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Substanzinduzierte Schlafstörungen und Schlafmittelmissbrauch

Substance-induced sleep disorders and abuse of hypnotics

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Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz Aims and scope

Zusammenfassung

Die Einnahme einer Vielzahl von Substanzen kann sich negativ auf den Schlaf auswirken. Dazu gehören die in unserer Gesellschaft häufig konsumierten Genussdrogen wie Koffein, Nikotin und Alkohol. Illegale Drogen, wie Heroin oder Ecstasy wirken unterschiedlich, aber mit einem hohen schlafstörenden Potenzial. Zudem können ärztlich verordnete Medikamente, zum Beispiel Kortikosteroide oder β-Blocker, die Schlafqualität negativ beeinflussen. Eine wichtige Frage ist, ob und in welchem Umfang die Einnahme von Hypnotika, speziell von Benzodiazepinen (BZ), den Schlaf langfristig negativ beeinträchtigt. Benzodiazepine bewirken initial eine Reduktion nächtlicher Wachperioden und eine Verlängerung der Gesamtschlafzeit. Bei vielen Hypnotika tritt eine Toleranzentwicklung auf, die zu Dosissteigerungen führen kann. Problematisch an den BZ-Hypnotika ist zudem der Rebound-Effekt, das heißt eine Verschlechterung der Schlafqualität beim Absetzen der Präparate, die zu Abhängigkeitsentwicklungen führen können. Weitere unerwünschte Nebenwirkungen (zum Beispiel nächtliche Stürze) und das Missbrauchs- und Abhängigkeitspotenzial werden ausführlich diskutiert.

Abstract

The intake of a large variety of substances has a negative impact on sleep. Widely used, readily available substances like alcohol, nicotine, or caffeine need to be mentioned here. Illicit drugs (e.g., heroine or ecstasy) have different mechanisms of action with a high sleep-disrupting potential. Prescription drugs, i.e., corticosteroids or β-blockers, may also negatively affect sleep. An important question is whether the intake of hypnotics, especially benzodiazepines, may have a negative long-term effect on sleep. Classical benzodiazepines (BZ) initially lead to a reduction of nocturnal wake time and prolong total sleep time as a desired effect. Regarding the microstructure of sleep, BZ lead to a reduction of slow frequencies and an increase of fast frequencies in the EEG. With many BZ, tolerance may occur, thus, leading to unwanted dose increases. Further problems include rebound effects that occur upon discontinuation of BZ, including a drastic deterioration of sleep upon drug withdrawal. This phenomenon may pave the way for the development of drug dependency. Further unwanted side-effects (e.g., nocturnal falls) and the question of BZ abuse and dependency will be discussed.

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Interessenkonflikt

Der korrespondierende Autor weist auf folgende Beziehungen hin: D. Riemann hat im letzten Jahr Mittel zur Durchführung einer „Investigator initiated study“ von Sanofi-Aventis bekommen. C. Nissen gibt keine Interessenkonflikte an.

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Riemann, D., Nissen, C. Substanzinduzierte Schlafstörungen und Schlafmittelmissbrauch. Bundesgesundheitsbl. 54, 1325–1331 (2011). https://doi.org/10.1007/s00103-011-1374-2

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