From the Guidelines
For poor sleep in someone with Hallucinogen Persisting Perception Disorder (HPPD), the best pharmacological options typically include low-dose doxepin (3 or 6 mg) or nonbenzodiazepine benzodiazepine receptor agonists (BZRAs) such as zolpidem (5-10mg) or eszopiclone (1-3mg) at bedtime, as these have been shown to improve sleep outcomes with minimal adverse effects 1.
When considering treatment options, it's essential to prioritize the patient's safety and well-being. The evidence suggests that nonpharmacologic behavioral interventions, such as cognitive behavioral therapy for insomnia (CBT-I), are more effective than pharmacologic therapies for treating chronic insomnia disorder 1. However, for patients who are unable or unwilling to receive CBT-I, pharmacotherapy may be considered.
The choice of pharmacotherapy should be based on the patient's response to the first treatment, and the medication should be started at the lowest effective dose to minimize side effects 1. It's also crucial to regularly reassess medication use to prevent dependence, particularly with benzodiazepines.
Some key points to consider when treating poor sleep in someone with HPPD include:
- Avoiding serotonergic medications like SSRIs and certain recreational substances, as they may worsen HPPD symptoms
- Using sleep hygiene practices to complement pharmacological interventions for optimal results
- Considering low-dose antipsychotics such as quetiapine (25-100mg at bedtime) for sleep and potentially reducing perceptual disturbances
- Using melatonin (1-5mg, 1-2 hours before bedtime) as a gentler option with minimal side effects
Overall, the goal of treatment should be to improve sleep outcomes and reduce associated distress and dysfunction, while minimizing the risk of adverse effects and dependence. By prioritizing the patient's safety and well-being, and using evidence-based treatment options, clinicians can help patients with HPPD achieve better sleep and improved quality of life.
From the Research
Pharmacological Options for Poor Sleep in HPPD
There are no direct studies on the pharmacological options for poor sleep in individuals with Hallucinogen Persisting Perception Disorder (HPPD). However, studies on insomnia and sleep disorders in other conditions can provide some insights:
- Benzodiazepines and hypnotic benzodiazepine receptor agonists, melatonin and melatonin receptor agonists, sedating antidepressants, antipsychotics, and antihistamines, and orexin receptor antagonists are commonly used to treat insomnia disorder 2, 3.
- A study on patients with Parkinson's disease and sleep disorders found that melatonin, clonazepam, and trazodone were effective in improving sleep quality, with melatonin associated with a higher decrease in RBD screening questionnaire score and trazodone associated with a higher decrease in Epworth Sleepiness Scale score 4.
- Non-pharmacological interventions such as cognitive behavioral therapy, stimulus control, sleep hygiene education, sleep restriction, paradoxical intention, relaxation therapy, biofeedback, and massage therapy may also be effective in improving sleep quality 3, 5.
Non-Pharmacological Interventions
Non-pharmacological interventions may be a useful alternative or adjunct to pharmacological treatments for poor sleep in HPPD:
- A systematic review and network meta-analysis found that massage therapy, music therapy, and treadmill training were effective in improving sleep quality in patients with Parkinson's disease 5.
- A randomized pilot study found that a self-administered hypnosis intervention improved sleep quality, sleep duration, and daytime sleepiness in adults with mild cognitive impairment 6.