I’m having trouble sleeping and I’m wondering if it has something to do with my new medications. I’ve begun taking sertraline (Zoloft) for depression at night and hydrocodone for pain which I take every morning. The problem is that I feel like a zombie at work but I stay up all night. Is this normal?--B.D. New York City
Answer: It’s all about timing and your timing is backwards! There’s a simple rule in pharmacy: Take energizing medications in the morning, and relaxing ones at night!
The reasoning behind that is to take advantage of the side effect that typically occurs with a particular medication. For example, in your case, the sertraline (Zoloft) is wonderful at raising energy levels and increasing alertness. The reason you are up all night is because you are taking an energizing medication at bedtime. Unless you enjoy informercials or like to facebook in the wee hours, I suggest you change your timing. In fact, all the medications in this class of SSRI antidepressants should be taken in the morning or around lunchtime.
Pain medications such as hydrocodone/acetaminophen (Lortab, Norco or Vicodin) are notorious for causing one to feel relaxed and sleepy and because you are taking it in the morning, you feel like a “zombie.” I recommend you take this medication a half-hour before bedtime. It’s okay to take pain meds with a little snack or some food to minimize any stomach discomfort should that be a problem for you. Prescribed analgesics in this class are known to slightly slow down respiration and heart rate, and sensitive people can feel dizzy too. Again, the time to take pain medications is at night so you can take advantage of the side effect that goes along with these medication and avoid daytime fatigue.
If you are uncertain about when to take your particular medication, please ask your local pharmacist to weigh in. Here are some basic guidelines to follow:
Sleeping medications- Take these 10 to 60 minutes before you want to go to sleep. This goes for over-the-counter sleep aids, as well as prescribed medications. Never combine these meds with alcohol.
Thyroid hormones- Take it first thing in the morning, upon arising and on empty stomach. Thyroid medications are intended to raise energy, speed up metabolic rate and burn fat during the day.
Blood Pressure Meds- Generally speaking, take these at bedtime, just get out of bed very slowly in the morning because they can cause orthostatic hypotension (a sudden drop in blood pressure when arising).
Nasal Decongestants- Often found in cold medications to help unstuff your nose. These are energizing so take them during the day. Sustained-release formulas cause less of a energy ‘jolt’ but still provide long-acting relief.
Diuretics- These “water pills” lower blood pressure by making you urinate more. Take them in the morning so you are not racing to the potty all night.