What medications should I stop before a Multiple Sleep Latency Test (MSLT)?

Medications to Stop Before Multiple Sleep Latency Test (MSLT)

You should stop all REM-suppressing antidepressants 2 weeks before MSLT (6 weeks for fluoxetine) to avoid false negative results and ensure accurate diagnosis of central disorders of hypersomnolence. 1

Pre-MSLT Medication Management

Antidepressants

• REM-suppressing antidepressants should be discontinued prior to MSLT as they significantly affect test results 1
• Patients who taper off REM-suppressing antidepressants before MSLT are more likely to demonstrate ≥2 sleep-onset REM periods (SOREMs) and have shorter mean sleep latency 1
• Standard discontinuation timeline: 2 weeks for most antidepressants, 6 weeks for fluoxetine due to its longer half-life 1

Other Medications to Discontinue

• Stimulants (amphetamines, methylphenidate, modafinil) should be stopped as they can mask sleepiness 2
• Sedating medications including benzodiazepines, hypnotics, antihistamines, and other sedating substances should be discontinued 2
• Any medications that could potentially affect sleep architecture or alertness should be discussed with your sleep specialist 3

Importance of Proper MSLT Preparation

Documentation of Sleep Habits

• Wrist actigraphy is recommended for 7-14 days prior to MSLT to document sleep habits and ensure adequate sleep time 2, 4
• Actigraphy provides more objective data than sleep logs, which tend to overestimate sleep time 5
• Concurrent sleep diary should be maintained alongside actigraphy to document unusual activities 5

Sleep Requirements Before Testing

• Minimum of 7 hours of sleep (with 8-hour recording time) on polysomnography the night before MSLT 6
• Inadequate sleep before MSLT can lead to false positive results due to sleep debt 7
• Effects of prior sleep deprivation can affect MSLT results for multiple days 8

Potential Pitfalls and Considerations

• Failing to discontinue REM-suppressing medications may lead to false negative results (missing SOREMs) 1
• Chronic sleep debt before examination, even with adequate sleep during initial polysomnography, can affect MSLT results and lead to improper diagnosis 7
• Forced awakening prior to MSLT may permit sleep deprivation to masquerade as narcolepsy or idiopathic CNS hypersomnia 8
• Patients should be advised about the importance of maintaining regular sleep schedules and avoiding sleep deprivation in the weeks leading up to testing 7

Special Considerations for Shift Workers

• For night shift workers, MSLT should be scheduled during the patient's habitual sleep period rather than at conventional daytime hours 5
• Actigraphy with light sensors can verify sleep timing and help define the major sleep period, particularly useful for shift workers 5