Antidepressants
The results for SSRIs as a class were inconsistent. One RCT (with a low risk of bias) in women after breast cancer found that paroxetine (10 or 20 mg/d for 9 weeks) was associated with an improvement in sleep compared with placebo,14 while another RCT (with a low risk of bias) in women after breast cancer with fluoxetine (20 mg/d for 9 weeks) did not report between-group differences for sleep disturbance compared with placebo.15 [ES17]
In a population of peri- and postmenopausal women, one RCT in a systematic review found that the SSRI escitalopram (10-20 mg/d for 8 weeks) had no statistically significant effect on sleep disturbance compared to placebo.18 [ES49]
Venlafaxine was the only SNRI assessed in the population of women experiencing menopausal symptoms after breast cancer. One RCT (with a moderate risk of bias) in women after breast cancer found no difference in sleep disturbance between venlafaxine 75 mg/d and placebo.21 [ES18]
Three RCTs (one with a low risk of bias and two with a moderate risk of bias) compared venlafaxine with clonidine 20, 22, 23 and only one of the three studies found an improvement in sleep for venlafaxine compared with clonidine.22 One additional RCT (with a moderate risk of bias) reported no statistical comparison for sleep disturbance between venlafaxine and acupuncture.25 [ES18]
In a population of postmenopausal women, three RCTs in a systematic review found the SNRI desvenlafaxine (100 or 150 mg/d for 12 weeks) significantly reduced the number of night-time awakenings compared to placebo.27 [ES50]
Sedatives
One RCT (with a moderate risk of bias) in women after breast cancer receiving an SSRI or SNRI for vasomotor symptoms found an improvement in sleep disturbance with 5 weeks augmentation with zolpidem (10 mg/d) compared with augmentation with placebo.30 [ES19]
Anticonvulsants
One RCT (with a moderate risk of bias) in women after breast cancer reported that the γ-aminobutyric acid analogue gabapentin (300mg/d or 900mg/d) had no effect on sleep compared with placebo.31 [ES20] One RCT (with a moderate risk of bias) reported that gabapentin (900mg/d for 4 weeks) also had no effect on sleep compared with venlafaxine (75mg/d for 4 weeks);24 however, another RCT (with a moderate risk of bias) reported that gabapentin (900mg/d for 12 weeks) improved sleep quality compared with Vitamin E (800 IU/d for 12 weeks).33 [ES20]