Alcohol and illegal drugs such as marijuana and cocaine can contribute to problems of initiating and maintaining sleep. Many other drugs used to treat a variety of medical conditions also possess the undesirable side effect of disturbed sleep. Barbiturates and other hypnotic drugs, for example, may produce sleep disruptions not only while they are being used but during the period of withdrawal as well. Some benzodiazepines have a short half-life (the period in which half the drug is metabolized), in some cases as little as four hours. This is desirable when control must be exercised over how long the drug acts in the body; the downside is that once the drug begins to wear off, sleeplessness may return. This phenomenon is called rebound insomnia. Interrupted sleep is also associated with the use of or withdrawal from those agents used in cancer chemotherapy and thyroid preparations, opiates, and anticonvulsive drugs.

Often a patient is reluctant to tell me about the use of controlled substances, especially the illegal ones or stimulants such as amphetamines. If I suspect that is the case, I will order blood or urine analysis tests. In extreme cases the use of EEG tracings can indicate the presence of drugs. My interest in ordering such tests is not to catch a patient in the act but to obtain as complete a medical profile as possible, so that I can understand the true nature of the problem and deal with it in the most appropriate fashion.

*119\226\8*