Zolpidem Induced Sleep-related Eating and Complex Behaviors in a Patient with Obstructive Sleep Apnea and Restless Legs Syndrome

Abstract

Zolpidem-induced sleep-related complex behaviors (SRCB) with anterograde amnesia have been reported. We describe herein a case in which the development of zolpidem-induced sleep-related eating disorder (SRED) and SRCB was strongly suspected. A 71-year-old Korean male was admitted to the Department of Psychiatry due to his repetitive SRED and SRCB with anterograde amnesia, which he reported as having occurred since taking zolpidem. The patient also had restless legs syndrome (RLS) and obstructive sleep apnea (OSA). His baseline serum iron level was low at admission. Zolpidem discontinuation resulted in the immediate disappearance of his SRED, but did not affect his RLS symptoms. These symptoms rapidly improved after adding a single i.v. iron injection once daily, and so he was discharged to day-clinic treatment. These findings indicate that zolpidem can induce SRCB. Although the pathophysiology of zolpidem-induced SRED and other SRCB remains unclear, clinicians should carefully monitor for the potential induction of complex behaviors associated with zolpidem in patients with comorbid RLS or OSA.

Chronic oral administration of Passiflora incarnata extract has no abnormal effects on metabolic and behavioral parameters in mice, except to induce sleep

“…Neuropsychiatric abnormal behaviors and symptoms, such as depression, anxiety and suicide have been reported in numerous studies [1,13,17,38]. Insomnia itself is an adverse event, but very dangerous physical and mental changes caused by sleeping pills have also been reported [2,4,15,16,19,25,29,33]. Drinking tea made from passion flowers, particularly Passiflora incarnata, has long been known to provide stability and induce sleep [22].…”

“…Many side effects of prescription sleeping pills have been reported according to the recent studies, which demonstrated that patients who suffering from irregular sleeping have possibility about metabolic disorders in bodies according to the studies [2,19,21]. In particularly, overdose and long-term intakes of sleeping pills are shown abnormal behavior during the sleep, and have reported high mortality rate of insomniac patients [19,21,29]. However, unexpected adverse effects of these prescription drugs on the human body and mind are not well known and thus the use of newly developed sleep-inducers needs to be very careful as long as potential side effects of the sleep-inducers are observed [19].…”

Zolpidem-Induced Sleep-Related Eating Disorder

“…Here we present 28 cases of zolpidem-induced SRED (Table 1) [8][9][10][11][12][13][14][15][16][17][18][19]. The mean age of the patients was 54.8 years, and they comprised 17 females and 11 males.…”

“…Therefore, replacing immediate-release zolpidem with zolpidem CR (comprising immediate-and slow-release components) or reducing the dosage could improve the condition. The [11] 44/F 10 Full OSA Dang et al [12] 45/M 10 Full None Miranda et al [13] 49/M 10 N/A N/A Yun and Ji [14] 45/M 10 Full RLS Wing et al [15] 61 [17] 53/F 10 Full None Kim et al [18] 57/F 10 Recall RLS Park and Shin [19] 71/M 12.5 Full RLS, OSA F: female, M: male, OSA: obstructive sleep apnea, RLS: restless legs syndrome second hypothesis is a theory related to GABA receptor desensitization [22]. Immediate-release zolpidem desensitizes GABA receptors more than does zolpidem CR, resulting in more arousal effects during sleep.…”

“…Another study compared pramipexole to placebo, and found that nocturnal eating frequency was reduced and sleep quality improved in the pramipexole group [26]. However, the most important treatment is to discontinue the causative drug [19]. The discontinuation of zolpidem causes SRED to disappear, while reducing the zolpidem dosage may also improve SRED.…”