How to Sleep While Taking Cymbalta

We all need sleep — it’s essential for both physical and mental health. But there are many factors that can influence sleep quality, including mood disorders, chronic pain, and the side effects of certain medications.

All are common issues, and they often go hand in hand. Chronic pain can lead to depression, which can then make the pain worse, or vice versa, according to research.

In fact, around 22.8 percent of adults in the U.S. experienced mental illness in 2021, and 14.5 percent had trouble falling asleep in 2020. Over 20 percent experienced chronic pain in 2019. If you live with major depression or chronic pain, chances are you’ve heard of or been prescribed Cymbalta®.

Cymbalta is primarily used to treat depression, anxiety, and certain chronic pain issues. However, it may come with side effects, including sleep disturbances.

Poor sleep can worsen depression and physical health, leading to a cycle of deteriorating emotional health and overall well-being. But rest assured, there are ways to overcome this issue.

Below, we’ll explain how this drug works, outline its common side effects, and give you some tips on how to sleep while taking Cymbalta.

Cymbalta, the brand name for the active ingredient duloxetine, belongs to a class of drugs known as serotonin-norepinephrine reuptake inhibitors (SNRIs). SNRIs work primarily on two chemicals in the brain: serotonin and norepinephrine.

Essentially, Cymbalta prevents brain cells from reabsorbing these two neurotransmitters, which positively affect your mood and help relieve pain. 

Approved by the FDA in 2004, Cymbalta is one of the most commonly prescribed antidepressants for mental health disorders, including:

• Major depressive disorder

• Generalized anxiety disorder

• Fibromyalgia

• Nerve pain and damage from diabetes (diabetic peripheral neuropathy)

• Long-term musculoskeletal pain

Many medications can cause side effects, and Cymbalta is no exception. Here are some of Cymbalta’s more common side effects:

• Nausea, constipation, and diarrhea

• Headache

• Dry mouth

• Sleepiness or tiredness

• Having trouble sleeping (insomnia)

• Dizziness

• Loss of appetite

• Excessive sweating

• Feeling nervous and agitated

Typically, these side effects go away or improve within a week or two.

Another possible side effect is sexual dysfunction, which can include low libido and trouble ejaculating and reaching orgasm. Also, research shows that some people initially experience weight loss followed by weight gain after long-term Cymbalta use.

As with any medication, there’s also a risk of side effects that are more severe. These can include:

• Liver problems and liver failure

• Eye pain and blurred vision

• Vertigo

• Allergic reactions and skin reactions, like blisters

• Abnormal bleeding

• Abdominal pain

• Seizures

Here are a few other medical conditions, interactions, and precautions to consider before taking Cymbalta:

• Serotonin syndrome — which may happen when there’s too much serotonin in your body, which may cause confusion, seizures, and unconsciousness — can be a side effect of taking SSRIs and SNRIs. That said, interactions with other drugs, such as monoamine oxidase inhibitors (MAOIs), antipsychotics, and blood thinners like warfarin, more commonly cause serotonin syndrome.

• Another serious side effect in children, adolescents, and young adults is suicidal thoughts. Watch for worsening suicidal thinking and behavior in kids and young adults.

• Cymbalta is not advised for people with glaucoma or a family history of glaucoma, or for people who use MAOIs.

• Cymbalta can make it harder to control blood sugar, so if you have diabetes, make sure to discuss this with your doctor before taking Cymbalta.

• More studies are needed to fully understand the impact of Cymbalta on people who are pregnant or breastfeeding, so talk to your doctor if you plan to be either. 

Reach out to your healthcare provider if you experience any of these rare but serious symptoms or if you have any of the above conditions.

Also, keep in mind that going off Cymbalta can cause withdrawal symptoms, so be sure to speak with your healthcare provider before you stop taking the medication.

Looking for more details? Our complete guide to duloxetine (Cymbalta) side effects goes over all the common side effects and risks of using Cymbalta for mood disorders.

You can also look at the prescribing information to learn more about the side effects, and talk to your doctor about drug interactions if you’re taking other medications for existing health conditions.

Yes, Cymbalta can affect sleep. And can cymbalta make you tired? Also yes. Feeling tired and sleepy or having trouble sleeping are common side effects of Cymbalta. 

You may wonder, how is it possible that one medication can produce opposite side effects? Well, medications can cause different side effects for different people. Additionally, when a medication affects the functioning of the sleep-wake center in the brain, you can see a range of disturbances, including both difficulty sleeping at night and fatigue during the day.

These side effects can be temporary, but that doesn't mean they aren’t uncomfortable or disruptive while they’re happening.

Nine percent of those taking Cymbalta report having insomnia or trouble falling or staying asleep.

On the other hand, if you’re having trouble starting or maintaining activities, difficulty concentrating, or a combination of the two, you may be experiencing fatigue as a side effect of Cymbalta. However, if the fatigue was present before starting Cymbalta, it’s more likely to be a symptom of anxiety or depression, which frequently cause fatigue.

There are many reasons why you may be experiencing insomnia. But if you’re having trouble sleeping after starting the medication, you may have Cymbalta insomnia. Trouble sleeping or insomnia can also be an adverse effect of Cymbalta withdrawal.

This is because Cymbalta and other SNRIs prevent your brain cells from reabsorbing serotonin and norepinephrine, which keep the brain active when awake.

Norepinephrine and serotonin also suppress rapid eye movement (REM) sleep, the deeper sleep state that sets in about 90 minutes after falling asleep.

Since Cymbalta helps keep more serotonin and norepinephrine in your system, you may feel more energized and have trouble falling asleep.

Adequate sleep promotes mental and physical well-being, so let’s discuss ways to address Cymbalta-induced insomnia.

1. Keep track of side effects

Whenever you start a new medication, it’s always wise to keep track of side effects and to let your healthcare provider know if any new ones emerge.

For the first few weeks on Cymbalta, pay attention to your sleep — and if you’re having trouble falling or staying asleep.

A healthcare professional may recommend waiting to see if the side effect resolves itself on its own. If your insomnia doesn’t go away, they may suggest trying a sleeping pill or a different medication or treatment for your depression.

2. Consider dosage

When starting a new antidepressant, you’ll typically be prescribed a lower dosage, and your healthcare provider may gradually increase it until reaching the recommended amount. You should take the same dose for at least 7 days before increasing the dosage.

One single patient trial found that higher dosages of Cymbalta might make insomnia worse.

If you start experiencing insomnia after increasing your dosage, your provider may choose to wait for the side effects to subside and for your body to adjust before increasing the amount of medication again. Your prescriber may also reduce your Cymbalta dosage or have you taper off to reduce withdrawal effects if insomnia persists.

3. Try appropriate sleep aids

If you’ve been having insomnia since starting Cymbalta, certain sleep aids can help. For example, some research has shown that melatonin makes it easier to fall asleep and establish better sleeping patterns.

Melatonin is safe to use with the typical dosage of 1mg to 5mg nightly. However, using melatonin while taking Cymbalta can increase side effects of dizziness, drowsiness, confusion, and difficulty concentrating. 

Keep in mind that other sleep-related over-the-counter supplements and medications can have adverse effects when taken with Cymbalta. These include:

• St. John’s wort

• Antidepressants like MAOIs (including phenelzine)

• Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen

• Blood thinners

• Some migraine medications (like naproxen) and other painkillers (like tramadol)

• High blood pressure medications

Make sure to let your healthcare provider know about any other medications you are taking or will take — including melatonin — before starting a Cymbalta prescription to treat anxiety or depression.

4. Change your Cymbalta schedule

If you notice that you’re feeling either fatigued or more alert and energized after taking your Cymbalta dose, you may want to change your dosage schedule.

Cymbalta can be taken at any time of day, but it should be taken at the same time every day for the most effective results.

If you currently take Cymbalta at night but are having trouble sleeping, talk to your healthcare provider about taking it first thing in the morning instead.

5. Avoid caffeine

While many of us turn to coffee to beat the afternoon slump, caffeine comes back with a vengeance when you’re trying to sleep. Caffeine blocks the chemical adenosine, which signals our body to become drowsy and sleep to rebuild energy levels.

Try to eliminate that post-lunch cup of coffee or switch to a drink with lower levels of caffeine, such as green tea. You can also try stretching or walking around the block for an energy boost that won’t mess with your sleep.

6. Practice good sleep hygiene

A promising way to ensure you get a good night’s rest is to have good sleep hygiene. Some tips include:

• Keep a set bedtime and wake-up time (even on the weekends)

• Avoid large meals too close to bedtime

• Limit or stop screen time at least 30 minutes before bed

• Take time to unwind from the day

Establishing a routine before your head hits the pillows will help you sleep better at night.

If you and your doctor decide that Cymbalta isn’t the right treatment option, there are other alternatives you can consider. We’ll highlight a few below. Keep in mind that these medications come with side effects, too. 

Other SNRIs

As we’ve mentioned, Cymbalta is an SNRI. These antidepressants are often prescribed to treat chronic pain, depression, and anxiety. Aside from Cymablta, there are a few different types of SNRIs, including:

• Venlafaxine (Effexor®)

• Desvenlafaxine (Pristiq®)

• Levomilnacipran (Fetzima®)

The side effects of other SNRIs are similar to those of Cymbalta.

Selective Serotonin Reuptake Inhibitors (SSRIs)

Unlike SNRIs, SSRIs only act on serotonin. They’re also some of the most common types of antidepressants for depression and anxiety treatment. Some examples include:

• Escitalopram (Lexapro®)

• Paroxetine (Paxil® and Seroxatr®)

• Sertraline (Lustral and Zoloft®)

• Fluoxetine (Prozac®)

Tricyclic Antidepressants (TCAs)

Emerging in the mid-20th century, TCAs were some of the first antidepressants developed. Some examples are:

• Imipramine (Tofranil®)

• Clomipramine (Anafranil®)

• Nortriptyline (Pamelor®)

Tricyclic antidepressants tend to cause more side effects than other antidepressants, so they aren’t typically prescribed as the first line of defense.

Norepinephrine and Dopamine Reuptake Inhibitors (NDRIs)

Bupropion (Wellbutrin® and Zyban®) belongs to a class of prescription drugs called NDRIs. These are often used to treat depression and aid in smoking cessation.

Researchers think bupropion works by affecting norepinephrine and dopamine, chemicals in the brain that impact mood, motivation, and more.

Though it is an alternative to Cymbalta, it may also have a side effect of insomnia.

Chronic pain, depression, anxiety, and sleep can all be interconnected. While Cymbalta can help break the vicious cycle between depression and chronic pain, insomnia is also a common side effect of Cymbalta.

Here’s what to remember about Cymbalta, as well as its side effects, and its impact on sleep:

• Cymbalta is a common treatment option for depression, anxiety, nerve pain, fibromyalgia, and more.

• As with many medications, Cymbalta may cause mild side effects or more serious adverse effects, such as serotonin syndrome and liver problems. It can also induce both sleepiness and insomnia.

• If you are experiencing insomnia as a side effect of Cymbalta, there are techniques to improve sleep. Talk to your provider to make sure you’re taking the correct dosage and taking it at the right time of day. Be sure to ask about sleep aid options, and establish a good sleep hygiene routine.

As always, it’s best to talk to a healthcare professional about your side effects and alternative options, as well as a plan for tapering off Cymbalta if your healthcare provider decides that’s the best course of action.

It’s also important to remember that there isn’t a universal best medication or treatment option for depression.

If you’re ready to take the next step, you can seek medical advice online from our psychiatry service for an evaluation to learn about all your options and determine which is the best fit for you.