Health.am| Table 89-5 Substance-induced sleep disorders | |||
Drug class | Subjective sleep complaintsa | Objective effects on sleep (acute administration) | Comments |
Alcohol | Hypersomnia (A) Insomnia (C, W) Nightmares, sleepwalking (C, W) | Decreased sleep latency, increased Stage 3/4 sleep, decreased REM sleep (first half of sleep period) Increased wakefulness, decreased Stage 3/4 sleep, increased REM sleep (second half of sleep period) Increased sleep apnea Chronic use leads to increased wakefulness, decreased Stage 3/4 sleep Withdrawal syndrome includes severe insomnia, REM rebound, decreased Stage 3/4 sleep | Dependence, tolerance, withdrawal insomnia very common Some patients may use alcohol to "treat" a primary sleep disturbance |
Barbiturates | Hypersomnia (A) Insomnia (C, W) | Decreased sleep latency, wakefulness; increased sleep time No change or decrease in Stage 3/4 sleep (slight) Decreased REM sleep Increased sleep spindling activity Respiratory suppression | Dependence, tolerance common, especially with short-acting agents Withdrawal can cause seizures, death Acute overdose can be lethal (respiratory suppression) Not recommended for treatment of sleep disorders |
Nonbarbiturate, nonbenzodiazepine hypnotic drugs (glutethimide, methy-prylon, chloral hydrate) | Hypersomnia (A) Insomnia (W) | Decreased sleep latency, wakefulness; increased sleep time No change or decrease in Stage 3/4 sleep Decreased REM sleep Respiratory suppression | Dependence, tolerance, withdrawal common Similar toxicity and cautions as for barbiturates Not recommended for treatment of sleep disorders |
Opiates | Hypersomnia (A, W) Insomnia (A, C) | Increased wakefulness, decreased sleep time Decreased Stage 3/4 sleep Decreased REM sleep | May be indicated for treatment-resistant cases of restless legs syndrome and control of pain interfering with sleep High potential for tolerance, dependence, withdrawal syndrome Withdrawal can be managed by using long-acting agent (e.g., methadone) or clonidine |
Amphetamine, cocaine, and related stimulants | Insomnia (A) Hypersomnia (W) Nightmares | Increased sleep latency, wakefulness; decreased sleep time Decreased Stage 3/4 sleep Decreased REM sleep | Amphetamine and methylphenidate indicated for treatment of narcolepsy, primary hypersomnia, attention-deficit/hyperactivity disorder Tolerance, dependence, withdrawal common in abuse Withdrawal syndrome may be associated with significant depression |
Caffeine | Insomnia (A, C) Hypersomnia (W) | Increased sleep latency, wakefulness; decreased sleep time Decreased Stage 3/4 sleep Increased REM sleep (inconsistent effect) | Patients often minimize amount and effects of caffeine use |
β-Antagonists (e.g., propranolol, atenolol) | Increased dreams, nightmares with lipophilic agents (A, C) Insomnia with lipophilic agents (A, C) | Increased sleep latency, wakefulness with lipophilic agents Decreased REM sleep (lipophilic agents in high doses) | Switching to less lipophilic agent can avoid sleep-related symptoms |
α2-Agonists (e.g., clonidine) | Hypersomnia (A, C) Nightmares (A, C) | Decreased sleep latency, increased sleep time Decreased Stage 3/4 sleep (inconsistent effect) Decreased REM sleep (human studies) | Often perceived as sedating |
Antihistamines | Hypersomnia (A) | Decrease or no change in sleep latency, wakefulness; no change in sleep time Increase or no change in Stage 3/4 sleep Decreased REM sleep (slight) Increased sleepiness with daytime administration | Reduce wakefulness at night Carryover sedation, decreased alertness, confusion can limit usefulness Specific agents differ in subjective sleep effects based on degree of penetration into the central nervous system |
Dopamine antagonists (antipsychotic drugs) | Hypersomnia (A) | Variable effects on sleep depend on dose, specific drug Increased sleep time, decreased sleep latency Increase or no change in Stage 3/4 sleep Increased REM sleep | Low-potency phenothiazine drugs generally more sedating Low-potency phenothiazine drugs also have anticholinergic and other actions that contribute to sleep effects |
Lithium | Hypersomnia (A, C) | Decreased sleep latency, wakefulness; increased sleep time (inconsistent effect) Increase or no change in Stage 3/4 sleep Decrease or no change in REM sleep | Tolerance can develop to sedation Increasing bedtime dose and decreasing daytime doses can reduce sleep-related symptoms |
Anticonvulsant drugs (e.g., carbamazepine, phenytoin, valproic acid) | Hypersomnia (A, C) | Decreased sleep latency Increased Stage 3/4 sleep (variable) Decreased REM sleep (slight) | Effects vary for different agents; carbamazepine more sedating than valproic acid, phenytoin Few EEG sleep studies have been conducted |