Case study of circadian rhythm sleep disorder following haloperidol treatment: reversal by risperidone and melatonin.
A patient with Gilles de la Tourette syndrome treated with haloperidol, ingested once daily after awakening from sleep, exhibited an irregular sleep-wake pattern with a free-running component of approximately 48 h. Transfer to risperidone, ingested once daily after awakening from sleep, was beneficial resulting in a sleep-wake cycle more synchronized at the appropriate phase to the external zeitgebers, and fewer nocturnal disturbances. The circadian sleep-wake schedule was fully synchronized when the patient had been subsequently treated with melatonin at 21:00h, before intended nocturnal sleep, in addition to risperidone in the morning. Restoration of the sleep-wake circadian pattern was accompanied by the patient's subjective report of significant improvement in his quality of life, social interactions, and occupational status. This observation suggests that circadian rhythm sleep disorders can be related to the typical neuroleptic haloperidol and restored by the atypical neuroleptic risperidone. Similar findings reported in patients suffering from other disorders support the hypothesis that the described disruption of the sleep-wake schedule is medication rather than illness-related. Therefore, it is very important to realize that circadian rhythm sleep disorders may be a side effect of neuroleptics.
Ayalon
Liat
L
Institute for Fatigue and Sleep Medicine, Sheba Medical Center, Tel Hashomer, Israel. liatay@post.tau.ac.il
Hermesh
Haggai
H
Dagan
Yaron
Y
D000328:Adult; D014150:Antipsychotic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D019454:Chronotherapy; D002940:Circadian Rhythm / Q000187:drug effects; D006220:Haloperidol / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008550:Melatonin / Q000627:therapeutic use*; D009043:Motor Activity / Q000187:drug effects; D018967:Risperidone / Q000627:therapeutic use*; D020178:Sleep Disorders, Circadian Rhythm / Q000139:chemically induced* / Q000188:drug therapy* / Q000503:physiopathology; D005879:Tourette Syndrome / Q000188:drug therapy
D014150:Antipsychotic Agents; D006220:Haloperidol; D008550:Melatonin; D018967:Risperidone