The effect of drugs on sleep quality and architecture

[Perrybucsdad]

Found this great article discussing some of the effects of certain drugs on sleep quality. Thought I would pass along the link to others.

https://www.sugarsync.com/pf/D6354786_0890504_661740

[ThirdOutOfFive]

Very interesting. I have been taking an anti-d for years, to help with insomnia related to fibromyalgia. Over the years I have learned that a night without my doxepin is a night without real sleep -- just naps. So far, I have not felt that PAPpy is increasing the amount that I sleep, but is helping me feel more alert when I get up. I consider that a good result; I keep hoping for a great one.

[Mary Z]

Great article, John. Keep them coming. I have learned more from the links to these articles that you have posted than my doctor knows.
This is the first time I have read that opiates can cause central and complex sleep apnea. My problems with being unable to achieve a normal AHI have been since the beginning of therapy, long before I was taking opiates for chronic pain.
I sure wish I could get my drug list down to just a couple of the most important ones.
The opiates are a tradeoff, without them I would not sleep or have very fragmented sleep due to chronic pain.

[ameriken]

In healthy individuals, opioid analgesics increase wake time and reduce slow wave and REM
sleep [5]. Tolerance to these effects develops rapidly, usually within days. In a double-blind
cross-over trial of 42 healthy volunteers, both sustained-release morphine and
methadone increased the percentage of total sleep time spent in stage 2, while reducing the
percentage of total sleep time spent in stage 3 and stage 4, compared to placebo [6]. Opioid
analgesics are also associated with a high prevalence of central and complex apnea among
patients who are using them to treat chronic pain or on methadone maintenance, according to several case series [7].

Yep, there's me. Methadone for back pain. I didn't realize that it was affecting the stage 3 and 4 sleep, that might be the cause of my tiredness despite the fact that the ASV machine is keeping me breathing.

[xenablue]

I was taking the smallest possible dose of an OTC sleep med which certainly helped me stay asleep, however DH finally decided to point out that my RLS had gotten worse unbeknownst to me.

On reading about sleep meds, it seems they can make RLS worse, so I changed to a tiny dose of melatonin and herbal tea which actually gives me better sleep overall and DH says I sleep 'like the dead' - no kicking, flailing or movement at all.

Cheers,
xena

[Uncle_Bob]

Very interesting to read about some a couple of the drugs i occasionally take, I'm going to look out for the desribed effects.

[sickwithapnea17]

does this article say that zolpidem helps stage 3/4 sleep?
are those GABA drugs safe?

[Mary Z]

does this article say that zolpidem helps stage 3/4 sleep?
are those GABA drugs safe?

I don't know- here are two quotes from the article, but I don't know if zolpidem has a benzo structure or not.

[/qBenzodiazepine receptor agonists — The major class of CNS drugs with primary
indication as hypnotics are the benzodiazepine receptor agonists [1]. Their mechanism of
action is facilitation of gamma-aminobutyric acid (GABA)-mediated inhibition of cell firing by
occupation of subunits (ie, the benzodiazepine receptor) of the GABA receptor complex
present throughout the brain, including the ventral lateral preoptic area which controls
sleep. Some agents share the benzodiazepine chemical structure, while others are
chemically not benzodiazepines, but still act by benzodiazepine receptor occupation (eg,
zolpidem, zaleplon, eszopiclone).quote]

[Agents with a benzodiazepine structure suppress deeper, non-REM (stages 3 and 4,
also called Slow Wave Sleep) sleep, while those with a non-benzodiazepine structure
do not. The clinical significance of these stage 3-4 effects is not known.
/quote]

[Perrybucsdad]

On reading about sleep meds, it seems they can make RLS worse, so I changed to a tiny dose of melatonin and herbal tea which actually gives me better sleep overall and DH says I sleep 'like the dead' - no kicking, flailing or movement at all.

I keep seeing this mention of melatonin more and more... I have to look into it and maybe give it a try. When I know I will have problems falling asleep, I crack out good ole Dr Benadryl. I'd like to see if there is a difference when I take melatonin vs Dr B.

[ameriken]

On reading about sleep meds, it seems they can make RLS worse, so I changed to a tiny dose of melatonin and herbal tea which actually gives me better sleep overall and DH says I sleep 'like the dead' - no kicking, flailing or movement at all.

I keep seeing this mention of melatonin more and more... I have to look into it and maybe give it a try. When I know I will have problems falling asleep, I crack out good ole Dr Benadryl. I'd like to see if there is a difference when I take melatonin vs Dr B.

I like melatonin because I believe it is a natural substance already in our bodies. It doesn't have the side effects of benadryl and it is pretty gentle. I took melatonin when I did both sleep studies and it did the job. Start with 1mg to see how it works for you and then move up to 3 if needed.

[sickwithapnea17]

yes it's definitely better not to take sleeping pills. but I have bad insomnia and I read in wikipedia that zolpidem isn't a benza so it seems that it won't supress stage 3/4. I'm interested in trying remeron or restoril since nothing works for me after 2 years.
restoril is in a different class of drugs that help you stay asleep while zolpidem seems to have it's main effect in helping you fall asleep

[Perrybucsdad]

I like melatonin because I believe it is a natural substance already in our bodies. It doesn't have the side effects of benadryl and it is pretty gentle. I took melatonin when I did both sleep studies and it did the job. Start with 1mg to see how it works for you and then move up to 3 if needed.

I see that you have to take this 1 - 2 hours before bed. What happens if you take it right at bedtime?

[pap4life]

On many occassions, I will take melatonin. I have the 5mg version, so I willl halve them. Works pretty good for me, to get me asleep, but don;t keep me down all night. Maybe I need to take the whole pill.

[avi123]

Check this about Zolpidem withdrawal:


http://www.non-benzodiazepines.org.uk/zolpidem.html


Excerpt:

Often Zolpidem users find that their medication over time turns against them with frequent awakenings during the night. This is often caused by rebound or withdrawal effects of the zolpidem. Zolpidem undergoes rapid metabolism in the body and the half life of Zolpidem is about 2 hours which is very short. People can experience withdrawal symptoms within as little as 1 or 2 hours of taking the drug. This often leads to a very disrupted sleep pattern with long term use of this drug (beyond 2 - 4 weeks).

[ameriken]

I see that you have to take this 1 - 2 hours before bed. What happens if you take it right at bedtime?

I've never taken it 1 to 2 hours before bedtime. 15 to 20 minutes works great for me before I start getting drowsy. So even if you take it right at bedtime, you'll be ok. It really doesn't take long to make you drowsy.