ABC of Sleep Disorders

Abstract

Our aim is to summarise how some of the most commonly used psychotropic drugs may affect sleep, and we will discuss them in three groups: S Drugs used primarily to improve sleep * Drugs used primarily to reduce sleepiness * Drugs used primarily to treat particular psychiatric disorders which have secondary effects on sleep I It is important that before prescribing any treatment the doctor should l _ try to make a precise diagnosis so that he or she can decide what kind of treatment is appropriate. For example, Mr Splitman, who complains of sleep disturbance during an acute exacerbation of schizophrenia, should be given treatment different from that given to Ms Downer, whose sleep disturbance is a feature of a major depressive episode. Mr and Mrs Kryer may benefit from psychotherapy for their recent bereavement, together with a drug to relieve secondary insomnia. Mr Bullneck's hypersomnolence, irritability, and mild depression could be a secondary 'Sula's dream' by Elspeth Grant. feature ofhis sleep apnoea (diagnosed by overnight electrophysiological testing), and he will probably require treatment other than drugs. In Factors in choosing the right' drug contrast, young Phil Drowsey's performance at school is deteriorating, and he has withdrawn from most ofhis extracurricular social activities. This is, * Pharmacokinetics however, secondary to depressed alertness, not to depressed mood, despite * Side effects: benefits apparently adequate nocturnal sleep, and suggests narcolepsy. * Side effects: disadvantages It is clear that drugs are only one ofthe treatments available for the * Contraindications various medicopsychiatric disorders, all ofwhich have disturbed sleep as a * Interaction with other drugs common denominator. If drugs are indicated the doctor is often caught in a * History of response pharmaceutical jungle; choosing the right drug can be a formidable task, * Doctor's knowledge of drug and the final selection depends on several factors.

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