Which beta blocker is least likely to cause nightmares and sleep disturbances?

Which beta blocker is least likely to cause nightmares and sleep disturbances?

• A. Propranolol
• B. Atenolol
• C. Bisoprolol
• D. Sotalol

Answer: (D)

Nightmares and sleep disturbances from beta blockers are more likely when the drug can enter the brain. Drugs that cross the blood–brain barrier (lipophilic ones) are more prone to causing CNS effects. Propranolol is highly lipophilic and commonly linked to vivid dreams and sleep problems. Atenolol and bisoprolol are more hydrophilic with limited CNS penetration, so they tend to have fewer CNS side effects. Sotalol, while nonselective like propranolol, is more hydrophilic and reaches the brain less, making it the least likely to cause nightmares or sleep disturbances.

Nightmares and sleep disturbances from beta blockers are more likely when the drug can enter the brain. Drugs that cross the blood–brain barrier (lipophilic ones) are more prone to causing CNS effects. Propranolol is highly lipophilic and commonly linked to vivid dreams and sleep problems. Atenolol and bisoprolol are more hydrophilic with limited CNS penetration, so they tend to have fewer CNS side effects. Sotalol, while nonselective like propranolol, is more hydrophilic and reaches the brain less, making it the least likely to cause nightmares or sleep disturbances.