Dr. Ahmed
Insomnia is a term people describe when they have:
- difficulty falling asleep
- difficulty staying asleep
- not feeling refreshed and feeling tired after waking up
- waking up frequently at night
- waking up in the morning tired and sleepy
Insomnia or trouble falling asleep has several reasons. Still, most people have underlying anxiety, depression, chronic pain disorders, are sick, or have insomnia because of a change in diet or medications.
Ozempic and Mounjaro are two blockbuster diabetes medications. These medicines cause significant weight loss and are highly potent in lowering the A1C.
These drugs act on the gut-brain axis to control satiety, apart from other effects like stomach fullness, delayed gastric emptying, and stimulating insulin release in a glucose-dependent mechanism.
The manufacturer has mentioned several side effects with Ozempic and Mounjaro, but insomnia is not one of them.
Here, we discuss insomnia in the context of Ozempic and Mounjaro and how people relate these side effects to their medications. In addition, we will explore what people found most helpful for achieving sound and restful sleep.
Mounjaro, Ozempic, and Insomnia . . .
Anxiety and depression are common causes of trouble falling or staying asleep. However, when it comes to Ozempic and Mounjaro, other factors may also contribute to insomnia, and these can be effectively managed if identified and diagnosed.
Hypoglycemia as a cause of insomnia:
Ozempic and Mounjaro are potent diabetes medications. While these medicines do not cause hypoglycemia (low blood sugar) but when they are used with insulin, Glipizide, Glimepiride, Glyburide, or other diabetes medications, they may cause a significant drop in your blood glucose.
When you develop hypoglycemia, your body tries to correct it by releasing hormones and chemicals. Among these chemicals are stress hormones, Adrenaline, and cortisol.
- Adrenaline causes palpitations, tremors, anxiety, insomnia, and restlessness, and activates the fear or fight-or-flight response.
- Cortisol is a stress hormone that can change your sleep cycle and you may find it difficult to fall asleep at night, have a deep sleep, and experience frequent awakenings.
Hypoglycemia can sometimes develop during sleep. You may not develop the classical symptoms of hypoglycemia if your blood sugars are low during your sleep. However, most patients who develop hypoglycemia during sleep notice that they have bad dreams or nightmares.
If you have started Ozempic or Mounjaro and have developed nightmares or bad dreams and are tired when you wake up you may be having hypoglycemia at night or during sleep. You may also notice that your blood sugars in the morning will be high (indicating the body’s normal stress response). This is also called the “Somogyi effect“.
What to do if you are having low blood sugars at night?
Here are some tips to avoid nighttime hypoglycemia and insomnia using Ozempic or Mounjaro:
- Start with a low dose and titrate your dose gradually as recommended. Do not jump directly to a higher dose of Ozempic or Mounjaro.
- Reduce your insulin dose by 25% or even more depending on your baseline blood glucose. For those with well-controlled blood glucose, you may need to reduce your insulin dose by at least 25%. Similarly, if you are on another diabetes medicine especially sulfonylureas (Glipizide, Glimepiride, or Glyburide, etc), you may need to reduce your dose by half. It is best to consult your doctor who can decide wisely about dose adjustments.
- Do not skip your evening meal.
- Take a glass of milk or one whole fruit, a cup of fresh fruit, a fruit chart, or two crackers at bedtime.
- Avoid taking caffeine, caffeinated beverages, chocolates, or tea at bedtime which can cause insomnia.
Here are some reviews of patients who have found that their sleep problems and insomnia were actually because of hypoglycemia:
| “I noticed that when my blood sugar drops, it’s what wakes me up. If I try really hard to go back to sleep, I’ll just end up waking up again in about an hour. But if I get up and eat a little snack, and then go back to bed, I’ll be able to sleep through the night until morning”. |
| “These meds mess with my sleep, and I’ve discovered that a spoonful of brown sugar knocks me right out. Turns out, it’s low blood sugar that’s messing with my sleep!” |
| “This sleep trouble didn’t start until I reached a dosage of 0.75. Before that, I was so exhausted that I could sleep for 10 hours straight. Another thing is that I wake up feeling extremely hungry, even on the nights when I manage to sleep well. A couple of things that have helped me are taking ashwagandha to manage my cortisol levels and doing some weightlifting at night. I also take a Dramamine along with my weekly shot at night, and that always helps me sleep soundly on that particular night”. |
Bloating, GERD, Indigestion, and Insomnia:
GERD (Gastroesophageal reflux disease), indigestion, bloating, abdominal pain, diarrhea, and constipation are the most common side effects of Ozempic and Mounjaro.
These side effects may be severe enough not to let you sleep properly. GERD is a known cause of insomnia and nighttime cough.
How to manage GERD and other GI side effects of Ozempic and Mounjaro?
Treating GI side effects and especially GERD and Sulfur Burps is important if these side effects are a cause of insomnia and disturbed sleep quality.
Simple tips to avoid symptoms of GERD and other GI side effects include:
- Titrate your dose gradually as per the manufacturer’s recommendations.
- Take small frequent meals instead of one or two heavy meals.
- Eat your evening meal at least one hour before going to bed.
- Do not eat spicy and oily food in your night meal.
If your symptoms persist despite these simple lifestyle changes, you may try these medications:
- Take an OTC antacid (Famotidine, Omeprazole, Pepto-Bismol, or Gaviscon syrup)
- Take prokinetic medicines that help improve your gut motility such as Domperidone (Motilium), Metoclopramide (Maxolon), and Itopride (Ganaton).
- Dimenhydrinate may be used which can alleviate symptoms of nausea and vomiting and simultaneously improve sleep.
Here are some reviews of patients who noticed that GERD and indigestion were the cause of insomnia when they started Ozempic or Mounjaro:
| “Yesterday, I got my first shot, and I was really looking forward to losing weight. However, it’s been quite frustrating because I experienced intense heartburn and indigestion that woke me up around 3 am. Before that, I had a headache and felt extremely tired, but I just couldn’t fall asleep” |
| I had to start taking a prescription antacid, and it has made a huge difference. Unfortunately, the doctor told me that I’ll have to keep taking it while I’m on Ozempic. Honestly, I don’t even want to risk going off it because the acid reflux and heartburn were so severe. I didn’t experience headaches, but I did feel tired. Thankfully, that passed over time. I’ve been on Ozempic for 12 weeks now, and it definitely suppresses my appetite, but it does come with some side effects, at least for me. It’s a matter of deciding whether I’m willing to tolerate the side effects for the long-term health benefits of losing weight. Right now, I am. |
| “After taking two shots of 0.5 mg Ozempic, my husband decided that he couldn’t handle this medication. He experienced awful nausea, diarrhea, vomiting, and a general feeling of being unwell. However, things took a turn for the worse about 10 days ago. He started experiencing extreme anxiety and terrible insomnia, to the point where even his 12.5 mg Ambien no longer helps him sleep. He hasn’t slept more than 2 hours a night for the past three nights. On top of that, his appetite still hasn’t returned, and he has completely stopped eating solid food. So yes, he has lost weight, but we believe that the risks outweigh the benefits. We strongly feel that the FDA should urgently investigate the negative impact this drug has on mental health!” |
Headache and Insomnia with Ozempic and Mounjaro:
Headache has been reported as a side effect of Ozempic and Mounjaro. Some people noticed a worsening of their pre-existing migraine headaches.
There is no clear association between headaches and Ozempic or Mounjaro but headache is a common reason for insomnia.
How to manage insomnia caused by Ozempic-induced headaches?
A good night time sleep can help your headaches. But what if you can not sleep because of the headaches? In addition, lack of sleep and disturbed sleep can worsen your headache.
You may try these simple tips to relieve your headache:
- Keep yourself well hydrated
- Practice yoga or other relaxation techniques. Prayer can help a lot.
- Avoid triggers like chocolates, caffeinated beverages, and processed foods.
- Sleep in a dark and quiet room
- Keep your posture comfortable
- Apply a cold compress and massage the scalp and head
- Take OTC pain medicines like:
You may need to consult your doctor if your headache persists despite these maneuvers and OTC medicines.
Those who have migraine may need to take novel medicines which are highly effective, including:
Other drugs in the “gepant” class can be used for migraine prevention such as Ajovy and Emgality. In addition, Cefaly is a medical device that modulates the neuronal signals of the trigeminal nerve and is simple to use as it is worn by the patient. Cefaly is also an acceptable option for pregnant females.
Buy Cefaly Migraine Device from Amazon
Here are some patients reviews who develop insomnia as a result of severe headaches caused by Ozempic:
| “I took my first dose of 0.25 mg about 24 hours ago, and I’m dealing with a really intense headache. On top of that, I’m feeling slightly nauseous in waves, which is not a pleasant experience. The worst part is that I’m having trouble sleeping, which is not normal for me.” |
| “It’s important to keep track of how much water you’re drinking compared to how much you’re urinating in the last 24 hours. With semaglutide, it’s recommended to drink a lot more water than you might think. It’s crucial for hydration. This should help ensure that your headaches are not due to dehydration, although you may still experience them. Taking painkillers can help alleviate the headache, and you may also consider using electrolyte powder to add to your water. Many people recommend brands like LMNT or the Keppi powder available on Amazon. Just hang in there and ride out the side effects. In my experience, the side effects have lessened with each passing week on this dose. I’ll be taking my fourth shot tomorrow.” |
Ozempic shot and Insomnia:
Some people develop insomnia with Ozempic only on the day of the Ozempic or Mounjaro shot. There is little evidence that the injection itself is causing insomnia, however, considering patient reviews, you may need to consider it as one of the side effects of Ozempic or Mounjaro.
Here are some tips to avoid Ozempic or Mounjaro injection-associated insomnia:
- If you are scared of injections, you may develop anxiety and insomnia. First, be calm. The needle that is used to inject Ozempic or Mounjaro is so fine that you won’t even feel it.
- Second, if you are getting Ozempic and Mounjaro shots in the evening or after a night meal, you may try switching it to the morning.
- Thirdly, some people get relief when they change the site. For example, if you are injecting it into your tummy, switch to the thighs.
- Lastly, if you develop soreness, redness, or pain after the injection, you may use a cold or ice compress, and take Tyelonol or Aleve for pain relief.
Here are some patients reviews who develop insomnia only on the days they used to inject Ozempic or Mounjaro:
| “It could be just me, but after my first two injections, I’ve had trouble sleeping the night after. Since my injection day is on Tuesday, Wednesday nights have been particularly difficult for me. It’s not due to any specific symptoms keeping me awake; I simply struggle to fall asleep. I’m wondering if it’s worth changing my shot day to Thursday instead. That way, if I can’t sleep well, it wouldn’t bother me as much since it’s closer to the weekend.” |
| “I can relate to that. The night I take my shot is usually the most challenging, and the effects can last for a few days. In my case, I administer the shot on Sundays, and my sleep tends to improve by Wednesday. I’ve tried different methods like taking it in the morning or evening or injecting it in my leg or stomach, but none of these made a difference in my insomnia. I was only able to reach a dosage of 0.5 mg before being advised to lower it back down to 0.25 mg due to the shortage. So, my current dose is quite low. Interestingly, my pharmacist mentioned that insomnia is not a recognized side effect of the medication. However, they suggested increasing my Trazodone dosage by 25 mg specifically on those nights to help with sleep.” |
Excitement or Dispair and Insomnia:
Excitement, and on the other hand, hopelessness or despair can both cause insomnia. If you have been started on Ozempic and you are too excited about your diabetes and weight loss journey, you may not sleep well because of all the heck going on in your mind.
Similarly, if your first injection gives you bad side effects and you are not happy as this goes without your expectations, you may have bad dreams and insomnia.
Try to take it easy. Consider Ozempic and Mounjaro as one of your diabetes medications. Don’t judge too early or too late as some of its fruitful effects may be observed very late.
Fatigue, tiredness, and Insomnia:
Fatigue and tiredness are reported frequently by patients using Ozempic or Mounjaro. Common reasons include a change in appetite, muscle loss, bad GI side effects, anxiety, palpitations, and a direct effect on the brain.
You can overcome fatigue if you start a little workout daily. You will get tired easily but with time your stamina will increase and you will feel more energetic.
You may also try some supplements like vitamin B12 and Vitamin D to get rid of fatigue. However, you may need to see your doctor if your fatigue is not going away and you are losing or gaining weight, develop menstrual irregularities, or have persistent GI upsets.
These symptoms may be suggestive of thyroid disorder with Ozempic and Mounjaro, iron deficiency as a result of heavy bleeding, and pancreatitis or electrolyte imbalance.
Here are some reviews of patients who develop fatigue and tiredness while using Ozempic and Mounjaro:
| “I began taking Ozempic in March, and ever since then, I’ve been struggling with sleep. On a good night, I manage to get only around 4 hours of sleep, if I’m lucky. No matter how tired I am, I just can’t seem to find a restful sleep. This is particularly challenging for me because I’m currently in Grad school, and the lack of sleep is affecting my studies. On top of that, I’m not seeing any weight loss results. It’s making me seriously consider quitting Ozempic altogether. |
| “Has anyone else been feeling extremely tired while taking Ozempic? I’ve always struggled with insomnia, so sleep has been a challenge for me my entire life. However, ever since I started Ozempic, and especially since I raised my dosage to 0.5mg last week, I’ve been feeling incredibly tired and sleepy. It’s really affecting my energy levels. I’m wondering if anyone else has experienced this side effect” |
| “I also experience tiredness, and I’ve noticed some really unusual and vivid dreams since starting Ozempic. I’m not sure if this is a common side effect, but it’s something that I’ve personally been experiencing” |
| I understand what you’re going through. I’m currently on week 3 of Ozempic as well, and I’ve been feeling exhausted since the day after my first injection. It’s been a struggle to stay awake, and I find myself taking naps after work or going to bed much earlier than usual. It doesn’t seem to matter what I do, I just can’t seem to get enough sleep. It’s quite frustrating and disheartening. |
Anxiety and Insomnia:
Anxiety and depression are probably among the top causes of insomnia. Anxiety is very prevalent and may or may not be associated with Ozmepic or Mounjaro injections.
However, people who develop severe side effects may develop anxiety or notice a worsening of their symptoms of anxiety and insomnia.
If you have symptoms of anxiety and insomnia, you should avoid the triggers, go for a walk, indulge in activities that you love the most, and consult your doctor.
Certain medications that can treat both anxiety and insomnia include:
- Short-acting benzodiazepines such as Triazolam, Temazepam, and Estazolam [Ref]
- Hypnotics such as Eszopiclone (Lunesta), Zolpidem (Ambien), and Zaleplon (Sonata)
- Melatonin agonists such as Ramelteon (Rozerem)
- Antidepressants such as Trazodone, Mirtazapine, Amitriptyline
- Orexin antagonists such as Daridorexant (Quviviq), Lemborexant (Dayvigo), Suvorexant (Belsomra)
Here are some patients reviews who develop anxiety and insomnia while using Ozempic:
| “Wow, I’m in my second week of taking Ozempic, and it’s been tough. I can’t sleep at night, and it’s making me feel miserable. The insomnia is really bad, especially from the night I get the injection until the third day. On top of that, I’m dealing with acid reflux and a sour stomach. I appreciate that you’ve lost weight with this medication, but I think you should seriously consider stopping it. Insomnia can lead to depression, anxiety, and other problems that might be worse than being overweight. My husband is also taking Ozempic to lose weight, but he hasn’t experienced any side effects yet. Personally, I’m thinking about quitting it. I hope things improve soon. I’ve also noticed that my blood pressure seems to be acting up more than usual since starting Ozempic. I’m not willing to take antipsychotics or benzodiazepines to deal with the insomnia. I’d rather wait and see if the situation with the Ozempic gets better on its own.” |
| “I’ve been dealing with terrible insomnia for around three days after taking my dose as well. It’s been really challenging, and nothing I’ve tried seems to help. However, I recently started adding magnesium and CBD to my routine along with Benadryl and Gabapentin, and finally, I’m able to sleep. It’s been a rough journey, and I’ve also experienced feelings of anxiousness and panic. Insomnia can really take a toll on your overall well-being.” |
Hyperglycemia and Insomnia:
Hyperglycemia is not common if your doctor adjusted your dose properly. However, some patients stop all diabetes medicines including Insulin and oral antidiabetic drugs when they start Ozempic or Mounjaro.
This may lead to hyperglycemia. In addition, the first four weeks are intended to develop tolerance and observe for any side effects. During the first four weeks, hyperglycemia is more common.
Hyperglycemia or high blood sugar can cause you to wake up at night to pee. In addition, it can cause dehydration which can also lead to insomnia.
To avoid hyperglycemia, it is best to consult your doctor. You may need to check your blood glucose a little more frequently during the first few weeks to avoid fluctuations in your glucose levels.
What helped patients achieve sound sleep while using Ozempic and Mounjaro?
Magnesium supplements:
Magnesium supplements are the best alternatives for people who do not like to use prescription medications or sleep medications because of their addictive properties.
Magnesium supplements have been proven in clinical trials for their efficacy in sleep disorders. In one study conducted on elderly patients who had insomnia, magnesium improved sleep scores and reduced the time to sleep and nighttime or early awakenings.
There are several magnesium supplements, however, Magnesium Glycinate is considered the best for people who have insomnia.
Here are some of the patients’ reviews about magnesium supplements for insomnia caused by Ozempic:
| I’ve always struggled with sleep issues, and unfortunately, I’ve noticed that Ozempic sometimes makes it even worse. However, I came across a suggestion from someone on another page to try taking magnesium glycinate before going to bed, and I’ve found that it has actually helped me a bit. |
| Magnesium can indeed be helpful for improving sleep, and if you’re feeling particularly anxious and tense at night, you can try adding 1/4 teaspoon of magnesium to a glass of water and drinking it. Additionally, sodium can aid in reducing cortisol levels in your body, and sometimes it’s the only thing that helps me during my most challenging nights of insomnia, even after taking melatonin and magnesium. |
Gabapentin for insomnia associated with Ozempic:
Gabapentin and Pregabalin are two drugs that are commonly used to treat diabetic patients with painful neuropathy. Although these are not sleep medicines, they may help people go to sleep.
Gabapentin may be best for you if you have body pains, burning feet, and insomnia as it will relieve most of these symptoms.
Here is a patient’s review of how Gabapentin helped her insomnia:
| No doubt about it, this is definitely a side effect, whether it’s officially recognized or not. It’s the middle of the night right now, and I’m awake, reading, and feeling frustrated. I’ve been taking a dosage of 1, and for the past two weeks, I tried taking the full dose instead of splitting it. But now I’ve decided to go back to splitting the dose because this is just terrible. Thankfully, taking Sonata along with Gabapentin and Atarax has provided some relief for me. |
Trazodone (Desyrel), Mirtazapine (Remeron), and Quetiapine (Seroquel):
Trazodone and Mirtazapine are two atypical antidepressants with sleep-inducing properties. These drugs may help people have sound sleep and relieve symptoms of depression as well.
In addition, these drugs have little addictive potential than most drugs, especially Lorazepam, Clonazepam, and Alprazolam. Trazodone should be avoided by patients who have cardiac disease.
Seroquel is an atypical antipsychotic. Some people find it much more helpful than most conventional sleep medications.
Here is a patient’s review of Trazodone that helped him sleep well:
| Trazodone is often considered a great option for insomnia because it’s non-addictive and doesn’t lead to weight gain. Although it doesn’t work for me personally, it’s been a lifesaver for many people. Right now, I’m taking Seroquel, but I’m hoping to stop because it’s causing me to gain weight. I think this weight gain might be hindering the significant results I could be seeing from Ozempic. If your insomnia is severe, it might be worth considering a combination of natural remedies and medication to address it. |
Vitamin B12 for insomnia:
Vitamin B12 may help you sleep better if you have a deficiency of vitamin B12 as a result of prolonged metformin use or if your diet is not good.
Vitamin B12 may help relieve your symptoms of numbness, burning, and other symptoms of peripheral neuropathy and may directly or indirectly help you sleep well.
Here is a patient review of Vitamin B12 helping her sleep well.
| “B12 and electrolytes can be really beneficial for you. When I increased my dosage to 0.5mg, I felt completely drained and exhausted. However, I found that taking B12 supplements and replenishing my electrolytes made a significant difference. They provided me with the energy and support I needed during that time. So, I would definitely recommend considering B12 supplements and focusing on electrolyte replenishment to help you feel better too” | e |
In conclusion:
The causes of Ozempic and Mounjaro-associated insomnia are multifactorial. One should avoid certain medications like decongestants, stimulant drugs, and theophylline.
Caffeinated drinks and teas should be best taken in the morning. Hypoglycemia and hyperglycemia should be identified and corrected.
Supplements such as Vitamin B12 and magnesium may be tried, however, sleep medications are often needed.
