From the Guidelines
Propranolol can affect sleep in some individuals, and this potential side effect should be considered when prescribing the medication, as stated in the clinical practice guideline for the management of infantile hemangiomas 1.
Potential Sleep Effects
The medication works by blocking beta-adrenergic receptors, which can interfere with the body's natural melatonin production and potentially disrupt normal sleep architecture. Some patients report insomnia, vivid dreams, or nightmares as side effects, particularly at higher doses or when taken close to bedtime.
Key Considerations
- The typical dosage ranges from 2 to 3 mg/kg per day, unless there are comorbidities or adverse effects, such as sleep disturbance, that necessitate a lower dose 1.
- Clinicians should evaluate patients for and educate caregivers about potential adverse effects of propranolol, including sleep disturbances, as recommended in the guideline 1.
- If you're taking propranolol and experiencing sleep problems, consider taking it earlier in the day rather than before bedtime, and always consult with your healthcare provider before making any changes to your medication regimen.
Mechanism and Side Effects
The mechanism of propranolol's effect on infantile hemangiomas likely involves several processes, including vasoconstriction, inhibition of angiogenesis, and stimulation of apoptosis, as noted in a study on the diagnosis and management of infantile hemangioma 2. Common side effects of propranolol include sleep disturbance, as well as discoloration with cooling of the hands and feet 2.
From the Research
Effects of Propranolol on Sleep
- Propranolol, a lipophilic beta-blocker, has been shown to increase waking and reduce REM sleep 3, 4.
- The use of propranolol may lead to increased recollection of dreaming and awakening in the night, despite actually reducing REM sleep 3.
- A study comparing the effects of different beta-blockers on sleep found that propranolol was associated with a higher risk of insomnia compared to other beta-blockers such as bisoprolol and atenolol 5.
- The lipophilicity of propranolol may contribute to its effects on sleep, as beta-blockers with low lipophilicity were found to have a lower risk of insomnia 5.
Comparison with Other Beta-Blockers
- Atenolol, a hydrophilic beta-blocker, was found to have no effect on subjective measures of sleep, but still reduced REM frequency 3.
- Bisoprolol and atenolol were associated with a lower risk of insomnia compared to propranolol 5.
- Beta-blockers with high selectivity in β(1)-receptors and/or low lipophilicity were found to have a lower risk of insomnia 5.
Clinical Implications
- The use of propranolol may be associated with sleep disturbances, particularly in elderly patients 5.
- Patients taking propranolol for hypertension or other conditions may experience insomnia or other sleep-related side effects 4, 5.
- Alternative treatments, such as melatonin, may be effective in improving sleep quality in patients with hypertension 6.