The effects of medications on sleep quality and sleep architecture
- Timothy Roehrs, PhD
Timothy Roehrs, PhD
- Director of Research
- Henry Ford Sleep Disorders Clinic
- Thomas Roth, PhD
Thomas Roth, PhD
- Adjunct Clinical Professor of Psychiatry
- University of Michigan
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, nonbenzodiazepine receptor agonists, orexin antagonists, antiseizure drugs, antidepressants, analgesics, and CNS stimulants.To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
- Mendelson W. Hypnotic medications: Mechanisms of action and pharmacologic effects. In: Principles and Practices of Sleep Medicine, 5th ed, Kryger MH, Roth T, Dement WC (Eds), Elsevier Saunders, St. Louis, MO 2011. p.483.
- Roehrs TA, Randall S, Harris E, et al. Twelve months of nightly zolpidem does not lead to rebound insomnia or withdrawal symptoms: a prospective placebo-controlled study. J Psychopharmacol 2012; 26:1088.
- Herring WJ, Snyder E, Budd K, et al. Orexin receptor antagonism for treatment of insomnia: a randomized clinical trial of suvorexant. Neurology 2012; 79:2265.
- Michelson D, Snyder E, Paradis E, et al. Safety and efficacy of suvorexant during 1-year treatment of insomnia with subsequent abrupt treatment discontinuation: a phase 3 randomised, double-blind, placebo-controlled trial. Lancet Neurol 2014; 13:461.
- Zee PC, Wang-Weigand S, Wright KP Jr, et al. Effects of ramelteon on insomnia symptoms induced by rapid, eastward travel. Sleep Med 2010; 11:525.
- Emens JS, Burgess HJ. Effect of Light and Melatonin and Other Melatonin Receptor Agonists on Human Circadian Physiology. Sleep Med Clin 2015; 10:435.
- Buysse DJ. Clinical pharmacology of other drugs used as hypnotics. In: Principles and Practices of Sleep Medicine, 5th ed, Kryger MH, Roth T, Dement WC (Eds), Elsevier Saunders, St. Louis, MO 2011. p.492.
- Hindmarch I, Dawson J, Stanley N. A double-blind study in healthy volunteers to assess the effects on sleep of pregabalin compared with alprazolam and placebo. Sleep 2005; 28:187.
- Schweitzer PK. Drugs that disturb sleep and wakefulness. In: Principles and Practices of Sleep Medicine, 5th ed, Kryger MH, Roth T, Dement WC (Eds), Elsevier Saunders, St. Louis, MO 2011. p.542.
- Foldvary-Schaefer N, De Leon Sanchez I, Karafa M, et al. Gabapentin increases slow-wave sleep in normal adults. Epilepsia 2002; 43:1493.
- Walsh JK, Zammit G, Schweitzer PK, et al. Tiagabine enhances slow wave sleep and sleep maintenance in primary insomnia. Sleep Med 2006; 7:155.
- Walsh JK, Perlis M, Rosenthal M, et al. Tiagabine increases slow-wave sleep in a dose-dependent fashion without affecting traditional efficacy measures in adults with primary insomnia. J Clin Sleep Med 2006; 2:35.
- Jain SV, Glauser TA. Effects of epilepsy treatments on sleep architecture and daytime sleepiness: an evidence-based review of objective sleep metrics. Epilepsia 2014; 55:26.
- Young AH, Currie A. Physicians' knowledge of antidepressant withdrawal effects: a survey. J Clin Psychiatry 1997; 58 Suppl 7:28.
- Peterson MJ, Benca RM. Mood disorders. In: Principles and Practice of Sleep, 4th ed, Saunders, Philadelphia 2005. p.1488.
- Dimsdale JE, Norman D, DeJardin D, Wallace MS. The effect of opioids on sleep architecture. J Clin Sleep Med 2007; 3:33.
- Cronin AJ, Keifer JC, Davies MF, et al. Postoperative sleep disturbance: influences of opioids and pain in humans. Sleep 2001; 24:39.
- Murphy PJ, Badia P, Myers BL, et al. Nonsteroidal anti-inflammatory drugs affect normal sleep patterns in humans. Physiol Behav 1994; 55:1063.
- Glidwell RN, Moorcroft WH, Lee-Chiong T. Comorbid insomnia: Reciprocal relationships and medication management. Sleep Med Clin 2010; 5:627.
- Nihino S, Mignot E. Wake-promoting medications: Basic mechanisms and pharmacology. In: Principles and Practices of Sleep Medicine, 5th ed, Kryger MH, Roth T, Dement WC (Eds), Elsevier Saunders, St. Louis, MO 2011. p.510.
- O'Malley MB, Gleeson SK, Weir ID. Wake-promoting medications: Efficacy and adverse effects. In: Principles and Practices of Sleep Medicine, 5th ed, Kryger MH, Roth T, Dement WC (Eds), Elsevier Saunders, St. Louis, MO 2011. p.527.
- Roehrs T, Roth T. Medication and substance abuse. In: Principles and Practice of Sleep Medicine, 5th ed, Saunders, 2010. p.1512.
- Sangal RB, Owens J, Allen AJ, et al. Effects of atomoxetine and methylphenidate on sleep in children with ADHD. Sleep 2006; 29:1573.
- Burke TM, Markwald RR, McHill AW, et al. Effects of caffeine on the human circadian clock in vivo and in vitro. Sci Transl Med 2015; 7:305ra146.
- Rosen RC, Kostis JB. Biobehavioral sequellae associated with adrenergic-inhibiting antihypertensive agents: a critical review. Health Psychol 1985; 4:579.
- Kostis JB, Rosen RC, Holzer BC, et al. CNS side effects of centrally-active antihypertensive agents: a prospective, placebo-controlled study of sleep, mood state, and cognitive and sexual function in hypertensive males. Psychopharmacology (Berl) 1990; 102:163.
- Kanno O, Clarenbach P. Effect of clonidine and yohimbine on sleep in man: polygraphic study and EEG analysis by normalized slope descriptors. Electroencephalogr Clin Neurophysiol 1985; 60:478.
- Ming X, Gordon E, Kang N, Wagner GC. Use of clonidine in children with autism spectrum disorders. Brain Dev 2008; 30:454.
- Spiegel R, DeVos JE. Central effects of guanfacine and clonidine during wakefulness and sleep in healthy subjects. Br J Clin Pharmacol 1980; 10 Suppl 1:165S.
- Schweitzer PK. Drugs that disturb sleep and wakefulness. In: Principles and Practice of Sleep Medicine, 4th ed, Saunders, 2005. p.499.
- Gillin JC, Jacobs LS, Fram DH, Snyder F. Acute effect of a glucocorticoid on normal human sleep. Nature 1972; 237:398.
- CENTRAL NERVOUS SYSTEM MEDICATIONS
- Benzodiazepines and nonbenzodiazepine receptor agonists
- Orexin receptor antagonists
- Melatonin and melatonin receptor agonists
- Antiseizure drugs
- Central nervous system stimulants
- ATYPICAL ANTIPSYCHOTIC MEDICATIONS
- CARDIAC MEDICATIONS
- Beta blockers
- Alpha adrenergic agonists
- PULMONARY MEDICATIONS
- SOCIETY GUIDELINE LINKS
- SUMMARY AND RECOMMENDATIONS