From the Guidelines
Propranolol can cause sleep disturbances in some individuals, and the dose should be adjusted to minimize this adverse effect, as recommended by the clinical practice guideline for the management of infantile hemangiomas 1.
Key Points to Consider
- The guideline suggests that clinicians should dose propranolol between 2 and 3 mg/kg per day, unless there are comorbidities or adverse effects, such as sleep disturbances, that necessitate a lower dose 1.
- Sleep disturbances, including sleep disorders, agitation during the night, and nightmares or night terrors, have been reported in 2% to 18.5% of patients treated with propranolol 1.
- The medication can potentially disrupt normal sleep architecture by reducing REM sleep and causing vivid dreams or nightmares in some users.
- If considering propranolol, it is essential to start with the lowest effective dose and monitor for side effects like fatigue, dizziness, or depression.
Recommendations for Clinical Practice
- Clinicians should evaluate patients for and educate caregivers about potential adverse effects of propranolol, including sleep disturbances 1.
- The benefits and risks of propranolol treatment must be carefully weighed, and the dose should be adjusted to minimize adverse effects.
- Patients who experience sleep disturbances or other adverse effects may require a lower dose of propranolol or alternative treatments.
Important Considerations
- Propranolol can worsen sleep apnea in susceptible individuals by relaxing airway muscles.
- Theoretical concerns about adverse effects of propranolol on brain development have been raised, but no appreciable neurodevelopmental differences were noted between propranolol-treated groups and the placebo group in a large prospective randomized trial 1.
- Always consult with a healthcare provider before using propranolol for sleep issues, as other medications might be more appropriate depending on the underlying cause of sleep difficulties.
From the Research
Propranolol and Sleep
- Propranolol is a beta-blocker that can affect sleep patterns, with studies suggesting that it can increase wakefulness and decrease REM sleep 2, 3.
- A controlled trial found that propranolol, along with other lipophilic beta-blockers, increased recollection of dreaming and awakening in the night, despite reducing REM sleep 2.
- The effects of propranolol on sleep are thought to be due to its ability to penetrate the brain and affect central adrenergic mechanisms, leading to increased wakefulness and decreased REM sleep 3.
- In contrast, other studies have focused on the treatment of insomnia using cognitive behavioral therapy (CBT-I), which has been shown to be an effective treatment for adults with chronic insomnia 4, 5.
- Melatonin supplementation has also been explored as a potential treatment for sleep disorders, with evidence suggesting that it can improve the onset, duration, and quality of sleep 6.