Can finasteride cause sleep apnea? Exploring the potential link and risks

October 7, 2025 •

4 min read

According to an analysis of the FDA's Adverse Events Reporting System (FAERS), finasteride use was associated with a significantly higher odds of obstructive sleep apnea (OSA) reporting. While this is a potential safety signal that does not prove causation, it raises important questions about whether can finasteride cause sleep apnea in some individuals.

Quick Summary

Studies show a potential safety signal indicating a link between finasteride use and reports of obstructive sleep apnea. The association, observed in FDA adverse event data, warrants further research into whether hormonal changes influence sleep regulation or if other factors are involved. Patients should discuss any sleep-related concerns with a healthcare provider.

Key Points

Potential Safety Signal: FDA adverse event data shows a higher rate of sleep apnea reports associated with finasteride use, though this does not prove a causal link.
Not a Proven Cause: The evidence is an association based on voluntary reporting, and large clinical trials have not identified sleep apnea as a direct side effect.
Possible Hormonal Link: As a 5-alpha-reductase inhibitor, finasteride lowers DHT, and changes in androgen levels are theorized to potentially influence respiratory control during sleep.
Conflicting Research Exists: Some controlled studies have shown finasteride can increase breathing stability, suggesting its effects on sleep-disordered breathing are complex and require further study.
Watch for Symptoms: Individuals using finasteride should monitor for signs of sleep apnea, such as snoring, daytime sleepiness, and gasping during sleep.
Consult a Doctor: If sleep apnea is suspected, it is crucial to speak with a healthcare professional for a proper evaluation, rather than self-diagnosing or stopping medication.
Potential for Insomnia: Studies also confirm a higher than expected reporting of insomnia among finasteride users, a component of potential Post-Finasteride Syndrome (PFS).
PFS Link: Sleep disturbances, including insomnia and obstructive sleep apnea, are symptoms sometimes associated with Post-Finasteride Syndrome.

Understanding the Link Between Finasteride and Sleep Apnea

Finasteride is a medication prescribed for male pattern hair loss (androgenetic alopecia) and benign prostatic hyperplasia (BPH). It works by inhibiting the enzyme 5-alpha-reductase, which reduces the conversion of testosterone to dihydrotestosterone (DHT). While finasteride has proven effective for its intended uses, concerns have emerged regarding its potential side effects, including sleep disturbances like insomnia and, more recently, sleep apnea.

FDA Adverse Event Reports Show Potential Signal

Research published in Skinmed and presented at the American Academy of Sleep Medicine found a significant association between finasteride use and reports of obstructive sleep apnea (OSA) within the US Food and Drug Administration (FDA) Adverse Event Reporting System (FAERS). A disproportionate number of sleep apnea reports were associated with finasteride compared to other medications in the database, with a reporting odds ratio (ROR) of 5.65 (95% CI 4.83–6.62). This indicates a potential safety signal that warrants further investigation.

It is crucial to understand that data from FAERS, which relies on voluntary reporting, can only suggest an association, not prove causation. The higher number of reports could be influenced by reporting bias or other factors. However, the findings are consistent across different finasteride indications (hair loss and BPH) and signal a need for greater clinical awareness and research.

Possible Mechanisms Connecting Finasteride and Sleep

While a direct causal mechanism for how finasteride might cause OSA has not been established, several hypotheses exist based on finasteride's known effects on the body:

Hormonal Influence: Finasteride lowers DHT levels, and some studies have linked decreased androgen levels to OSA and reduced sleep efficiency. Androgens, including DHT, play a role in regulating the body's respiratory control centers. By crossing the blood-brain barrier and altering androgen activity in the brain, finasteride could potentially destabilize breathing patterns during sleep.
Mood and Psychological Effects: Depression, anxiety, and insomnia are documented side effects of finasteride and are also associated with Post-Finasteride Syndrome (PFS). These psychological issues can significantly impact sleep architecture and indirectly contribute to sleep disorders, including OSA.
Nocebo Effect: For some individuals, the anxiety and anticipation of potential side effects can manifest as real, perceived symptoms. Worry about potential sleep disturbances could contribute to problems falling or staying asleep.

Navigating Conflicting Research

To add complexity, not all research supports the notion that finasteride increases breathing instability. A 2013 study in the journal Sleep investigated the effect of finasteride on central sleep apnea (CSA) in a small group of healthy young men. This study found that finasteride actually increased breathing stability during non-REM sleep by decreasing hypocapnic chemoreflex sensitivity. The findings of this controlled study appear to contradict the observational FAERS data, which primarily reflect OSA, not CSA. This highlights the need for more targeted research to fully understand the effects of finasteride on different forms of sleep-disordered breathing.

Obstructive Sleep Apnea (OSA) Symptoms to Watch For

If you are taking finasteride and are concerned about sleep apnea, here are some common symptoms of OSA to be aware of:

Loud snoring
Breathing cessation or gasping during sleep (witnessed by a partner)
Excessive daytime sleepiness
Morning headaches
Difficulty concentrating
Irritability
Dry mouth or sore throat upon waking
High blood pressure

If you experience these symptoms, it is important to discuss them with your healthcare provider. They can determine if a sleep study (polysomnography) is appropriate to properly diagnose any underlying sleep disorder.

Comparing Sleep Disorder Evidence


Feature	FAERS Study (Observational, 2018/2020)	Sleep Journal Study (Controlled, 2013)
Study Type	Retrospective analysis of adverse event reports	Prospective controlled study
Population	Broad dataset of individuals reporting adverse events	14 healthy young men without sleep apnea
Primary Finding	Higher odds of reported obstructive sleep apnea (OSA)	Increased breathing stability in non-REM sleep
Type of Apnea	Primarily obstructive sleep apnea (OSA) reports	Central sleep apnea (CSA) mechanism
Interpretation	Potential safety signal for OSA, requires further research	Suggests finasteride may increase breathing stability for CSA
Limitations	Inherently subject to reporting bias; association, not causation	Small sample size, healthy participants, limited scope

What to Do If You're Concerned

For patients taking finasteride, monitoring for new or worsening sleep disturbances is a crucial step. If you notice any symptoms of sleep apnea, speak with your doctor. Providing a complete medical history, including all medications and supplements, is essential for a proper evaluation. Your doctor can help determine if finasteride is a contributing factor or if another medical issue is the cause. Do not stop taking finasteride without consulting your doctor first, as abrupt discontinuation can lead to side effects or a return of hair loss.

Conclusion

While large-scale clinical trials have not linked finasteride directly to sleep apnea, observational data from the FDA's reporting system suggests a potential association that warrants attention and further research. The hormonal and psychological effects of finasteride are possible mechanisms, though definitive causation has not been established. Patients taking finasteride should be mindful of sleep-related symptoms and discuss any concerns with a healthcare professional to ensure proper diagnosis and management. The evidence is complex, highlighting the importance of personalized medical evaluation.

For more detailed information on the FAERS database study, see the publication in Skinmed: https://pubmed.ncbi.nlm.nih.gov/32790610/.

Frequently Asked Questions

While finasteride has not been proven to cause sleep apnea, an analysis of FDA adverse event reports found a statistically significant association, or "potential safety signal," for obstructive sleep apnea (OSA) reports among finasteride users.

The primary evidence comes from an analysis of the FDA's Adverse Events Reporting System (FAERS), which found finasteride users had a higher odds ratio of reporting OSA compared to users of other drugs. Because FAERS data is based on voluntary, self-reported information, this represents an association rather than proven causation.

One theory suggests finasteride's ability to cross the blood-brain barrier and lower androgen levels could influence respiratory control centers in the brain, as some studies link lower androgen levels to sleep apnea. Psychological side effects like anxiety and depression could also indirectly impact sleep.

Obstructive sleep apnea (OSA) occurs when the throat muscles and tissues relax, blocking the airway during sleep. Central sleep apnea (CSA) happens when the brain fails to send the proper signals to the muscles that control breathing. The FAERS data primarily concerns OSA reports associated with finasteride.

Common symptoms of sleep apnea include loud snoring, gasping for air during sleep, excessive daytime sleepiness, morning headaches, and difficulty concentrating. Any new or worsening sleep issues should be discussed with a doctor.

No, you should not stop taking finasteride without first consulting a healthcare provider. Discuss your concerns with your doctor, who can help determine the best course of action and evaluate your sleep health. A sudden cessation can also lead to other side effects or hair loss returning.

Sleep disturbances, including insomnia and obstructive sleep apnea, are among the symptoms reported by some individuals who experience Post-Finasteride Syndrome. The connection to PFS underscores the need for more research into the persistent side effects experienced by some former users.

Yes, the same FDA adverse event analysis that found a signal for sleep apnea also confirmed a greater than expected reporting of insomnia with finasteride use. Insomnia is also recognized as a symptom of Post-Finasteride Syndrome.