The patients medical history indicates the patient has been taking tricyclic antidepressants for the past 5 years. The tech should anticipate the patients may have an increased likelihood of:

• A. Complex partial seizures
• B. Central sleep apnea
• C. REM sleep behavior disorder
• D. Restless leg syndrome

Answer: (C)

Antidepressants, including tricyclics, can alter REM sleep in a way that unmasked or worsened REM-related motor activity. REM sleep behavior disorder occurs when the normal muscle atonia that should accompany REM sleep is absent, so a person acts out dreams, sometimes with movements, yelling, or kicking. Long-term use of TCAs can increase the likelihood of this phenomenon, particularly in older adults, so the sleep tech should be alert for dream enactment and safety concerns. In polysomnography you’d expect REM periods with reduced or absent chin EMG tone (REM without atonia), often accompanied by movements during REM sleep. Clinically, patients or bed partners may report vivid dreams and enactment behaviors. Management focuses on safety, and treatment options include melatonin or low-dose clonazepam, plus reassessing the medication regimen if feasible. Other conditions listed—central sleep apnea, complex partial seizures, or restless legs syndrome—do not align as closely with long-term tricyclic antidepressant effects; they have different typical causes and diagnostic features.