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, including workableness and propensity toward accidents and clashes.

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 cerebral degenerative disorders

In this article, Dr. Raman Malhotra, Co-Director of the SLUCare Sleep Disorders Center at Saint Louis University School of Medicine and Dr. Alon Avidan of the University of California, Los Angeles discuss the connections between sleep and cerebral degenerative disorders. Degenerative diseases of the central nervous system are a large and varied group of disorders that affect a range of neurologic function. Sleep disorders are commonly seen in patients with cerebral degenerative diseases. Much of this may be related to the underlying central nervous system damage to sleep regulatory centers of the brain. Research has shown that sleep disorders may serve as a biomarker to predict development of a future neurodegenerative disorder. Increasing new data has suggested that disrupted sleep may accelerate the degenerative process in conditions such as Alzheimer dementia and Parkinson disease. One potential mechanism is emerging evidence of the role of sleep in glymphatic clearance of metabolic waste products from the brain. Prompt attention to and treatment of sleep symptoms can result in significant improvement in quality of life or possibly delay in progression of disease.

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Spotlight on Impact of sleep on epileptic manifestations

The circadian, homeostatic, ultradian, and microstructural processes that regulate the sleep-wake cycle are endowed with modulatory properties on epileptic events. In particular, sleep is a powerful trigger of both ictal and interictal manifestations. Non-REM sleep and cyclic alternating pattern promote strong activating effects, although REM sleep tends to exert a more inhibitory action. These characteristics are highly expressed in nocturnal frontal lobe epilepsy.

In this article, Dr. Parrino of the University of Parma discusses the impact of sleep on epileptic manifestations.

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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.

To view the complete article, click here and log in.

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.

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 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.