Spotlight on Hypersomnolence

Hypersomnolence is deleteriously prevalent, especially in modern society. The common medical complaint has various underpinnings. Sleep medicine, as a growing field or subspecialty, can evaluate the nature of the problem and improve life and longevity with a myriad of scientifically effective interventions. The cost to society, if sleepiness is left unaddressed, is profound given the negative effects on health and on education and on work-related issues. Fitness to drive is a challenging dilemma given an aging and senior population.

Hypersomnolence, or excessive daytime sleepiness, is a frequent complaint of patients and a symptom associated with many medical conditions, including intrinsic sleep disorders, such as narcolepsy and obstructive sleep apnea or insufficient nighttime sleep. Though a nearly universal experience, sleepiness is often ignored or minimized by patients, often increasing their risk for industrial or motor vehicle accidents. In this article, Dr. Richard Knudsen of University of California Davis Medical Center discusses the differential diagnosis, evaluation, and treatment of this often overlooked symptom complex. Information from the International Classification of Sleep Disorders (3rd edition) is highlighted. Newer therapeutic agents, deemed somnolytics, are reviewed.

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Spotlight on Sleep and depression

Sleep disturbances are common in psychiatric disorders. The relationship between poor sleep and depression is well established. Epidemiologic data suggest that people with psychiatric disorders account for 30% to 40% of those in a community reporting symptoms of insomnia and that depression is the most common psychiatric cause of insomnia. Depression is associated with longer sleep latency, frequent and long awakenings, and/or early morning awakening associated with poor sleep satisfaction. Sleep disturbance associated with depression sometimes responds to treatment of the underlying depression. Some antidepressants, such as mirtazapine, directly improve sleep quality. Unfortunately most antidepressants, including the selective serotonin reuptake inhibitors and duloxetine, have the side effect of insomnia. Adjunctive medication is often necessary to treat depression- or antidepressant-associated insomnia.

In this article, Dr. Federica Provini of the University of Bologna and IRCCS Institute of Neurological Sciences of Bologna discusses the evaluation and treatment of sleep disorders associated with depression.

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Spotlight on Sleep and alcohol use and abuse

In this article, Dr. Deirdre Conroy of the University of Michigan explains the basics of alcohol-related sleep disorders. She discusses the acute and chronic effects of alcohol on sleep as well as the management of sleep disorders during alcohol withdrawal and in recovering alcoholics. Insomnia in abstinent alcoholics is a common clinical problem that can increase the risk of relapse. Unfortunately, this is an area of only limited clinical research, though there are some data for the utility of cognitive-behavioral therapy for the treatment of insomnia in recovering alcoholics. The potential usefulness of ramelteon, gabapentin, and acamprosate for this condition is also discussed. New research has focused on the effects of ethanol on circadian rhythms. Child and adolescent sleep disturbances may predict alcohol abuse.

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Spotlight on Sleep and stroke

It may be difficult to differentiate the sleepiness and other symptoms associated with obstructive sleep apnea from such acute manifestations of cerebrovascular disease as lethargy, apathy, and neglect, particularly with strokes in specific locations, such as bilateral paramedian thalamic infarctions. The spouse of a stroke victim may describe a lack of energy, falling asleep during activities, and fatigue. Additional questioning may elicit a history of snoring (with repetitive respiratory interruptions), restless sleep, nonrestorative sleep, and weight gain prior to or following the stroke.

In this article, Dr. Antonio Culebras of SUNY Upstate Medical University highlights the importance of obstructive sleep apnea as a risk factor for stroke. Rehabilitation and recovery are less successful in the presence of sleep apnea. Habitual short and long sleep durations, long-standing night shift work, and periodic leg movements of sleep negatively affect cerebrovascular morbidity and mortality.

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Spotlight on Recurrent hypersomnia

Although rarely observed, Kleine-Levin syndrome is an interesting disorder affecting 1 to 2 patients per million inhabitants worldwide and is associated with recurrent cognitive behavioral and emotional problems. It may severely affect quality of life and social adaptation. Increasing evidence points to a diencephalic dysregulation as the main source of symptoms. Recent functional neuroimaging results, as well as late reports of 2 affected couples of monozygotic twins, provide new insights to better understanding of the physiopathology of this disorder. Clinical and cognitive follow-up of affected patients has in several cases demonstrated persistence of memory impairments long after resolution of episodes of the disorder itself, especially in patients with longstanding disease. A recent Cochrane review of drug trials for the management of Kleine-Levin syndrome symptoms did not find eligible studies to recommend any of the different treatments so far employed, even if therapeutic. Lithium seems to hold the best prospective benefits.

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MedLink Neurology authors are always at work to bring you broad and up-to-date coverage of neurology topics. We are pleased to highlight clinical summaries that have been recently added or updated and to introduce the authors who write these authoritative articles. We hope you enjoy these overviews and appreciate the contributions of our more than 450 authors who keep MedLink Neurology the premier information resource for neurologists.

Spotlight on Drug-induced sleep disorders

A large number of drugs are associated with sleep disorders. In this article, Dr. K K Jain, a neurology consultant in Basel, Switzerland, starts with a classification of various drug-induced sleep disorders and lists drugs associated with each. Some sleep disorders, such as sleepwalking, have been associated with the use of hypnotics for insomnia. Pathomechanism is described when known. This knowledge may help in the modification of drug therapy or alternative medications.

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MedLink Neurology authors are always at work to bring you broad and up-to-date coverage of neurology topics. We are pleased to highlight clinical summaries that have been recently added or updated and to introduce the authors who write these authoritative articles. We hope you enjoy these overviews and appreciate the contributions of our more than 450 authors who keep MedLink Neurology the premier information resource for neurologists.

Spotlight on Cyclic alternating pattern

In this clinical summary, Dr. Liborio Parrino of the University of Parma discusses cyclic alternating pattern, an EEG marker of sleep instability that modulates the flexibility of sleep in both physiological conditions and in sleep disorders. Together with sleep duration, sleep intensity, and sleep continuity, cyclic alternating pattern represents a topical pillar of sleep quality. The interaction between cyclic alternating pattern, neurovegetative fluctuations, and motor events determines the pathophysiology of several sleep disorders and the effect of medication and continuous positive airway pressure (CPAP) treatment. Recent studies indicate the possibility of scoring cyclic alternating pattern automatically, opening new perspectives for a wider exploitation of this fundamental mechanism of the sleeping brain.

To view the complete clinical summary, click here.

MedLink Neurology authors are always at work to bring you broad and up-to-date coverage of neurology topics. We are pleased to highlight clinical summaries that have been recently added or updated and to introduce the authors who write these authoritative articles. We hope you enjoy these overviews and appreciate the contributions of our more than 450 authors who keep MedLink Neurology the premier information resource for neurologists.

Spotlight on Sleep and stroke

In this clinical summary, Dr. Culebras of SUNY Upstate Medical University and the Sleep Center at Upstate University Hospital in Syracuse, New York highlights the importance of obstructive sleep apnea as a risk factor for stroke. Rehabilitation and recovery are less successful in the presence of sleep apnea. Habitual short and long sleep durations, long-standing night shift work, and periodic leg movements of sleep negatively affect cerebrovascular morbidity and mortality.

To view the complete clinical summary, click here.

MedLink Neurology authors are always at work to bring you broad and up-to-date coverage of neurology topics. We are pleased to highlight clinical summaries that have been recently added or updated and to introduce the authors who write these authoritative articles. We hope you enjoy these overviews and appreciate the contributions of our more than 450 authors who keep MedLink Neurology the premier information resource for neurologists.

Spotlight on Sleep and dementia

Disordered sleep and dementia are 2 neurologic issues that are found in many of the same patients and may, indeed, interact. In dementia, degeneration of central sleep-wake mechanisms frequently leads to sleepiness and insomnia with sundowning. REM sleep behavior disorder can herald a synucleinopathy. In some cases, sleep apnea might result from degeneration of medullary respiratory centers. The treatment of sleepiness and insomnia with sundowning is not well-established, as many medications have risks that outweigh their benefits; however, REM sleep behavior disorder often responds to clonazepam, and continuous positive airway pressure therapy can improve cognition in some cases of obstructive sleep apnea. In this clinical summary, Dr. Kyoung Bin Im and Dr. HyungSub Shim of the University of Iowa review these interactions, including recent updates on REM sleep behavior disorder.

To view the complete clinical summary, click here.

MedLink Neurology authors are always at work to bring you broad and up-to-date coverage of neurology topics. We are pleased to highlight clinical summaries that have been recently added or updated and to introduce the authors who write these authoritative articles. We hope you enjoy these overviews and appreciate the contributions of our more than 450 authors who keep MedLink Neurology the premier information resource for neurologists.

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Spotlight on Narcolepsy

In this clinical summary, Dr. Antonio Culebras, Professor of Neurology at Upstate Medical University, SUNY, reviews the current information on narcolepsy, a disease that has progressed in only 50 years from a quasi-psychiatric condition to a true neurologic disorder. New knowledge of the etiology and mechanism of disease relative to the hypocretins has opened a major pathway to understanding excessive sleepiness not only in narcolepsy but also in other sleep disorders. Most cases of narcolepsy with cataplexy are associated with the loss of approximately 50,000 to 100,000 hypothalamic neurons containing hypocretin. Pharmacologic treatment remains symptomatic but increasingly effective.

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MedLink Neurology authors are always at work to bring you broad and up-to-date coverage of neurology topics. We are pleased to highlight clinical summaries that have been recently added or updated and to introduce the authors who write these authoritative articles. We hope you enjoy these overviews and appreciate the contributions of our more than 450 authors who keep MedLink Neurology the premier information resource for neurologists.