Rx: Medication Quick Reference

May improve sleep onset and alter spindle/fast EEG activity. Watch for residual sedation, confusion, or complex sleep behaviors. Record the formulation and administration time.

May increase sleep and cause residual sleepiness. Sleep paralysis or sleep-related hallucinations can occur. Consider product-specific respiratory precautions; do not assume breathing is unaffected in every patient.

May suppress or delay REM. Serotonergic antidepressants can be associated with increased REM muscle activity or worsening RLS symptoms. Document the findings without assuming medication causation.

REM suppression or delayed REM may occur. Watch for increased REM muscle activity or leg movements. Document recent dose changes.

MSLT: medication exposure or recent withdrawal can affect interpretation.

RLS treatment may reduce symptoms or movement activity. Watch for sleepiness and respiratory depression in susceptible patients, especially with other CNS depressants. Not interchangeable with ordinary gabapentin.

May reduce or delay REM. Watch for possible increased REM muscle activity or RLS symptoms.

MSLT: REM-modifying treatment can affect results.

May improve sleep continuity and cause residual impairment. Watch for confusion, getting out of bed, or other complex sleep behaviors. Document actual administration time.

RLS treatment may reduce symptoms. Sleepiness and dizziness may occur. Respiratory-depression risk is greater with opioids, other CNS depressants, respiratory impairment, or older age.

Treatment may reduce RLS symptoms or PLMS. Ask about augmentation: symptoms starting earlier, becoming more intense, or spreading. Record timing and missed doses. Excessive sleepiness or sudden sleep episodes can occur.

Can markedly suppress REM and change sleep continuity.

MSLT: REM suppression and withdrawal-related rebound are important potential confounders. Never recommend abrupt discontinuation.

Can alter REM expression and cause sedation. Note reduced/delayed REM and actual medication timing.

MSLT: document its use and the clinician’s preparation plan.

Can markedly suppress REM; sleep disruption may also occur.

MSLT: medication and withdrawal effects can complicate interpretation. Do not change the medication plan independently.

Increased alertness or insomnia may affect sleep onset. Record the last dose.

MSLT/MWT: interpret its use according to the purpose of the test and the clinician’s plan.

May suppress or delay REM. Its long persistence in the body matters when documenting recent discontinuation.

MSLT: a recent stop does not necessarily mean the medication effect has cleared.

Sedation may occur. Mirtazapine has provoked PLMS in a small experimental study. Record leg movements using standard scoring criteria; do not assume movements prove RLS or PLMD.

May improve sleep maintenance and cause sedation. Do not assume low-dose Silenor has the same sleep effects as higher antidepressant doses of doxepin. Record the exact product and dose.

Increased alertness or insomnia may affect sleep onset. Blood pressure and heart rate can increase. Report concerning symptoms or rhythm changes per protocol.

MSLT/MWT: document use and test-specific instructions.

May increase alertness or cause insomnia. Has a QT-prolongation warning. Report concerning symptoms or rhythm findings; a routine PSG EKG channel is not a definitive QT assessment.

Can cause CNS and respiratory depression; central apneas and oxygen desaturation have been observed. Annotate actual dose times and watch breathing and responsiveness. Follow the ordered schedule and facility medication procedures.

May delay REM and increase REM muscle activity. Watch for movements or dream-enactment behavior, and preserve video when appropriate. REM without atonia alone does not establish REM behavior disorder.