Cognitive performance following premature awakening from zolpidem or melatonin induced daytime sleep

Background: The hypnotic zolpidem and the hormone melatonin were evaluated and directly compared for their effects on performance when subjects sleeping under their influence were prematurely awakened from daytime sleep. Method: Non-sleep deprived volunteers (eight men and five women) received single oral doses of 5 or 10mg melatonin (Mel-5; Mel-10), 10 or 20 mg zolpidem (Zol-10; Zol-20), or placebo immediately before retiring at 13:00. Performance testing and subjective evaluations occurred prior to dosing and following forced awakening at 15:00, 2 h after dosing. Results: Compared with placebo, on being awakened under Zol-20, significant performance decrements were prevalent on 9 of 10 cognitive tasks, including grammatical reasoning, mathematical processing, and word memory. Recovery required up to 6 h post-awakening for the more complex tasks. Loss of coordination and nausea were also present on awakening under Zol-20. On being awakened under Zol-10, significant but relatively less severe and shorter duration performance decrements occurred for 4 of the 10 tasks and recovered by 4 h post-awakening. Under Mel-5 or Mel-10, performance decrements seldom occurred and were considerably less severe, briefer, and less systematic than for zolpidem. Conclusion: Findings indicated that when operational personnel sleeping with the aid of either 10 or 20 mg zolpidem are prematurely awakened, it would be prudent to evaluate their general well-being and possible need for assistance prior to their being permitted to depart crew-rest or to perform tasks and duties. In contrast, we found little to no evidence of deteriorated well-being or need for assistance when awakened while sleeping under the influence of melatonin.