Zolpidem-induced sleep-related eating disorder

Abstract

Zolpidem is widely used worldwide for the treatment of insomnia. However, the sleep-related eating disorder (SRED) caused by zolpidem has recently become a major challenge. The risk of SRED caused by zolpidem is reportedly higher mainly in the elderly, women, and patients with comorbid medical illnesses. There may also be an increased risk in those with a sleep disorder or a family history of sleep disorders. Restless legs syndrome (RLS), obstructive sleep apnea, and sleepwalking could also increase the risk. There are three main hypotheses for the underlying mechanism. The first hypothesis is related to the concentration of zolpidem. Zolpidem is absorbed quickly by the body so as to cause a rapid increase in its concentration, resulting in SRED appearing like delirium. The second hypothesis is a theory related to GABA receptor desensitization, which results in more arousal effects during slow-wave sleep. The third hypothesis is that zolpidem stimulates the brain. The most important treatment is to discontinue the causative drug, which causes SRED to disappear. Reducing the dosage of zolpidem may also improve SRED. Another intervention is to perform a drug switch. Finally, there is a treatment based on the spectrum perspective, in which nocturnal eating is treated by placing SRED and night eating syndrome (NES) at the two ends of a line. Patients appearing closer to SRED on the line require identification and treatment of the underlying sleep problem. We previously reported a SRED patient receiving zolpidem who had RLS. The successful treatment of that patient included administering ropinirole combined with zolpidem discontinuation, indicating that it is important to treat underlying sleep disorders in SRED caused by zolpidem. On the other hand, if the nocturnal eating behavior is closer to NES, such as in patients with few amnesia and eating problems during the daytime, treatments can involving using selective serotonin-reuptake inhibitors, topiramate, and lamotrigine by evaluating mood disorders associated with the eating problem or by focusing on eating disorders.