This article was written by Dr. Babar Naeem (MBBS, MRCPCH) – a licensed and practicing medical doctor – to ensure maximum factual accuracy and unique content.
Sudafed is the brand name for a nasal decongestant that contains pseudoephedrine.
Nasal congestion is caused by swollen blood vessels that can happen during flu, allergies, a cold, or a sinus infection.
Sudafed works by causing shrinkage of the vessels in the respiratory mucosa, which decreases the edema and improves airway patency – helping you to breathe more easily .
But can Sudafed keep you awake?
Sudafed can keep you awake and cause insomnia because it contains pseudoephedrine that has a stimulatory effect on the body – increasing norepinephrine levels, stimulating the nervous system, and increasing blood pressure.
So how can you sleep better on Sudafed?
The best way to sleep better when taking Sudafed is to take it in the morning so the stimulatory effects will have worn off by nighttime. Using a warm compress, nasal irrigation, or antihistamine instead of Sudafed can also prevent insomnia.
The rest of this article explains in more detail how Sudafed can keep you awake and 9 ways that you can sleep better when taking Sudafed.
This article has been written by a medical doctor but it is no substitute for the advice of your own doctor.
How Does Sudafed Keep You Awake?
According to the NHS, the side effects associated with Sudafed use are headaches, dry mouth, increased blood pressure, irregular heartbeat, and sleep disturbance – due to the pseudoephedrine content.
B. Bertrand et al conducted a study in Belgium and revealed that almost 13% of the participants complained of sleep disturbance when taking pseudoephedrine .
In another study conducted in the United States in 2019, it was revealed that 98 people complained of insomnia, out of 282 .
Pseudoephedrine acts through multiple mechanisms that can keep you awake – as described below :
1: Increased Norepinephrine Levels
Pseudoephedrine displaces norepinephrine from its storage site, resulting in increased levels of norepinephrine in the body that cause sleep disturbance.
Norepinephrine is one of the main chemicals that is released in the brain to keep the body in an aroused state.
Norepinephrine also acts as a stress hormone that prepares the person for a fight and flight response.
This fight and flight response keeps the person alert and exacerbates insomnia .
2: Stimulation of Sympathetic System
The sympathetic system has a significant influence on the regulation of the sleep/wake pattern.
Pseudoephedrine activates the sympathetic system and gives the body a sense of energy.
This system, when activated, prepares the person for stressful situations and flushes the body with hormones.
It causes increased heart rate, blood pressure, alertness, and insomnia.
3: Beta Receptor Stimulation
Pseudoephedrine stimulates the beta receptors, resulting in tachycardia and increased blood pressure.
The overall effect of the beta receptor stimulation is hyperactivity and sleep disturbance.
9 Ways to Sleep Better When Taking Sudafed
Below are 9 ways to sleep better when taking Sudafed:
1: Take Sudafed in the Morning
Sudafed has a stimulatory effect on the body and can cause insomnia and sleep disturbance when taken at bedtime.
Studies have shown that Sudafed starts producing its effects within 30 minutes of its administration, stays in the body for about 6 to 8 hours, and is then excreted through urine .
So the best time to take Sudafed is in the morning so that the stimulatory effects wear off before bedtime and help prevent insomnia.
If it’s not possible to take Sudafed in the morning, then the next best time to take it is 6 to 8 hours before bedtime.
However, the sensitivity and metabolic activity of each individual are different, and the half-life of the Sudafed can vary widely.
There are different types of Sudafed formulations available on the market, and some knowledge of these is also important:
- Immediate release – starts acting shortly after administration, and stays in the body for about 6 hours.
- Extended release – is available in 12 and 24 hour formulations. As the names suggest, the 12 hour formulation stays in the body for 12 hours, and the 24 hour formulation for a whole day. As these formulations are long-acting, they should be taken in the morning.
- Sudafed PE – is a drug that contains a combination of pseudoephedrine and phenylephrine. The main advantage of this combination is that it has less stimulatory effects as compared to the other formulations.
2: Avoid Smoking
Smoking cessation is the best thing that you can do for your health.
The nicotine present in tobacco has a similar stimulatory effect on the body to Sudafed.
So if a person smokes and is using Sudafed, the chances of getting a night of good quality sleep will be decreased markedly.
A famous study done at the University of Wisconsin-Madison demonstrated that smoking is associated with difficulty initiating sleep, nightmares, and disturbing dreams .
The combination of nicotine and pseudoephedrine can have disastrous effects on your sleep.
It causes fragmentation, insomnia, snoring, and sleep apnea.
Quitting smoking can also have short-term unpleasant side effects, including irritability, sleepless nights, and headaches.
3: Avoid Caffeine and Other Stimulants
Because Sudafed is a stimulant, its combined use with other stimulants should be avoided.
Caffeine is a very popular stimulant of the nervous system that increases sleep disturbances.
It is found in coffee, tea, cocoa, and caffeine tablets.
Caffeine provides an energy boost that can help in many situations but is associated with increased heart rate, jitteriness, headache, and insomnia.
When it is used for a prolonged period, its stimulatory effect is decreased.
- Ritalin (methylphenidate) is another drug that is used for a variety of purposes. Its use alone, or in combination with Sudafed, is associated with insomnia.
- Alcohol is another drug that disrupts the quality of sleep. It can induce sleep at the start, but can cause you to wake up during the night. The sleep inducing effect is also lost when its intake is continued.
- Steroids also have a strong potential to disrupt sleep.
4: Take Sudafed in Combination with Antihistamine
Combining an antihistamine with pseudoephedrine can help with insomnia and difficulty sleeping.
The addition of the antihistamine not only helps the patient better control the symptoms but also introduces additional sedating properties.
Sudafed is available on the market, in combination with Desloratadine, Cetirizine, and Fexofenadine.
A study done in the USA revealed that the addition of Desloratidine to the pseudoephedrine was associated with a lower incidence of insomnia when compared to those who received Sudafed alone .
5: Use Sudafed for a Short Period Only
Sudafed should be used for less than 10 days to avoid prolonged side effects.
The efficacy of Sudafed in treating nasal congestion is well established – it acts by constricting the blood vessels in the nasal mucosa.
However, when it is used for a longer period, beneficial effects are decreased, and the side effects are increased.
Rhinitis Medicamentosa is a disease in which a person experiences nasal congestion due to prolonged use of nasal decongestants .
This is due to the fact that the receptors on which Sudafed acts (alpha-receptors) are downregulated.
Moreover, when treatment is discontinued, there is a rebound increase in the dilation of the vessels and recurrence of congestion .
6: Discontinue Sudafed
The most obvious and effective way to solve the sleep disturbance caused by Sudafed is to discontinue the drug.
Pseudoephedrine is very effective in the treatment of nasal congestion, but if sleep disturbance or other side effects impair the quality of life, then the best decision is to withdraw the drug.
There are a lot of other medications available that can be used as an alternative.
One very important point that I always tell my patients to keep in mind is the major depression symptoms associated with the withdrawal of Sudafed.
Pseudoephedrine is a sympathomimetic drug, that keeps the body stimulated.
Once the drug is withdrawn suddenly, this stimulatory effect is lost, and the person experiences lethargy, depression, and somnolence.
So I always recommend discontinuing the drug gradually.
First, decrease the dose of the medicine over a few days, and then withdraw.
7: Use Alternate Treatment Options
There are a variety of other treatment options that can be used as an alternative to Sudafed.
These are simple to use, cost-effective, and avoid the side effects that are associated with other drugs.
Some of these are described below:
A warm compress can relieve nasal congestion, flu, and blocked sinus.
The warm temperature has been shown to decrease inflammation and pain associated with many conditions.
To apply a warm compress, soak a towel in warm water, squeeze the towel to remove the water, and place it over the forehead and nose.
This process can be repeated as required.
Nasal irrigation using bulb syringes, nasal spray bottles, and specialized devices can be done to open the clogged sinuses.
This method is also approved by the Food and Drug Administration (FDA).
Follow these steps to use this method effectively:
- Wash and air dry your hands.
- Put distilled or boiled and cooled tap water in the irrigation device.
- Lean over a sink with your head to the side.
- Breathe through the mouth.
- Pour the water into the upper nostril. Water will drain through the lower nostril, and it will be cleared.
- Repeat the procedure with the other nostril.
- Do not use untreated tap water, as it is not safe for your health.
Use a Humidifier
A humidifier is another simple and effective way to reduce nasal congestion.
Cold and dry air interfere with the normal sinus drainage and results in congestion.
Moist air provides a soothing effect to the engorged and irritated nasal mucosa.
A humidifier is a device that converts water into moisture, which it releases into the air, providing humidification.
When we breathe in this moist air, it improves the patency of our airways.
A humidifier can be run during the day in the office and at night.
When a humidifier is run at night, it opens up the congested airways and makes sleeping comfortable, so the quality of sleep can be improved without using drug therapy.
Another quick and simple way to increase the humidity in the air is the use of steam.
It thins out the mucus in the nose and sinuses and helps with the drainage.
Boost Your Immune System
You can decrease the chances of having sinus and other infections if you have a strong immune system.
The immune system is like your internal army that fights off germs.
The best thing that you can do to support your immune system is to take vitamins and herbs that boost your immunity.
- Vitamin E has been shown to be the most effective nutrient for modulating the immune system. Its deficiency is associated with increased susceptibility to infections, and supplementation enhances the normal functioning of the immune system .
- Vitamin C is another supplement that has been shown in studies to boost the immune system. It decreases the duration and severity of the common cold.
8: Drink Plenty of Water
Drinking a lot of water can help flush Sudafed out of the body faster.
Sudafed is removed from the body through various mechanisms.
A small portion is metabolized through the liver, and about 55-75% is excreted through urine.
Elimination of Sudafed is increased when urinary pH is alkaline and decreased when it’s acidic.
Water keeps the body hydrated, and that will thin out the mucus membrane in the nose.
Irritation and sleep disturbance will also improve.
Drinking a hot drink can also provide relief from the common cold and congestion .
9: Take Standard Precautions While Using Sudafed
There are certain standard precautions that should be kept in mind to minimize the side effects and maximize the benefits of Sudafed as follows:
- Use Sudafed exactly as per the directions of your doctor or pharmacist.
- Avoid Sudafed if you are taking anti-depressants, herbal products, or nutritional supplements.
- Sudafed should be avoided during pregnancy, and in patients suffering from hypertension, glaucoma, diabetes, thyroid, and heart disease.
- Sudafed should be stored at room temperature, and in a tightly sealed container.
- It should be taken after a meal.
- Take it with a full glass of water.
- It is usually taken as needed, but prolonged use should be avoided.
- Do not take a double dose if you missed one – it is no big deal to miss a single dose.
- Contact a poison control center if you suspect an overdose.
Conclusion: Take Sudafed in the Morning
Sudafed is a stimulant drug that is very effective at reducing nasal congestion and cold symptoms but can cause many unwanted effects, including insomnia.
To combat this problem, the best strategy is to take the drug in the morning.
If the side effects are too severe, the drug should be withdrawn.
Concomitant use of stimulants drugs should be avoided while on Sudafed.
Sources and References
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2. B Bertrand 1, J Jamart, J L Marchal CA. Cetirizine and pseudoephedrine retard alone and in combination in the treatment of perennial allergic rhinitis: a double-blind multicentre study. Available from: https://pubmed.ncbi.nlm.nih.gov/8876070/
3. Gelotte CK, Albrecht HH, Hynson J, Gallagher V. A Multicenter, Randomized, Placebo-Controlled Study of Pseudoephedrine for the Temporary Relief of Nasal Congestion in Children With the Common Cold. J Clin Pharmacol [Internet]. 2019/07/05. 2019 Dec;59(12):1573–83. Available from: https://pubmed.ncbi.nlm.nih.gov/31274197
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No part of this article or website offers medical advice – always consult with a qualified medical professional.
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