M05.08.04 Drugs That Alter Sleep

Various drugs can influence sleep, each affecting different stages and aspects of the sleep cycle. The following is an overview of how certain drugs modify sleep patterns, REM (rapid eye movement) sleep, and the overall architecture of sleep.

Dopamine and Dopamine Blockers

• Dopamine: Increases wakefulness and reduces sleep.
• Dopamine Blockers (e.g., Antipsychotics): Promote sleep by blocking dopamine receptors.

Benzodiazepines

• Effects on Sleep:
  • Slightly reduce REM and Stage 4 (deep) sleep.
  • Chronic Use and Withdrawal: When used over time, benzodiazepines decrease sleep latency (time to fall asleep), but upon withdrawal, sleep latency increases.

Alcohol

• Moderate Consumption:
  • Leads to early sleep onset but causes increased wakefulness during the second half of the night.
• Intoxication:
  • Decreases REM sleep.
  • Withdrawal:
    • Causes REM rebound, often accompanied by nightmares.

Barbiturates

• Effects on Sleep:
  • Decrease REM sleep.
  • Withdrawal:
    • Triggers REM rebound, which can include nightmares.

Depression and Sleep

• Major Depression:
  • Increases REM sleep but shortens REM latency (45 minutes instead of the typical 90 minutes).
  • Decreases the duration of Stages 3 and 4 sleep (deep sleep).
  • Additional Effects:
    • Causes early morning awakenings and multiple disturbances during the night.

Points to Remember:

• Dopamine: Promotes wakefulness, while dopamine blockers promote sleep.
• Benzodiazepines: Cause mild decreases in deep and REM sleep; withdrawal leads to increased sleep latency.
• Alcohol: Initially helps with sleep onset but leads to wakefulness later in the night. Withdrawal causes REM to rebound with nightmares.
• Barbiturates: Suppress REM, and withdrawal leads to REM rebound.
• Depression: Increases REM but shortens latency and decreases deep sleep stages, causing multiple nighttime awakenings.

Table: Drug Effects on Sleep

Bibliography:

1. National Institute on Drug Abuse (NIDA): Drugs and Sleep.
2. American Psychiatric Association (APA): Understanding the Role of Sleep in Mental Health.
3. Sleep Foundation: How Medications Affect Sleep.