If you have obstructive sleep apnea (OSA), you should not take sleeping pills without first talking with your doctor. Some sleep medications can relax the muscles in the upper airway or reduce your body’s ability to respond to breathing problems during sleep, potentially making OSA worse. However, not all sleep aids affect breathing in the same way. A sleep doctor can determine whether sleeping pills are safe for you based on your OSA severity, current treatment, other medications, and the cause of your insomnia.

Current clinical guidance also recommends cognitive behavioral therapy for insomnia, known as CBT-I, as the first choice for chronic sleeplessness (1). When medication is needed, doctors may consider prescription options. At the same time, experts advise against routinely using older sedatives like benzodiazepines, over-the-counter antihistamines, or trazodone (1).

Why Some Sleeping Pills Pose a Breathing Risk

During normal sleep with obstructive sleep apnea, the soft tissues in your throat collapse and block your airway. When your airflow stops, your oxygen levels drop and carbon dioxide builds up. Normally, your brain senses this change and triggers a brief, subconscious awakening to reopen your airway so you can breathe again.

The main danger with certain sleeping pills is that they alter this safety system. Heavy sedatives can relax the throat muscles even further, making collapses more frequent. They can also raise your waking threshold, meaning your brain takes longer to realize you are choking. In a review of patients with diagnosed OSA, recent use of benzodiazepines was linked to 2.7 times higher odds of experiencing adverse respiratory events and acute breathing failure (2).

Because different drug families work on different brain receptors, the specific medication you take makes a huge difference.

Are Benzodiazepines Safe With Sleep Apnea?

Benzodiazepines include familiar medications like clonazepam, lorazepam, diazepam, alprazolam, and temazepam. These medications require extra caution when sleep apnea is present.

The official prescribing label for clonazepam warns that it can cause respiratory depression and should be used cautiously in people with breathing disorders, including sleep apnea (3). The danger increases significantly if these medications are combined with alcohol or prescription pain relievers (3).

If you already take a benzodiazepine every night, do not stop taking it cold turkey just because you received a sleep apnea diagnosis. Sudden stopping can trigger severe and potentially dangerous withdrawal symptoms (3). Instead, our sleep physicians work with patients to create a safe, gradual taper while setting up proper airway treatment.

Can You Take Ambien, Lunesta, or Other Z-Drugs?

Medications like zolpidem (Ambien), eszopiclone (Lunesta), and zaleplon belong to a class called Z-drugs. These drugs affect the brain differently than classic benzodiazepines, and research shows they do not universally worsen sleep apnea.

A large analysis of 17 studies found that Z-drugs generally did not increase the number of nightly breathing pauses in people with sleep apnea (4). However, these drugs are still not risk-free. The prescribing information for zolpidem notes that patients with mild to moderate sleep apnea spent more time with lower oxygen levels when taking the medication compared to a placebo (5). A sleep specialist must still review your oxygen history and medical background before deciding if a Z-drug is appropriate for you.

Are Newer Orexin Sleeping Pills (DORAs) Safer?

A newer class of prescription sleep aids known as dual orexin receptor antagonists, or DORAs, offers an encouraging alternative. Instead of sedating the whole brain like older sleeping pills, medications like suvorexant, lemborexant, and daridorexant simply turn down the chemical signals that keep you awake.

Clinical trials have shown promising results for people with sleep apnea:

  • A review of multiple clinical studies found that DORAs improved total sleep time and sleep quality without significantly increasing breathing interruptions or dropping oxygen saturation (6).
  • In a five-day study testing daridorexant in adults with severe, untreated sleep apnea, patients gained about 32.5 minutes of extra sleep per night with no meaningful worsening in their breathing events or oxygen levels (7).
  • Similar studies testing lemborexant in moderate to severe sleep apnea found no significant differences in oxygen drops compared to a placebo (8).

While these results are reassuring, they do not mean these drugs are safe for everyone. Your overall lung health, age, and apnea severity still dictate what is safe. A sleep specialist must still review your full clinical picture before deciding whether a Z-drug is appropriate.

The Overlap: Insomnia and Sleep Apnea (COMISA)

Many people assume their sleeplessness comes down to just one condition, but insomnia and sleep apnea frequently occur together. This condition is called COMISA, short for comorbid insomnia and sleep apnea.

Research indicates that about 38% of people with sleep apnea also meet the criteria for clinical insomnia (9). Furthermore, roughly 35% of people seeking help for insomnia turn out to have underlying sleep apnea (9).

In our clinic, we see this frustration firsthand. Patients often feel completely exhausted from airway blockages during the day, yet find themselves lying wide awake at night. When they try starting continuous positive airway pressure (CPAP) therapy, racing thoughts or bedtime anxiety can make tolerating the mask feel impossible.

Why Behavioral Therapy (CBT-I) Comes First

Before relying on nightly medication, treating the underlying insomnia habits is the most durable solution. Cognitive behavioral therapy for insomnia (CBT-I) uses structured adjustments in your sleep schedule and thoughts to rebuild natural sleep drive.

When used alongside sleep apnea treatment, CBT-I creates lasting improvements. In a clinical trial of patients with both conditions, completing four CBT-I sessions before starting CPAP helped patients wear their mask an average of 61 minutes longer each night, with a 99% initial treatment acceptance rate (10). Addressing sleep anxiety directly makes staying on airway therapy much easier.

What to Tell Your Doctor

Before you take any pill to help you sleep, have an open discussion with your doctor and bring the following:

  • Your most recent sleep study report showing your apnea severity and oxygen levels.
  • Your current CPAP or oral appliance compliance data.
  • A complete list of all medications, including over-the-counter sleep aids, allergy pills, pain relievers, and supplements.

If you struggle with sleep apnea and cannot fall asleep or stay asleep, our team at The Insomnia and Sleep Institute of Arizona can evaluate both conditions together. With locations across Phoenix, Scottsdale, and Gilbert, our board-certified sleep physicians can help you address the root cause of your sleeplessness and find the safest path to a restful night. Message us!

References

  1. VA.gov | Veterans Affairs. (2025). DeptVetAffairs. https://www.healthquality.va.gov/guidelines/CD/insomnia/index.asp
  2. Wang, S.-H., Chen, W.-S., Tang, S.-E., Lin, H.-C., Peng, C.-K., Chu, H.-T., & Kao, C.-H. (2019). Benzodiazepines Associated With Acute Respiratory Failure in Patients With Obstructive Sleep Apnea. Frontiers in Pharmacology, 9. https://doi.org/10.3389/fphar.2018.01513
  3. DailyMed – CLONAZEPAM tablet. (2026). Nih.Gov. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=3aa9c3eb-3a0a-4e8b-af68-4f87d87194dd
  4. Nigam, G., Camacho, M., & Riaz, M. (2019). The effect of nonbenzodiazepines sedative hypnotics on apnea–hypopnea index: A meta-analysis. Annals of Thoracic Medicine, 14(1), 49. https://doi.org/10.4103/atm.atm_198_18
  5. (2022). Nih.Gov. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=404c858c-89ac-4c9d-8a96-8702a28e6e76
  6. Yeh, W. C., Li, Y. S., Chang, Y. P., & Hsu, C. Y. (2024). The efficacy and safety of dual orexin receptor antagonists in obstructive sleep apnea: A systematic review and meta‐analysis of randomised controlled trials. Journal of Sleep Research, 34(4). https://doi.org/10.1111/jsr.14399
  7. Fietze, I., Boof, M.-L., Lederer, K., Lemoine, V., Vaillant, C., & Pépin, J.-L. (2026). Daridorexant in severe obstructive sleep apnea: effects on sleep-disordered breathing and sleep. Sleep. https://doi.org/10.1093/sleep/zsag145
  8. Cheng, J. Y., Lorch, D., Lowe, A. D., Uchimura, N., Hall, N., Shah, D., & Moline, M. (2024). A randomized, double-blind, placebo-controlled, crossover study of respiratory safety of lemborexant in moderate to severe obstructive sleep apnea. Journal of Clinical Sleep Medicine, 20(1), 57–65. https://doi.org/10.5664/jcsm.10788
  9. Zhang, Y., Ren, R., Lei, F., Zhou, J., Zhang, J., Wing, Y.-K., Sanford, L. D., & Tang, X. (2019). Worldwide and regional prevalence rates of co-occurrence of insomnia and insomnia symptoms with obstructive sleep apnea: A systematic review and meta-analysis. Sleep Medicine Reviews, 45, 1–17. https://doi.org/10.1016/j.smrv.2019.01.004
  10. Sweetman, A., Lack, L., Catcheside, P. G., Antic, N. A., Smith, S., Chai-Coetzer, C. L., Douglas, J., O’grady, A., Dunn, N., Robinson, J., Paul, D., Williamson, P., & McEvoy, R. D. (2019). Cognitive and behavioral therapy for insomnia increases the use of continuous positive airway pressure therapy in obstructive sleep apnea participants with comorbid insomnia: a randomized clinical trial. Sleep, 42(12). https://doi.org/10.1093/sleep/zsz178

 

Disclaimer: The information provided in this blog post is for educational and informational purposes only and is not intended as a substitute for professional medical advice, diagnosis, or treatment. Always consult with a licensed healthcare provider for recommendations specific to your individual health needs.