Medications for the Treatment of Sleep Disorders: An Overview
Primary Care Companion J Clin Psychiatry 2001;3(3):118-125
© Copyright 2017 Physicians Postgraduate Press, Inc.
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.