Table S2.

Selected common medications with potential to disrupt wake

Drug Class	Examples	Typical Indications	Patient Complaints	Mechanism	Potential Solutions
Selective serotonin reuptake inhibitors	sertraline, paroxetine	Major depression, anxiety, postmenopausal hot flashes	Daytime sleepiness	Sedating effects of medication19	Reassess original indication, consider taper or substitution of an agent with a more alerting side effect profile (e.g., venlafaxine or bupropion)
Tricyclic antidepressants	amitriptyline	Insomnia, major depression, anxiety, chronic neuropathic pain	morning grogginess nonrestorative sleep daytime sleepiness	Sedating effects of medication Prolonged half-life for some medications leads to next-day “hangover”	Reassess original indication, consider dose decrease, consider nocturnal dosing schedule, consider alternate agent
Benzo-diazepines	diazepam, clonazepam, flurazepam	Insomnia, anxiety, muscle spasms, REM behavior disorder	morning grogginess, nonrestorative sleep, daytime sleepiness	Sedating effects of medication; prolonged half-life for some medications leads to next-day “hangover”	Reassess original diagnosis, consider alternate agent, consider addition of daytime alerting agent if agent is considered medically necessary
Anticonvulsants	gabapentin, phenytoin, levetiracetam	Seizure disorder, neuropathic pain, migraine prophylaxis	Daytime sleepiness	Sedating effects of medication	Consider dose decrease, consider alternate agent, consider addition of daytime alerting agent if agent is considered medically necessary
Neuroleptics	quetiapine, risperidone, haloperidol	Psychotic disorders, major depression, attention deficit disorder	Daytime sleepiness	Sedating effects of medication	Reassess original diagnosis, consider alternate agent, consider addition of daytime alerting agent if agent is considered medically necessary
Beta blockers	metoprolol, propranolol, bisoprolol	Hypertension, tachyarrhythmias migraine prophylaxis	Daytime fatigue	Central adrenergic blockade→fatigue or drowsiness20,21	Consider less lipophilic agent (e.g., atenolol), consider alternate drug class
Statins	atorvastatin, simvastatin, pravastatin, rosuvastatin	Hyperlipidemia	Daytime fatigue, poor exercise tolerance due to muscle pain	Statin induced myopathy, possible statin induced arthralgia16,17,20	Reassess original diagnosis, reassess treatment goals, consider lower dose, consider alternate agent
Antihistamines	Diphenhydramine, hydroxyzine	Allergic reactions, anxiety, pruritic conditions, insomnia	Daytime fatigue Daytime sleepiness Poor attention and concentration22	Blockade of central histaminergic receptors→ drowsiness, anticholinergic effects on basal forebrain decreases concentration and information processing ability	Consider lower dose, consider nonsedating alternatives, consider addition of daytime alerting agent if agent is considered medically necessary
Social drugs	Alcohol	n/a	Daytime fatigue Headaches Depression Anxiety	Alcohol can lead to daytime impairment symptoms by virtue of its effects on sleep (see Table S1), by direct CNS sedative effects, toxicity (“hangover”) effects, or due to withdrawal symptoms.	Taper and discontinue use