Article

Writing emails as part of sleepwalking after increase in Zolpidem

Authors:
To read the full-text of this research, you can request a copy directly from the authors.

No full-text available

Request Full-text Paper PDF

To read the full-text of this research,
you can request a copy directly from the authors.

... The review of zolpidem-related sleepwalking identified cross-sectional surveys [40,41], marketing or open trials [42][43][44], and case reports-16 with adults [45][46][47][48][49][50][51][52][53][54][55][56][57][58] and two with adolescents [59,60]. The two post-marketing reviews of adult patients found the incidence of zolpidem-induced sleepwalking rates were 0.5% [42] and 1.1% [43]-in children the rate was 2.2% [44]. ...
... Case reports included patients with complex medical histories or who were concurrently taking other medications [41,45,47,[49][50][51][60][61][62][63] and patients who were otherwise healthy aside from their presenting problem [48,53,55,56]. There was one report of zolpidem interacting with an anticonvulsant medication prior to sleepwalking [50]. ...
... Only one case study reported alcohol being combined with zolpidem to precipitate sleepwalking [56]. Individual case reports showed that while there are cases of sleepwalking as a consequence of higher than recommended doses of zolpidem [48,51,63], more commonly zolpidem precipitated M A N U S C R I P T A C C E P T E D ACCEPTED MANUSCRIPT 8 sleepwalking at the recommended dose [45,46,49,52,53,55,61,62]. Only one case study reported a previous history of sleepwalking during childhood [53]; all others reported participants experiencing sleepwalking for the first time subsequent to taking zolpidem [48-50, 52, 55, 60-62]. ...
Article
Medications that trigger sleepwalking may inadvertently put the patient at risk of injury to themselves and/or others, and contribute to poor treatment adherence. The aim of this study was to systematically review the literature to identify drugs that may increase the risk of sleepwalking. A search of CINAHL, EMBASE, PsycINFO, PubMed, and ScienceDirect was conducted with the keywords ‘sleepwalking’ OR ‘somnambulism’. Of the original 83 sourced papers, 62 met the inclusion criteria and were subsequently included for review. Twenty-nine drugs, primarily in four classes—benzodiazepine receptor agonists and other GABA modulators, antidepressants and other serotonergic agents, antipsychotics, and β-blockers—were identified as possible triggers for sleepwalking. The strongest evidence for medication-induced sleepwalking was for zolpidem and sodium oxybate. All other associations were based on case reports. This research highlights the importance of considering sleepwalking in risk profiles in clinical trials, particularly for drugs that enhance GABA activity at the GABAA receptor, enhance serotonergic activity, or block the activity of noradrenaline at β receptors. The results also have implications for prescribers to consider sleepwalking as a potential adverse effect and ensure that: 1) the patient is educated about a safe sleep environment; 2) they are encouraged to report the onset or exacerbation of sleepwalking, and 3) alternative treatments are considered if sleepwalking occurs.
... 3 This review did not include a series of 19 cases with sleeprelated eating disorders associated with ZPD published as abstracts. 4,5 Three more cases have been reported since then, [6][7][8] which means that there are at least 37 known cases. Behaviours during sleep induced by non-BZD receptor agonists are diverse and include cleaning, shopping 9 , sending emails 4,10 and driving vehicles. ...
... Finally, there are also other interesting indirect consequences resulting from activities such as using the telephone or the computer. 6 One of our patients even managed to call the bank to give instructions. ...
Article
Full-text available
To present five patients with zolpidem-induced sleep-related behavioural disorders. Evaluation using a questionnaire designed to study sleep behaviours and past medical history in all patients. The patients performed complex actions while sleep-walking (telephoning, house-cleaning, feeding the dog or waxing their legs). Inappropriate feeding behaviour with excessive food intake during the night were reported by all patients. All had weight gain, which in one patient led to extreme obesity. Two patients suffered injuries (knife cuts and burns) related to attempting to prepare food. One patient took a laxative. Withdrawal of zolpidem resolved the behaviours in all cases, highlighting the importance of an adequate diagnosis of this side effect.
... En relación con el caso comentado, existen estudios en la literatura médica que hacen referencia a la realización de llamadas telefónicas, envío de mensajes de texto y de correos electrónicos 18 . Este último hallazgo estuvo relacionado con una paciente de 44 años que padeció insomnio idiopático la mayor parte de su vida. ...
... Este caso difiere del que exponemos, ya que nuestro paciente utilizó el medicamento solo durante una semana, sin modificación de la dosis inicial (10 mg), e iniciando los comportamientos extraños al tercer día de uso. Existe en la literatura la descripción de otro caso similar al nuestro, con envío de un correo electrónico 18 . ...
Article
El zolpidem es un medicamento ampliamente distribuido, comercializado y prescrito como tratamiento para el insomnio de conciliación.
... While believed to be a safer alternative to benzodiazepines for the treatment of insomnia, having lower risks for both toxicity and dependence (3,4), numerous instances of adverse events after administration have been reported. These include bizarre dissociative behaviors such as sleep driving, anterograde amnesia, hallucinations (including self-harm command hallucinations), and suicide (4)(5)(6)(7)(8)(9)(10)(11). Despite its lower risk of toxicity, cases of accidental and deliberate zolpidem poisoning have been reported (12)(13)(14)(15)(16)(17). ...
... As noted earlier, there have been concerns about reports of atypical, dissociative behaviors occurring among patients after consuming zolpidem (4)(5)(6)(7)(8)(9)(10)(11). Evidence for such sequelae of zolpidem ingestion was seen here. ...
Article
Full-text available
All cases presenting to the New South Wales Department of Forensic Medicine between January 1, 2001 and September 31, 2010 in which zolpidem was detected, were retrieved. A total of 91 cases were identified. The mean age was 49.4 years, 65.9% were male, and 61.5% were suicides. Zolpidem was a factor contributing to death in 35 (37.3%) cases, of which 31 (34.1%) involved zolpidem toxicity. The median blood zolpidem concentration was 0.20 mg/L (range 0.05-3.50 mg/L), with no significant gender difference. Drug toxicity cases involving zolpidem had significantly higher median blood zolpidem concentrations than other cases (0.50 vs. 0.10 mg/L). In 83.5% of cases, psychoactive substances other than zolpidem were detected, most commonly antidepressants (46.2%), benzodiazepines (35.2%), opioids (26.4%), and alcohol (39.6%). In summary, zolpidem was a factor contributing to death in a large proportion of cases, predominately involving drug toxicity and suicide.
... Ainsi, deux autres sous-types de somnambulisme impliquent l'ingestion compulsive d'aliments ou encore l'engagement dans différentes activités d'ordre sexuel (Ibid.). Et il y a au moins un cas attesté d'envoi de courriers électroniques pendant un épisode de somnambulisme(Siddiqui et al. 2009). Mais la conduite des somnambules peut entraîner bien plus loin les individus qui subissent le trouble, comme nous pourrons comprendre à travers deux cas extrêmes mais emblématiques dans la littérature scientifique et légale sur la question. ...
Thesis
Notre thèse explore deux anomalies quant aux théories sur les interactions hydriques transfrontalières. Le lac Victoria, où toutes les conditions matérielles, économiques et environnementales sont données pour les conflits, et pourtant la coopération s’impose. Et le fleuve Uruguay, où un régime institutionnel solide existait et les conditions environnementales étaient optimales, et pourtant la coopération fût brisée et le conflit éclata. Pour élucider l’énigme de ces cas, au lieu de sonder les aspects politiques et institutionnels des bassins, comme font certaines approches, ou ceux physiques, comme en font d’autres, nous proposons une autre voie. Notre démarche consiste à porter le regard vers ce qui donne naissance aux actions des agents en interaction avec leur milieu, à savoir la nature humaine et le fonctionnement du cerveau. Afin de conduire cette enquête, nous nous appuyions sur trois axes. Le premier est celui des entretiens que nous avons réalisés dans les bassins étudiés. Le deuxième est la sociologie de Gabriel Tarde, laquelle invite à une continuation actualisée d’un projet de recherche du social permettant l’intégration des développements scientifiques biologiques, évolutifs et cognitifs. Le troisième axe est celui des neurosciences, lesquelles confirment plusieurs intuitions tardiennes, et permettent de mieux cerner les aspects référant à la nature humaine dans son interaction avec la société et l’environnement. Notre enquête montre alors comment les dynamiques du conflit et de la coopération convergent dans la conscience, en tant que la clé qui, par-delà toute situation environnementale donnée, permet aux humains d’actualiser d’innombrables potentialités.
... Less dramatic, though no less intriguing, are cases involving agents performing other complex actions, while apparently asleep. Siddiqui et al. (2009), for example, recently described a case of sleep emailing. These cases illustrate the complexity of the behaviors in which agents may engage in the apparent absence of awareness. ...
Article
Full-text available
In recent decades, with advances in the behavioral, cognitive, and neurosciences, the idea that patterns of human behavior may ultimately be due to factors beyond our conscious control has increasingly gained traction and renewed interest in the age-old problem of free will. To properly assess what, if anything, these empirical advances can tell us about free will and moral responsibility, we first need to get clear on the following questions: Is consciousness necessary for free will? If so, what role or function must it play? Are agents morally responsible for actions and behaviors that are carried out automatically or without conscious control or guidance? Are they morally responsible for actions, judgments, and attitudes that are the result of implicit biases or situational features of their surroundings of which they are unaware? What about the actions of somnambulists or cases of extreme sleepwalking where consciousness is largely absent? Clarifying the relationship between consciousness and free will is imperative if we want to evaluate the various arguments for and against free will. For example, do compatibilist reasons-responsive and deep self accounts require consciousness? If so, are they threatened by recent developments in the behavior, cognitive, and neurosciences? What about libertarian accounts of free will? What powers, if any, do they impart to consciousness and are they consistent with our best scientific theories about the world?
... These complex behaviors included driving a car, cleaning the house, writing a e-mail with inputing correct user name and password to log on, engaging in conversation and sex. 18,19) Especially, these complex behaviors resulted in car accidents or crime such as violence and sex offense, 2) although cause and effect was not always clear. Regarding to anterograde amnesia, our patient presented that most zolpidem-induced SRED and single zolpidem-induced complex behaviors were accompanied with the anterograde amnesia. ...
Article
Full-text available
Zolpidem-induced sleep-related complex behaviors (SRCB) with anterograde amnesia have been reported. We describe herein a case in which the development of zolpidem-induced sleep-related eating disorder (SRED) and SRCB was strongly suspected. A 71-year-old Korean male was admitted to the Department of Psychiatry due to his repetitive SRED and SRCB with anterograde amnesia, which he reported as having occurred since taking zolpidem. The patient also had restless legs syndrome (RLS) and obstructive sleep apnea (OSA). His baseline serum iron level was low at admission. Zolpidem discontinuation resulted in the immediate disappearance of his SRED, but did not affect his RLS symptoms. These symptoms rapidly improved after adding a single i.v. iron injection once daily, and so he was discharged to day-clinic treatment. These findings indicate that zolpidem can induce SRCB. Although the pathophysiology of zolpidem-induced SRED and other SRCB remains unclear, clinicians should carefully monitor for the potential induction of complex behaviors associated with zolpidem in patients with comorbid RLS or OSA.
... Sleepwalking is a frequently reported side effect of zolpidem which is a short-acting hypnotic drug potentiating activity of GA-BA A receptors [1][2][3][4][5][6][7]. Paradoxically, the most commonly used medications for somnambulism are benzodiazepines especially clonazepam, which also potentiates activity of GABA A receptors [8,9]. ...
Article
Sleepwalking is a frequently reported side effect of zolpidem which is a short-acting hypnotic drug potentiating activity of GABA(A) receptors. Paradoxically, the most commonly used medications for somnambulism are benzodiazepines, especially clonazepam, which also potentiate activity of GABA(A) receptors. It is proposed that zolpidem-induced sleepwalking can be explained by the desensitization of GABAergic receptors located on serotonergic neurons. According to the proposed model, the delay between desensitization of GABA receptors and a compensatory decrease in serotonin release constitutes the time window for parasomnias. The occurrence of sleepwalking depends on individual differences in receptor desensitization, autoregulation of serotonin release and drug pharmacokinetics. The proposed mechanism of interaction between GABAergic and serotonergic systems can be also relevant for zolpidem abuse and zolpidem-induced hallucinations. It is therefore suggested that special care should be taken when zolpidem is used in patients taking at the same time selective serotonin reuptake inhibitors.
... For a case in which a highly similar sleepwalking defense was rejected by an American jury see Cartwright, 2004 . For other examples of remarkably complex behavior during apparent sleepwalking, see Schenck and Mahowald ( 1995 ) and Siddiqui et al. ( 2009 ). ...
... though no less intriguing, are cases involving agents performing other complex actions while, apparently, asleep (Levy, 2014, p. 72). Siddiqui, Osuna and Chokroverty (2009), for example, recently described a case of sleep emailing. As Levy describes it: 'After the ingestion of zolpidem for treatment of insomnia, the patient arose from her bed, walked to the next room and logged onto her email. ...
... However, it has been suggested that "sleepwalking" in this group of heavily medicated patients may actually represent the effects of significant central nervous system (CNS) depression and not typical sleepwalking. 36 There have been numerous case reports of complex behaviors in sleep related to benzodiazepines and other drugs that act at the g-aminobutyric acid (GABA) receptor, such as zolpidem, [87][88][89][90] zaleplon, 91 and zopiclone. 92 In a case series of 125 patients attending a psychiatric clinic who were taking zolpidem, 19 subjects (15%) had features of complex sleep-related behaviors such as sleepwalking and SRE after commencing this drug. ...
Article
Full-text available
Sleepwalking is not a rare condition and most commonly occurs in children and adolescents. Epidemiologic data have shown that prevalence reduces with age. There has been an increasing interest in the genetic basis of sleepwalking, although the role of genetic inheritance in predetermining risk remains undetermined but of great interest. Clinical features vary from individual to individual and may vary as the person gets older. In sleepwalking higher cognitive functions such as memory, planning, and social interaction are severely limited or absent. Sleepwalking may appear in several forms. Sleepwalkers will have a predisposition (genetic) and several potential triggers to induce sleepwalking.
... Complex sleep behaviors (CSBs) are complex activities, normally associated with wakefulness, that occur when the subject is in a sleep-like state after taking a hypnosedative drug; when the subject awakens the next morning, the subject has little or no memory of the activity. CSBs include sleepwalking with object manipulation, 1,2 sleep-related eating disorders, 3,4 and sexual assault. 5 These behaviors may not occur frequently, but clinical awareness of the potential for associated danger and harm is necessary. ...
Article
Full-text available
Complex sleep behaviors (CSBs) are classified as "parasomnias" in the International Classifcation of Sleep Disorders, Second Edition (ICSD-2). To realize the potential danger after taking two short-acting Z-hypnosedative drugs, we estimated the incidence of CSBs in nonpsychotic patients in Taiwan. Subjects (N = 1,220) using zolpidem or zopiclone were enrolled from the psychiatric outpatient clinics of a medical center in Taiwan over a 16-month period in 2006-2007. Subjects with zolpidem (N = 1,132) and subjects with zopiclone (N = 88) were analyzed. All subjects completed a questionnaire that included demographic data and complex sleep behaviors after taking hypnotics. Among zolpidem and zopiclone users, 3.28% of patients reported incidents of somnambulism or amnesic sleep-related behavior problems. The incidence of CSBs with zolpidem and zopiclone were 3.27%, and 3.41%, respectively, which was signifcantly lower than other studies in Taiwan. These results serve as a reminder for clinicians to make inquiries regarding any unusual performance of parasomnic activities when prescribing zolpidem or zopiclone.
Article
The study of human consciousness has demonstrated that there are both conscious and unconscious systems. Other work, particularly in animals, has shown that there are habit and nonhabit systems and that these involve different brain regions and memory processes. Here, we argue that habits can be equated with unconscious behavior, and nonhabits, with conscious behavior. This equation makes the extensive physiological literature on habit/nonhabit relevant to the less tractable issue of consciousness. On the basis of this line of reasoning, it appears that different parts of the BG and different memory structures mediate conscious and unconscious processes. It is further argued here that the unconscious system is highly capable; it can both process sensory information and produce behavior. The benefit of such a dual system is multitasking; the unconscious system can execute background tasks, leaving the conscious system to perform more difficult tasks.
Article
Full-text available
The extended-release formulation of zolpidem (Ambien CR) is approved for the treatment of insomnia without a treatment duration limit. Acutely zolpidem impairs performance, and no research to date has examined whether tolerance develops to these performance impairments during nighttime awakening. The present double-blind, placebo-controlled study examined whether tolerance develops to zolpidem-induced acute performance impairment after repeated (22-30 days) nightly use. Effects of bedtime administration of zolpidem extended-release (ZOL; 12.5 mg) were tested on a battery of performance measures assessed during a forced nighttime awakening in 15 healthy male volunteers who completed overnight polysomnographic recording sessions in our laboratory at baseline and after approximately a month of at-home ZOL. As expected, bedtime ZOL administration was associated with changes in sleep architecture and impairments across all performance domains during nighttime testing (psychomotor function, attention, working memory, episodic memory, metacognition) with no residual next morning impairment. Tolerance did not develop to the observed ZOL-related impairments on any outcome. Possible evidence of acute abstinence effects after discontinuation of ZOL was observed on some performance and sleep outcomes. Overall, these findings suggest that performance is significantly impaired during nighttime awakening even after a month of nightly ZOL administration, and these impairments could significantly impact safety should nighttime awakening require unimpaired functioning (e.g., driving; combat-related activities in the military).
Article
Zolpidem is a widely prescribed nonbenzodiazepine hypnotic medication available in the United States since 1992. Attention has been drawn recently to its potential to cause sleep-related, complex behaviors such as sleepwalking and sleep driving. These automatic behaviors have led to a deluge of legal claims. To the authors' knowledge, this is the first review in the forensic literature of the legal ramifications of zolpidem. In this article, the medical literature will be reviewed to explore the current understanding of zolpidem's specific psychopharmacology. Case law will be explored to determine how the courts have handled the claims surrounding sleep-related, complex behaviors alleged to be caused by zolpidem. Finally, a summary of recommendations will be provided for forensic psychiatrists who are asked to be experts in these cases.
Article
Objective Benzodiazepines with a unique chemical structure of three-ring diabenzine can induce the benzodiazepine-gamma aminobutyric acid A receptor complex to produce sedative, anxiolytic, muscle-relaxant, and anticonvulsant effects. But they have serious side effects such as tolerance and withdrawal, memory and performance impairments, and complex behaviors associated with amnesia. Method We searched zolpidem-related published papers from Taiwan from 2003 to 2011. All bibliographical data of original clinical reports were studied. We focused only on complex behaviors related to zolpidem and not on the symptoms of zolpidem-related addiction, tolerance, and withdrawal. Results The search in PubMed with the keyword “zolpidem” yielded 729 articles published from 2003 to 2011. Of these, 20 articles were written by Taiwanese author(s). There were 15 case reports and five clinical studies. Besides the symptoms of addiction, tolerance, and withdrawal, these papers describe complex behavioral disturbances, such as performance impairments, behavioral impairment with amnesia, sleepwalking, sleep-related eating disorder, and hallucination and sensory distortion. Conclusion We have summarized the case reports and clinical studies of zolpidem-related adverse effects published from Taiwan and reviewed concerns about zolpidem’s safety that international researchers have been voicing out in recent years. The incidence of those zolpidem-induced complex behaviors is similar to that found in Western countries. Clinicians should therefore use more antidepressants to treat the underlying diseases that present with insomnia (such as major depressive disorder or generalized anxiety disorder).
Article
Full-text available
Resumen Objetivo Presentar cinco pacientes con trastornos conductuales durante el sueño, sin conciencia posterior de los mismos, inducidos por zolpidem. Métodos Evaluación con un cuestionario diseñado para estudiar las características y las conductas realizadas durante el sueño por todos los pacientes. Resultados Las conductas realizadas por los pacientes fueron muy variadas (telefonear, limpieza y labores del hogar, alimentar al perro o depilarse), aunque en todos los pacientes se recogieron conductas alimentarias inapropiadas. Todos sufrieron una ganancia ponderal importante, debido a su preferencia por alimentos hipercalóricos durante los episodios, que en una de las pacientes desembocó en una obesidad extrema. Dos de los pacientes sufrieron lesiones (cortes con cuchillo y quemaduras) en relación con el intento de elaboración de platos. Un paciente llegó a ingerir un laxante. Conclusiones La retirada de zolpidem resolvió de forma inmediata las conductas anormales durante el sueño en todos los casos. Esto subraya la importancia de diagnosticar adecuadamente este efecto secundario.
Article
This chapter presents the comparative studies on the use of hypnosedatives and anxiolytics. The anxiolytic buspirone in therapeutic doses appears to have less detectable deleterious effects on cognition when given acutely. Intravenous sodium valproate has been compared with an infusion of diazepam for control of refractory status epilepticus in an open, randomized study in 40 children with refractory status epilepticus. It is found there were no adverse effects on liver function with valproate. High-dose of diazepam is found to be associated with time-dependent increases in the intensity of subjective drug effects (strength of drug effect, sedation) and reductions in psychological performance in patients taking methadone or buprenorphine. While studying the effects of lorazepam on psychology, it is found that Acute lorazepam affected reasoning in two ways: it slowed processing non-specifically when the demands of working memory increased and it augmented validation time depending on the difficulty in generating and/or manipulating mental representations by the central executive.
Article
Full-text available
Background Being a nonbenzodiazepine, zolpidem is believed to have a favorable side-effect profile and is widely prescribed for insomnia. However, in the past few years, numerous neuropsychiatric adverse reactions, particularly complex sleep behaviors (CSBs), have been reported with zolpidem. Objective To conduct a systematic review of zolpidem-associated CSBs. Data Sources An electronic search was conducted using MEDLINE, Embase, PubMed, and Cochrane database of systematic reviews to extract relevant articles till July 2020. Study Eligibility Criteria Any type of literature article (case report, case series, and observational or interventional study) reporting CSBs associated with zolpidem. Results In this review, we present aggregate summarized data from 148 patients presenting with zolpidem-induced CSBs (79 patients from 23 case reports and 5 case series; 69 patients out of 1454 taking zolpidem [4.7%] from three observational clinical studies). Various types of CSBs associated with zolpidem were reported, most common being sleepwalking/somnambulism and sleep-related eating disorder. On causality assessment, around 88% of cases were found to have a probable association with zolpidem. Limitations Extraction of data from observational studies and spontaneous reports, due to nonavailability of any randomized controlled trials relevant to the study objective. Conclusion and Implication of Key Findings Zolpidem-induced CSBs, although not very common, may develop when the drug is used at therapeutic doses for insomnia. Doctors need to be alert to monitor such adverse effects of zolpidem and exercise caution while prescribing it.
Article
Full-text available
Zolpidem is a safe and effective drug for the treatment of insomnia. However, there are some reports of adverse effects, such as delirium, after administration of zolpidem. The aim of this study was to evaluate the incidence of and risk factors for zolpidem-induced delirium.
Chapter
Nocturnal wanderings, especially when they occur in adults, have provided endless fascination, fear, perplexity, and occasional bemusement. Most often, nocturnal wanderings in adults are sleepwalking (SW) episodes. Frequent, chronic, and/or potentially injurious SW in adults is a parasomnia that usually begins as an incomplete arousal from non-rapid eye movement (NREM) 3 sleep. SW occurs at a peak age of 8–12 years, only a quarter continue beyond age 13 years. Epidemiological studies suggest that 2–4 % of adults sleepwalk at least once a year, but less than 0.5 % walk frequently. Most have a history of SW as children. Complex motor behaviors during sleep (such as eating, driving a motor vehicle, or sexual behavior) may be a variant of SW, but must be distinguished from other causes (e.g., rapid eye movement (REM) sleep behavior disorder, parasomnia overlap syndrome, drug impairment, dissociation, and even malingering). SW in adults tends to be chronic, often a persistence or recurrence of childhood SW, but then precipitated, primed, and/or triggered by a host of factors that impair arousal and deepen and fragment NREM 3 sleep. Other primary sleep disorders (especially obstructive sleep apnea, restless legs, or a circadian rhythm disorder) can precipitate or exacerbate SW, especially in individuals with a familial or genetic susceptibility for it. Video-polysomnography (PSG) is usually indicated. Treatment of SW consists of reassurance, education of the patient and family, setting up a safe sleep environment, identifying and treating other sleep disorders, and reducing or avoiding priming or precipitating factors. Video-PSG findings and indications for pharmacotherapy are reviewed.
Chapter
Medical causes of parasomnia are few and far between, but occasional reports are available in the literature. Mechanism is unclear given the rarity of these events, but a combination of arousal and sleep seems to be a gateway to the generation of parasomnia behavior. The specific pairing of medical conditions and their parasomnia counterparts lends some insight to the role of sleep as a window to overall health. The medical conditions discussed in this chapter include: gastroesophageal reflux disease, obstructive sleep apnea, infection, autonomic dysfunction, and hormonal disorders. The relationship of these disorders with parasomnias is likely bidirectional in nature. The role of stress associated with hospitalization and chronic illness is also discussed. Finally, parasomnias associated with the use of medications including antipsychotics, antidepressants, and sedative hypnotic medications are discussed. The parasomnias included in this discussion include sleepwalking, sleep driving, and other complex behaviors.
Article
Sleeping pills are one of the most common drugs taken by adults when afflicted by insomnia. Adverse effects of pharmacotherapy, however, should not be overlooked, and monitoring is needed to check for an overdose of sleeping pills. We reviewed zolpidem overdose and patient suicide with benefits and disadvantages of pharmacotherapy. Cases of adverse effects concerning the central nervous system, including delirium and hallucination, as well as abnormal behavior during sleep, are commonly reported among patients who have taken zolpidem for more than 1 year. The serious problem of long-term prescription to medication can lead to a higher mortality rate of insomniac patients. An alternative to medication for treating insomnia is cognitive behavioral therapy, which can improve sleeping habits. Cognitive behavioral therapy induces patients to recognize and change the negative thoughts that affect their sleep. Medical providers should be aware of the adverse effects of sleep inducers and provide sufficient information to their patients about them. When establishing treatment plans, they should encourage patients to make the proper decisions and try to reduce the adverse effects of any medication as much as possible.
Article
To explore the risk predictors for complex sleep-related behaviors (CSBs) in subjects with a DSM-IV-diagnosed depressive disorder, anxiety disorder, adjustment disorder, somatoform disorder, or sleep disorder taking hypnosedative drugs. One hundred twenty-five subjects using hypnosedatives were enrolled from the psychiatric outpatient clinics of a medical center in Taiwan from May 2006 to July 2006. All subjects completed a questionnaire that included demographic data, current and childhood sleep habits, and CSBs after taking hypnosedatives. Complex sleep-related behaviors were defined as somnambulism with object manipulation, sleep-related eating, and other amnestic sleep-related behaviors. Demographic and clinical variables were compared in those with CSBs and those without. Then multiple logistic regression analyses were performed in order to identify significant risk predictors for CSBs. Of the 125 subjects, 19 (15.2%) reported CSBs, all of whom took zolpidem. Among a total of 67 subjects taking zolpidem, those with CSBs were significantly more likely to be younger (P = .023), to be female (P = .011), to take a higher dose of zolpidem (> 10 mg/d; P < .001), and to not go to sleep immediately after taking zolpidem (P = .047). Multiple logistic regression analyses showed that a higher dose of zolpidem (> 10 mg/d) was the only significant predictor of CSBs (OR = 13.1; 95% CI, 2.6-65.9; P = .002). This pilot study suggests that a higher dosage of zolpidem (> 10 mg/d) is the key risk predictor for CSBs.
Article
We evaluated with clinical interviews and polysomnographic examinations 10 adults with the complaint of sleepwalking, often accompanied by violent behavior or self-injury. During the polysomnographic studies, 8 patients had 47 distinct somnambulistic episodes. All episodes occurred in non-REM sleep, with 91% occurring in slow-wave sleep. Contrary to previous reports, episodes were not confined to the 1st 3rd of the night. Clinical EEGs were normal in 5 of 6 patients. In the 7 patients tried on 1 or more treatment regimens, clonazepam effectively suppressed the somnambulism in 5 of 6 patients in whom it was tried, carbamazepine in 1 of 3, flurazepam in 2 of 2, and a combination of clonazepam and phenytoin in one.
Article
Sleepwalking is a dissociation between body sleep and mind sleep. We report single photon emission computed tomography (SPECT) in a man with a history of sleepwalking. Our findings suggest that this dissociation arises from activation of thalamocingulate pathways and persisting deactivation of other thalamocortical arousal systems.
Imidazopyri-dines in sleep disorders
  • Sauvanet Jp
  • Langer
  • Sz
  • Morselli
  • Pl
In: Sauvanet JP, Langer SZ, Morselli PL, editors. Imidazopyri-dines in sleep disorders. New York: Raven Press; 1988. p. 219–30.
Open long term trials with zolpidem with insomnia
  • Sauvenet Jp
  • Roger L M Maarek
  • Renaudin J E Louvel
  • Orofiamma
Sauvenet JP, Maarek L, Roger M, Renaudin J, Louvel E, Orofiamma B. Open long term trials with zolpidem with insomnia.
Somnoabulism in adults
  • Kavey
Open long term trials with zolpidem with insomnia
  • Sauvenet