This handy chart provides information regarding Tmax, T1/2, sleep latency, sleep efficiency, percent of stage N3, percent of stage R, stage R latency, morning sedation, and motor restlessness for more than 50 prescription and over-the-counter drugs that your patients may be consuming.
Many medications can impact sleep parameters in various ways. When interpreting polysomnograms, it is important for sleep specialists to understand the basics of these effects.
Drugs used to treat mood disorders and insomnia generally have a greater impact on sleep than any other class of medications. This is due mainly to their influences on serotonergic, noradrenergic, GABAergic, and histaminergic systems, as well as other more minor influences.
Although the rate of absorption (reported as Tmax) and the rate of elimination (reported as half-life or T1/2) of these medications may specifically influence sleep each night, changes in sleep architecture may still be altered after some medications are discontinued, even after several months (for example, fluoxetine). Likewise, rebound phenomena may be obvious immediately after the discontinuation of some medications, especially those that tend to suppress a specific sleep stage. Stage R (REM) sleep rebound is one of the most obvious examples, often related to withdrawal from selective serotonin reuptake inhibitors (SSRIs) and serotonin–norepinephrine reuptake inhibitors (SNRIs). So, you should ask patients if they have recently discontinued any medications, as well as documenting the ones they are currently taking.
A greater understanding of these medication effects—such as those provided in this table—may aid in the scoring and interpretation of sleep studies.
James MacFarlane, PhD, FAASM, is assistant professor of psychiatry at the University of Toronto and director of education for the MedSleep network of clinics.
1. Brunton LL, Hilal-Dandan R, Knollmann BC, eds. Goodman & Gilman’s: The Pharmacological Basis of Therapeutics. 13th ed. New York: McGraw-Hill; 2017.
2. Compendium of Pharmaceuticals and Specialties — CPS (2018), Canadian Pharmacists Association, National Library of Canada.
Table values also derived from multiple peer-reviewed articles.