provider. Keeping track of your sleep patterns can also be helpful in deciding whether you need an adjustment in your medications. 

Frequently asked questions on blood pressure medication and sleep

Can taking blood pressure medication at night improve sleep quality?

Yes. Taking your blood pressure medications before going to bed helps avoid high blood pressure during sleep, which is a risk factor for cardiovascular disease.

Are there natural ways to have better sleep quality alongside blood pressure medications? 

Absolutely. Sticking to a sleep schedule, being conscious of your food and drink intake, creating a restful environment, exercising, incorporating stress management techniques, and limiting daytime naps can all improve sleep quality. 

Does melatonin interact with blood pressure medications?

Melatonin might worsen your condition or interact with your treatment. Before incorporating melatonin into your daily regimen, consult with your doctor. 

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