Effects of antipsychotic medications on sleep in schizophrenia

Abstract

Schizophrenia is often accompanied by sleep problems. Evidence exists that these sleep difficulties have significant effects on individuals with this disorder. The mainstay of treatment for this condition is the administration of medications that have effects on neurotransmitter systems, which play an important role in sleep-wake function, including histamine, acetylcholine, serotonin, norepinephrine and dopamine. Little systematic attention, however, has been paid to how the sleep effects of these agents might play a role in the course of treatment, function and quality of life of schizophrenia patients. Schizophrenia medications can improve sleep problems and reverse the sleep architectural derangements that are common among patients with schizophrenia and, therefore, have the potential to improve the quality of life and functional capacity of the patient. Conversely, some sleep-wake effects of these medications can impair patient function and quality of life. In this study, we review the effects of schizophrenia medications and discuss their relevance to optimizing the clinical treatment of people with schizophrenia with regard to sleep-wake function.

State-dependent alterations in sleep/wake architecture elicited by the M4 PAM VU0467154 – Relation to antipsychotic-like drug effects

“…In general, APDs alleviate some of the sleep disruptions in patients with schizophrenia by increasing sleep duration, delaying REM onset, increasing the amount of SWS compared to REM sleep, and/or increasing SWA during SWS (Cohrs, 2008; Krystal et al, 2008; Sprecher et al, 2015). However, the effects of clozapine and other APDs on sleep do not substantially improve cognition (Barch and Ceaser, 2012; Nuechterlein et al, 2004), perhaps due to residual sedative effects during wake.…”

“…For example, elevated power in the high frequency gamma band (e.g., >30 Hz in humans) is associated with positive symptoms, whereas lower gamma power at rest and reduced elevations in gamma power during cognitive testing is linked to cognitive impairments (Baldeweg et al, 1998; Chen et al, 2014; Lee et al, 2003; Uhlhaas and Singer, 2014). To date, clinically available APDs provide modest to no therapeutic benefit for many of the symptoms observed in schizophrenia patients, including negative symptoms and cognitive deficits (Krystal et al, 2008; Reichenberg and Harvey, 2007). At therapeutically relevant doses, many APDs, including the atypical APD clozapine, increase total sleep time and SWA.…”

Sleep disturbances in a clinical forensic psychiatric population

“…With regard to medication, we categorized hypnotics (especially those prescribed for sleep), sleep-promoting medications (prescribed for other purposes than sleep), and medications with a sleep disrupting effect. Benzodiazepines, the so-called Z drugs (e.g., zolpidem, zopiclone) and antipsychotic and antidepressant medications with sedating properties (e.g., clozapine, risperidone, olanzapine, quetiapine, mirtazapine) were considered as sleep-promoting medications or hypnotics, depending on the indication [20][21][22]. Thus, melatonin was included in the group of hypnotics.…”

“…Thus, melatonin was included in the group of hypnotics. Serotonin-reuptake inhibitors and stimulant drugs (e.g., methylphenidate, dextroamphetamine) were considered to have a sleep-disrupting effect [20,21,23,24]. We also took into account other well-known side effects of psychopharmacologic drugs when exploring possible causes of sleep disturbances, as many atypical antipsychotic medications and some antidepressant medications cause weight gain [25,26], which increases the risk for a sleep-related breathing disorder [27].…”

Antipsychotic-Induced Somnolence in Mothers with Schizophrenia

“…Antipsychotic medication can adversely affect alertness, concentration, attention, memory, cognition, psychomotor accuracy, and skilled performance, although tolerance to some of these effects develops over time. Such performance decrements can threaten the safety of the person taking the drug and those with whom that person comes into contact, especially infants [24][25][26][27][28]. As a result of pregnant mothers taking antipsychotics, neonates born to women with schizophrenia show significantly reduced arousal at 3-4 days of age when compared to controls [29].…”