Insomnia is a common complaint in HD. Clinical studies show that sleep is disordered [Petit D 2004] and circadian rhythm (day/night sleep cycle) is disrupted [Morton AJ 2005]. There are no studies testing drug benefit for this problem in HD people. However, improved sleep and cognition benefit, as well as easier rousability (a measure of apathy) was shown in HD mice when given alprazolam (Xanax®), a benzodiazepine medication [Ramalle-Gomara E 2007].

Insomnia Treatments: The most important treatment is improving sleep habits . This can reset the circadian rhythm, improve mood and energy levels, and evidence increasingly suggests that better sleep can slow down neurodegeneration.

Though there have been no clinical studies done on treatment benefit, in clinical practice drugs from several classes can improve sleep. It is important to treat depression and anxiety with SSRI, NSRI or mirtazapine antidepressants because these symptoms contribute to insomnia. Antipsychotic and mood stabilizer drugs should not be used if the only indication for use is insomnia.

Commonly Used Insomnia Medications

Trazodone (Desyrel®) is a (non-selective) serotonin reuptake inhibitor that is often used for sleep. Dosages start at 50 mg and increase to a maximum of 200 mg. Side effects include dry mouth and constipation. Serious side effects that are rare include priapism (prolonged erection) and heart arrhythmias.

Mirtazapine (Remeron®) is also an excellent choice when insomnia occurs with depression.

Benzodiapepines such as lorazepam (Ativan®) are also used.

References

Petit D, Gagnon JF, Fantini ML, Ferini-Strambi L, Montplaisir J. Sleep and quantitative EEG in neurodegenerative disorders. J Psychosom Res. 2004 May;56(5):487-96. PubMed abstract

Morton AJ, Wood NI, Hastings MH, Hurelbrink C, Barker RA, Maywood ES. Disintegration of the sleep-wake cycle and circadian timing in Huntington's disease. J Neurosci. 2005 Jan 5;25(1):157-63. PubMed abstract

Ramalle-Gomara E, Gonzalez MA, Perucha M, Quinones C, Lezaun ME, Posada-De la Paz M. Huntington's disease mortality in Spain in the period 1981-2004. Rev Neurol. 2007 Jul 16-31;45(2):88-90. PubMed abstract