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Hypnosedative-induced complex behaviours : incidence, mechanisms and management.
Christian R Dolder1, Michael H Nelson
1Wingate University School of Pharmacy, Wingate, North Carolina 28174, USA. cdolder@wingate.edu
CNS Drugs
|November 13, 2008
Summary
Hypnosedative medications can cause complex sleep behaviors like sleepwalking and sleep eating. Management strategies include dose adjustment, switching medications, and careful patient selection to prevent these adverse effects.
Area of Science:
- Pharmacology
- Sleep Medicine
- Neuroscience
Background:
- Hypnosedative medications, particularly nonbenzodiazepine receptor agonists (NBRAs), are increasingly associated with complex sleep-related behaviors.
- Regulatory agencies have issued warnings, yet understanding of these behaviors remains limited.
Purpose of the Study:
- To review and evaluate published evidence on the clinical presentation, incidence, mechanisms, and management of NBRA-induced complex sleep behaviors.
Main Methods:
- Literature review of published case reports concerning NBRA-induced complex sleep behaviors.
- Analysis of patient demographics, medications, reported behaviors, and potential contributing factors.
Main Results:
- Ten case reports involving 17 patients were identified, with zolpidem being the most common agent implicated.
- Common behaviors included sleep eating, sleepwalking, sleep driving, and sleep sex.
- Elevated drug concentrations and GABAergic mechanisms are potential contributors, though not fully explanatory.
Conclusions:
- NBRAs can induce complex sleep behaviors, with zolpidem being frequently involved.
- While GABA receptor activity is a proposed mechanism, other factors likely contribute.
- Management involves dose reduction, medication changes, and careful consideration of drug interactions and patient factors.
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