Citalopram (Celexa) is a selective serotonin reuptake inhibitor (SSRI) prescribed to manage depression and anxiety. The drug alters the chemical balance in the brain, primarily involving the neurotransmitter serotonin. Since serotonin regulates various bodily functions, including the sleep-wake cycle, Citalopram commonly causes noticeable alterations in sleep patterns.
How Citalopram Interacts with Sleep Regulation
Citalopram works by blocking the reabsorption (reuptake) of serotonin back into the nerve cells. This inhibition increases serotonin concentration in the synaptic cleft (the space between neurons), enhancing communication between brain cells. Serotonin influences alertness, mood, and appetite, and its increased availability can disrupt the brain’s normal rhythm for initiating and maintaining sleep.
The immediate effect on sleep often presents in two opposite ways as the body adjusts. Some individuals experience increased wakefulness or insomnia, finding it difficult to fall asleep or stay asleep. This activating effect is linked to the initial surge in serotonin activity.
Conversely, others may initially experience drowsiness or daytime fatigue (somnolence), especially when starting the medication or at higher doses. This sedative effect can cause people to feel tired and require naps. Both insomnia and sedation are recognized side effects stemming from increased serotonin influence on the central nervous system’s regulatory centers.
Specific Changes to the Sleep Cycle
Citalopram significantly modifies sleep architecture beyond general wakefulness or fatigue. A hallmark effect of SSRIs is the suppression of Rapid Eye Movement (REM) sleep, the stage associated with most dreaming and deep cognitive processing. The drug noticeably reduces the total time spent in REM sleep and increases REM latency (the time it takes to enter the first REM period).
This reduction is dose-dependent; higher doses typically lead to greater suppression. Chronic use maintains this effect, often resulting in less frequent or less intense dreams. The suppression of this restorative phase may contribute to less refreshing sleep or morning grogginess, even if total sleep time is unchanged.
The drug’s influence on Non-REM (NREM) sleep, which includes lighter stages and deep sleep (slow-wave sleep), is less dramatic but present. Some studies suggest Citalopram can cause a shift in NREM stages, potentially increasing lighter stage 2 sleep. Changes in NREM architecture are not as consistently altered as the profound suppression observed in REM sleep.
Strategies for Optimizing Sleep While Taking Citalopram
For many people, sleep-related side effects, particularly initial insomnia or sedation, lessen within the first few weeks as the body adapts. Consistency in taking the medication is important during this adjustment period to allow brain chemistry to stabilize. The duration of these effects can vary greatly between individuals.
A practical strategy involves adjusting the timing of the dose, which must be done in consultation with a healthcare provider. If Citalopram causes increased alertness, taking the medication in the morning may minimize sleep disruption at night. Conversely, if the primary side effect is sedation, shifting the dose to the evening allows the peak sedative effect to occur during normal sleep hours.
Adherence to healthy sleep hygiene practices is important when taking Citalopram. This includes maintaining a consistent sleep schedule, even on weekends, to reinforce the body’s natural circadian rhythm. Limiting exposure to bright screens, such as phones and tablets, in the hour leading up to bedtime is also helpful.
Avoiding heavy meals close to sleep is recommended. Furthermore, substances that interfere with sleep, such as caffeine and alcohol, should be minimized, as their disruptive effects can be amplified by the medication.
If sleep disturbances are severe or continue persistently beyond the initial adjustment period, contact a doctor. Persistent issues may indicate the need for a dosage adjustment or the temporary addition of a non-interacting sleep aid, but these changes require professional medical direction.