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Often, medication rather than illness is the culprit behind sleep problems. A number of drugs are common sleep robbers, while others may cause unwanted drowsiness. Sometimes your doctor may be able to suggest alternatives that do not disrupt sleep.

Antidepressants
Selective Seortonin Reuptake Inhibitors (SSRIs) — such as fluoxetine (Prozac), sertraline (Zoloft), and paroxetine (Paxil) — disrupt sleep or produce daytime fatigue in about 15% of those who take them. These medications are increasingly used to treat some of the symptoms of narcolepsy, a condition marked by powerful daytime drowsiness and sleep attacks, and a variety of sleep problems, whether or not the person is depressed.

Antiarrhythmics
These drugs, used to treat heart rhythm problems, may cause daytime fatigue and sleep difficulties at night. Such medications include procainamide, quinidine, and disopyramide.

Sedating antihistamines
These medications, commonly taken to relieve cold or allergy symptoms, also cause drowsiness in most people. They are also the active ingredients in most over-the-counter sleep aids and motion-sickness pills. To find out if a medication might cause unwelcome drowsiness, check with a pharmacist. If you are taking a sedating antihistamine and are bothered by drowsiness, your physician may recommend a non-sedating alternative that does not readily enter the brain and affect wakefulness and sleep.

Beta blockers
Beta blockers are used to treat high blood pressure, arrhythmias, and angina. These drugs can promote insomnia, awakenings in the night, and nightmares.

Medications containing caffeine
Caffeine, which is in some over-the-counter painkillers and appetite suppressants, is a nervous system stimulant that can induce insomnia. Caffeine makes people feel alert by blocking the action of adenosine, a substance that promotes drowsiness. Caffeine’s effects gradually diminish but nonetheless may linger for six or seven hours.

Medications containing alcohol
Cough medicines often contain alcohol, which can suppress REM sleep.

Clonidine
This medication, which acts on nerve cells that respond to the neurotransmitter norepinephrine, is used to treat hypertension and occasionally to curb nicotine craving in people who are quitting smoking. The drug can cause daytime drowsiness and fatigue; it also may interfere with REM sleep. Some people report no problems with clonidine; others note restlessness, early morning awakening, and nightmares.

Corticosteroids
Corticosteroids such as prednisone, which are used to suppress inflammation and asthma, often cause daytime jitters and nighttime insomnia.

Diuretics
Diuretics, which are taken to rid the body of excess sodium and water, can interfere with sleep by inducing urination throughout the night. Potassium deficiency, a common side effect of some diuretics, can cause painful nocturnal cramping of calf muscles during sleep.

Nicotine patches
Patches used to curb smoking deliver small doses of nicotine into the bloodstream around the clock. People who use them often suffer insomnia or experience disturbing dreams.

Sympathomimetic stimulants
Sympathomimetic stimulants — such as dextroamphetamine (Dexedrine), methamphetamine (Desoxyn), methylphenidate (Ritalin), and pemoline (Cylert) — are powerful central nervous system stimulants that enhance the effect of brain chemicals involved in wakefulness. People taking these agents have difficulty falling asleep; once asleep, they spend less time in REM sleep and non-REM deep sleep. When the drug is discontinued, extreme sleepiness and a craving for REM sleep may follow.

Theophylline
This respiratory stimulant used to treat asthma is chemically related to caffeine. Many people who use it require doses that are high enough to disrupt sleep.

Thyroid hormones
Thyroid hormones taken to counteract the effects of an underactive gland may cause sleeping difficulties at higher doses.