Sleep antipsychotic drugs

Monti JM, Monti D (2004) Sleep in schizophrenia patients and the effects of antipsychotic drugs. Sleep Med Rev 8 133-148... 

Most antipsychotic drugs cause unpleasant subjective effects in nonpsychotic individuals. The mild to severe EPS, including akathisia, sleepiness, restlessness, and autonomic effects are unlike any associated with more familiar sedatives or hypnotics. Nevertheless, low doses of some of these drugs, particularly quetiapine, are used to promote sleep onset and maintenance, although there is no approved indication for such usage. 

YamashitaH, Mori K, Nagao M, Okamoto Y, Morinobu S, Yamawaki S (2005) Influence of aging on the improvement of subjective sleep quality by atypical antipsychotic drugs in patients with schizophrenia comparison of middle-aged and older adults. Am J Geriatr Psychiatry 13 377-384... 

Wetter TC, Lauer CJ, Gillich G, Pollmacher T. The elec-troencephalographic sleep pattern in schizophrenic patients treated with clozapine or classical antipsychotic drugs. J Psychiatr Res 1996 30(6) 411-9. 

Antipsychotic drugs have inconsistent effects on sleep patterns but tend to normalize sleep disturbances characteristic of many psychoses and mania. The capacity to prolong and enhance the effect of opioid and hypnotic drugs appears to parallel the sedative, rather than the neuroleptic, potency of a particular agent thus, potent, less-sedating antipsychotics do not enhance sleep. 

As defined in Chapter 23, the antipsychotic drugs are not addicting, but some degree of physical dependence may occur, with malaise and difficulty in sleeping developing several days after abrupt drug discontinuation after prolonged use. 

Benzodiazepines are used as hypnotics because they have the ability to increase total sleep time. They demonstrate minimal cardiovascular effects, but do have the ability to increase heart rate and decrease cardiac output. Most CNS depressants, including the benzodiazepines, exhibit the ability to relax skeletal muscles. Clozapine, a dibenzodiazepine, is used in the treatment of schizophrenia. It has both sedative and antipsychotic actions, and is the only FDA-approved medication indicated for treatment-resistant schizophrenia, and for reducing the risk of suicidal behavior in patients with schizophrenia. This drug can have potentially life-threatening side effects, but appears to have no abuse potential and will not be considered further. 

Stahl s Essential Psychopharmacology has established itself as the preeminent source of education and information in its field. This much expanded second edition enlists advances in neurobiology and recent clinical developments to explain with renewed clarity the concepts underlying drug treatment of psychiatric disorders. New neurotransmitter systems, new theories of schizophrenia, clinical advances in antipsychotic and antidepressant therapy, new coverage of attention deficit disorder, sleep disorders, and drug abuse, and a new chapter on sex-specific and sexual function-related psychopharmacology—these are all features of this edition. 

Other classes of drugs not included in Figure 22-3 that may exert sedative effects include most antipsychotic and many antidepressant drugs and certain antihistaminic agents (eg, hydroxyzine, promethazine). As discussed in other chapters, these agents differ from conventional sedative-hypnotics in both their effects and their major therapeutic uses. Since they commonly exert marked effects on the peripheral autonomic nervous system, they are sometimes referred to as "sedative-autonomic" drugs. Certain antihistaminics with sedative effects are available in over-the-counter sleep aids. Their autonomic properties and their long durations of action can result in adverse effects. 

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