Published: 13 December 2018

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Parasomnias – A Medicine Nightmare

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Prescriber Update 39(4): 61
December 2018

Background

Parasomnia is an umbrella term for complex movements or behaviours during sleep. These can include abnormal dreaming, nightmares (paroniria), sleepwalking (somnambulism) and sleep-related eating disorder¹ . Some medicines are known to interfere with non-rapid eye movement (NREM) and/or rapid eye movement (REM) sleep, resulting in parasomnias. These include widely used medicines such as beta-blockers, statins, selective serotonin re-uptake inhibitors (SSRIs) and nicotine replacement therapies² .

Antipsychotics

At their 174^th meeting, the Medicines Adverse Reactions Committee (MARC) reviewed a safety signal of somnambulism and sleep-related eating disorder induced by atypical antipsychotics. Based on the evidence provided, the Committee concluded that there is an association between these events and quetiapine, olanzapine, and ziprasidone. The data sheets for these medicines are currently being updated to include somnambulism and related sleep disorders as adverse effects. Other antipsychotics will continue to be monitored as part of regular pharmacovigilance activities³ .

New Zealand reports

The Centre for Adverse Reactions Monitoring (CARM) has received over 70 reports of various parasomnias over the past 5 years. Although arousal-associated parasomnias typically affect children¹ , CARM has received reports of parasomnias from all age groups, associated with various medicines. The most frequently reported terms are:

• abnormal dreams (n=21)
• paroniria (n=42)
• sleep disorder (n=11).

Medicines commonly reported in association with parasomnias include:

• statins (n=6)
• varenicline (n=17)
• montelukast (n=5).

References

1. Vaughn B. 2018. Approach to abnormal movements and behaviors during sleep. In: UpToDate 6 June 2018. URL: www.uptodate.com/contents/approach-to-abnormal-movements-and-behaviors-during-sleep (accessed 4 October 2018).
2. Harvard Health Publishing. 2010. Medications that can affect sleep. URL: www.health.harvard.edu/newsletter_article/medications-that-can-affect-sleep/ (accessed 4 October 2018).
3. Medsafe. 2018. Minutes of the 174^th Medicines Adverse Reactions Committee 3 July 2018. URL: www.medsafe.govt.nz/profs/adverse/Minutes174.htm (accessed 4 October 2018).