Any medication that passes through the blood-brain barrier has the potential to alter the quality and/or architecture of sleep:
- Sleep quality is the degree to which restful sleep is maintained during the night and the individual feels refreshed on waking and throughout the day. Traditional measures of sleep quality include latency until sleep onset, wakefulness after sleep onset, and/or the duration of sleep.
- Sleep architecture is the structure of sleep. It is cyclical, composed of rapid eye movement (REM) and several non-REM sleep stages, and assessed primarily by electroencephalography (EEG) during polysomnography.
Medication-induced changes in sleep quality and/or architecture are not synonymous with a sleep disturbance; in some cases the changes may be therapeutic, while in others they may be benign or not well understood. The effects of medications that target the central nervous system, cardiovascular system, or respiratory system on sleep quality and sleep architecture are reviewed here. The stages and architecture of normal sleep are described separately. (See "Stages and architecture of normal sleep".)
CENTRAL NERVOUS SYSTEM MEDICATIONS
Commonly prescribed medications that act on the central nervous system (CNS) and can affect sleep include benzodiazepines, antiepileptics, antidepressants, analgesics, and CNS stimulants.
Benzodiazepines and benzodiazepine receptor agonists — Benzodiazepines (eg, diazepam, lorazepam, midazolam) and benzodiazepine receptor agonists (eg, zolpidem, zaleplon, eszopiclone) are commonly prescribed sedative-hypnotic medications used to treat insomnia or anxiety. Both types of agents facilitate gamma-aminobutyric acid (GABA)-mediated inhibition of cell firing by binding to a subunit of the GABA receptor complex called the benzodiazepine receptor. The GABA receptor complex is present throughout the brain, including the ventral lateral preoptic area that controls sleep.