- This article was written and researched by Dr. Albert Stezin (MBBS, Ph.D – clinician and neuroscientist) to ensure maximum factual accuracy and unique content.
Cymbalta – generically called ‘duloxetine’ – is a common neuropsychiatric medicine used in the treatment of a variety of conditions such as peripheral neuropathy, anxiety, depression, and chronic pain syndromes.
Cymbalta works by modulating the level of neurotransmitters such as serotonin and norepinephrine in critical brain regions.
While Cymbalta is an effective drug in many neuropsychiatric conditions, it is known to have sleep-related side effects such as insomnia, daytime sleepiness, and early wakening – sleep may also be disturbed due to other side effects of Cymbalta.
So how do you sleep better when taking Cymbalta?
The most effective ways to sleep better when taking Cymbalta are to talk to your doctor to ensure you are dosing correctly, avoid interactions with other medications, take Cymbalta in the morning to avoid insomnia, try light exposure therapy, magnesium, and good sleep hygiene.
The rest of this article explains in more detail how to sleep better when taking Cymbalta using 7 of the best doctor-verified strategies.
There is also helpful information on which supplements and medications to avoid taking whilst you are on Cymbalta.
However, this article is no substitute for the advice of your own doctor.
Always consult with a qualified medical professional before taking Cymbalta, altering your dose, or taking other medications alongside Cymbalta – since there can be serious interactions with Cymbalta.
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7 Ways to Sleep Better Whilst Taking Cymbalta
Here are 7 of the best ways to get to sleep whilst taking Cymbalta:
1: Take Cymbalta as Prescribed by Your Doctor
Cymbalta is a prescription-only medication that you should take as prescribed by your doctor – typically once or twice per day – and you should adhere strictly to the timings in order to maintain the optimal levels in your blood and minimize the impact on your sleep quality.
If you miss a single dose – and there are more than six hours before your next scheduled dose – you should take the tablet immediately, but if you are less than six hours away from the next dose you should skip it.
Moreover, never take two tablets to make up for a forgotten dose because Cymbalta has a half-life of 12 hours, and if the drug concentration is higher than optimal there can be side effects.
Missing a dose increases the risk of a relapse of symptoms, so it may be helpful to set the alarm or use a pill organizer if you forget doses often.
Consider downloading an online smartphone app that can send you medication reminders at specified times.
In case of intentional or accidental overdose with Cymbalta, you could experience excessive drowsiness, dizziness, restlessness, vomiting, tremor, fast heart rate (>100 beats per minute), and seizures.
If you – or someone you know – have these symptoms while on Cymbalta, get to the hospital without delay.
You can take Cymbalta with food or on an empty stomach, but you should swallow enteric-coated tablet capsules whole – not chewed or crushed – to prevent the drug from metabolizing before being absorbed into the blood.
You should not take alcohol with Cymbalta because it increases your risk of liver damage – plus avoid driving, using heavy machinery, and other hazardous activity as Cymbalta can worsen your reaction time and cause accidents.
Never stop the medicine abruptly, as it can result in unpleasant withdrawal symptoms such as irritability, nausea, dizziness, vomiting, nightmares, headache, and paresthesia (a burning or prickling sensation in the hands and feet).
If your doctor decides to stop Cymbalta, they will taper the dose down over a couple of weeks or even several months to avoid withdrawal symptoms.
2: Increase the Dose Gradually to Avoid Sleep Disturbances
Cymbalta is a prescription drug and not available as an over-the-counter medicine.
Your doctor will probably get you to scale up from a low dose to the desired target level over a few weeks, but if you take this medicine for painful neuropathy or depression, it may take several months to reach the desired target dosage.
However, if you develop side effects, it is better to slow down the titration and use the lowest dose that provides you with clinical benefits.
When given for depression, Cymbalta dosage starts at 30mg daily and is increased to 60mg after one week, but you should stop taking it if there is no response to treatment after six weeks.
The side effects of Cymbalta – including sleep disturbances – are mild to moderate in severity and usually temporary, but they should gradually improve once your body adjusts to the drug.
Hence, your doctor may only ask you to slow down the dose increase and not change the target dose, but you must inform your physician at once if you have severe side effects.
Watch out for side effects such as tightness in the chest, shortness of breath, hallucination, aggressive behavior, mania, suicidal thoughts, constant headache, confusion, recurrent muscle cramps, eye pain, blurred vision, bleeding, passing dark-colored urine or stools, and excessive menstrual bleeding.
If you experience any of the symptoms above, your doctor will change your medicine to a safer alternative.
3: Avoid Drug Interactions that Could Impact Your Sleep
Before taking Cymbalta, you must consult with your doctor to ensure that it won’t interact with any other medications that you are taking because not only could such interactions impact your sleep, they could cause severe side effects that may even be life-threatening – such as serotonin syndrome.
Cymbalta selectively inhibits the reuptake of serotonin and norepinephrine, so it may interact synergistically or antagonistically with other medicines that could alter the neurotransmitter milieu of your brain.
Below is a list of medicines you should NOT take with Cymbalta.
Never take medicines called MAO inhibitors (MAOIs) within two weeks of taking Cymbalta, as MAOIs inhibit the enzyme responsible for removing neurotransmitters such as serotonin, norepinephrine, and dopamine.
The combined effect of Cymbalta and MAOI can cause serotonin syndrome, a potentially life-threatening condition.
Medicines under the MAOI class include phenelzine (Nardil), tranylcypromine (Parnate), isocarboxazid (Marplan), rasagiline (Azalect), and selegiline (Emsam) and are commonly used for the treatment of depression, Parkinson’s disease, restless leg syndrome, etc.
Serotonin syndrome may also be triggered if you take other medicines such as tricyclic antidepressants, antipsychotics (Geodon), migraine (Imitrex), pain medications (Ultram), antibiotics (Zyvox), amphetamines, cold medicines, and recreational drugs (MDMA, Ecstasy).
Be cautious when taking Cymbalta with medicines such as cimetidine (Tagamet), ciprofloxacin (Cipro), fluoxetine (Prozac), fluvoxamine (Luvox), and paroxetine (Paxil).
The medicines above can modulate the enzymes that metabolize Cymbalta and decrease its removal from the body, potentially worsening the side effects.
Cymbalta can increase the effect of blood-thinning medicines such as warfarin (Coumadin) and aspirin and cause bleeding, while similar effects are possible with Ibuprofen (Advil, Motrin) and other anti-inflammatory medication.
In short, Cymbalta can interact with a whole host of medicines that are very commonly prescribed, especially in the elderly, so my professional opinion is to consult your doctor and evaluate potential interactions if you take multiple medications.
4: Treat the Sleep-Related Side Effects of Cymbalta
People taking Cymbalta have three main sleep-related side effects that include insomnia, somnolence (drowsiness), and frequent awakening.
These symptoms are common in patients with depression, making the cause difficult to identify, as the sleep disturbances may be related to either Cymbalta or depression.
There are few ways of mitigating your sleep disturbances when taking Cymbalta, as follows:
Insomnia is the most common sleep-related side effect of Cymbalta, but there are strategies to tackle sleeplessness.
It helps if you take Cymbalta in the morning to avoid nighttime symptoms and aim to keep the dose low, as insomnia is a dose-related side effect.
Understand that the sleep disruptive side effects tend to be temporary, although some patients may still have insomnia with a morning regime and low dosage, and some strategies won’t work if you take Cymbalta twice a day.
Some patients benefit from a short course of sedatives with severe symptoms, but you must speak with your doctor before commencing sedatives due to potential drug interactions.
Try to maintain strict sleep hygiene practices, e.g., keep to a fixed sleep and wake up schedule, remain active during the day, avoid daytime naps, limit or stop caffeine, nicotine, and alcohol intake, and avoid large meals or beverages close to bedtime.
You may also benefit from cognitive behavior therapy strategies such as stimulus control therapy, relaxation techniques like deep breathing, therapeutic sleep restriction, and light therapy, and consult a psychologist to help master some of these techniques if necessary.
Somnolence is defined as excessive daytime sleepiness, and in most cases, is the result of insufficient sleep or even due to changes in the neurotransmitter levels in your brain.
If somnolence is secondary to insomnia, it will improve on its own once insomnia abates, but if it is severe, you may need medicines to help.
Wakefulness-promoting agents such as modafinil or stimulants like methylphenidate can offer clinical benefits, while behavioral strategies such as light exposure therapy, changing position frequently, and physical activity are helpful additions to medicines.
Regardless of the cause of somnolence, it impairs your judgment, so I advise you not to drive, ride, operate heavy machinery, etc.
Early awakening is upsetting and can cause physical and mental exhaustion, so to get adequate sleep, follow the same steps as described under ‘insomnia.’
Avoid medicines to treat sleep disturbances as much as possible due to the potential combined side effects; for example, Xanax with Cymbalta may worsen side effects like dizziness, drowsiness, confusion, and difficulty concentrating.
Moreover, medications used with the elderly could result in impaired thinking, poor judgment, and motor coordination; hence, only use drug therapy when all other methods fail.
5: Treat the Non-Sleep Related Side Effects of Cymbalta
Cymbalta has many side effects that do not directly affect sleep neurobiologically but can still cause sleep disturbances – although not everyone gets them all, nor do they become clinically significant enough to warrant medicines.
I have compiled a list of Cymbalta-related side effects that can affect sleep and how you might avoid them, but if the side effects cause you severe discomfort and sleep problems, do not hesitate to contact your doctor.
Headaches affect less than 10 percent of people on Cymbalta, and it is rarely long-lasting or severe.
To avoid headaches, get lots of rest and drink plenty of water, but if you do get a headache – and it disturbs your sleep – take paracetamol tablets as needed, but avoid other pain killers or anti-inflammatory medicines.
I recommend that you visit your doctor or emergency department if your headache is severe, lasts more than a week, or causes visual symptoms.
With its abdominal pain and bloating, constipation can impact sleep quality and affects around 11 percent of patients on Cymbalta.
To avoid this unpleasant side effect, make sure you eat fiber-rich foods like fresh fruits and veggies, cereals, drink plenty of water, and do mild to moderate exercise regularly to improve your gut motility.
If these suggestions don’t work, talk to your pharmacist or doctor about starting stool softeners or osmotic stimulants to relieve constipation, as symptom relief will help improve your sleep quality.
Diarrhea affects eight percent of patients taking Cymbalta, so if you have moderate to severe diarrhea, increase your water uptake to avoid dehydration.
However, I do not recommend you take any medicines – over-the-counter or prescription drugs – to treat diarrhea as they often interact with Cymbalta and produce severe side effects.
Nausea and Vomiting:
Nausea and vomiting are the most common side effect of Cymbalta and affects up to 20 percent of patients, so you should eat only simple meals that are not acidic or spicy while you are taking Cymbalta.
If you do feel nauseous, try taking the tablet with food, but avoid antacids or medicines for vomiting as they can potentially decrease the clinical effect of Cymbalta.
Dry, Parched Mouth:
Affects 15 percent of patients on Cymbalta, and can severely impair sleep, so try chewing on sugar-free gums or sweets to remedy the situation.
Sweating affects 6 percent of patients and is very severe in some people.
The best approach is to wear loose, breathable fabrics, use an antiperspirant, and keep cool using a fan or air conditioning, but if your sweating becomes too severe, you may need to stop Cymbalta.
Dizziness after standing up is a side effect of Cymbalta, caused by a sudden drop in blood pressure.
Although dizziness is not a sleep-related symptom, it can occur when you get out of bed and increase your risk of falls and accidental injury.
Remember to get up very slowly or do so in multiple short phases, such as stay sitting down until you feel right and then get up, but if you begin to feel dizzy, lie down again so that you don’t faint.
Watch the video above to see how to get out of bed in a controlled manner that doesn’t strain your body or worsen your back pain.
If this doesn’t work, start wearing elastic stockings on your lower limb to prevent your blood pressure from falling too much.
If you have recurrent falls, meet your doctor as soon as possible to discuss switching to other medicines, and don’t attempt to drive or use power tools or machines while you have this symptom.
Investing in a high-quality adjustable bed can make it easier to get in and out of bed as well as help with conditions like back pain, GERD, acid reflux, COPD, and snoring.
6: Use Sleep-Promoting Home Remedies and Sleep Aids
If sleep problems persist whilst taking Cymbalta, try some of these sleep-promoting home remedies – but I urge you to talk to your physician before taking these natural products.
Many natural sleep aids have known interactions with Cymbalta (see below), but for some, there is a lack of evidence on potential interactions.
Magnesium supplements have sleep-promoting, relaxing effects due to magnesium’s ability to regulate the melatonin and gamma-aminobutyric acid levels in your brain.
Other studies have demonstrated that a combination of magnesium, melatonin, and vitamin B can effectively treat insomnia.
Moreover, studies of magnesium taken as 225mg and 500mg tablets – compared with placebos – demonstrated improved sleep quality in the magnesium-treated group, though it is unclear if the sleep-promoting effect would prevail in those without a magnesium deficiency.
Magnesium supplements are available in pharmacies OTC.
Glycine is an amino acid that can improve sleep quality, and it only takes 3mg before bedtime to produce results.
A few studies have found that patients on glycine fall asleep faster and perform better during the daytime.
Glycine is available as a supplement powder, but its safety in different medical conditions is unproven.
One study performed on a limited population (n=23) demonstrated higher side effects when glycine and Cymbalta were used concurrently over a long duration.
You may want to try glycine for short durations or supplement glycine through natural glycine-rich foods such as bone broth, eggs, poultry, fish, beans, spinach, kale, cabbage, and fruits like bananas and kiwi.
Do NOT Use St John’s Wort With Cymbalta:
Historically used as a treatment for anxiety, depression, and insomnia, St John’s wort increases serotonin levels in the brain.
Studies show that St John’s wort modulates and increases REM sleep and deep sleep, but preparations of St John’s wort can interact with Cymbalta to produce serotonin syndrome, a condition that can trigger muscle spasms and overactive reflexes.
Do NOT Use Valerian Root With Cymbalta:
Valerian extract has sedative properties and is considered a safe supplement with anti-anxiety and sleep-promoting properties, but it is also known to have a moderate interaction with Cymbalta.
Typical side effects are dizziness, drowsiness, confusion, and difficulty concentrating; hence, it is better to avoid using valerian root extract with Cymbalta.
Do NOT Use Chamomile With Cymbalta:
Chamomile has a mild sedative action that can help ease insomnia (click here for 8 ways to sleep better with chamomile tea).
The exact mechanism of chamomile is unclear, but researchers think it is due to its effect on benzodiazepine receptors – the same receptors that sleeping pills bind to.
Although no interaction studies exist, chamomile may interact with Cymbalta, so, for now, at least, I advise you to avoid chamomile when you are on Cymbalta.
I also recommend you avoid the following natural sleep aids with Cymbalta because of potential interactions: primrose oil, fenugreek, flaxseed, 5 HTP (tryptophan), feverfew, fish oils, omega 3, flaxseed, ginkgo, ginseng, nutmeg, red clover, SAMe, willow bark, glucosamine, green tea, and horse chestnut seed.
7: Use Sleep Props That Adequately Support You
Doctors prescribe Cymbalta to patients with peripheral neuropathy, anxiety, depression, and chronic pain syndromes.
If you have peripheral neuropathy or chronic pain syndromes, you most likely have sleep disturbance due to the pain and paresthesia, so consider props to help you sleep better in addition to Cymbalta.
It is a cost-effective, worthwhile strategy since peripheral neuropathy and pain syndromes are chronic conditions that can last for a long time.
Adjustable Bed Frames/Recliner Beds
You can arrange a recliner bed in several different sleeping postures based on your needs and comfort.
These beds have a motorized base with hinges that allow different segments to move independently, giving you an optimal sleep posture for long periods, resulting in superior pain relief and better sleep quality.
Moreover, recliner beds help you get in and out of bed with considerable ease, which is another reason they are so popular, especially in patients with chronic pain syndrome.
A wedge pillow is a cheaper alternative to a recliner bed and is a triangular or wedge-shaped prop that you place at the head end of the bed to support your head, neck, and upper torso.
Wedge pillows are ideal for people with sleep disturbances and who spend a lot of time on or in the bed reading, resting, or watching TV.
Pillows are an economical alternative to recliner beds and wedge pillows that you can use individually or together to prop up painful areas, typically placed between your legs, under your lower back, or hip to enhance your level of comfort.
Bedside Rail Grabs
These safety rails run along the bedside to prevent you from falling out, and they help you heave yourself up into a sitting or stand-up position.
The collapsible mechanism lowers the rail to mattress level so that you can get in and out easily, and they are also portable, transportable, and fit to any bed.
Rope Ladders and Overhead Trapeze
Overhead trapeze and rope ladders can help you pull yourself up from a lying to a sitting position and are especially helpful for people with painful conditions, but the downside is that you need ample upper body strength to use them.
The silky smoothness of satin sheets can help you turn easily in bed, which makes them ideal for patients with peripheral neuropathy, anxiety, and painful muscles who frequently toss and turn during the night.
Designer satin sheets have a satin panel in the middle where your hips and trunk rest and the slippery smoothness decreases friction, making it much easier for you to turn.
Orthopedic mattresses are designed with uniform support or to provide focused support to specific areas as required.
Irrespective of the type of damage, these beds help you maintain a neutral position for the affected muscles to rest and recover, and you can find them in medium-firm, firm, or ultra-firm varieties.
Because Orthopedic mattresses are used in treatment, your doctor or physical therapist may even prescribe one.
Opt for an orthopedic mattress made of memory foam, innerspring, latex, or bonded foam.
Cymbalta and Sleep- FAQs
Below are the answers to some of the most common questions regarding sleep and Cymbalta.
How Does Cymbalta Affect Sleep?
Cymbalta – known generically as duloxetine – is a selective serotonin and a NERI or norepinephrine reuptake inhibitor that leads to an increase in the levels of serotonin and norepinephrine, resulting in a decrease in both the quantity and quality of REM sleep and sleep onset latency, and it happens in both healthy and depressed people.
Sleep results from a complex interaction of more than eleven neurotransmitters, and Cymbalta affects two of these neurotransmitters, i.e., norepinephrine, and serotonin.
Norepinephrine handles the arousal from sleep, and at higher levels, it decreases REM sleep, while serotonin is produced solely in the raphe nucleus yet has a similar effect on the sleep-wake cycle as norepinephrine.
Serotonin also helps maintain arousal and cortical responsiveness and inhibits REM sleep.
Previous studies on Cymbalta have demonstrated an increase in the amount of serotonin in the synapse to be associated with a decrease in REM percentage in the early stage of treatment, and as the treatment continued, these effects diminished.
The effect of Cymbalta on sleep initiation and maintenance is not clear but is thought to be due to antagonism of H1 histamine, cholinergic receptors, or postsynaptic 5HT2C receptors.
Can Cymbalta Keep You Awake at Night?
Cymbalta can keep you awake at night – whilst 80% of patients taking Cymbalta do not have any sleep-related side effects, around 20% have decreased REM sleep, insomnia, somnolence, and early awakening from sleep.
In clinical trials using SNRI, treatment-related insomnia and treatment-related somnolence saw an average of 13% and 10% of patients, respectively, and these sleep disturbances usually improved after a few weeks of treatment.
Should You Take Cymbalta at Night or in the Morning?
It’s better to take Cymbalta in the morning if you have insomnia, sexual dysfunction, or urinary disturbances after taking it, or at night if drowsiness and nausea/vomiting are the more prominent side effects.
Can You Take Melatonin with Cymbalta?
Melatonin is an all-natural hormone responsible for regulating 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, and there is no known interaction between Cymbalta and melatonin, which makes it ideal for use as short term solution for insomnia in conjunction with Cymbalta.
Melatonin is available in pharmacies in strengths between 3–10mg, and you can obtain it without a prescription in many countries.
What Is the Most Dangerous Side Effect of Cymbalta?
The most dangerous side effect of Cymbalta is an increase in suicidal thoughts or actions and is particularly common in children, teenagers, or young adults within a few months of starting Cymbalta or after a change in the dosage.
To avoid this danger, you should pay close attention to changes in mood and behavior, and call your doctor immediately you notice any warning signs.
Is Cymbalta Safe During Pregnancy and Breastfeeding?
Cymbalta is not safe during pregnancy or while breastfeeding.
Cymbalta may harm your unborn baby if taken during pregnancy, and if you plan to get pregnant, your doctor will first assess the need to continue Cymbalta and most likely switch you over to safer medicine, but if you are already pregnant and taking Cymbalta, it is vital to assess the risk of possible malformations in your unborn child.
Similarly, Cymbalta can pass into breast milk and harm the newborn that way, so I recommend you talk over these concerns with your doctor.
What Is Serotonin Syndrome?
Serotonin syndrome occurs when there is an abnormally high level of serotonin in your brain, and too much serotonin causes signs and symptoms such as: shivering, diarrhea, agitation, confusion, increased heart rate, dilated pupils, muscle twitching, sweating, severe muscle rigidity, fever, and seizures.
If left untreated, serotonin syndrome can even lead to death.
Cymbalta – when combined with psychoactive medications – can cause serotonin syndrome.
Hence, it is necessary to disclose all medicines and prescriptions with your doctor.
Conclusion: Professional Guidance is Essential
Due to the side effects and drug interactions that are possible when taking Cymbalta, it is essential that you talk to your doctor before starting this medication, altering your dose, or taking any other medications or supplements alongside it.
If Cymbalta is also causing you sleep issues, then you should also mention this to your doctor since they will be able to take into consideration your unique circumstance.
Sources and References
 Chung-Soo K, Jin-Yi H, Seunghwan K, Jin Tae H, Ki-Wan Oh. “Herbs for the Treatment of Insomnia” – retrieved on 10th September 2021.
 Wichniak A, Wierzbicka A, Walęcka M, Jernajczyk W. “Effects of Antidepressants on Sleep”- retrieved on 2nd September 2021.
 Hutka P, Krivosova M, Muchova Z, Tonhajzerova I, Hamrakova A, Mlyncekova Z, Mokry J, Ondrejka I. “Association of sleep architecture and physiology with depressive disorder and antidepressants treatment”- retrieved on 10th September 2021.
No part of this article or website offers medical advice – always consult with a qualified professional for the best guidance.
Image Attribution and Licencing
Main image: ‘Woman Sleeping’ by Creatas Images (Photo Images) – used with permission under the terms of Canva’s One Design Use License Agreement.
Dan is the founder and head content creator at Bedroom Style Reviews.
He has been working as a professional online product reviewer since 2015 and was inspired to start this website when he ended up sleeping on a memory foam mattress that was too soft and gave him backache.
Through in-depth research and analysis, Dan’s goal with this website is to help others avoid such pitfalls by creating the best online resource for helping you find your ideal mattress, bedding, and bedroom furniture.
Dan is a qualified NVQ Level 2 Fitness Instructor with 6 years’ experience helping clients improve their health through diet, exercise, and proper sleep hygiene.
He also holds several college and university-level qualifications in health sciences, psychology, mathematics, art, and digital media creation – which helps him to publish well researched and informative product reviews as well as articles on sleep, health, wellbeing, and home decor.
Dan also has direct personal experience with insomnia, anxiety, misophonia (hypersensitivity to sounds), and pain from both acute and long-standing sporting injuries – he enjoys writing insightful articles around these subjects to help fellow sufferers of such conditions.
Learn more about Dan here.