Sleep, the workplace, and driving

As we age, the nature of our sleep – in terms of architecture and duration – changes. But in addition, the accrual of morbidities throughout life frequently gives rise to an increasing pharmacological burden, with polypharmacy a commonly encountered situation. Many medications have an under-recognised impact on sleep, through their effects on neurotransmitter function and alteration of sleep architecture, although often, the mechanism whereby a drug causes a disruption of sleep/wakefulness is not fully understood. In many cases, a simple amendment to the dose regime may address the problem (eg changing the timing of doses), but in others an alternative should be sought. In any patient with a sleep complaint, the drug history – both for prescribed and non-prescribed medications – should be carefully examined. This chapter will briefly address drugs causing sleepiness, drugs causing insomnias, and medications used in the management of sleep disorders.