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Drug Education for Drug Education program.
I am getting ready to start the scoring part of my training. I have heard tales of scoring techs that can see the effects of drugs in the psg. I WANT TO BE THAT TECH! I see hundreds of different pts on many different medications, yet I know very little about them. I need to learn my drugs! I am proposing a drug education for a drug education program. It will work like this. You give me your medications, and I will research them. We both get an education. That easy!
I am hoping to find/accomplish a few specific things for each medication:
1. How it effects your sleep latency and staging.
2. How it effects apnea and other sleep disorders.
3. How or if it will show up on a PSG.
4. Build a library that myself or any member can reference at any time.
I do have a few rules/disclaimers:
1. I am an unregistered sleep tech. I am in no way a doctor or should any of this information be used as a basis to start or stop medication without discussing it with a doctor.
Acebutolol- Increases REM
Alcohol- Suppressed REM, Increased N2, Increased N3, Increased Apneas, Fragmented Sleep
Alprazolam- Suppressed N3, Suppressed REM, Decreased N1, Increase N2, Decrease Leg Movements, Increased Apneas, Fragmented Sleep
Alprenolol- EEG Arousals, fragmented Sleep
Amantadine- Insomnia, Hallucinations
Ambien- Increased Sleep latency, Drowsiness, Increased Deep Sleep, Increased Apneas
Amitriptyline-Suppressed REM, Suppressed N3, Drowsiness, Somnambulism, Sedation
Amphetamine- Delayed Sleep Onset, Suppressed REM, Delayed REM Onset, Stimulating Effects.
Asamanex- Suppressed REM, Suppressed N3, Increased N2, Sleep Disturbances, EEG Arousals
http://www.ncbi.nlm.nih.gov/pubmed/3614616
Aspirin- Suppressed N3, Increased N2
Atenolol- Suppressed REM,
Azathioprin- Sleep Disturbances, EEG Arousals
http://www.ncbi.nlm.nih.gov/pubmed/12174106
http://www.semel.ucla.edu/sleepresearch/04%20hcrt%20immuno%20boehme...
Brompheniramine- Suppressed REM
Bupropiron- Insomnia
Buspiron- Insomnia
Caffeine- suppressed N3, Stimulating Effects
Carbamazepine- Suppressed REM
Celebrix- Increased Apneas
http://patientsville.com/symptoms/sleep-apnoea-syndrome.htm
Chlorpromazine- Increased REM
Cimetidine- Increased N3
Clomipramine- Supressed REM
Clonazepam- Suppressed REM, Increased N3, Decrease N2, Decreased Leg Movements
Clonidine- Suppressed REM, Increased N3, Increase N2, Insomnia, Vivid Dreams, Nightmares, Sedation, Fragmented Sleep
Clorgyline- Suppressed REM
Cocaine- Delayed Sleep Onset, Stimulating Effects, Insomnia
Cyclazocine- Suppressed REM, Increased N1, Increased EEG Arousals
Cyproheptadine- Suppressed REM, Increased N3
Desipramine- Suppressed REM
Diazapam- Increased Apneas, Decreased Sleep Latency
Diethylpropian- Insomnia
Domperidone- Drowsiness
Doxepin- Suppressed REM, Drowsiness, Sedation
Enprofylline- Insomnia, Sleep Disturbances, EEG Arousals
Ephedrine- Stimulating Effects, Insomnia, Delayed Sleep Onset
Estratest- So far all I can find on this one is that it improves sleep in adult women by reducing the sleep disturbances relating to menopause.
Ethosuximide- Suppressed N3, Suppressed REM, Increased N1, Increased Leg Movements, Insomnia
Fencamfamine- Suppressed REM
Fenluramine- Suppressed REM, Increased N3, Sedation, Sleep Disturbances, EEG Arousals
Fenofibrate- Insomnia, Drowsiness
Fluoxetine- Prozac- Suppressed N3, Suppressed REM, Delayed REM Onset, Increased Sleep Onset, REM Onset (SOREM) if left out of medical history a tech could confuse the effects of this drug with narcolepsy.
Flurazepam- Decreased Sleep Latency, increased Apneas
Flutamide- Insomnia, Nightmares, Drowsiness, Somnolence, Fatigue
Guanafacine- Suppressed REM
Heroin- Suppressed REM, Increased N1, Decreased Leg Movements, Increased Apneas,
Hydralazine- Sleep Disturbances, EEG Arousals
Hyoscine- Suppressed REM, Delayed REM Onset, increased Leg Movements, Decreased Eye Movements, Sedation
Hyzaar- Insomnia, Nocturia, Somnolence
http://stanford.wellsphere.com/wellpage/Hyzaar-sleep
Indalpine- Suppressed REM
Indoramin- Drowsiness, Sedation, Increased Sleep Onset
Isosorbide ER-Common: Tiredness, sleep disturbances (6%) and gastrointestinal disturbances (6%) have been reported during clinical trials with isosorbide mononitrate modified release tablets
http://stanford.wellsphere.com/wellpage/isosorbide-sleep
Ketanserin- Suppressed REM
Leodopa- Suppressed N3, Suppressed REM, Delayed REM Onset, Increased Sleep Spindles, Increased Leg Movements, insomnia, Vivid Dreams, Nightmares, Sleep Disturbances, EEG Arousals, Hallucinations, Somniloquy
Levoxyl- Insomnia
http://drugs.emedtv.com/levoxyl/levoxyl-and-insomnia.html
Lithium- Suppressed REM, Increased N3, Delayed REM Onset, Insomnia, Somnambulism
Lovastatin- Insomnia
Lunesta- Insomnia
http://patientsville.com/symptoms/sleep-apnoea-syndrome.htm
Lysergic Acid- Increased REM, Increased Leg Movements, Increased Arousals
Maprotiline- Suppressed REM
Mazindol- Insomnia
Methadone- Suppressed REM, Increased N1, Decreased Leg Movements, Increased Apneas
Methoxyphenamine- Delayed Sleep Onset, Stimulating Effects, Insomnia
Methyldopa- Suppressed N3, Suppressed REM, Insomnia, Nightmares, Drowsiness, Sedation, Sleep Disturbances, EEG Arousals
Methylphenidate- Suppressed REM, Stimulating Effects, Delayed Sleep Onset, Insomnia
Methysergide- Decreased Leg Movements
Plavix-
http://www.insidermedicine.com/archives/VIDEO_Aspirin_and_Plavix_Co...
Vytorin- Maintenance Issues, Insomnia
http://www.google.com/search?hl=en&rls=com.microsoft:en-US&...
I am hoping to find/accomplish a few specific things for each medication:
1. How it effects your sleep latency and staging.
2. How it effects apnea and other sleep disorders.
3. How or if it will show up on a PSG.
4. Build a library that myself or any member can reference at any time.
I do have a few rules/disclaimers:
1. I am an unregistered sleep tech. I am in no way a doctor or should any of this information be used as a basis to start or stop medication without discussing it with a doctor.
Acebutolol- Increases REM
Alcohol- Suppressed REM, Increased N2, Increased N3, Increased Apneas, Fragmented Sleep
Alprazolam- Suppressed N3, Suppressed REM, Decreased N1, Increase N2, Decrease Leg Movements, Increased Apneas, Fragmented Sleep
Alprenolol- EEG Arousals, fragmented Sleep
Amantadine- Insomnia, Hallucinations
Ambien- Increased Sleep latency, Drowsiness, Increased Deep Sleep, Increased Apneas
Amitriptyline-Suppressed REM, Suppressed N3, Drowsiness, Somnambulism, Sedation
Amphetamine- Delayed Sleep Onset, Suppressed REM, Delayed REM Onset, Stimulating Effects.
Asamanex- Suppressed REM, Suppressed N3, Increased N2, Sleep Disturbances, EEG Arousals
http://www.ncbi.nlm.nih.gov/pubmed/3614616
Aspirin- Suppressed N3, Increased N2
Atenolol- Suppressed REM,
Azathioprin- Sleep Disturbances, EEG Arousals
http://www.ncbi.nlm.nih.gov/pubmed/12174106
http://www.semel.ucla.edu/sleepresearch/04%20hcrt%20immuno%20boehme...
Brompheniramine- Suppressed REM
Bupropiron- Insomnia
Buspiron- Insomnia
Caffeine- suppressed N3, Stimulating Effects
Carbamazepine- Suppressed REM
Celebrix- Increased Apneas
http://patientsville.com/symptoms/sleep-apnoea-syndrome.htm
Chlorpromazine- Increased REM
Cimetidine- Increased N3
Clomipramine- Supressed REM
Clonazepam- Suppressed REM, Increased N3, Decrease N2, Decreased Leg Movements
Clonidine- Suppressed REM, Increased N3, Increase N2, Insomnia, Vivid Dreams, Nightmares, Sedation, Fragmented Sleep
Clorgyline- Suppressed REM
Cocaine- Delayed Sleep Onset, Stimulating Effects, Insomnia
Cyclazocine- Suppressed REM, Increased N1, Increased EEG Arousals
Cyproheptadine- Suppressed REM, Increased N3
Desipramine- Suppressed REM
Diazapam- Increased Apneas, Decreased Sleep Latency
Diethylpropian- Insomnia
Domperidone- Drowsiness
Doxepin- Suppressed REM, Drowsiness, Sedation
Enprofylline- Insomnia, Sleep Disturbances, EEG Arousals
Ephedrine- Stimulating Effects, Insomnia, Delayed Sleep Onset
Estratest- So far all I can find on this one is that it improves sleep in adult women by reducing the sleep disturbances relating to menopause.
Ethosuximide- Suppressed N3, Suppressed REM, Increased N1, Increased Leg Movements, Insomnia
Fencamfamine- Suppressed REM
Fenluramine- Suppressed REM, Increased N3, Sedation, Sleep Disturbances, EEG Arousals
Fenofibrate- Insomnia, Drowsiness
Fluoxetine- Prozac- Suppressed N3, Suppressed REM, Delayed REM Onset, Increased Sleep Onset, REM Onset (SOREM) if left out of medical history a tech could confuse the effects of this drug with narcolepsy.
Flurazepam- Decreased Sleep Latency, increased Apneas
Flutamide- Insomnia, Nightmares, Drowsiness, Somnolence, Fatigue
Guanafacine- Suppressed REM
Heroin- Suppressed REM, Increased N1, Decreased Leg Movements, Increased Apneas,
Hydralazine- Sleep Disturbances, EEG Arousals
Hyoscine- Suppressed REM, Delayed REM Onset, increased Leg Movements, Decreased Eye Movements, Sedation
Hyzaar- Insomnia, Nocturia, Somnolence
http://stanford.wellsphere.com/wellpage/Hyzaar-sleep
Indalpine- Suppressed REM
Indoramin- Drowsiness, Sedation, Increased Sleep Onset
Isosorbide ER-Common: Tiredness, sleep disturbances (6%) and gastrointestinal disturbances (6%) have been reported during clinical trials with isosorbide mononitrate modified release tablets
http://stanford.wellsphere.com/wellpage/isosorbide-sleep
Ketanserin- Suppressed REM
Leodopa- Suppressed N3, Suppressed REM, Delayed REM Onset, Increased Sleep Spindles, Increased Leg Movements, insomnia, Vivid Dreams, Nightmares, Sleep Disturbances, EEG Arousals, Hallucinations, Somniloquy
Levoxyl- Insomnia
http://drugs.emedtv.com/levoxyl/levoxyl-and-insomnia.html
Lithium- Suppressed REM, Increased N3, Delayed REM Onset, Insomnia, Somnambulism
Lovastatin- Insomnia
Lunesta- Insomnia
http://patientsville.com/symptoms/sleep-apnoea-syndrome.htm
Lysergic Acid- Increased REM, Increased Leg Movements, Increased Arousals
Maprotiline- Suppressed REM
Mazindol- Insomnia
Methadone- Suppressed REM, Increased N1, Decreased Leg Movements, Increased Apneas
Methoxyphenamine- Delayed Sleep Onset, Stimulating Effects, Insomnia
Methyldopa- Suppressed N3, Suppressed REM, Insomnia, Nightmares, Drowsiness, Sedation, Sleep Disturbances, EEG Arousals
Methylphenidate- Suppressed REM, Stimulating Effects, Delayed Sleep Onset, Insomnia
Methysergide- Decreased Leg Movements
Plavix-
http://www.insidermedicine.com/archives/VIDEO_Aspirin_and_Plavix_Co...
Vytorin- Maintenance Issues, Insomnia
http://www.google.com/search?hl=en&rls=com.microsoft:en-US&...
Views: 193
Replies to This Discussion
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Permalink Reply by Saz RPSGT on
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Hey Rock,
As a scoring tech and former night tech...good luck. Learning to score really improved my night work and it's very fun.
"Prozac Eyes" are a nifty one. Instead of the slow rolling eyemovements of stage one you get a patient that looks like they're watching a ping-pong match.
Benzodiazepines obscure alpha (8-12hz) making the wake/sleep transitions tough. This class of drug also makes sleep spindles very difficult and impossible to see. Basically everything looks like wake until you see k-complexes and delta sleep. This is where "alpha delta" sleep comes from which isn't normal sleep EEG.
Antipsychotics increase delta sleep.
Clonazepam and fluoxetine seem to greatly decrease REM.
Alcohol you'll get a quick sleep onset and it also depresses REM.
Then there is something I like to call the "drug cocktail effect". You'll find this in no books, but when a patient is on several medications you get this very high amplitude EEG (that isn't delta because it's too fast) with no clear alpha.
Good luck Rock!
Jason
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Permalink Reply by Duane McDade on
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I am currently scoring a xzyrem, valium, nicotine patch, marajuana and mirapex study, on the fly. We feel all tests should be done on the fly. I've been doing this for so long that I get very bored when I can't. Drug studies are hard to score, but you look for things that stand out from the noise. K's, spindles, slow eyes, fast eyes and score. Things strat to fall in place Ambiguious sleep is a drag, but you have to do your job and be confident.
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Permalink Reply by RockRpsgt on
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i try to score on the fly. We see some pretty difficult pts at the new lab. scoring is not always possible. Sounds like a fun one Duane.
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Permalink Reply by susan mccord on
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Rock, I take a LOT of Rx meds. I wonder about their impact on this apnea stuff a lot. I'll play!! Where should I list my Rx info?
-Susan McCord
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you can list it here or pm me. If you list here I will answer here. If you PM me I will answer back the same way and post the results at an undetermined date to protect you. up to you.
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Permalink Reply by Judy on
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Well, I am on Imuran (azathioprine) which is an immunosuppressant. One of the common side effects is sleepiness so it is often recommended that the dose be taken at night. I've never noticed that it affected my sleep or sleepiness one way or the other no matter when I take it: morning, midday or before bed. Another common side effect is nausea, at least at first, and I was fortunate not to experience that unpleasant side effect either. (God looks after fools).
I am also on Pentasa (mesalamine) and have had no problems w/it either. I've been on it so long I don't even remember the most common side effects it can cause.
I know that prednisone can cause sleep and personality problems but have been blessed w/not having had much experience w/it!!!
Trazadone made me higher than a kite! My first and only "out of body" experiences!!! (Can you tell I am not a child of the 60s?)
Valium, years ago, first made me higher than a kite even at 1/2 dose and taken w/food. When the doctors insisted I stay on it to soothe the gut (before the Crohn's disease Dx) I spent one evening laughing hysterically at anything, then getting nastier than a stepped on rattlesnake and then crying hysterically for no reason. Needless to say I refused to continue taking it.
Versed, a relative of valium, given to me for a colonoscopy at first made me agitated, then I got HOSTILE!!
Ambien is good for getting me 4-5 hours of sleep. Have never tired Ambien CR.
Lunesta was good for 7-8 hours of sleep but left such a long-lasting, foul-taste in my mouth I refused to take more than the original one dose. (Too bad too, I really liked their "butterfly" commercial).
Sonata didn't do diddley-squat for me. I might as well have taken a sugar pill.
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Rock, I don't mind posting here. Maybe there's something in MY Rx plan that will help you or someone else on here. I take a LOT of meds which include: Vytorin--Plavix--Isosorbide ER--Hyzaar (which is being changed to Lisinipril but I haven't switched yet)--Nitro PRN (rarely anymore)--Celebrex (also being changed to another generic due to cost)--Wellbutrin XL--Xanax 1.0 mg qhs only (never take it at other times)--Estratest--Rx Pepcid bid to (hopefully) prevent stomach bleeding from meds--Ecotrin 81 mg qd--ALSO take the following supplements daily: Centrum Silver--Vitamin E--Glucosamine/Chondroitin--Tylenol PRN--.....I think that's it. I have CAD, dx 10/05, have one stent and another blockage that can't be stented due to location--both blockages were (are) LAD ; also have microvascular spasms, which is the reason for Isosorbide; I rarely, if ever, have angina anymore. However, during my first sleep study, they came in about halfway through to put CPAP on due to sx appearing-within about 20 minutes I started having chest pain which didn't resolve with nitro--I ended up in ER, had gel nitro, and was released about 4-5 hours later. Lab said they had enough info for titration study. I have regular follow-up with cardiologist, PCP, and labs without fail, and always have. My dad (had) and my two sons (47 and 43) have Type II Diabetes. I'm tested for blood sugar everytime I go for labs--sugar's never been out of normal range.
Hope this helps with what you're doing--I'm chemically-altered for life! Oy vey.....
-Susan McCord
Rock Hinkle said:you can list it here or pm me. If you list here I will answer here. If you PM me I will answer back the same way and post the results at an undetermined date to protect you. up to you.
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I am working and hanging out with my daughters. I have a good list. I will post results soon.
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Susan McCord! Your "microvascular spasms" sound like they might be the same as the "endothelial dysfunction" my neighbor has been Dx'd with. Has the Isosorbide helped you??
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Rock--I'm picking up COMPLETE copies of all my records from the Sleep Study Clinic today, so I'll have answers to some of these technical questions that aren't on the half-a.. copy I got from Neuro.
Have fun with your kids!!! :-)
Susan McCord
Rock Hinkle said:I am working and hanging out with my daughters. I have a good list. I will post results soon.
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the new spriggs has an ok listing. I will post links and references. i ahve recieved quite a few request. I only work 3 days this week.Like a vacation! I will be working on it in my spare time.
Cindy Brown said:Rock,
Could you post references as well? I'm interested, as well, in the effects of drugs on sleep and have had difficulty in the past finding a good reference, plus I'm a bit lazy and usually limit myself to what I can find easily, i.e. the web and what little reference material we have at work.
Cindy
Rock Hinkle said:I am working and hanging out with my daughters. I have a good list. I will post results soon.
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Hi Judy--the Isosorbide ER has TOTALLY helped. I've been on it for, I think, about 2 years. I was having numerous angina episodes, so many that I ended up with 2 extra heart caths (separate from original 2) to check it out. Caths were clear. My cardiologist, who is young and just terrific, said he thought it was probably microvascular spasms, which is not uncommon with female heart patients. Per him, our arteries are smaller than men's, so anything that irritates or annoys them can cause them to spasm. I think I've only had to take nitro x 3 ever since I started on it. I take it at bedtime because it makes me feel like crap! I've talked to several women who can't tolerate it because of the side effects. But it's been a miracle for me, so I just tolerate the sides. I have so many side effects now that it's just ridiculous. It used to upset me but I have to take all this stuff, so there's no use being upset. I'd rather stay alive for awhile. I feel the same about the CPAP deal. The difference is I had excellent education and support with the heart problems, still do. The apnea medical community needs a serious tune-up. I get most of my info right here on SleepGuide.....
What's the condition your neighbor (?) has? Is it a cardiac issue? I've never heard of it, but then I haven't heard about a LOT of things!!!!
Susan McCord :-)
Judy said:Susan McCord! Your "microvascular spasms" sound like they might be the same as the "endothelial dysfunction" my neighbor has been Dx'd with. Has the Isosorbide helped you??
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