7 OTC Medications to Approach With Caution When You Have Obstructive Sleep Apnea

Obstructive sleep apnea (OSA) happens when the muscles in your throat relax too much during sleep, causing your airway to narrow or close and briefly cut off your breathing.

“In sleep apnea, the muscles in your upper airway are already more relaxed than normal as you drift off, and that relaxation deepens even further during REM sleep,” says Safia S. Khan, MD, an associate professor of neurology at UT Southwestern Medical Center and a sleep disorder specialist in Dallas. That’s what causes airflow to become reduced or blocked, and your oxygen levels to fluctuate, during a typical apnea episode, she says.

A sedating medication like a sleep aid adds another layer on top of that: It increases that relaxation of the muscles, says Dr. Khan. “It can make the airflow further reduced by way of increasing the upper airway collapse. Taking a sedative medication when you have untreated sleep apnea can be actually dangerous for you,” she says.

Nonetheless, if you have OSA, it’s worth discussing these seven common OTC medications with your doctor before use to make sure their benefits outweigh their risks for you.

First-Generation Antihistamines

Common brand names: Benadryl, Unisom SleepTabs

Antihistamines like Benadryl are typically used to relieve allergy symptoms, such as sneezing, itching, and a runny nose.

“First-generation antihistamines are also central nervous system depressants,” says Khan. That sedating effect can overly relax the muscles in your upper airway, making the tissue more likely to collapse during sleep, she says.

Not all antihistamines carry this risk. Nonsedating options, like Claritin, Zyrtec, and Allegra, are less likely to cause this kind of muscle relaxation, says Khan.

OTC Nighttime Pain Relievers

Common brand names: Tylenol PM, Advil PM

These combine a pain reliever with a sedating antihistamine, so you get muscle relaxation on top of a slower arousal response if your breathing stops overnight, says Kristine Cline, PharmD, an assistant professor in the Division of Pharmacy Education and Innovation at the Ohio State University College of Pharmacy in Columbus.

Dr. Cline generally steers patients away from combination products like these. “For many patients, they end up taking additional medications they do not actually need solely because it came in the combination product,” she says.

When someone needs medication to assist with pain relief, assuming acetaminophen and ibuprofen are safe options for them, she typically recommends stand-alone over-the-counter options for pain relief over the combination PM products.

Oral Decongestants

Common brand names: Sudafed, Claritin-D

Decongestants like these relieve nasal and sinus congestion. They contain pseudoephedrine or phenylephrine, which work by narrowing blood vessels in your nose, but that effect isn’t limited to your nose, says Cline. They tighten blood vessels throughout your body, which raises your blood pressure and heart rate, she says.

“With obstructive sleep apnea, you are already in an elevated adrenaline state from each time breathing pauses during sleep,” she says. That’s one reason why adding a decongestant’s fight-or-flight–like effect on top of that isn’t ideal, says Cline.

“While medication like pseudoephedrine does open nasal passages, it is generally not a proven treatment for sleep apnea,” she says.

OTC Pain Relievers With Caffeine

Common brand names: Excedrin Extra Strength, Anacin

Some pain relievers, like Excedrin Extra Strength, add caffeine to make the medication work faster or more effectively.

If you’re going to take an OTC medication with caffeine or consume caffeine in the form of coffee or energy drinks, Khan generally recommends doing it moderately and avoiding it after lunch.

Motion Sickness Pills

Common brand name: Dramamine

Dramamine is actually an antihistamine, something many people don’t realize since they’re taking it for motion sickness rather than allergies, says Cline.

“Like other first-generation antihistamines, it depresses the central nervous system and can cause the muscles in the mouth and throat to relax too much,” says Khan.

This kind of unintentional overlap happens more often than you’d think, especially with combination products that contain multiple ingredients, Cline says. “This is another great reason people should talk to their pharmacist,” she says. A pharmacist can quickly flag whether an OTC treatment is appropriate for you and check for duplicate or interacting medications, she says.

Certain Cough and Cold Syrups

Checking the label can help you spot these ingredients, says Cline. Every approved OTC medication has a Drug Facts label listing active ingredients near the top and inactive ingredients toward the bottom, she says, though it isn’t always obvious which ones are sedating just from the name.

“If you are concerned about sedation with any over-the-counter medication, talk to your pharmacist,” she says.

Supplements and Herbal Remedies

Common examples: melatonin, valerian

Melatonin is a hormone your body naturally produces to regulate sleep, and it’s sold as a supplement to help you fall asleep faster; valerian is an herbal supplement marketed for sleep and relaxation.

“Melatonin can cause the muscles in your upper throat and airway to relax too much,” says Khan. If you’re considering melatonin, start with a low dose, 3 to 5 milligrams (mg) for most adults, since more isn’t necessarily better, she says.

What to Do if You Have OSA and Use an OTC Medication

If you’re not sure how an OTC medication might be affecting your sleep apnea, or you rely on one of these medications for real symptom relief and want a safer alternative, talk to your doctor or pharmacist, says Cline.

Pharmacists can be easier to access than other medical professionals because pharmacies are often open in the evenings and on weekends and typically do not require an appointment, she says.

“This makes your local pharmacy a great resource when deciding to try something over-the-counter or to help you understand when you need an appointment with your prescriber,” says Cline.