From the FDA Drug Label
14.3 Studies Pertinent to Safety Concerns for Sedative/Hypnotic Drugs Next-Day Residual Effects Next-day residual effects of zolpidem tartrate were evaluated in seven studies involving normal subjects In three studies in adults (including one study in a phase advance model of transient insomnia) and in one study in elderly subjects, a small but statistically significant decrease in performance was observed in the Digit Symbol Substitution Test (DSST) when compared to placebo Studies of zolpidem tartrate in non-elderly patients with insomnia did not detect evidence of next-day residual effects using the DSST, the Multiple Sleep Latency Test (MSLT), and patient ratings of alertness
The medications that need to be held for MSLT (Multiple Sleep Latency Test) are sedative/hypnotic drugs like zolpidem.
- Zolpidem may cause next-day residual effects, which could impact the results of the MSLT. It is recommended to hold zolpidem before the MSLT to ensure accurate test results 1.
From the Research
Medications that should be held before a Multiple Sleep Latency Test (MSLT) include stimulants, antidepressants, sedatives, sleep aids, REM-suppressing medications, caffeine, and alcohol, as they can significantly alter sleep architecture and REM sleep patterns. The most recent and highest quality study 2 suggests that antidepressants, particularly those that suppress REM sleep, should be discontinued prior to MSLT to ensure accurate results. Some key medications to hold before MSLT include:
- Stimulants such as modafinil, methylphenidate, and amphetamines, which should be stopped for at least 2 weeks prior to testing
- Antidepressants including SSRIs, SNRIs, tricyclics, and MAOIs, which should be discontinued for 2-3 weeks before the test
- Sedatives and sleep aids such as benzodiazepines, Z-drugs, and antihistamines, which should be stopped for at least 1-2 weeks
- REM-suppressing medications like opioids and certain antipsychotics, which should be discontinued
- Caffeine and alcohol, which should be avoided for at least 24 hours before testing It is essential to consult with the prescribing physician before stopping any medication, as some may require gradual tapering to avoid withdrawal effects, as noted in studies 3, 4, 5, 6.