Sleep and sleep disorders

Abstract

Nearly all drugs of abuse and alcohol have considerable effects on sleep efficiency, sleep continuity, sleep stages, and consequent next-day alertness. It has been hypothesized that such drug effects on sleep and wake function may act as contributing factors in maintaining compulsive and excessive drug use, as well as factors that increase the risk for relapse. Alcohol at high doses disrupts sleep continuity and suppresses REM sleep. In abstinent alcoholics, a REM sleep disturbance is predictive of relapse. Stimulants, which have daytime alerting effects, have been shown to increase alertness and wakefulness at night, and suppress REM sleep. Analgesics have been found to decrease REM sleep and total sleep time, as well as increase daytime sleepiness. Hallucinogens have varying effects on sleep. MDMA has been shown to reduce sleep time without having major effects on REM sleep, whereas marijuana has been found to decrease REM sleep while increasing slow wave sleep. Older sedative-hypnotics like the barbiturates are also REM suppressant. In fact, virtually all drugs of abuse have REM suppressant properties, at least acutely. In contrast, the newer sedative-hypnotics (i.e., the benzodiazepine receptor agonists) which have a low abuse liability have been shown to have little effect on REM sleep.