Hydroxychloroquine (HCQ), commonly known by the brand name Plaquenil, is often prescribed to reduce symptoms of lupus, including fatigue. It may even contribute to improved energy levels in some people. Its relatively low risk of serious side effects makes HCQ a long-term treatment option for many people with lupus. In fact, rheumatologists often recommend that people with lupus stay on HCQ for the long term or even for life.

However, because HCQ can help improve energy levels, some people worry that hydroxychloroquine might interfere with their sleep or even cause vivid dreams. One MyLupusTeam member said, “I’m wondering if the second (nighttime) pill gives me such a surge of energy that it’s keeping me awake. I can’t sleep!”

For those taking HCQ regularly, understanding how it might affect sleep and choosing the best time to take it can be crucial. Here’s a closer look at how HCQ might impact sleep, when to take it, and tips for achieving the best results while minimizing side effects.

Common Side Effects of Hydroxychloroquine

Hydroxychloroquine is generally well tolerated, but like most medications, it can have side effects. Although HCQ is known for its safety, newer studies suggest insomnia may be a lesser-known side effect of hydroxychloroquine, contrary to previous assumptions. In fact, HCQ has been found to potentially cause sleep disturbances for some users, with possible symptoms including anxiety, rapid heartbeat, night sweats, vivid dreams, or nightmares. Together, these effects could negatively affect how long and well you sleep. If you have these symptoms and they are bothersome, talk to your doctor.

The most common side effects of hydroxychloroquine are gastrointestinal side effects, which affect the stomach and include:

• Nausea
• Diarrhea
• Stomach cramps
• Vomiting

These symptoms can also affect your ability to get a good night’s sleep, but they should clear up after a few days, once your body starts adjusting to the medication.

Can You Take Hydroxychloroquine at Bedtime?

This can be a common question for those who want to avoid daytime side effects like nausea or stomach cramps. Some people may wonder if taking HCQ right before bed might help avoid daytime side effects by allowing them to sleep through any discomfort. While this may work for some, this timing isn’t the best choice for everyone. If HCQ gives you an energy boost, taking it at night may interfere with sleep quality. On the other hand, if nausea or cramping is your main concern, taking HCQ at night could help. The best way to figure out what works for you is to talk to your health care provider. They can help you adjust the timing of your HCQ to fit your symptoms and daily routine.

Other Causes of Insomnia With Lupus

Most people with lupus experience sleep problems, such as difficulty falling asleep or waking up often throughout the night. These issues can lead to daily fatigue, a weakened immune system, and an increased risk of depression.

There are several reasons why people with lupus have trouble sleeping. Symptoms like chronic pain, hot flashes, and itchy skin can make it hard to sleep. Other medications you take to manage lupus flares can also affect your sleep.

For example, the corticosteroid prednisone can cause hyperactivity. Taking prednisone first thing in the morning can help prevent it from keeping you up at night.

While some causes of insomnia are easy to spot, others can be harder to figure out, especially if they’re due to a combination of factors. Your doctor might suggest a sleep study or other tests to learn more about your insomnia before offering specific medical advice.

Strategies To Improve Sleep

Making some changes to your daily routine can improve your sleep. Here are some tips for better sleep:

• Stick to a consistent sleep schedule, which may include going to bed and waking up at the same time each day.
• Limit your caffeine intake. The U.S. Food and Drug Administration (FDA) says up to 400 milligrams of caffeine per day is safe for most adults, but everyone reacts to caffeine differently.
• Avoid caffeine at least eight hours before bedtime. If you go to bed at 10 p.m., stop drinking caffeine after 2 p.m.
• Stay away from alcohol before bed, as it tends to cause insomnia and excessive sleepiness the next day.
• Finish eating at least one to two hours before bedtime.
• Keep pets out of the bedroom.
• Make sure your mattress and pillows are comfortable.
• Set up your bedroom environment to be cool and dark.
• Try using a sound machine or fan to drown out distracting sounds.
• Turn off electronic devices with screens, such as mobile devices, phones, and TVs, at least 30 minutes before bedtime.

If you take naps, try to nap at the same time each day as well. Don’t nap too close to bedtime, as it may make it harder to sleep at night. A 20-minute nap may be enough to give you a boost. Otherwise, aim for 90 minutes, which is the length of an average sleep cycle.

Addressing Potential Side Effects of Hydroxychloroquine

If hydroxychloroquine makes you feel restless or causes you to fidget or pace around, exercise might help. Exercise can help control anxiety that may negatively impact your sleep and quality of life. However, if you have joint pain or other health issues, it’s a good idea to speak with a physical therapist before choosing a workout program. They can help you find exercises that are safe and beneficial for your body.

You can also ask for a referral to a mental health professional. They can suggest relaxation techniques and counseling to better manage stress. If you notice any symptoms of heart rhythm changes while taking hydroxychloroquine, such as a fast heartbeat or “thumping” in your chest, report them to your doctor. These could be signs of a serious side effect or health condition other than anxiety.

Answering questions about medications and their side effects isn’t always easy, as people can respond differently to the same drugs. Most people who take hydroxychloroquine don’t experience more difficulty sleeping, but some do.

Your health care provider can help you weigh the pros and cons of different lupus treatment options. They can guide you in deciding if a specific medication is right for you. You can also connect with other people — such as MyLupusTeam members who’ve taken hydroxychloroquine for decades — to get different perspectives and feel more confident in your treatment decisions.

Talk With Others Who Understand

MyLupusTeam is the social network for people with lupus and their loved ones. On MyLupusTeam, over 232,000 people with lupus come together to ask questions, give advice, and share their stories.

Have you experienced any adverse effects from hydroxychloroquine related to sleep? Do you use any over-the-counter sleep aids or other treatments? Post your thoughts in the comments below, or start a conversation by sharing on your Activities page.