Pharmacological alteration of sleep and dreams ? a clinical framework for utilizing the electrophysiological and sleep stage effects of psychoactive medications

Pagel, J.F.

doi:10.1002/(sici)1099-1077(199605)11:3<217::aid-hup790>3.0.co;2-0

Cited by 19 publications

(11 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Less commonly, agents such as antibiotics, antihypertensives, oral contraceptives, and thyroid replacements can induce insomnia in susceptible individuals (Table 2). 11,24 Over-the-counter medications that may induce insomnia include decongestants (including nose sprays), weight loss agents, ginseng preparations, and high-dose vitamin B 1 . Finally, chronic and long-term sedative/hypnotic use to induce sleep may cause tolerance to the sedative effect and can contribute to chronic insomnia.…”

Section: Medications Inducing Insomniamentioning

confidence: 99%

“…Typically, psychoactive medications alter background EEG frequencies and the occurrence, frequency, and latency of the various sleep stages (Tables 1 and 3). 24,[29][30][31] In general, drug-induced EEG changes are associated with characteristic behavioral effects. This relationship has been utilized to suggest therapeutic possibilities for medications that produce characteristic EEG effects.…”

Section: Medication-induced Alterations In Sleep Stages and Sleep Eegmentioning

confidence: 99%

“…Medications such as lithium that can increase deep sleep can induce the occurrence of arousal disorders such as somnambulism. 2,24 The influence of psychoactive medications on sleep states has a positive side as well. For example, REM sleep suppressive medications can be useful adjuncts in the treatment of REM sleep parasomnias and symptoms.…”

Section: Clinical Use Of Sleep Stage and Eeg Effectsmentioning

confidence: 99%

“…Similarly, the arousal disorders can be treated with medications affecting deep sleep (benzodiazepines and others) (see Tables 1 and 3). 24,36,37 SPECIFIC SLEEP-RELATED MEDICATION EFFECTS…”

Section: Clinical Use Of Sleep Stage and Eeg Effectsmentioning

confidence: 99%

See 3 more Smart Citations

Medications for the Treatment of Sleep Disorders

Pagel

Parnes

2001

Prim. Care Companion CNS Disord.

Self Cite

120

View full text Add to dashboard Cite

Sleep disorders can be divided into those producing insomnia, those causing daytime sleepiness, and those disrupting sleep. Transient insomnia is extremely common, afflicting up to 80% of the population. Chronic insomnia affects 15% of the population. Benzodiazepines are frequently used to treat insomnia; however, there may be a withdrawal syndrome with rapid eye movement (REM) rebound. Two newer benzodiazepine-like agents, zolpidem and zaleplon, have fewer side effects, yet good efficacy. Other agents for insomnia include sedating antidepressants and over-the-counter sleep products (sedating antihistamines). Nonpharmacologic behavioral methods may also have therapeutic benefit. An understanding of the electrophysiologic and neurochemical correlates of the stages of sleep is useful in defining and understanding sleep disorders. Excessive daytime sleepiness is often associated with obstructive sleep apnea or depression. Medications, including amphetamines, may be used to induce daytime alertness. Parasomnias include disorders of arousal and of REM sleep. Chronic medical illnesses can become symptomatic during specific sleep stages. Many medications affect sleep stages and can thus cause sleep disorders or exacerbate the effect of chronic illnesses on sleep. Conversely, medications may be used therapeutically for specific sleep disorders. For example, restless legs syndrome and periodic limb movement disorder may be treated with dopamine agonists. An understanding of the disorders of sleep and the effects of medications is required for the appropriate use of medications affecting sleep.

show abstract

Section: Medications Inducing Insomniamentioning

confidence: 99%

Section: Medication-induced Alterations In Sleep Stages and Sleep Eegmentioning

confidence: 99%

Section: Clinical Use Of Sleep Stage and Eeg Effectsmentioning

confidence: 99%

“…Similarly, the arousal disorders can be treated with medications affecting deep sleep (benzodiazepines and others) (see Tables 1 and 3). 24,36,37 SPECIFIC SLEEP-RELATED MEDICATION EFFECTS…”

Section: Clinical Use Of Sleep Stage and Eeg Effectsmentioning

confidence: 99%

See 2 more Smart Citations

Medications for the Treatment of Sleep Disorders

Pagel

Parnes

2001

Prim. Care Companion CNS Disord.

Self Cite

120

View full text Add to dashboard Cite

show abstract

“…gabapentin, phenobarbitol) (Westbrook 2000). Some drugs may act by glutamate antagonism and others by having direct effects on CNS electrophysiology (Pagel 1996). In individuals being treated with such medications for seizure disorders, the clinical differential between medication effects and sedation secondary to recurrent seizures can be difficult to determine (Manni and Tartara 2000).…”

Section: Other Agents Inducing Sedationmentioning

confidence: 99%

Treating insomnia with medications

Pagel

Pandi‐Perumal²,

Monti

2018

Sleep Science Practice

Self Cite

View full text Add to dashboard Cite

Insomnia is a conspicuous problem in modern 24 h society. In this brief overview, medications used to treat insomnia such as hypnotics, sedatives, medications inducing sedation as a side effect, medications directed at the sleep-associated circadian neuroendocrine system, and agents utilized in treating insomnia-inducing sleep diagnoses such as restless leg syndrome are discussed. The newer GABA-effective hypnotics are the only medications with demonstrated effectiveness in treating chronic insomnia with the majority of evidence supporting treatment efficacy for cognitive-behavioral therapy and short acting GABA-receptor agonists. In patients with comorbid insomnia the use of hypnotics can improve outcomes and potentially reduce morbidity and mortality associated with the use of more toxic medications. Except in individuals whose insomnia is secondary to circadian disturbance, mood disorder/depression and/or restless leg syndrome , there is minimal evidence supporting the efficacy of other medications used to treat insomnia despite their widespread use. Sedatives and other medications used off-label for sedative side-effects are a contributing factor to drug induced hypersomnolence, a factor in more than 30% of motor accident deaths. Hypnotic medications with low toxicity, addictive potential, minimal next day sleepiness, and an otherwise benign side-effect profile can be utilized safely and effectively to treat and improve function and quality of life for patients suffering from insomnia. These are the agents that should be exclusively classified as hypnotics and utilized to induce sleep when medications are required to treat the complaint of insomnia. Other pharmacological agents producing sedation (sedatives and agents used off-label for sedative side-effects) should be used cautiously for the treatment of insomnia due to the increased risk of next day sleepiness as well as for known toxicities and adverse side effects.

show abstract