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Medications that increase or decrease slow wave sleep

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Medications that increase or decrease slow wave sleep

Postby ToHellAndBack » Tue Aug 26, 2008 12:26 am

Because slow wave sleep seems to be a big thing in successful OSA treatment, I took it upon myself recently to research common psychiatry medications which affect slow wave or deep restorative sleep. My source is psychopharmacology author and researcher Dr. Stephen Stahl M.D.'s latest book titled "Stahl's Essential Psychopharmacology: Neuroscientific Basis and Practical Applications." This is the third edition of this book and was published in 2008, hence its psychopharmacology info is up to date.

Of interest, the book has an entire chapter on the psychopharmacology of sleep medicine. Here is what Stahl has to say about psychiatry meds and their effect on critical slow wave sleep:

Drugs that interfere or decrease slow wave sleep include: Some agents, such as serotonergic antidepressants (SSRIs, SNRIs, stimulants, and stimulating antidepressants (NDRI) can all interfere with slow wave sleep.

Also, while not stated in the text, my sleep doctor told me caffeine can interfere with slow wave sleep. I referred to another Stephen Stahl psychopharmacology manual and indeed, Stahl mentions caffeine and amphetamines decrease slow wave sleep, while Stahl claimed Provigil has neither a decreasing or increasing effect on SWS.

So common antidepressants screw up slow wave sleep and could theoretically prevent you from getting the most "bang for your buck" with CPAP.

On the other hand, some medications enhance slow wave sleep according to Dr. Stahl. These include gabapentin (Neurontin) and pregabalin, the GABA reuptake inhibitor tiagabine, trazodone and the recently FDA approved drug GHB.

Gabapentin is notorious for causing weight gain, so I doubt that would be a viable option for OSA sufferers. Pregabalin and tiagabine are both epilepsy drugs, used off label for bipolar disorder. I dont know if those cause weight gain or not.

Dr. Stahl claims augmenting with slow wave sleep enhancing agents can sometime reduce symptoms, especially in patients with "affective spectrum disorder" (mood disorders) or a "functional somatic synhdrome" (pain patients).

Fred
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Postby zaquon » Wed Aug 27, 2008 2:13 pm

This got me thinking as to how the meds I've been taking affect slow wave sleep. It turns out Xanax and indeed many on the benzos can shorten or delay SWS. I've been taking Xanax almost every night since I started CPAP. Last night I replaced the Xanax with Valarian root, which some studies suggest may shorten SWS latency and duratian, and had the best night's sleep I've had so far! I don't know how well the root really works, but I'm ok taking a placebo as long as it doesn't hurt.

I took xanax before my last split night sleep study and I had very little SWS with the CPAP and none without, even though I probably should have had a ton.

_z
"Try. Fail. Try again. Fail better." - Samuel Beckett
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Re: Medications that increase or decrease slow wave sleep

Postby RAM_Sleep » Thu Aug 28, 2008 12:45 am

ToHellAndBack wrote:Because slow wave sleep seems to be a big thing in successful OSA treatment, I took it upon myself recently to research common psychiatry medications which affect slow wave or deep restorative sleep. My source is psychopharmacology author and researcher Dr. Stephen Stahl M.D.'s latest book titled "Stahl's Essential Psychopharmacology: Neuroscientific Basis and Practical Applications." This is the third edition of this book and was published in 2008, hence its psychopharmacology info is up to date.

Of interest, the book has an entire chapter on the psychopharmacology of sleep medicine. Here is what Stahl has to say about psychiatry meds and their effect on critical slow wave sleep:

Drugs that interfere or decrease slow wave sleep include: Some agents, such as serotonergic antidepressants (SSRIs, SNRIs, stimulants, and stimulating antidepressants (NDRI) can all interfere with slow wave sleep.

Also, while not stated in the text, my sleep doctor told me caffeine can interfere with slow wave sleep. I referred to another Stephen Stahl psychopharmacology manual and indeed, Stahl mentions caffeine and amphetamines decrease slow wave sleep, while Stahl claimed Provigil has neither a decreasing or increasing effect on SWS.

So common antidepressants screw up slow wave sleep and could theoretically prevent you from getting the most "bang for your buck" with CPAP.

On the other hand, some medications enhance slow wave sleep according to Dr. Stahl. These include gabapentin (Neurontin) and pregabalin, the GABA reuptake inhibitor tiagabine, trazodone and the recently FDA approved drug GHB.

Gabapentin is notorious for causing weight gain, so I doubt that would be a viable option for OSA sufferers. Pregabalin and tiagabine are both epilepsy drugs, used off label for bipolar disorder. I dont know if those cause weight gain or not.

Dr. Stahl claims augmenting with slow wave sleep enhancing agents can sometime reduce symptoms, especially in patients with "affective spectrum disorder" (mood disorders) or a "functional somatic synhdrome" (pain patients).

Fred


Just to show how random this topic can be, I will list a few meds that I have read about and their effects on sleep. Medications, in myopinion, are tough because there are million variables and many people are not on a single drug, which may cause interactions and complications with the info that is written in texts and anywhere else. In any event:

Out of the SSRI/SNRI category, Venlafaxine and Duloxetine will decrease SWS, while Fluvoxamine, Fluoxetine, Paroxetine, Sertraline, Citalopram, and Escitalopram show no effect on SWS.

Generally, Benzodiazepines will decrease SWS, some markedly so. Triazolam seems to be an exception.

Non-Benzo Hypnotics increase SWS.

Antipsychotics increase SWS.

3º amines increase SWS.

2º amines increase SWS.

Misc Antidepressants can go either way. Mirtazapine, Nefazodone, and Trazodone can increase SWS.

Anti-epileptics (such as Gabapentin) generally increase SWS. Phenytoin is an exception.

Thats just a small list.
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Re: Medications that increase or decrease slow wave sleep

Postby ToHellAndBack » Thu Aug 28, 2008 11:45 am

RAM_Sleep wrote:
ToHellAndBack wrote:Because slow wave sleep seems to be a big thing in successful OSA treatment, I took it upon myself recently to research common psychiatry medications which affect slow wave or deep restorative sleep. My source is psychopharmacology author and researcher Dr. Stephen Stahl M.D.'s latest book titled "Stahl's Essential Psychopharmacology: Neuroscientific Basis and Practical Applications." This is the third edition of this book and was published in 2008, hence its psychopharmacology info is up to date.

Of interest, the book has an entire chapter on the psychopharmacology of sleep medicine. Here is what Stahl has to say about psychiatry meds and their effect on critical slow wave sleep:

Drugs that interfere or decrease slow wave sleep include: Some agents, such as serotonergic antidepressants (SSRIs, SNRIs, stimulants, and stimulating antidepressants (NDRI) can all interfere with slow wave sleep.

Also, while not stated in the text, my sleep doctor told me caffeine can interfere with slow wave sleep. I referred to another Stephen Stahl psychopharmacology manual and indeed, Stahl mentions caffeine and amphetamines decrease slow wave sleep, while Stahl claimed Provigil has neither a decreasing or increasing effect on SWS.

So common antidepressants screw up slow wave sleep and could theoretically prevent you from getting the most "bang for your buck" with CPAP.

On the other hand, some medications enhance slow wave sleep according to Dr. Stahl. These include gabapentin (Neurontin) and pregabalin, the GABA reuptake inhibitor tiagabine, trazodone and the recently FDA approved drug GHB.

Gabapentin is notorious for causing weight gain, so I doubt that would be a viable option for OSA sufferers. Pregabalin and tiagabine are both epilepsy drugs, used off label for bipolar disorder. I dont know if those cause weight gain or not.

Dr. Stahl claims augmenting with slow wave sleep enhancing agents can sometime reduce symptoms, especially in patients with "affective spectrum disorder" (mood disorders) or a "functional somatic synhdrome" (pain patients).

Fred


Just to show how random this topic can be, I will list a few meds that I have read about and their effects on sleep. Medications, in myopinion, are tough because there are million variables and many people are not on a single drug, which may cause interactions and complications with the info that is written in texts and anywhere else. In any event:

Out of the SSRI/SNRI category, Venlafaxine and Duloxetine will decrease SWS, while Fluvoxamine, Fluoxetine, Paroxetine, Sertraline, Citalopram, and Escitalopram show no effect on SWS.

Generally, Benzodiazepines will decrease SWS, some markedly so. Triazolam seems to be an exception.

Non-Benzo Hypnotics increase SWS.

Antipsychotics increase SWS.

3º amines increase SWS.

2º amines increase SWS.

Misc Antidepressants can go either way. Mirtazapine, Nefazodone, and Trazodone can increase SWS.

Anti-epileptics (such as Gabapentin) generally increase SWS. Phenytoin is an exception.

Thats just a small list.


Id REALLY like to see the source of your info! Not because I'm contesting you at all, most of what you are saying I agree with and have already read. But Id like to know the source so I could read it myself, because I'm interested in this subject. ;-)

The only thing you claim that doesnt jibe with what Ive read is the thing about SSRIs. Ive read many places that SSRIs interfere/stop SWS and I had a board certified sleep medicine doctor tell me recently that SSRIs compress REM sleep. That doctor's background before sleep medicine was psychiatry.

And why would venlafaxaine and cymbalta suppress SWS sleep, while SSRIs have no effect on SWS? All SNRIs are is extra strength SSRIs, afterall. They work by the same mechanism. Venlafaxine and cymbalta are SNRIs (Selective Norephinephrine Reuptake Inhibitors)...these meds selectively block the reuptake pumps for serotonin and norephinephrine. Whereas SSRIs are Selective Serotonin Reuptake Inhibitors and only block the serotonin reuptake pumps.

Seems since norephinephrine is a stimulant type neurotransmitter, the SNRIs would interfere more with SWS than SSRIs.

This is an interesting subject, at least to me.

I also read in this same book "Stahl's Essential Psychopharmacology: Neuroscientific Basis and Practical Applications, Third edition" the following under the sleep disorders chapter: "Nevertheless, an important subset of sleep apnea patients present with treatment resistant depression and undiagnosed sleep apnea, suggesting that a higher index of suspicion for sleepiness in general and sleep apnea in particular would be well served in psychopharmacology." CPAP and Provigil or stimulants may be more effective for the depression in such patients than combinations of antidepressants alone"

This comment by expert psychopharmacology researcher and author Dr. Stephen Stahl, MD confirms my own recent findings that for me, just 50 mg zoloft plus CPAP gives a hundred times better clinical effect (antidepressant/anti-anxiety effect) than did 200 mg Zoloft combined with 45 mg Remeron! I was labeled one of these "treatment resistant clinical depression patients prior to CPAP. I could take maximum dosages of an antidepressant, combine that with another maximum dosage of antidepressant and still have a HAMD score of 30! Not so on just 50 mg zoloft plus CPAP.

Fascinating subject and makes me wonder if some psychopharmacology practices are leaving many OSA patients with less than stellar results?

Fred
"We don't need socialized medicine, what we need is insurance reform."


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Postby RAM_Sleep » Thu Aug 28, 2008 1:19 pm

Hardman JG, Limbird LE, Goodman AG, eds. Goodman & Gilman's The Pharmacological Basis of Therapeutics. 11th ed. New York: McGraw-Hill; 2006.
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Postby ToHellAndBack » Thu Aug 28, 2008 2:23 pm

RAM_Sleep wrote:Hardman JG, Limbird LE, Goodman AG, eds. Goodman & Gilman's The Pharmacological Basis of Therapeutics. 11th ed. New York: McGraw-Hill; 2006.


I know about Goodman and Gillman's textbooks. Thanks, I will check that source out!

Fred
"We don't need socialized medicine, what we need is insurance reform."


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Postby MrsBaddawg » Thu Aug 28, 2008 2:53 pm

zaquon wrote:This got me thinking as to how the meds I've been taking affect slow wave sleep. It turns out Xanax and indeed many on the benzos can shorten or delay SWS. I've been taking Xanax almost every night since I started CPAP. Last night I replaced the Xanax with Valarian root, which some studies suggest may shorten SWS latency and duratian, and had the best night's sleep I've had so far! I don't know how well the root really works, but I'm ok taking a placebo as long as it doesn't hurt.

I took xanax before my last split night sleep study and I had very little SWS with the CPAP and none without, even though I probably should have had a ton.

_z


Really? I guess it depends on your condition. I have mixed (just found out from getting the actual report, not just listening to PCP). My Dr. says because of the centrals I'm having panic attacks in my sleep and waking up hyperventilated. Xanax actually has helped with that. Now to deal with my OSA...
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Postby RAM_Sleep » Thu Aug 28, 2008 3:20 pm

zaquon wrote:This got me thinking as to how the meds I've been taking affect slow wave sleep. It turns out Xanax and indeed many on the benzos can shorten or delay SWS. I've been taking Xanax almost every night since I started CPAP. Last night I replaced the Xanax with Valarian root, which some studies suggest may shorten SWS latency and duratian, and had the best night's sleep I've had so far! I don't know how well the root really works, but I'm ok taking a placebo as long as it doesn't hurt.

I took xanax before my last split night sleep study and I had very little SWS with the CPAP and none without, even though I probably should have had a ton.

_z


Ive read that valerian doesn't do a whole lot, aside from increasing efficiency and reducing latency. In any event, if it works for you, then great.

It should be better than the Alprazolam you were taking, in terms of SWS and possibly REM.
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Postby ToHellAndBack » Thu Aug 28, 2008 4:44 pm

MrsBaddawg wrote:
zaquon wrote:This got me thinking as to how the meds I've been taking affect slow wave sleep. It turns out Xanax and indeed many on the benzos can shorten or delay SWS. I've been taking Xanax almost every night since I started CPAP. Last night I replaced the Xanax with Valarian root, which some studies suggest may shorten SWS latency and duratian, and had the best night's sleep I've had so far! I don't know how well the root really works, but I'm ok taking a placebo as long as it doesn't hurt.

I took xanax before my last split night sleep study and I had very little SWS with the CPAP and none without, even though I probably should have had a ton.

_z


Really? I guess it depends on your condition. I have mixed (just found out from getting the actual report, not just listening to PCP). My Dr. says because of the centrals I'm having panic attacks in my sleep and waking up hyperventilated. Xanax actually has helped with that. Now to deal with my OSA...



Wouldn't it make more sense to get your doctor to prescribe you one of these newer, sophisticated CPAPs or BIPAPs specifically designed for central and mixed apneas? I know Resmed makes at least one machine for central/mixed apnea, something like a VPAP or some name like that.

To me, that would make more sense than loading up on a sedative benzo like benzo, which makes the obstructive part of SA worse. I am trying to slowly wean myself away from all sedative medications, especially benzos, COMPLETELY.

Fred
"We don't need socialized medicine, what we need is insurance reform."


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