Does Tylenol Keep You Awake or Cause Sleepiness? (Doc’s Verdict)

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  • This article was written and researched by Dr. Albert Stezin (MBBS, Ph.D – clinician and neuroscientist) to ensure maximum factual accuracy and unique content.

If you are taking Tylenol (acetaminophen) and experiencing sleep disturbances, then you may be wondering if this medication is to blame.

So does Tylenol cause insomnia or drowsiness?

Tylenol can cause both insomnia and sleepiness depending on the individual. Insomnia is the most likely sleep disturbance potentially due to neurotransmitter changes, agitation, or anxiety. Drowsiness may occur if taken with other medications like Tylenol PM or Tylenol Nighttime.

So how can you sleep better if Tylenol is causing insomnia?

The most effective way to stop Tylenol from keeping you awake is to lower the dose as much as possible, stop taking the medication, or switch to Tylenol Nighttime. Taking Tylenol no sooner than 3-4 hours before bedtime may help to limit insomnia if discontinuation isn’t possible.

In the rest of this article, I have used my professional knowledge as a practicing medical doctor to explain in more detail how Tylenol affects sleep and how you can stop this medication from disrupting your sleep.

However, Tylenol can be harmful to your health – with higher doses being potentially fatal – so always consult with your doctor before altering your treatment plan.

Related: try these 9 ways to sleep better with a fever.

How Does Tylenol Affect Sleep?

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Here’s a detailed explanation of how Tylenol can disrupt your sleep:

Tylenol Can Cause Insomnia

Insomnia and frequent awakening are reported in 7% of people using Tylenol.

The exact mechanism of disruption is not known but it’s believed to be secondary to neurotransmitter changes in the brain.

Another hypothesis is that other brain-related side effects of Tylenol, such as agitation, anxiety, and headache may precipitate insomnia, especially in the elderly.

In my professional experience as a doctor, people who use Tylenol for chronic pain conditions tend to develop a medication overuse headache, and sleep disturbances.

This usually goes away after stopping Tylenol use.

Furthermore, Tylenol can sometimes cause gastritis and heartburn, which can keep you awake at night.

Click here for 11 ways to sleep better with acid reflux and heartburn.

Tylenol May Cause Insomnia When Combined With Other Medicines

When Tylenol is combined with other medicines, it may act synergistically or antagonistically with them, to precipitate sleep problems.

It is known that some people who use a combination of Tylenol and antihistamine medicines may develop restless leg syndrome – a condition characterized by a persistent need to move the limb continuously, especially at night time.

Similarly, Tylenol is often available in combination with caffeine, a potent sleep disruptor.

Click here for 15 ways to sleep better after consuming too much caffeine.

Tylenol Can Cause Sleepiness In Some Individuals

Tylenol may cause some individuals to feel sleepy.

In my geriatric clinical practice, I have often noticed that elderly patients use Tylenol for sleep problems, even when there are no underlying pain complaints – this anecdotal evidence may sound paradoxical given that insomnia is a known side effect of Tylenol.

However, in support of this observation, a recent survey reported that among people using non-prescription medicines for sleeping problems, 19% used Tylenol.

There are many hypotheses put forward to explain this sedative effect.

It is possible that the positive effect on sleep may be due to Tylenol’s beneficial effect on unrecognized pain, and other pain-associated complaints – another possible mechanism is that Tylenol may reinforce the activity of cannabinoid receptors and serotonergic systems in the brain.

These systems are known to produce a sedative effect in people.

If Tylenol is used in combination with medicines such as dimenhydrinate and chlorpheniramine (available as Tylenol PM or Tylenol Nighttime), sedation may result due to the synergistic sedative properties of both medicines.

It is also possible that, at least in some people, Tylenol may enhance sleep by acting as a placebo.

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7 Ways to Sleep Better When Taking Tylenol

If Tylenol is causing insomnia, here are 7 tips to follow to solve this:

1: Reduce the Dose or Stop Taking Tylenol

The most effective way to stop Tylenol from disrupting your sleep is to lower the dose as much as possible – or stop taking it completely – this will also protect your health because Tylenol can be harmful or even fatal at higher doses.

An overdose of Tylenol can kill you, due to severe hepatotoxicity – adults should not take more than 6 x 500mg tablets in a day.

If you are over 65 years old, are an alcoholic, or have liver or kidney disease, this threshold is much lower.

In most cases, you will be prescribed up to a maximum of 4 tablets per day, to be taken for a maximum of 7 to 10 days (except in chronic pain conditions).

A Tylenol overdose can cause abdominal pain, encephalopathy, sleep reversal, irritability, generalized weakness, loss of appetite, jaundice (yellow appearance of skin and eyes), diarrhea, nausea, vomiting, convulsions, and coma.

Recently, it was reported that pre-existing sleep disorders could predispose a patient to developing Tylenol toxicity.

I recommend that you stick to the dose and regimen prescribed to you – rather than self-medicating – in order to ensure that you do not experience major sleep disturbances or damage to your general health.

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2: Treat Severe Tylenol-Related Insomnia Using Sedatives

Insomnia due to Tylenol usually affects 6 to 7% of users.

It is usually mild to moderate and abates after halting Tylenol use.

However, when used for chronic pain conditions, Tylenol can take a toll on your sleep in a very significant way.

A vicious cycle is often seen to ensue: Tylenol disrupts sleep, and poor sleep further exacerbates pain, leading to insomnia. 

If the insomnia is severe and starts affecting the patient’s quality of life or functioning, treating the insomnia directly may become necessary.

Improving sleep quantity and quality in patients – naturally, or by use of medications – may help break this vicious cycle and improve or enhance the overall health and quality of life of the patient. 

Many doctors suggest stopping Tylenol use as the first line of management.

While this may work, it will worsen pain or fever, and disturb sleep.

Hence, the challenge is to choose the lesser evil and individualize treatment.

Reducing the dose may help many people.

In some users, avoiding taking Tylenol 3 to 4 hours before bedtime seems to work.

If insomnia still persists, you need to consult your doctor.

In most cases, they will prescribe you a short course of sleep medicine.

In my practice, I use a melatonin agonist, named Ramelteon, as the first-line treatment.

Ramelteon does not have any significant addiction potential, and also does not cause rebound insomnia as a side effect.

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3: Treat Tylenol Side Effects That Disrupt Your Sleep

Even at regular therapeutic doses, you may experience sleep problems due to side effects like gastritis, agitation, anxiety, headaches, and restless leg syndrome that can affect your sleep quality.

Treating these symptoms as follows may help you sleep better.  

Gastritis

This is the most common side effect of Tylenol.

To avoid gastritis (heartburn, nausea, vomiting), you should take Tylenol a half to one hour after food.

Consume only simple meals which are non-acidic and non-spicy, and strictly avoid alcohol and coffee. 

If the symptoms are severe, you should consult your doctor.

You will most likely be prescribed a course of antacids or anti-ulcer medicines.

To avoid heartburn when sleeping, avoid eating for 3 hours before sleep time, and sleep with your head and chest elevated with a wedge pillow or an adjustable bed.

Agitation and Anxiety

In some people, Tylenol can cause clinically significant agitation and anxiety.

Many people describe the sensation as having butterflies in their stomach or a racing heart.

You may also feel out of control, have nightmares, or have panic attacks.

In my practice, I advise my patients to drink chamomile tea and use relaxation techniques, such as mindfulness meditation, exercise, or biofeedback.

I do not recommend the use of anti-anxiety medicines unless the anxiety is debilitating.

Headache

This affects a significant proportion of patients after chronic use of Tylenol. 

However, it is rarely long-lasting nor severe. 

To avoid headaches, you should rest, and drink plenty of water.

Since many people experience analgesic-induced headaches, I advise taking a planned drug holiday for a few days, during which I advise other methods of pain control.

Restless Leg Syndrome

This condition is seen in some people who use Tylenol in combination with medicines used for flu and allergies, as well as antidepressants.

It manifests as an overwhelming urge to move your legs, especially in the evenings and at night.

It usually affects women more than men.

Massage, stretching, and application of heat or cold have some benefits.

In severe cases, changing the dose or use of anti-seizure/neuropathy medicines is recommended.

Sedation

Rarely, Tylenol can cause excessive sedation and daytime sleepiness.

This is also seen more in people who use a combination of medicines.

Often, it may manifest as tiredness, fatigue, and excessive sleepiness.

The first step in treating sedation is to change over to plain Tylenol and see if the symptoms improve.

In a few patients, I also prescribe stimulant drugs, such as caffeine, modafinil, or methylphenidate.

However, you should speak to your doctor before starting any of these medicines, as a thorough evaluation to rule out many other medical conditions is required.

If you have sedation, you should avoid driving and working with heavy machinery.

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4: Don’t Take Other Acetaminophen Medicines Concurrently

The ‘only one’ rule in pharmacotherapy is that you should avoid the use of fixed-dose combinations and interacting medicines unless it is absolutely necessary.

The active ingredient in Tylenol – acetaminophen – is present in more than 500 medicines used as pain relievers, sleep aids, and decongestants, so you may be taking more than the recommended dose of acetaminophen if you are on other medications.

In such cases, not only do you increase the risk of toxicity, but you also worsen the side effects.

Notorious sleep-disrupting combinations are acetaminophen with dimenhydrinate, duloxetine, doxylamine, metaprolol, hydrocodone, caffeine, and cetirizine – these combinations can cause or worsen insomnia or sedation.

Diphenhydramine, doxylamine, and cetirizine, when combined with Tylenol, can cause sedation, daytime drowsiness, dry mouth, blurred vision, constipation, and urinary retention.

It is interesting to note that diphenhydramine with acetaminophen (Benadryl + Tylenol, Tylenol nighttime, Tylenol PM) is often prescribed as sleep-inducing medicine, due to their sedative properties.

However, this is not something I recommend, as in many cases, it produces an uncomfortable drowsiness, rather than sleep.

Here are 10 ways to sleep better when taking Afrin.

5: Treat the Underlying Condition

Many people who use Tylenol do so without consulting a doctor to diagnose their underlying condition – this leads to irrational use of pain medicines and unnecessary side effects such as insomnia.

There are many conditions, such as fibromyalgia, migraine, and neuralgia, whose pain fails to respond to Tylenol, but responds to other groups of medicines.

Hence, consulting a doctor, and treating the underlying causative condition may be more appropriate.

Try these 7 ways to improve your sleep when taking Cymbalta.

6: Use Sleep Props to Improve Comfort

If possible, use adjustable bed frames or recliner beds, which can be altered to a number of different sleeping postures, based on your preference and need.

They have hinges and a motorized base, which allows different segments of the bed to move independently of each other.

By allowing you to sleep comfortably, in an optimal sleep posture, they offer superior pain relief and better sleep quality.

Alternatively, you can use a mattress lifter, a wedge-shaped pillow, or add a regular pillow to help keep your upper trunk elevated, which will prevent painful heartburn that may happen at night.

You should sleep on your left side to improve the flow of acid and other contents from the esophagus into the stomach. 

I also recommend the use of weighted blankets and eye pillows as sleep aids.

They are known to stimulate the autonomic nervous system and cause the release of melatonin, which will naturally improve sleep.

Click here to see the best adjustable beds to buy now.

7: Take Natural Supplements to Improve Sleep Quality

If you are taking Tylenol and have insomnia, give these natural supplements a try.  

Valerian Root 

Valerian extract has sedative properties.

It is a safe supplement, which has no interaction with Tylenol.

It also has additional anti-anxiety and sleep-promoting properties. 

Clinical trials have demonstrated the sleep-inducing effect of Valerian extract.

Regular consumption is known to improve sleep quality, by decreasing sleep latency and night awakenings.

Magnesium Supplements

Magnesium has a sleep-promoting and relaxing effect, due to its ability to regulate the melatonin hormone and gamma-aminobutyric acid levels in the brain.

Previous studies have demonstrated combinations of magnesium, melatonin, and vitamin B to be effective in the treatment of insomnia.

Magnesium supplements are widely available in pharmacies over the counter. 

Chamomile

Chamomile has a mild sedative action and can help ease insomnia.

The exact mechanism of chamomile is not clearly understood, but it is believed to be due to the action on the benzodiazepine receptors (the same receptors that sleeping pills act on). 

Drink strong chamomile tea, made with 2 to 3 tea bags, to get the best sleep-promoting effect.

Glycine

It has been demonstrated that 3 mg of glycine before sleep time may improve sleep quality when compared to a placebo group. 

The study reported that their subjects fell asleep faster, and had better performance during the daytime.

You may use glycine as a supplement powder, or consume glycine-rich foods – such as bone broth, eggs, poultry, fish, beans, spinach, kale, cabbage, and fruits like bananas and kiwi.

Melatonin

Melatonin is a natural hormone that regulates sleep and wakefulness in humans.

Studies on exogenous melatonin supplementation have shown that it can improve the quality of sleep in people with sleep disorders.

It is available in strengths between 3 and 10 mg in pharmacies and can be obtained without a prescription in some countries.

St John’s-Wort

St John’s-Wort has historically been used as a treatment for anxiety, depression, and insomnia.

It increases the levels of serotonin in the brain.

Studies show that St John’s-Wort modulates and increases REM sleep and deep sleep.

Although no studies have shown any definitive adverse interactions between Tylenol and St John’s-wort, I recommend that you consult your doctor before using it.

Here are 31 reasons why you have morning fever.

Conclusion: Tylenol Mainly Causes Insomnia

To conclude, Tylenol can indeed have sleep-related side effects in a minority of people – usually causing insomnia but wakefulness is also possible in some individuals or if other medications are being taken.

Although it is an OTC medicine, you should use Tylenol sparingly and responsibly.

To get better sleep, you should use Tylenol as prescribed by your doctor; be mindful of the sleep-related and non-sleep-related side effects, and treat them as required; avoid taking combinations of Tylenol and other interacting medicines; and treat the underlying condition adequately.

If clinically significant sleep problems persist, use natural sleep aids or sleep medicines, and invest in sleep props.

Above all, discuss with your doctor, and follow their advice.

Up next: 6 ways to sleep better with stomach pain.


References

1: P J Murphy, P Badia, B L Myers, M R Boecker, K P Wright Jr. ‘Nonsteroidal anti-inflammatory drugs affect normal sleep patterns in humans’. Physiology & Behavior; 1994;55(6): 1063-1066.

2: X Fan, K Zhang, X Wang, X Zhang, L Zeng, N Li, Q Han, Z Liu. ‘Sleep disorders are associated with acetaminophen-induced adverse reactions and liver injury’. Biomedicine & Pharmacotherapy. 2021; 134: 111-50.

3: AV Gastel. ‘Drug-induced insomnia and excessive sleepiness’. Sleep Medicine Clinics. 2018; doi.org/10.1016/j.jsmc.2018.02.001.

4: K Chung-Soo, H Jin-Yi, K Seunghwan, H Jin Tae, O Ki-Wan. ‘Herbs for the Treatment of Insomnia’ – retrieved on 29th Dec 2021.

5: www.uptodate.com/contents/acetaminophen – retrieved on 26th Dec 2021

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Main image: ‘Woman Addicted to Painkillers Holding Pills in Her Hand Palm’ by engagestock (used with permission and commercially licensed through Envato Elements).