Healthy adults spend about 20% of their sleep time in rapid eye movement, or REM, sleep. People on prescription antidepressants—such as citalopram, escitalopram, fluoxetine, paroxetine, duloxetine, venlafaxine, bupropion, mirtazapine, and trazodone—are known to decrease time in REM. But studies on the impacts on REM sleep by prescription antipsychotics—such as haloperidol, aripiprazole, lurasidone, olanzapine, risperidone, quetiapine, and ziprasidone—have been few and far between and their results inconsistent.
Elahhe Afkhamnejad, a third-year medical student at Wake Forest University School of Medicine with an interest in sleep medicine, realized that Wake Forest Department of Sleep Medicine had a lot of unanalyzed data on this subject. So, with co-researcher Sandhya Kumar, MD, she decided to do retrospective chart review of 258 polysomnograms (PSG) from patients of the Wake Forest Department of Sleep Medicine from September 2012 to July 2017. To be included, patients must have been over the age of 18 and undergone a full-night PSG while on an antidepressant and/or an antipsychotic.
The results, which were presented at the American Academy of Neurology’s (AAN) 70th Annual Meeting, surprised Afkhamnejad. “I didn’t expect antidepressants and antipsychotics to be so different in how much they lowered REM sleep. I thought they would be along the same level, but it turned out that antipsychotics lowered the amount of REM sleep significantly, even compared to antidepressants,” she tells Sleep Review in person during a poster session at the conference.
The poster titled “The Role of Prescription Drugs in REM Sleep” found that the average percent REM sleep to be:
- Patients on one antidepressant: 12.4%
- Patients on multiple antidepressants: 12.5%
- Patients on an antidepressant and antipsychotic: 8.2%
- Patients on an antipsychotic alone: 8.8%
Afkhamnejad says she doesn’t think the study has immediate clinical implications but notes that it is “important to know the full effect of medications.”
Sree Roy is editor of Sleep Review.