Sleep disorders are common in HD. They can include trouble falling asleep, staying asleep, waking up early, and disrupting day-night cycles causing day-time sleepiness. Drug treatments for sleep disorders in HD are similar to those recommended for sleep disorders in other neurodegenerative diseases. If drugs are used, drug choice should be influenced by the presence of other symptoms of HD.

Depression and anxiety can cause or add to sleep problems, while sleep problems can cause or worsen several other symptoms of HD including anxiety, depression, irritability, and apathy. When chorea is problematic, it may interfere with falling asleep. Experts also noted that drugs commonly used in HD for other symptoms may contribute to daytime sleepiness.

Clinical Practice Guidelines for Sleep Disorders in HD Note that this author has changed some of the wording that appears in the journal article for purposes of making it more user friendly. If you wish to share with your medical provider, it would be best to copy the journal link [Anderson KE 2018] for the doctor's review.

General Recommendations

  1. Identify and treat medical conditions or unmet needs that may be contributing to sleep problems
  2. Treat anxiety, depression and obsessive perseverative behaviors that cause or contribute to sleep disorders
  3. Assess and adjust dosing schedules of drugs that can contribute to day time sleepiness or night time sleep problems

Behavioral Recommendations

  1. Provide information about good sleep hygeine and emphasize this as the initial treatment for sleep problems (limit day-time naps, avoid caffeine or other stimulants and alcohol before bedtime, aim for the same times for going to bed and getting up, limit bedtime stimulation like TV or electronic games, bedroom should be quiet, dark, and at comfortable temperature)

Drug Treatment Recommendations

  1. Melatonin is an option particularly if there is disruption of day-night cycles
  2. Sedating antidepressents like mirtazapine (Remeron®) or trazodone (Desyrel®) given at bedtime are drug options
  3. Sedating antipsychotics like olanzapine (Zyprexa®) or quetiapine (Seroquel®) given at bedtime are drug options (these drugs given during the day will promote day-time sleepiness)
  4. Clomipramine (Anafranil®) is an option particularly if severe obsessive perseverative symptoms are present
  5. The use of a benzodiazepine is discouraged in ambulatory individuals (due to increased risk of confusion and falls) unless all other options have failed

Author's comments: Though not addressed by the guidelines, it is thought by many experts that poor sleep accelerates rate of disease progression in HD. That sleep disorders contribute to a lot of burden and poor quality of life in HD, worsen other disease symptom, and likely increase disease progression rate makes this a vital symptom to treat.

References

Anderson KE, van Duijn E, Craufurd D, Drazinic C, Edmondson M, Goodman N, van Kammen D, Loy C, Priller J, Goodman LV. Clinical Management of Neuropsychiatric Symptoms of Huntington Disease: Expert-Based Consensus Guidelines on Agitation, Anxiety, Apathy, Psychosis and Sleep Disorders. J Huntingtons Dis. 2018;7(3):239-250. doi: 10.3233/JHD-180293. PubMed abstract