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Medication Effects in Polysomnography <ul><li>Midwest Sleep and Neurodiagnostic Institute </li></ul>
What the technologist needs to know <ul><li>Possible effects on sleep </li></ul><ul><li>Basic concepts of pharmacokinetics...
Medication Effects on Sleep Architecture <ul><ul><li>   Sleep Latency </li></ul></ul><ul><ul><li>   REM Latency </li><...
Medication Effects on Other Aspects of Sleep <ul><li>   Arousals – Sleep disruption </li></ul><ul><li>   PLM’s </li></...
Pharmacokinetics <ul><li>Dosage </li></ul><ul><li>Terms to know </li></ul><ul><ul><li>Onset of action - Absorption </li></...
Hypnotics <ul><li>All decrease sleep latency </li></ul><ul><ul><li>Barbiturates </li></ul></ul><ul><ul><li>Benzodiazepines...
Barbiturates <ul><li>Increased TST </li></ul><ul><li>Potent REM suppression </li></ul><ul><ul><li>Increased REM latency </...
Benzodiazepines (BZD) <ul><ul><li>Indicated for insomnia </li></ul></ul><ul><ul><li>Short term treatment </li></ul></ul><u...
Benzodiazepines (BZD) <ul><ul><li>Effect on Sleep </li></ul></ul><ul><ul><ul><ul><li>Decrease arousals & decrease WASO </l...
 
Benzodiazepines (BZD) <ul><ul><li>Classified according to their half-life and duration </li></ul></ul><ul><ul><ul><li>Shor...
Non-Benzodiazepines <ul><ul><li>Zolpidem (Ambien), Zalepon (Sonata) </li></ul></ul><ul><ul><ul><ul><li>Short acting  </li>...
OTC Substances  <ul><ul><li>L-Tryptophan (amino acid) </li></ul></ul><ul><ul><ul><li>May decrease sleep latenc </li></ul><...
OTC Substances <ul><li>Antihistamines </li></ul><ul><ul><li>Shorten sleep latency </li></ul></ul><ul><ul><li>REM suppressi...
Antidepressants <ul><li>Wide variance in effects across and within categories </li></ul><ul><ul><ul><li>Tricyclics </li></...
Antidepressants <ul><li>Tricyclics  [Hard to classify as a group] </li></ul><ul><ul><li>Some sedating </li></ul></ul><ul><...
Antidepressants <ul><li>MAO’s </li></ul><ul><ul><li>Strong REM suppression </li></ul></ul><ul><ul><li>Decrease TST </li></...
Antidepressants <ul><li>SSRI’s </li></ul><ul><ul><li>Prosac (Fluoxitine) </li></ul></ul><ul><ul><li>Paxil (Paroxetine) </l...
Antidepressants <ul><li>SSRI’s </li></ul><ul><ul><li>No effect on sleep onset </li></ul></ul><ul><ul><li>Reduces SWS </li>...
Stimulants <ul><li>Amphetamines/Ritalin/Cylert/Cocaine </li></ul><ul><li>Theophylline </li></ul><ul><li>Decongestants </li...
Stimulants   <ul><ul><li>Effects on sleep </li></ul></ul><ul><ul><ul><li>Increase sleep latency </li></ul></ul></ul><ul><u...
Stimulants – Overdose
Alcohol <ul><li>Decrease sleep latency </li></ul><ul><li>Decrease REM (leads to REM rebound and nightmares after eliminati...
 
Resources <ul><li>PDR </li></ul><ul><li>Nursing & Other drug references </li></ul><ul><li>Principles & Practice of Sleep M...
Exam Content Areas Related to Medication Effects <ul><li>Domain 1, Task 1 </li></ul><ul><ul><li>Review medical information...
Exam Content Areas Related to Medication Effects <ul><li>Domain 1, Task 2 </li></ul><ul><ul><li>Collect data from the pati...
Exam Content Areas Related to Medication Effects <ul><li>Domain 1 Task 3 </li></ul><ul><ul><li>Analyze in integrate collec...
Exam Content Areas Related to Medication Effects <ul><li>Domain 3 Task 4 </li></ul><ul><ul><li>Implement appropriate inter...
Exam Content Areas Related to Medication Effects <ul><li>Domain 4, Task 1 </li></ul><ul><ul><li>Score stages </li></ul></u...
Exam Content Areas Related to Medication Effects   <ul><li>Domain 4, Task 2 </li></ul><ul><ul><li>Score clinical events </...
Exam Content Areas Related to Medication Effects   <ul><li>Domain 5, Task 5 </li></ul><ul><ul><li>Educate patients </li></...
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Apt medication effects in polysomnography

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Medication alterations to sleep

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Apt medication effects in polysomnography

  1. 1. Medication Effects in Polysomnography <ul><li>Midwest Sleep and Neurodiagnostic Institute </li></ul>
  2. 2. What the technologist needs to know <ul><li>Possible effects on sleep </li></ul><ul><li>Basic concepts of pharmacokinetics </li></ul><ul><li>Specific effects of classes of medications </li></ul><ul><li>Specific effects of commonly used substances </li></ul><ul><ul><li>Withdrawal effects also </li></ul></ul><ul><li>Resources </li></ul>
  3. 3. Medication Effects on Sleep Architecture <ul><ul><li> Sleep Latency </li></ul></ul><ul><ul><li> REM Latency </li></ul></ul><ul><ul><li> SWS sleep </li></ul></ul><ul><ul><li> TST </li></ul></ul><ul><ul><li> REM </li></ul></ul><ul><ul><li> Stage 1 </li></ul></ul><ul><ul><li> WASO </li></ul></ul>
  4. 4. Medication Effects on Other Aspects of Sleep <ul><li> Arousals – Sleep disruption </li></ul><ul><li> PLM’s </li></ul><ul><li> Fast activity / spindles </li></ul><ul><li> SREMS </li></ul><ul><li> Apnea duration & severity </li></ul><ul><li>Improve or disturb subjective sleep </li></ul><ul><li> daytime sleepiness </li></ul>
  5. 5. Pharmacokinetics <ul><li>Dosage </li></ul><ul><li>Terms to know </li></ul><ul><ul><li>Onset of action - Absorption </li></ul></ul><ul><ul><li>Elimination half life </li></ul></ul><ul><ul><li>Withdrawal </li></ul></ul><ul><li>Age related </li></ul><ul><ul><li>Paradoxical effects in children </li></ul></ul><ul><ul><li>Much slower elimination in patients </li></ul></ul><ul><ul><ul><li>Who are older </li></ul></ul></ul><ul><ul><ul><li>have compromised liver or kidney function </li></ul></ul></ul>
  6. 6. Hypnotics <ul><li>All decrease sleep latency </li></ul><ul><ul><li>Barbiturates </li></ul></ul><ul><ul><li>Benzodiazepines </li></ul></ul><ul><ul><li>Nonbenzodiazepines </li></ul></ul>
  7. 7. Barbiturates <ul><li>Increased TST </li></ul><ul><li>Potent REM suppression </li></ul><ul><ul><li>Increased REM latency </li></ul></ul><ul><li>May increase sleep spindles </li></ul><ul><li>May increase slow wave sleep </li></ul><ul><li>Decreased WASO </li></ul><ul><li>Decreased TST and subjective sleep upon withdrawal </li></ul>
  8. 8. Benzodiazepines (BZD) <ul><ul><li>Indicated for insomnia </li></ul></ul><ul><ul><li>Short term treatment </li></ul></ul><ul><ul><li>Works best with combination of Sleep Hygiene measures </li></ul></ul>
  9. 9. Benzodiazepines (BZD) <ul><ul><li>Effect on Sleep </li></ul></ul><ul><ul><ul><ul><li>Decrease arousals & decrease WASO </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Reduce general body movements </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Increase TST </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Increase stages 1 and 2 </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Increase fast EEG activity incl. spindles </li></ul></ul></ul></ul><ul><ul><ul><ul><li>May increase REM latency and decrease REM </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Decrease SWS </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Improves subjective sleep </li></ul></ul></ul></ul>
  10. 11. Benzodiazepines (BZD) <ul><ul><li>Classified according to their half-life and duration </li></ul></ul><ul><ul><ul><li>Short-acting(initiating sleep) </li></ul></ul></ul><ul><ul><ul><ul><li>Triazolam (Halcion-acting </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Temazepam (Restoril) </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Estazolam (Prosom) </li></ul></ul></ul></ul><ul><ul><ul><li>Long-acting (maintaining sleep) </li></ul></ul></ul><ul><ul><ul><ul><li>Fluazepam (Dalmane) </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Quazepam (Doral) </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Clonazepam (Klonopin) </li></ul></ul></ul></ul><ul><ul><ul><ul><li>[May produce daytime sleepiness] </li></ul></ul></ul></ul>
  11. 12. Non-Benzodiazepines <ul><ul><li>Zolpidem (Ambien), Zalepon (Sonata) </li></ul></ul><ul><ul><ul><ul><li>Short acting </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Rapid onset </li></ul></ul></ul></ul><ul><ul><ul><ul><li>does not accumulate with once a day dosing </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Induces sleep pattern similar to physiologic sleep </li></ul></ul></ul></ul><ul><ul><ul><ul><li>No tolerance or withdrawal symptoms </li></ul></ul></ul></ul>
  12. 13. OTC Substances <ul><ul><li>L-Tryptophan (amino acid) </li></ul></ul><ul><ul><ul><li>May decrease sleep latenc </li></ul></ul></ul><ul><ul><li>Melatonin </li></ul></ul><ul><ul><ul><li>Decreases sleep latency </li></ul></ul></ul><ul><ul><ul><li>May decrease WASO </li></ul></ul></ul><ul><ul><ul><li>May produce daytime sleepiness and altered sleep patterns </li></ul></ul></ul>
  13. 14. OTC Substances <ul><li>Antihistamines </li></ul><ul><ul><li>Shorten sleep latency </li></ul></ul><ul><ul><li>REM suppression </li></ul></ul><ul><ul><li>Daytime somnolence </li></ul></ul>
  14. 15. Antidepressants <ul><li>Wide variance in effects across and within categories </li></ul><ul><ul><ul><li>Tricyclics </li></ul></ul></ul><ul><ul><ul><li>MAO’s </li></ul></ul></ul><ul><ul><ul><li>SSRI’s </li></ul></ul></ul><ul><ul><ul><li>Others </li></ul></ul></ul>
  15. 16. Antidepressants <ul><li>Tricyclics [Hard to classify as a group] </li></ul><ul><ul><li>Some sedating </li></ul></ul><ul><ul><li>Moderate to strong REM suppression </li></ul></ul><ul><ul><li>Generally increase TST </li></ul></ul><ul><ul><li>May increase PLM’s </li></ul></ul>
  16. 17. Antidepressants <ul><li>MAO’s </li></ul><ul><ul><li>Strong REM suppression </li></ul></ul><ul><ul><li>Decrease TST </li></ul></ul><ul><ul><li>Increase WASO </li></ul></ul>
  17. 18. Antidepressants <ul><li>SSRI’s </li></ul><ul><ul><li>Prosac (Fluoxitine) </li></ul></ul><ul><ul><li>Paxil (Paroxetine) </li></ul></ul><ul><ul><li>Serazone </li></ul></ul><ul><ul><li>Trazadone (Desyrel) </li></ul></ul>
  18. 19. Antidepressants <ul><li>SSRI’s </li></ul><ul><ul><li>No effect on sleep onset </li></ul></ul><ul><ul><li>Reduces SWS </li></ul></ul><ul><ul><li>May increase WASO </li></ul></ul><ul><ul><li>Decreases REM </li></ul></ul><ul><ul><li>May worsen RLS </li></ul></ul><ul><ul><li>May increase SREMS in NREM sleep </li></ul></ul>
  19. 20. Stimulants <ul><li>Amphetamines/Ritalin/Cylert/Cocaine </li></ul><ul><li>Theophylline </li></ul><ul><li>Decongestants </li></ul><ul><li>Nicotine </li></ul><ul><li>Caffeine & other xantheines </li></ul><ul><ul><li>Coffee, teas, soft drinks, chocolate, </li></ul></ul><ul><ul><li>OTC diet and pain medication </li></ul></ul>
  20. 21. Stimulants <ul><ul><li>Effects on sleep </li></ul></ul><ul><ul><ul><li>Increase sleep latency </li></ul></ul></ul><ul><ul><ul><li>Decreased TST </li></ul></ul></ul><ul><ul><ul><li>Increase arousals & WASO </li></ul></ul></ul><ul><ul><ul><li>Increase stage 1 </li></ul></ul></ul><ul><ul><ul><li>Decrease SWS </li></ul></ul></ul>
  21. 22. Stimulants – Overdose
  22. 23. Alcohol <ul><li>Decrease sleep latency </li></ul><ul><li>Decrease REM (leads to REM rebound and nightmares after elimination) </li></ul><ul><li>Increase WASO (after elimination) </li></ul><ul><li>May increase delta </li></ul><ul><li>Worsen OSA </li></ul>
  23. 25. Resources <ul><li>PDR </li></ul><ul><li>Nursing & Other drug references </li></ul><ul><li>Principles & Practice of Sleep Medicine </li></ul><ul><li>Sleep Disorders Medicine (Chokroverty) </li></ul><ul><li>Atlases </li></ul><ul><li>SLEEP (reviews on treating Insomnia) </li></ul><ul><li>Advanceforsleep.com </li></ul>
  24. 26. Exam Content Areas Related to Medication Effects <ul><li>Domain 1, Task 1 </li></ul><ul><ul><li>Review medical information to become familiar with potential study requirements/parameters </li></ul></ul><ul><ul><ul><li>Consider questions related to: </li></ul></ul></ul><ul><ul><ul><ul><li>Medication effects on sleep architecture </li></ul></ul></ul></ul><ul><ul><ul><ul><li>What will you expect to see </li></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>from medication X? </li></ul></ul></ul></ul></ul>
  25. 27. Exam Content Areas Related to Medication Effects <ul><li>Domain 1, Task 2 </li></ul><ul><ul><li>Collect data from the patient by observation & interview </li></ul></ul><ul><ul><ul><li>Consider questions related to: </li></ul></ul></ul><ul><ul><ul><ul><li>Acute alcohol or caffeine administration </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Recent medication changes </li></ul></ul></ul></ul>
  26. 28. Exam Content Areas Related to Medication Effects <ul><li>Domain 1 Task 3 </li></ul><ul><ul><li>Analyze in integrate collected information </li></ul></ul><ul><ul><ul><li>Consider questions related to </li></ul></ul></ul><ul><ul><ul><ul><li>Need for interventions, e.g. nocturnal dosing </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Should study continue? </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Should medical director be called? </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Withdrawal effects </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Will the patient wake more, or less? </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Will there be REM rebound? </li></ul></ul></ul></ul>
  27. 29. Exam Content Areas Related to Medication Effects <ul><li>Domain 3 Task 4 </li></ul><ul><ul><li>Implement appropriate interventions </li></ul></ul><ul><ul><ul><li>Consider questions related to </li></ul></ul></ul><ul><ul><ul><ul><li>Possible overdose </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Adverse reactions </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Severity of apneas </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Severity of PLM’s </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Patient self administration </li></ul></ul></ul></ul>
  28. 30. Exam Content Areas Related to Medication Effects <ul><li>Domain 4, Task 1 </li></ul><ul><ul><li>Score stages </li></ul></ul><ul><ul><ul><li>Consider questions related to: </li></ul></ul></ul><ul><ul><ul><ul><li>Sleep architecture </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Sleep micro architecture </li></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Does the EEG show a medication effect? </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Does the EOG show a medication effect? </li></ul></ul></ul></ul></ul>
  29. 31. Exam Content Areas Related to Medication Effects <ul><li>Domain 4, Task 2 </li></ul><ul><ul><li>Score clinical events </li></ul></ul><ul><ul><ul><li>Consider questions related to: </li></ul></ul></ul><ul><ul><ul><ul><li>Sleep apnea duration </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Number of arousals </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Prevalence of PLM’s </li></ul></ul></ul></ul>
  30. 32. Exam Content Areas Related to Medication Effects <ul><li>Domain 5, Task 5 </li></ul><ul><ul><li>Educate patients </li></ul></ul><ul><ul><li>Consider questions related to: </li></ul></ul><ul><ul><ul><ul><li>Sleep hygiene </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Patient safety </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Use of OTC sleep aids </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Use of alcohol & effect on CPAP efficacy </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Effect of caffeine on sleep efficiency </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Effect of caffeine & stimulants on PLM’s </li></ul></ul></ul></ul>

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