How your chronotype and your sleep affect the medication you take
When you’re sick, sleep often becomes difficult. If you’re uncomfortable or in pain, it can be harder to fall asleep and stay asleep throughout the night. When you’re under the weather, you might wake a lot more often, toss and turn, and struggle to get comfortable in your bed.
Medications you take for illness also can affect sleep, even as they help to heal what ails you.
What’s more, the timing of dosage can have a significant influence on the effectiveness of medications you take. That’s right: there is a when to taking medication, in alignment with your chronotype.
Using your chronotype to heal faster
Some of the very first breakthroughs in our understanding of chronotype and bio time came from studying the daily bio rhythms of disease and of healing. Decades ago, pioneering scientists discovered daily fluctuations in immune system function, as well as in the body’s response to toxins and to medications used to heal.
These scientific discoveries happened more than a half-century ago. But the standard approach to the timing of medication dosage hasn’t changed much. The “take once a day” model that most of are accustomed to using doesn’t take into account the role that chronotype plays in the effectiveness of our medicines.
Fortunately, the old model is starting to change, as doctors and scientists pay greater attention to the influence of bio time on healing. Recent research shows that some of the most commonly used mediations work better when taken at certain times of day:
Aspirin. In 2014, scientists looked at the timing of aspirin use among heart attack survivors. Because of its ability to reduce blood platelet activity and clotting, aspirin is often prescribed to people who’ve suffered a heart attack, to reduce their future risk. Blood platelet activity follows a daily bio rhythm, and is most active in the morning. Scientists tested dosing first thing in the morning and in the evening. They found the evening aspirin dose was more effective at reducing platelet activity than the morning dose. Also, the patients who took evening doses tolerated the stomach upset that aspirin can bring better than the morning dose patients. Why did the evening dose work better? A nighttime dose of aspirin prevented platelets from forming. And asleep, patients weren’t bothered by stomach upset.
Statins. Scientists examined the effect of morning and evening dosing on lowering cholesterol. The body produces cholesterol in larger quantities overnight. Researchers found that statins work more effectively to reduce cholesterol when taken before bed.
High blood pressure medication. Blood pressure fluctuates on bio time. It rises in the morning and drops between 10-20 percent overnight. When people have high blood pressure, their levels stay high at night rather than dropping. Scientists studying the impact of this lack in blood pressure drop on heart attack and stroke risk found that people who take high blood pressure medication at night have a 33 percent lower risk, compared to people who take their pills in the morning.
There are also exciting developments in cancer treatment using bio-time strategies. Cancer tumors grow more aggressively at night. Scientists have identified a daily rhythm to a class of steroid hormones, known as glucocorticoids, or GCs, that interact with cell receptors. These cell receptors promote cell growth—both in healthy cells and in malignant ones. GC levels are high during the day and low at night. When GC levels are low, those cell receptors become more active and tumors grow more aggressively. In studies of mice, scientists have found that the giving drugs designed to inhibit those cell receptors at night results in smaller tumors.
Why chronotype matters to your medication
What’s behind the bio time of medication dosing? Why do medications work better at some times than others? Because the illnesses themselves fluctuate according to their own bio rhythms. Many conditions present themselves differently throughout the day:
Allergies are at their worst in first thing in the morning. Pollen accumulates during the night. That’s the reason allergy sufferers are apt to wake up sneezing and wheezing.
Arthritis pain and stiffness also peak in the morning. The worst hours of the day for arthritis are between 8 a.m. and 11 a.m. That’s because the immune system goes into high gear at night, increasing inflammation.
Asthma attacks occur most frequently in the early morning, between 4-6 a.m. That’s when lung function is at its worst.
Depression is another condition that is most aggravated in the morning. The worst time for depression symptoms? Upon waking, around 8 a.m.
Heart attacks happen most often between 6 a.m. and noon, due to overactive platelets and clotting proteins.
High blood pressure will reach its peak in the evening, around 9 p.m.
High blood sugar will be especially elevated in the morning. That’s because your liver pushes glucose into your system between 4-6 a.m., to help wake you up for the day.
Hot flashes in menopausal women tend to be most intense and frequent in the evening and throughout the overnight hours.
Migraines begin to form most often at around 4 p.m. and are most often felt first thing in the morning.
Restless leg syndrome is worst in the evenings and during the night.
Seizures happen most frequently between 3 p.m. and 7 p.m.
Strokes are most likely to occur in the morning, between 6 a.m. and noon.
Tension headaches appear most often in the late afternoon.
There is a best time to take your meds
Think about the advice and instructions you’ve received over the years about the timing of taking your medication.
Take at meals, to avoid an upset stomach, or
Take at bedtime—or first thing in the morning.
These directions are often about convenience—bedtime and first thing in the morning are easy times to schedule a routine dose of medication. They’re also about comfort—because medication can sometimes make your stomach hurt, and that’s no fun.
In most cases, these directions don’t take into consideration the time of day when a medication can have the greatest effect in healing. Thanks to ongoing scientific research, we’re learning more and more about the bio rhythms of illness—and how to time medications to harness their power.
Best bio times for meds
Drug - Ideal dosing time
Antihistamines - evening
Aspirin - bedtime
ACE inhibitors and ARBs - bedtime
Acid reflux drugs - before breakfast
Beta-blockers - bedtime
Corticosteroids - afternoon, to help reduce overnight inflammation
Heartburn pills - after dinner
Multivitamin - after breakfast
NSAIDs - four hours before maximum pain
Osteoporosis drugs - an hour before breakfast
Probiotics - with breakfast
Rheumatoid arthritis drugs - bedtime
Statins - bedtime
One important note: You should always consult your doctor before you make any changes to your existing medication routine. This is not medical advice, but it is information you can use as a conversation-starter with your physician at your next appointment.
There is even a best time to call in a prescription. When getting medication from your pharmacy, plan to call in the prescription in the morning—and schedule to pick up your medication in the afternoon. Getting your prescription in early, and giving the pharmacy plenty of time to prepare your medication, will reduce the likelihood of a mistake caused by rushing.
Talk with your doctor about the timing of your medications. If your physician is not familiar with the influence of bio time on dosing, mention the studies I’ve discussed here as a way to get this important conversation rolling.
Michael J. Breus, PhD
The Sleep Doctor™