Abstract
Sleep medication helps patients who suffer from insomnia to fall asleep and maintain asleep, but unfortunately hypnotic drugs often have residual effects that may affect daily activities such as driving a car. Epidemiological studies show that patients who use sleep medication are at increased risk of becoming involved in traffic accidents. These studies show an increased traffic accident risk for patients using benzodiazepine hypnotics or zopiclone.
This chapter reviews the experimental studies assessing the effects of various hypnotic drugs on driving ability. On-the-road studies confirm that benzodiazepine hypnotics and zopiclone significantly impair driving ability the morning following bedtime administration, whereas the Z-drugs zolpidem and zaleplon do not affect driving performance when taken as recommended. Impairment was dose dependent and most prominent in benzodiazepines with a relative long half-life.
Epidemiological studies show that tolerance to the impairing effects on driving ability of hypnotic drugs develops slowly. However, experimental evidence from on-the-road driving studies on the effects of chronic use of hypnotics is currently lacking. Also, the impact of untreated insomnia on driving should be examined in future studies.
Current hypnotics all act at the GABA receptor which may explain their residual effects on driving performance. Various newly developed hypnotic drugs have a different mechanism of action and may therefore be devoid of residual effects on driving performance.
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References
Ohayon MM (2002) Epidemiology of insomnia: What we know and what we still need to learn. Sleep Med Rev 6: 97–111
Verster JC, Pandi-Perumal SR, Streiner DL (Eds) (2008) Sleep and Quality of Life in Clinical Medicine. Humana Press (Springer).
Morin AK, Jarvis CI, Lynch AM (2007) Therapeutic options for sleep-maintenance and sleep-onset insomnia. Pharmacotherapy 27: 89–110
Verster JC, Veldhuijzen DS, Patat A, Olivier B, Volkerts ER (2006) Hypnotics and driving safety: meta-analyses of randomized controlled trials applying the on-the-road driving test. Current Drug Safety 1: 63–72.
Vermeeren A (2004) Residual effects of hypnotics: epidemiology and clinical implications. CNS Drugs 18: 1–37
O’Hanlon JF (1984) Driving performance under the influence of drugs: rationale for, and application of, a new test. Br J Clin Pharmacol 18: 121S–129S.
Volkerts ER, Louwerens JW, Gloerich ABM, et al. (1984) Zopiclone’s residual effect upon actual driving performance versus those of nitrazepam and flunitrazepam. VSC, Report 84-10, TrafficResearchCentre, Groningen, The Netherlands
O’Hanlon JF, Volkerts ER (1986) Hypnotics and actual driving ability. Acta Psychiatr Scand 74(suppl 332): 95–104.
Brookhuis KA, Volkerts ER, O’Hanlon JF (1990) Repeated dose effects of lormetazepam and flurazepam upon driving performance. Eur J Clin Pharmacol 38: 1–5.
Volkerts ER, van Laar MW, van Willigenburg APP (1992) A comparative study of on-theroad and simulated driving performance after nocturnal treatment with lormetazepam 1 mg and oxazepam 50 mg. Hum Psychopharmacol 7: 297–309
Louwerens JW, Gloerich ABM, De Vries G, Brookhuis KA, O’Hanlon JF (1987) The relationship between drivers’ blood alcohol concentration (BAC) and actual driving performance during high speed travel. In: Noordzij, P.C. and Roszbach R. (Eds) Alcohol, Drugs and Traffic Safety. Amsterdam: Excerpta Medica. 183–192.
Vermeeren A, Danjou PE, O’Hanlon JF (1998) Residual effects of evening and middle-ofthe-night administration of zaleplon 10 and 20 mg on memory and actual driving performance. Hum Psychopharmacol Clin Exp 13: S98–S107
Vermeeren A, O’Hanlon JF, DeClerck AC, et al. (1995) Acute effects of zolpidem and flunitrazepam on sleep, memory and driving performance, compared to those of partial sleep deprivation and placebo. Acta Therapeutica 21: 47–64
Bocca ML, le Doze F, Etard O et al. (1999) Residual effect of zolpidem 10 mg and zopiclone 7.5 mg versus flunitrazepam 1 mg and placebo on driving performance and ocularsaccades. Psychopharmacology 143: 373–379
Schmidt U, Brendemuhl D, Ruther E (1986) Aspects of driving after hypnotic therapy with particular reference to temazepam. Acta Psychiatr Scand 332 (suppl): 112–118
Iudice A, Bonnani E, Maestri M et al. (2002) Lormetazepam effects on daytime vigilance, psychomotor performance and simulated driving in young adult healthy volunteers. Int J Clin Pharmacol Ther 40: 304–309.
Betts TA, Birtle J (1982) Effects of two hypnotics on actual driving performance next morning. Br Med J 285: 852.
Laurell H, Tornros J (1986) The carry-over effects of triazolam compared with nitrazepam and placebo in acute emergency driving situations and in monotonous simulated driving. Acta Pharmacol Toxicol 58: 182–186.
Tornros J, Laurell H (1990) Acute and carry-over effects of brotizolam compared to nitrazepam and placebo in monotonoussimulateddriving. PharmacolToxicol 67: 77–80.
Vermeeren A, Riedel WJ, van Boxtel MPJ, et al. (2002) Differential residual effects of zaleplon and zopiclone on actual driving: a comparison with a low dose of ethanol. Sleep 25: 224–231
Barbone F, McMahon AD, Davey PG, Morris AD, Reid IC, McDevitt DG, MacDonald TM (1998) Association of road-traffic accidents with benzodiazepine use. The Lancet 352: 1331–1336
Verster JC, Volkerts ER, Schreuder AHCML, et al. (2002) Residual effects of middle-ofthe-night administration of zaleplon and zolpidem on driving ability, memory functions, and psychomotor performance. J Clin Psychopharmacol 22: 576–583
Verster JC, Volkerts ER, Johnson W, Liddicoat L (2007) Zolpidem and traffic safety—the importance of treatment compliance. Current Drug Safety 2: 220–226
Verster JC, Veldhuijzen DS, Volkerts ER (2004) Residual effects of sleep medication on driving ability. Sleep Medicine Reviews 8: 309–325
Hemmelgarn B, Suissa S, Huang A, Boivin J-F, Pinard G (1997) Benzodiazepine use and the risk of motor vehicle crash in the elderly. JAMA 278: 27–31
Ray WA, Fought RL, Decker MD (1992) Psychoactive drugs and the risk of injurious motor vehicle crashes in elderly drivers. Am J Epidemiol 136: 873–883
Neutel CI (1995) Risk of traffic accident injury after a prescription for a benzodiazepine. Ann Epidemiol 5: 239–244
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Verster, J.C., Mets, M.A., Leufkens, T.R., Vermeeren, A. (2009). Insomnia, hypnotic drugs and traffic safety. In: Verster, J.C., Pandi-Perumal, S.R., Ramaekers, J.G., de Gier, J.J. (eds) Drugs, Driving and Traffic Safety. Birkhäuser Basel. https://doi.org/10.1007/978-3-7643-9923-8_14
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