A double-blind comparison of the effect of the antipsychotics haloperidol and olanzapine on sleep in mania

Abstract

The effects of haloperidol and olanzapine on polysomnographic measures made in bipolar patients during manic episodes were compared. Twelve DSM-IV mania patients were randomly assigned to receive either haloperidol (mean ± SD final dosage: 5.8 ± 3.8 mg) or olanzapine (mean ± SD final dosage: 13.6 ± 6.9 mg) in a 6-week, double-blind, randomized, controlled clinical trial. One-night polysomnographic evaluation was performed before and after the haloperidol or olanzapine treatment. Psychopathology and illness severity were rated respectively with the Young Mania Rating Scale (YMRS) and the Clinical Global Impressions -Bipolar version (CGI-BP). There was a significant improvement in the YMRS and CGI-BP scores at the end of the study for both groups. Mixed ANOVA used to compare the polysomnographic measures of both drugs demonstrated significant improvement in sleep measures with olanzapine. In the olanzapine group, statistically significant time-drug interaction effects on sleep continuity measures were observed: sleep efficiency (mean ± SEM pre-treatment value: 6.7 ± 20.3%; after-treatment: 85.7 ± 10.9%), total wake time (pre-treatment: 140.0 ± 92.5 min; aftertreatment: 55.2 ± 44.2 min), and wake time after sleep onset (pretreatment: 109.7 ± 70.8 min; after-treatment: 32.2 ± 20.7 min). Conversely, improvement of polysomnographic measures was not observed for the haloperidol group (P > 0.05). These results suggest that olanzapine is more effective than haloperidol in terms of sleeppromoting effects, although olanzapine is comparatively as effective as haloperidol in treating mania. Polysomnography records should provide useful information on how manic states can be affected by psychopharmacological agents.

Clinical Pharmacology of Other Drugs Used as Hypnotics

“…Uncontrolled and placebo-controlled treatment studies using these medications as primary or adjunctive treatments demonstrate improved subjective sleep quality and reduced sleepiness in patients with schizophrenia, 178,179 unipolar depression, 180,181 and bipolar depression. [183][184][185][186][187] Similar self-reported and PSG effects have been demonstrated in small clinical studies of patients with depression, 188 mania, 189 and schizophrenia. [183][184][185][186][187] Similar self-reported and PSG effects have been demonstrated in small clinical studies of patients with depression, 188 mania, 189 and schizophrenia.…”

British Association for Psychopharmacology consensus statement on evidence-based treatment of insomnia, parasomnias and circadian rhythm disorders: An update

“…Risperidone and olanzapine both improved sleep continuity when added to an SRI in depression (Sharpley et al, 2003; 2005; Lazowski et al, 2014). Furthermore, Moreno et al (2007) found that olanzapine improved sleep continuity in patients with bipolar disorder during a manic episode. Using actigraphy, Todder et al (2006) and Kim et al (2014) showed that adjunctive or monotherapy quetiapine improved sleep continuity in patients with unipolar or bipolar disorder.…”

Antidepressant and Antipsychotic Drugs

“…[94] Small PSG studies of olanzapine in healthy controls and in patients with mood disorders and schizophrenia suggest that this agent improves sleep latency, wake time after sleep onset, sleep efficiency, and sleep quality and increases slow-wave sleep time. [88,153–158] Quetiapine dosed in a range from 25–75 mg has also been studied in an open-label study in patients with primary insomnia and was noted to improve self-reported sleep onset latency, sleep efficiency, and total sleep time. [159] Open-label PSG studies of the treatment of patients with schizophrenia with 10 mg of olanzapine have been carried out and confirm that this agent decreases the number of awakenings, increases total sleep time, and increases the percentage of slow-wave sleep.…”