Sedative-hypnotic drugs can increase the frequency and severity of obstructive sleep ap- nea events. Parasomnias are associated with use of benzodiazepine receptor agonists, es- pecially when these medications are taken at higher doses and when they are combined with other sedative drugs. Abrupt discontinuation of chronic sedative, hypnotic, or anx- iolytic use can lead to withdrawal but more commonly rebound insomnia, a condition of an exacerbation of insomnia upon drug discontinuation for 1-2 days reported to occur even with short-term use. Sedative, hypnotic, or anxiolytic drugs with short durations of action are most likely to produce complaints of rebound insomnia, whereas those with longer durations of action are more often associated with daytime sleepiness. Any sedative, hypnotic, or anxiolytic drug can potentially cause daytime sedation, withdrawal, or re- bound insomnia.
Amphetamines and related substances and other stimulants. Sleep disorders induced by amphetamine and related substances and other stimulants are characterized by insomnia during intoxication and excessive sleepiness during withdrawal. During acute intoxication, stimulants reduce the total amount of sleep, increase sleep latency and sleep continuity distur- bances, and decrease REM sleep. Slow-wave sleep tends to be reduced. During withdrawal from chronic stimulant use, there is both prolonged nocturnal sleep duration and excessive daytime sleepiness. Multiple sleep latency tests may show increased daytime sleepiness dur- ing the withdrawal phase. Drugs like 3,4-methylenedioxymethamphetamine (MDMA; “ec- stasy”) and related substances lead to restless and disturbed sleep within 48 hours of intake; frequent use of these compounds is associated with persisting symptoms of anxiety, depres- sion, and sleep disturbances, even during longer-term abstinence.
Tobacco. Chronic tobacco consumption is associated primarily with symptoms of insom- nia, decreased slow-wave sleep with a reduction of sleep efficiency, and increased daytime sleepiness. Withdrawal from tobacco can lead to impaired sleep. Individuals who smoke heavily may experience regular nocturnal awakenings caused by tobacco craving.
Other or unknown substances/medications. Other substances/ medications may pro- duce sleep disturbances, particularly medications that affect the central or autonomic nervous systems (e.g., adrenergic agonists and antagonists, dopamine agonists and antag- onists, cholinergic agonists and antagonists, serotonergic agonists and antagonists, anti- histamines, corticosteroids).
Insomnia in children can be identified by either a parent or the child. Often the child has a clear sleep disturbance associated with initiation of a medication but may not report symptoms, although parents observe the sleep disturbances. The use of some illicit sub- stances (e.g., cannabis, ecstasy) is prevalent in adolescence and early adulthood. Insomnia sideration of whether the sleep disturbance is due to consumption of these substances.
Help-seeking behavior for the sleep disturbance in these age groups is limited, and thus corroborative report may be elicited from a parent, caregiver, or teacher. Older individuals take more medications and are at increased risk for developing a substance/medication- induced sleep disorder. They may interpret sleep disturbance as part of normal aging and fail to report symptoms. Individuals with major neurocognitive disorder (e.g., dementia) toms, making corroborative report from caregiver(s) particularly important.
are normative for certain age groups. They are relevant for, and likely applicable to, the type of sleep disturbance encountered (see the chapter "Substance-Related and Addictive
Disorders” for descriptions of respective substance use disorders).