Stimulants are substances that have an effect on the central nervous system and body, leading to increased alertness and difficulty in getting to sleep. This is in contrast to sedatives and hypnotics, which decrease the activity of the brain and increase sleepiness.

For this reason, stimulants are commonly associated with wakefulness and can help to improve mood and stress response during the day. Stimulants can also be used to improve sleep in some patients, particularly when given in doses during the day to improve function.

What is a Stimulant?

A stimulant is any substance that exerts an effect on the body to increase physiological or nervous activity. They often act on the central nervous system to increase mental alertness and brain function, reducing the feeling of sleepiness.

Caffeine is a commonly available stimulant that many people use to self-manage excessive sleepiness during the day. It helps to increase mental alertness and can improve thinking pathways, which can offer an effective stimulatory effect for mild cases of sleepiness.

However, for more severe cases such as narcolepsy or sleep apnea, stimulant medications may offer a more profound benefit. Examples of stimulants include:

• Armodafinil (Nuvigil)
• Methylphenidate (Ritalin)
• Amphetamines (Adderall)
• Modafinil (Nuvigil)

Stimulants to Improve Excessive Sleepiness

It is important first to consider the underlying cause of excessive sleepiness when commencing management for the condition. This typically includes alterations to sleep schedule, routines, stress and sleeping environment.

Some medications can be useful in the treatment of excessive sleepiness, including some stimulants. These can be prescribed to help individuals to stay awake and participate in daily activities as usual.

Additionally, shift workers that have an interrupted sleep schedule often feel sleepy at work and may benefit from stimulant medications when other methods, such as changing sleep habits, are not successful.

Stimulants to Improve Sleep in Adults with ADHD

Attention deficit/hyperactivity disorder (ADHD) is linked to symptoms such as increased sleep latency and daytime somnolence and reduced REM sleep. Adult patients may benefit from the use of central nervous stimulants such as methylphenidate to aid sleep. Sleep is a significant issue for many adults with ADHD, and poor sleep habits can worsen daytime symptoms and create a vicious cycle.

One study suggested that administration of the stimulant help to improve sleep, including the polysomnographic recordings, sleep latency and nocturnal awakenings. However, the overall sleep quality and reported satisfaction of rest were similar between the methylphenidate group and the control group.

Adverse Effects and Safety

Several considerations should be accounted for during the decision-making process when using stimulants to increase daytime wakefulness or aid sleep at night.

Adverse effects of stimulants may include:

• Hypertension
• Irritability
• Tremor
• Insomnia
• Headache
• Nausea and diarrhea
• Anxiety
• Dizziness
• Stuffy nose
• Back pain

The side effects experienced depend on the specific drug used, dosages and the individual characteristics of the patient.

It is important to understand that stimulant medications should be used in combination with other management techniques, such as habitual changes or anxiety management.

References

• http://www.medscape.org/viewarticle/571987
• http://www.ncbi.nlm.nih.gov/pubmed/11780875
• https://sleepfoundation.org/excessivesleepiness/content/excessive-sleepiness-treatment
• https://www.med.upenn.edu/uep/user_documents/dfd23.pdf

Further Reading

• All Sleep Content
• What is Sleep?
• Types of Sleep Disorders
• Promoting Sounder Sleep in Older Adults
• Sleep Deprivation – Inadequate Quantity of Sleep

Written by

Yolanda Smith

Yolanda graduated with a Bachelor of Pharmacy at the University of South Australia and has experience working in both Australia and Italy. She is passionate about how medicine, diet and lifestyle affect our health and enjoys helping people understand this. In her spare time she loves to explore the world and learn about new cultures and languages.