Juvenile-HD

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INDEX Page
Tools For Viewing
10 The Most Commonly Asked Questions
Clinical Trials & Research
Huntington's Disease~WeMove Info
Advocacy/Donations/Press Info
Clinical Definition & Search
Facing HD~Family Handbook
JHD Handbook-Chapter 1
JHD Info-Stanford Univ.
Physician's Guide To HD
Caring for People with HD
Physical & Occupational Therapy In HD
Understanding Behaviour in HD-Dr. Jane Paulsen
Understanding Behavioral-Dr. Edmond Chiu
Advanced Stages Caregivers Handbook
First Shift-Certified Nursing Assistants
Activities of Daily Living-HD
Unified HD Rating Scale (UHDRS) Motor Section
Westphal Variant
SECTION 1 - AT RISK
Age & Probability Chart
At Risk For HD-What Next?
At-Risk Checklist
Best Interest of Child?
Crystal Ball?
Food For Thought
Parent Hasn't Tested?
Q&A On Risk of Inheriting JHD
Testing Children
SECTION 2 - GENETIC TESTING
Genetic Disorders & Birth Defects
Genetic Testing for HD
Genetic Counseling-In General
Psychological Impact
Intro: Genetics/Genetic Testing
Prenatal & Preimplanation
Prenatal Testing-In General
o Genetic Testing Resources
o Personal Stories
SECTION 3 - JHD
Coping With The Early Years
Age of HD Appearance
Age of Onset-Historical
Family-HD Underestimated
Children of Parents With HD
Child~Parent Ill
Clinical Description JHD
HD - What Kids Are Saying
HD & Me
JHD-Duration of Illness
JHD-Clinical and Research
JHD Symptoms
Parenting With HD
Patients/Families Coping
Talking With Children About HD
5 Stages of HD
JHD Resources
SECTION 4 - SYMPTOM RECOGNITION
Parent Resources
8 Fears of A Chronic Illness
Anxiety/Apathy/Irritability~HD
Anxiety, Fears & Phobias
Apathy-Physician's Guide
Ataxia
Attention-Perceptual/Unawareness Physician's Guide
Bed/Pressure Sores
Bed/Pressure Ulcer Guideline
Behavior Management
Bi-Polar Disorders
Botulinum toxin therapy
Bradykinesia
Caring Tips
Child Abuse-Reconizing Signs
Chorea-Physician's Guide
Chorea
Cognitive/Decision Making/Impulsivity
Cognitive-Short Tips
Contractures~Joints Locking
Dehydration-Physician's Guide
Dehydration
Delirium
Denial of HD
Depression~Physician's Guide
Depression-Understanding It
Depression-How To Help
Depression - Treatment Resistant Patient
Depression-Other Resources
-Read If Your Child Is On Antidepressant
Disgust - Impaired Recognition in HD
Dissociative disorders
Driving - Physician's Guide
Dyslexia
Dyslexia Resources
Dystonia
Dystonia/Rigidity & Spasticity Physician's Guide
Dystonia-Predominant Adult-Onset HD
Epileptic Seizures and Epilepsy
Epilepsy-Seizures~PG
-Seizures ~Special Populations
Falling~Safety
Falling - Subdural Hematoma Risk
Fevers - Unexplained
Fevers, sweating & menstural cycles in HD
GERD (Stomach)
HD Principle Treatments
Hallucinations/Psychosis~PGHD
Hand muscle reflexes in HD
Hypothalamus - A Personal Theory
Insomia ~Physician's Guide
Irritability~Temper Outburst Physician's Guide
Learning Disability
Mania/OCD~Physician's Guide
Mood Disorder Rate In HD
Myoclonus (Movements)
Nails-What To Look For
Night Terrors
Obsessive Compulsive OCD
Panic Disorder
Personality disorders
Pneumonia
Pneumonia-Advanced Stages
Pneumonia - Aspirated (Inhaled)
Prosody - Social Impairment
Sexuality~Physician's Guide
Skins Sensitivity
Sleep Disorders
Smoking-Physician's Guide
Spasticity
Stress
Tremors
Why Certain Symptoms Occur
Symptom & Treatment Resources
SECTION 5 - COMMUNICATION
Communication Resources
Communication Problems
Communication Strategies For HD~Jeff Searle
SECTION 6 - EATING/SWALLOWING/NUITRITION
Hints For Weight Loss in HD
HD & Diet~HSA Fact Sheet 7
Nutrients: Some Possible Deficiency Symptoms
Nutrition and HD~Anna Gaba (Recipes)
Nutrition Information In HD~Naomi Lundeen
Speech & Swallowing~Lynn Rhodes
Swallowing & Nutrition Physician's Guide To HD
Swallowing & Nuitrition Resources
Swallowing Warning Signs
5 Swallowing Problems
Taste changes in HD
Weight Gain
Resources-Drinks/Shakes
-Feeding Tubes~Advanced Stages of HD
-Feeding Tube~Jean Miller
-Feeding Tubes: One More Word ~Jean Miller
-Feeding Tubes & Baby Foods
-Feeding Tube~Dental Care
-Feeding Tube Instructions~Jean Miller
-Feeding Tube Resources
SECTION 7 - THERAPIES
Finding a Therapist - Behavoir
What Is A Physiotherapist?
Physical Therapy In HD
Speech-Language Therapy
Therapy Descriptions
Therapy Resources- Easter Seal
Therapy Resources
SECTION 8 - MEDICATIONS
HD Treatments
Medications-Movement Disorders
Medication/Emergency Info Forms
Cutting Prescriptions
Drugs-Look 'Em Up
-Adolescents Under 25
-Antidepressant Adverse Effects
-Anti-psychotic
-Anxiety-Antidepressant
A-Z Mental Health Drugs
-Creatine
-EPA~Fish Oil
-Haldol/Haloperidol - Clinical Sheet
-Haldol~Clinician Description
-Haldol & HD
-Haldol/HD Patient Experiences
-Haldol~ Patient Handout
-Mood Stabilizers: ASK 3 Questions
-Neuroleptic Malignant Synd WARNING
-Olanzipine-Risperidone/blood tests
-Celexa/Luvox/Paxil/Prozac/Zoloft
-Psychiatric Drugs & Children
Sertraline ~Zoloft
-Spasticity Meds/Treatments
-SSRI Medications
-Tardive Dyskinesia WARNING
-Weight Gain Medications
-Sites/Help the Medicine Go Down
-Vitamin & Mineral Deficiencies
SECTION 9 - SURGERIES
Surgery-Movement Disorders
o Surgery Resources
SECTION 10 - PROCEDURES
Clinic Visits-How To Prepare
CT Scans, MRI's etc.
Swallowing Tests
Tests Commonly Used
o Procedures Resources
SECTION 11- ALCOHOL/DRUGS
Alcohol-Parent's Guide
Alcohol-Talking To Your Child
Drugs-What To Do?
Drugs-Talking To Your Child
Disciplining-Ages 0-13 & Up
SECTION 12- SUICIDE
Straight Talk On Suicide
Teen Suicide-You Need To Know
o Suicide Resources
SECTION 13 - DIVORCE
Divorce & Child Stress
Tips For Divorcing Parents
SECTION 14 - DISABILITY ISSUES
Guides To Disability Issues
Caring-Child & Medical Technology
Caring for a Seriously Ill Child
Child Long Term Illness
Disability-Special Education Plan
IFSP Early Intervention Process
Disability Resources
Financial Planning
Wishes Can Come True-Children's Wish Foundations
Special Needs Resources
Special Needs Camp - About
Special Needs Camp - Finding One
SECTION 15 - ASSISTIVE TECHNOLOGY
Child Assistive Technology
Adaptive Equipment Resources
Products
SECTION 16 - EMOTIONAL ISSUES
Signs of Unhealthy Self-Esteem
Emotional Behavior Links
o Emotional Support Resources
SECTION 17 - GRIEF
Helping Child Deal With Death
o Grief Addtional Resources
SECTION 18 - ADD/ADHD
ADD & Teens
Conduct Disorders
FAQS & Related Info
Understanding AD/HD
What Is AD/HD?
Research Articles
Resources
SECTION 19 - HD SUPPORT GROUPS
HD Support Groups
National Youth Association
SECTION 20 - HD LINKS
HD Links
Related Resources
Tips For Friends
SECTION 21 - BENEFITS/INSURNACE
HD Disability
Benefits Check UP - See What You Can Get
Medical Insurance Bureau's Facts On You!
Medicare-Medicaid
Medicare Rights-Home Health & Hospice
Medicare Rights Center Resources
No Insurance? Try This!
Prescription Drug Cards Part I
Prescription Drug Cards Part II
Social Security-Children With Disabilities
SECTION 22 - ARTICLES/JHD
JHD and ADD
SECTION 23 - CAREGIVING
Articles-Resources
Caregiver Self-Assessment
Caregiver's Handbook
"First Shift With A Person With HD"
Getting Respite Care/Help At Home
Helpful Forms-Info
Home Emergency Preparations
Symptom Management
Ten Tips
Useful Tools
SECTION 24 - BIO
Our Personal Experience
Coping At The End
Kelly E. Miller
Song & Verse
Letter From My Heart
GUESTBOOK
Insomia ~Physician's Guide

INDEX Page

Chapter 6-Physician's Guide To The Management of HD

Sleep Disorders

Sleep disturbance is a common problem in Huntington's disease, and can be due to a variety of causes. A complaint of sleeplessness may be due to a mood disorder, either depression, or, less commonly, mania. In these cases, treatment of the mood disorder should lead to a normalization of sleep. The clinician should conduct a careful interview and speak to the patient's family to rule out this possibility.

Good sleep hygiene is also important. Patients who do not have enough to do, and whose days are insufficiently structured may develop a reversal of the sleep-wake cycle in which they nap most of the day, and are then awake at night. This pattern tends to reinforce itself and can be hard to interrupt. Helpful strategies include sleeping consistently in a room which is not used for wake-time activities, having a regular bedtime and waking time, and enrolling in a day program, which keeps the patient occupied and prevents daytime napping. In the later stages of illness, patients may have an increased need for rest and daytime napping may be entirely appropriate, as long as the patient is sleeping at night.

Some patients will require pharmacologic treatment of their insomnia. We would caution against long-term use of benzodiazepine or barbiturate hypnotics because of the potential for tolerance, dependence, and delirium and usually prefer to use a small dose of a sedating antidepressant such as trazodone (Desyrel), beginning at 25-50mg and increasing to about 200mg as necessary. Sedating tricyclics such as doxepin (Sinequan) or amitriptyline (Elavil) can also be employed, but are highly dangerous in overdose.

It is not entirely true that chorea ceases when patients are asleep. Sleep studies conducted in patients with refractory insomnia have suggested that some HD patients have restless sleep because of a large amount of involuntary movements at night. The patient himself will often be unaware of these nighttime movements, but they will often be reported by the spouse or caregiver. A small dose of fluphenazine, haloperidol (0.5-2mg) or clonazepam (0.5-lmg) at bedtime, may suppress the movements sufficiently to allow more restful sleep. Polysomnography or referral to a sleep disorder center may be helpful in these difficult cases.

Painful leg cramping caused by dystonia and spasticity can also disrupt sleep. Treatment with a muscle relaxant, such as baclofen may relieve the problem.

__________________________________________________________
 
 
Insomnia due to Medications
http://www.fpnotebook.com/PSY173.htm
Type in Insomnia
 
Drugs that cause Insomnia
    Alcohol
    Antihypertensives
    Antineoplastics
    Beta Blockers
    Caffeine
    Diuretics
    Levodopa
    Oral Contraceptives
    Phenytoin (Dilantin)
    Selective Serotonin Reuptake Inhibitors (SSRI)
    Protriptyline (Vivactil)
    Corticosteroids
    Stimulants
    Theophylline
    Thyroxine

Medication Causes of Nightmares
http://www.fpnotebook.com/PSY174.htm
Nightmares due to Medications

Altered CNS Neurotransmitters
    Antidepressant Medications
        Tricyclic Antidepressants
        Monoamine Oxidase Inhibitors
        Selective Serotonin Reuptake Inhibitors (SSRI)
    Centrally acting Antihypertensive Medications
        Beta Blockers
        Rauwolfia alkaloids
        Alpha Adrenergic Agonists
    Antiparkisonian Medications
        Levodopa
        Selegiline

Chemical Dependency: Drug Withdrawal
    Alcohol Abuse with withdrawal
    Barbiturate Abuse with withdrawal
    Benzodiazepine Abuse with withdrawal

Miscellaneous medications
    Flutamide
    Procarbazine
    Ketamine
    Short-acting Barbiturates
__________________________________________________________

SLEEP DISTURBANCES

Although written for PD, helpful information

Difficulties with sleep are common in Parkinson's disease, and can be categorized into four types:

  • difficulty staying asleep; early morning awakening
  • involuntary movements and pain interrupting sleep
  • frequent nighttime urination (addressed in Chapter 7)
  • vivid dreams, nighttime agitation and hallucinations (addressed in Chapter 5)

graphicDifficulty maintaining nighttime sleep is probably the most common sleep complaint in PD. Normal sleep is organized into stages, and an individual usually cycles through the various stages of sleep in a set order and time pattern. In Parkinson's disease the normal sleep cycles are frequently interrupted. Patients typically complain of difficulties staying asleep despite having little trouble falling asleep initially. In fact, many people complain that they fall asleep "too early" (7-8 p.m.) and then awaken at 3-4 a.m., unable to resume sleep. In addition, many people with PD will awaken several times throughout the night, although they may have no recollection of these events. Spouses may be more aware of the disrupted sleep than the patient. This disruption of normal sleep patterns may contribute to the daytime sleepiness often reported by Parkinson patients.

MEDICATIONS TO IMPROVE THE SLEEP CYCLE

While disrupted sleep seems to be an integral part of living with Parkinson's disease, the conventional antiparkinson drugs are not usually helpful. In fact, Parkinson drugs may be the cause of sleep disturbance in some patients. For example, selegiline can cause insomnia, particularly if taken in the afternoon or evening. By contrast, some patients sleep better on a trial of controlled-release Sinemet or one of the dopamine agonist preparations dosed late in the day, due to the long duration of action of these compounds. These drugs are probably most beneficial in those instances when the patient complains of severe immobility or tremor preventing resumption of sleep in the middle of the night. No single drug has proven to be uniformly effective in restoring nighttime sleep in Parkinson patients.

EXAMPLES OF DRUGS USED TO PROMOTE AND MAINTAIN SLEEP graphic

  • zolpidem (Ambien®)
  • nefazodone (Serzone®)
  • amitriptyline (Elavil®)
  • nortriptyline (Pamelor®)
  • trazodone (Desyrel®)
  • temazepam (Restoril®)
  • diphenhydramine (Benadryl®, Tylenol PM®)
  • chloral hydrate

Some of the older antidepressant drugs can also be used to promote sleep because of their sedative properties; for example, amitriptyline or nortriptyline 10 - 25 mg. can be taken at bedtime. Some patients are able to achieve a more stable sleep pattern by using diphenhydramine 25 - 50 mg. at bedtime. Available as Benadryl® and many generic brands, this medication is available over-the-counter, and may also help reduce tremor and drooling in some patients. Patients should check with their physicians before using over-the-counter medications such as Benadryl®.

Benzodiazepines, discussed previously for treating anxiety, are also sometimes used as a sleep aid. These drugs can be helpful in falling asleep initially, but may wear off in 3-4 hours, thus providing no relief from early morning awakening. Also, tolerance to benzodiazepines develops with regular use over time, and dose increases have significant risks in the elderly, such as over-sedation, confusion, and balance impairment increasing the risk of falls.

graphicEstablishing good sleep hygiene habits can also help one get a good night's sleep. These include establishing a regular bedtime and getting up time, limiting daytime napping, and avoiding food, excessive fluid intake, and alcohol for several hours prior to bedtime.


 

Source: http://www.parkinson.org/med36.htm

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Sleep Disorders - How is it treated?

Drug therapy, when combined with good sleep hygiene, may be helpful for the short-term management of insomnia.

Benzodiazepines are commonly used for the management of sleep disorders. Shorter-acting benzodiazepines are less likely than long-acting benzodiazepines to be associated with drowsiness or sluggishness the next morning.

Other drugs used in the short-term management of insomnia include a unique agent called Ambien(zolpidem), barbiturates, sedating antihistamines, and a new drug called Sonata.

Drug classes used to treat Sleep Disorders

Barbiturates
Barbiturates slow down central nervous system function, heart rate, and respiration. People who use them continually may become tolerant to the effects of barbiturates, which also produce potentially serious side effects.
 
Drugs in the class
 
Amobarbital (Amytal)
Butabarbital (Butalan Elixir, Butisol, Sarisol No.2)
Pentobarbital Oral (Nembutal)
Phenobarbital (Bellatol, Solfoton)
Secobarbital (Seconal)
Pentobarbital Injection (Nembutal Injection)
 

Benzodiazepines
Benzodiazepines are drugs that relieve anxiety by acting on the limbic system, an area deep inside the brain that appears to be involved in primitive emotional responses.
 
Benzodiazepines work at the level of the nerve cells in the brain. They enhance the effects of a chemical messenger called gamma aminobutyric acid (GABA) that slows down the activity of the nerve cell. When GABA binds to the nerve cell, a channel is widened allowing more chloride ions to move into the nerve cell. This makes the cell less active. When benzodiazepines bind to GABA receptors, the effects are enhanced.  
 
Benzodiazepines enhance the sedating effect of GABA by allowing chloride ions (Cl-) into the nerve cells, slowing the activity of the neuron. 
 
Drugs in the class
 
Alprazolam (Xanax)
Chlordiazepoxide (Libritabs, Librium, Mitran, Reposans-10, Sereen)
Clonazepam (Klonopin)
Clorazepate (ClorazeCaps, ClorazeTabs, GenENE, Tranxene, Tranxene-SD)
Diazepam (Valium, Valrelease)
Estazolam (ProSom)
Flurazepam (Dalmane)
Lorazepam (Ativan)
Oxazepam (Serax)
Temazepam (Restoril)
Triazolam (Halcion)
Lorazepam Injection (Ativan Injection)
 

Miscellaneous Sedatives and Hypnotics
Sonata is a newer drug, released in 1999 for the treatment of short-term insomnia. It is not a benzodiazepine or a barbiturate. This hypnotic's main advantage is that it is associated with less next morning drowsiness.
 
Ambien is not a benzodiazepine or a barbiturate, but it slows down the brain's normal function, in a way that is not harmful but that promotes sleep. It works relatively quickly and has fewer side effects than some of the other sleep-inducing medications.
 
Drugs in the class
 
Chloral Hydrate ()
Zolpidem (Ambien)
Zaleplon (Sonata)
Chloral Hydrate Rectal (Aquachloral Supprettes)
ETHCHLORVYNOL (Placidyl)