Effects of selective serotonin reuptake inhibitors on objective and subjective sleep quality

The purpose of this paper is to review the effects of selective serotonin ( 5-HT) reuptake inhibitors on objective and subjective sleep and awakening q uality measures. Polysomnography (PSG) demonstrated in both healthy volunte ers and depressed patients a decrease in sleep efficiency and total sleep t ime, a lengthening of sleep latency and a deterioration in sleep continuity , including an increase in the number of awakenings and wake time during th e total sleep period. Sleep architecture mostly showed an increase in S1 an d S2 and a decrease in S3, S4 and REM sleep as well as a lengthening of REM latency. Objective awakening quality, if measured at all by psychometry, g enerally showed no decrements. Concerning subjective sleep and awakening qu ality, normals demonstrated either no changes or a tendency towards a deter ioration, while in patients some improvement was observed. Reasons for th i s discrepancy will be discussed. Novel 5-HT reuptake inhibitors with additi onal modes of action such as 5-HT2 antagonism (e.g. trazodone, nefazodone) are more likely to improve objective and subjective sleep quality, although some shortcomings may be inherent in regard to comorbidity (e.g. sleep-rel ated breathing disorders). Thus, PSG seems to be a necessity for diagnosis and treatment of complex sleep disorders. Copyright (C) 2000 S. Karger AG, Basel.