Sleep and some psychoactive drugs

Effects of antiepileptic drugs on sleep structure : are all drugs equal?

Good-quality sleep is an important and frequently overlooked component of general health, but it is particularly essential to patients with epilepsy. Their sleep can be affected by seizures, concurrent sleep disorders and seizure treatment. Worsening sleep can result not only in poor daytime functioning but also potentially in worsening epilepsy. The effects of antiepileptic drugs (AEDs) on sleep are of particular concern. Some agents have detrimental effects on sleep, particularly benzodiazepines and barbiturates but also phenytoin and, possibly, carbamazepine. Others, especially gabapentin, seem to actually improve sleep quality. Much research in this area is confounded by the effects of seizures and concurrent conditions on sleep, making it difficult to isolate the direct effects of AEDs on sleep. But because AEDs have independent effects on sleep quality, the choice of an appropriate agent not only determines whether seizures are completely controlled but also whether the patient performs optimally on a daily basis.

Sleep-related epilepsy

Sleep is important for the general health of all, but is particularly essential for individuals with epilepsy. In these patients, a complex relationship exists between seizures and sleep, and both must be considered for optimal care. In this review, recent advances in the field of epilepsy and sleep are considered. These include sleep disorders with a specific relationship to epilepsy, the influences of sleep and sleep deprivation on interictal epileptiform discharges, detrimental effects of seizures on sleep, and the effects (good and bad) of epilepsy treatments on sleep.

Amphetamine withdrawal and sleep disturbance

Sleep duration and indices of disturbed sleep, such as night-time waking and day-time sleep, were investigated in amphetamine users following hospital admission and withdrawal from the drug. Compared to controls, the amphetamine group showed an initial period of oversleeping and, towards the end of the first week, they showed a considerable degree of reduced sleep which persisted for the 20 days of this study. There was greater variability in sleep duration within the amphetamine group on almost all nights, and the variability in sleep duration from one night to the next was also greater. More night-time sleep disturbance was evident among the amphetamine ex-users. These results are discussed with respect to previous work and the pattern is seen to be more complex than had been imagined. A tentative neurochemical model is suggested and clinical implications are considered.

Acute heroin abstinence in man: II. Alterations in rapid eye movement (REM) sleep

The purpose of this study was to examine the effects of withdrawal from heroin upon rapid eye movement (REM) sleep. Subjects included both heroin-dependent patients and drug-free controls. The drug users were young males who had an average daily intake of approximately 973 mg of 92 - 98% pure heroin before entering the study. All electrophysiological data were obtained via a telemetry system on a 24-hour per day basis for 5 to 7 consecutive days. EEG records were scored into the standard awake and sleep states. Results showed a marked decrease in total amount of REM sleep during heroin withdrawal. This total decrease was associated with a decrease in duration of individual REM episodes and a large decrease in the number of occurrences of REM sleep. The heroin-dependent patients during withdrawal also showed a prolonged latency from sleep onset to first REM episode and a reduced number of REM shifts per 24-hour period. No significant difference in REM sleep interval was observed between the control subjects and drug users. Some of the overt behavioral characteristics associated with heroin withdrawal may be indirectly related to the concurrent loss in REM sleep as observed in this study.

Acute heroin abstinence in man: I. Changes in behavior and sleep

The purpose of this study was to examine overt behavioral characteristics and sleep during acute heroin abstinence in man. Both heroine-dependent patients and drug-free control subjects were observed and monitored on a 24-hour per day basis for 5 to 7 days. Observational data were analyzed for frequency of occurrence of various behaviors including the signs and symptoms of withdrawal. Electroencephalographic (EEG) data were scored into awake and sleep stages according to standard techniques. The heroin-dependent subjects generally displayed a higher number of observations across all recording days as compared to the controls. In addition, the signs and symptoms of withdrawal for these patients peaked on day 1 or day 2 and then declined over the remaining recording days. The EEG state data showed an increase in waking and decrease in both slow wave and REM sleep during acute heroin withdrawal. Total sleep was maximally suppressed on withdrawal days 2 and 3 and was still below normal control values on withdrawal days 5 - 7. REM sleep was more disrupted than slow-wave sleep during withdrawal from heroin. Results of this study indicate that heroin withdrawal produces a differential action upon central nervous system structures responsible for the various states of sleep, waking and related behaviors.

The action of lithium carbonate on the sleep-waking cycle in the cat

The therapeutic effect of lithium carbonate on manic-depressive psychosis is now universally recognized. In view of this positive action on the cyclic endogenous manifestations, it was interesting to investigate the possible effects of lithium on the sleep-waking cycle in the cat. Polygraphic recording from three adults cats was carried out during 24 h periods before, and on different days after, beginning treatment with lithium carbonate. With low doses (30 and 50 mg/kg/day), important morphological changes were observed 5 days later while a new balance of the sleep-waking stages occurred. The EEG of each stage was characterized by slowing and amplitude increase of the different frequencies. The rhythms which appeared in long runs during quiet wakefulness and paradoxical sleep (PS) in the somaethetic cortex (mu rhythm) and the visual areas (alpha rhythm) were increased, slowed and almost continuously present. From the quantitative point of view, the percentage of time of deep slow wave sleep (DSWS) was increased from 38% to 55%. Conversely, the waking and PS times were both reduced, the latter from 18% to 10%. In contrast with human data, the mean duration of PS episodes was unchanged. Furthermore, lithium induced a slight dissociation between EEG activity and waking behaviour. With toxic dose (90 mg/kg/day) all the above changes were again observed, but more conspicuously. During wakefulness and SWS, bursts of generalized paroxysmal events appeared, in frequent association with a myoclonic jerk. SP became atypical and its percentage of time was drastically reduced.