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03. Medication-Induced SRED, Sleepwalking, and Sleepdriving

Published on March 1, 2023 Certification expiration date: March 1, 2026

Carlos H. Schenck, M.D.

Professor & Senior Staff Psychiatrist at the Hennepin County Medical Center (HCMC) - University of Minnesota

Key Points

Atypical antipsychotics have been reported to induce secondary SRED.
Mirtazapine has also been reported to induce secondary SRED.
Sedative-hypnotic medications can induce sleepwalking, SRED, and sleep driving.
Zolpidem is the most commonly reported hypnotic medication to induce non-REM sleep parasomnias.

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Slides and Transcript

Slide 1 of 13

I now want to mention that sleep-related eating disorder can be induced by various psychotropic medications.

Medication-Induced SRED, Sleepwalking, and Sleepdriving Slide 1 of 13

Slide 2 of 13

There's a long list now, a growing list of medications that can induce secondary sleep-related eating disorder, including olanzapine, risperidone, quetiapine, aripiprazole, mirtazapine, and even a rare case of clonazepam, since clonazepam is on the list of medications to treat idiopathic sleep-related eating disorder, but it's really down the list.

References:

Tamanna, S., Ullah, M. I., Pope, C. R., Holloman, G., & Koch, C. A. (2012). Quetiapine-induced sleep-related eating disorder-like behavior: A case series. Journal of Medical Case Reports, 6(1).
Ghosh, D., Petrecca, A. M., & Khuhro, A. L. (2018). Sleep-related eating disorder (SRED): Paradoxical effect of clonazepam. Journal of Clinical Sleep Medicine, 14(07), 1261-1263.

Medication-Induced SRED, Sleepwalking, and Sleepdriving Slide 2 of 13

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Slide 3 of 13

I know that most psychiatrists are aware that mirtazapine can cause weight gain and they need to be aware that one of the possible mechanisms for the weight gain induced by mirtazapine is via the mechanism of mirtazapine-induced sleep-related eating disorder. So, you need to talk to the patient, have them talk to the bed partner or roommate about any type of complex sleep behaviors during the night as the possible cause for the weight gain associated with mirtazapine.

References:

Jeong, J., & Bahk, W. (2014). Sleep-related eating disorder associated with Mirtazapine. Journal of Clinical Psychopharmacology, 34(6), 752-753.
Shinith, D., Mathilakath, A., Kim, D., & Patel, B. (2018). Sleep-related eating disorder with mirtazapine. BMJ Case Reports, bcr-2018-224676.

Medication-Induced SRED, Sleepwalking, and Sleepdriving Slide 3 of 13

Slide 4 of 13

There is a related condition called night eating syndrome that actually is related in terms of abnormal eating in the evening or at night, but these patients are awake and they know what they are doing. They just cannot control their eating. And that's very different from sleep-related eating disorder where the patient is asleep, with partial or complete amnesia.

References:

American Psychiatric Association. DSM-5 Task Force. (2017). Diagnostic and statistical manual of mental disorders: DSM-5.
American Academy of Sleep Medicine. (2014). International classification of sleep disorders (3rd ed.).

Medication-Induced SRED, Sleepwalking, and Sleepdriving Slide 4 of 13

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Slide 5 of 13

So, with night eating syndrome there is inappropriate excessive eating in the evening, either before falling asleep, in other words, between dinner and bedtime, or after an awakening during sleep, a full awakening being fully oriented, aware of what you're doing and then you have the urge to eat. Very different from sleep-related eating disorder where the person is not aware of what he or she is doing.

References:

American Psychiatric Association. DSM-5 Task Force. (2017). Diagnostic and statistical manual of mental disorders: DSM-5.
American Academy of Sleep Medicine. (2014). International classification of sleep disorders (3rd ed.).

Medication-Induced SRED, Sleepwalking, and Sleepdriving Slide 5 of 13

Slide 6 of 13

So, with night eating syndrome, certainly, various psychotropic medications such as trazodone or quetiapine can induce wakeful eating with weight gain before going to sleep.

References:

C.H. Schenck, personal communication, February, 15, 2022

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Slide 7 of 13

But sleep-related eating disorder is a condition that occurs after someone has fallen asleep, either idiopathically or associated with zolpidem or other hypnotic medication.

References:

Tamanna, S., Ullah, M. I., Pope, C. R., Holloman, G., & Koch, C. A. (2012). Quetiapine-induced sleep-related eating disorder-like behavior: A case series. Journal of Medical Case Reports, 6(1).

Medication-Induced SRED, Sleepwalking, and Sleepdriving Slide 7 of 13

Slide 8 of 13

I will now address the issue of medication-induced sleepwalking. Helen Stallman from Australia and her colleagues published an article in Sleep Medicine Reviews 2018, entitled Medication-induced Sleepwalking: A Systematic Review. They did a very extensive database search using the keyword sleepwalking and somnambulism. Seventy-two publications met the inclusion criteria. The results show that there were primarily four classes of medications that induce sleepwalking.

References:

Stallman, H. M., Kohler, M., & White, J. (2018). Medication induced sleepwalking: A systematic review. Sleep Medicine Reviews, 37, 105-113.

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Slide 9 of 13

First of all, benzodiazepine receptor agonists and other GABA modulators with zolpidem being identified in 26 studies and other drugs in 10 studies. Second, serotonergic antidepressants and also bupropion. Third, older generation antipsychotics. And fourth, beta-blockers.

References:

Stallman, H. M., Kohler, M., & White, J. (2018). Medication induced sleepwalking: A systematic review. Sleep Medicine Reviews, 37, 105-113.

Medication-Induced SRED, Sleepwalking, and Sleepdriving Slide 9 of 13

Slide 10 of 13

And they identified four cases of sleep-related driving with zolpidem.

References:

Stallman, H. M., Kohler, M., & White, J. (2018). Medication induced sleepwalking: A systematic review. Sleep Medicine Reviews, 37, 105-113.

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Slide 11 of 13

And my key points here are that: There's a broad array of atypical antipsychotics that have been reported to induce secondary sleep-related eating disorder. Also, the antidepressant mirtazapine has also been reported to induce secondary sleep-related eating disorder.

Medication-Induced SRED, Sleepwalking, and Sleepdriving Slide 11 of 13

Slide 12 of 13

Sedative-hypnotic medications can induce various non-REM sleep parasomnias, including sleepwalking, sleep-related eating, and sleep driving. Also, zolpidem is the most commonly reported hypnotic medication to induce non-REM parasomnias, which I will elaborate on further during my talk.

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Slide 13 of 13

Medication-Induced SRED, Sleepwalking, and Sleepdriving Slide 13 of 13

Next Section

04. Zolpidem and Amnestic Complex Behaviors During Sleep

Learning Objectives:

After completing this activity, the learner will be able to:

Recognize and analyze abnormal non-REM sleep behaviors.
Correlate sedative-hypnotics use patterns with the occurrence of parasomnias.
Confidently diagnose sleep-related eating disorder and sleepwalking.

Original Release Date: March 1, 2023

Review and Re-release Date: March 1, 2024

Expiration Date: March 1, 2026

Expert: Carlos Schenck, M.D.

Medical Editor: Horia Batranu, M.D.

Relevant Financial Disclosures:

Carlos H. Schenck, M.D. declares the following interests:

- Eisai, Inc.: One time lecture on REM sleep behavior disorder, without any product promotion.

All of the relevant financial relationships listed above have been mitigated by Medical Academy and the Psychopharmacology Institute.

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