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Continuum (Minneapolis, Minn.) Aug 2020This article explains the clinical approach to patients presenting with sleepiness or sleeplessness in a neurologic practice setting. Addressing the patient's sleep... (Review)
Review
PURPOSE OF REVIEW
This article explains the clinical approach to patients presenting with sleepiness or sleeplessness in a neurologic practice setting. Addressing the patient's sleep symptoms may help improve symptoms of their other underlying primarily neurologic disorder.
RECENT FINDINGS
New diagnostic modalities at home such as home sleep apnea testing have improved access and diagnosis of sleep apnea. Consumer health tracking devices have also helped patients focus on their sleep duration and quality, prompting them to bring their concerns to their neurologist.
SUMMARY
Like many neurologic disorders, a detailed history and physical examination are critical in the evaluation of patients with sleepiness or sleeplessness. Patients who have neurologic disorders are more likely to have poor-quality sleep. Questions about the patient's sleep schedule or screening patients for common sleep disorders such as sleep apnea and restless legs syndrome (RLS) are useful to add to a typical neurologic evaluation to better recognize sleep disorders in this population. Polysomnography, home sleep apnea testing, multiple sleep latency tests, and actigraphy can be used with the available history and examination to determine the proper diagnosis and management plan for these patients.
Topics: Actigraphy; Humans; Nervous System Diseases; Neurologic Examination; Polysomnography; Sleep Initiation and Maintenance Disorders; Sleepiness
PubMed: 32756226
DOI: 10.1212/CON.0000000000000880 -
American Journal of Respiratory and... Jan 2020
Topics: Accidents, Traffic; Automobile Driving; Humans; Sleepiness
PubMed: 31939703
DOI: 10.1164/rccm.2012P3 -
Sleep Medicine Clinics Dec 2019Drowsy driving is common and causes 21% of fatal crashes. Individuals at risk include young men, shift workers, older adults, and people with chronic short sleep... (Review)
Review
Drowsy driving is common and causes 21% of fatal crashes. Individuals at risk include young men, shift workers, older adults, and people with chronic short sleep duration, untreated obstructive sleep apnea (OSA), and narcolepsy. Untreated OSA is a particular concern in commercial drivers, who are at higher risk for the disorder. Treatment for sleep problems such as sleep extension for chronic short sleep, positive airway pressure (PAP) for OSA, pharmacologic treatments, and drowsy driving countermeasures may reduce the risk of crashes. Implementing screening measures to identify common sleep problems contributing to drowsy driving continues to be of high importance.
Topics: Accidents, Traffic; Automobile Driving; Humans; Sleep Wake Disorders; Sleepiness
PubMed: 31640875
DOI: 10.1016/j.jsmc.2019.07.001 -
Sleep Medicine Clinics Sep 2022Excessive daytime sleepiness (EDS) is defined as "irresistible sleepiness in a situation when an individual would be expected to be awake, and alert." EDS has been a big... (Review)
Review
Excessive daytime sleepiness (EDS) is defined as "irresistible sleepiness in a situation when an individual would be expected to be awake, and alert." EDS has been a big concern not only from a medical but also from a public health point of view. Patients with EDS have the possibility of falling asleep even when they should wake up and concentrate, for example, when they drive, play sports, or walk outside. In this article, clinical characteristics of common hypersomnia and pharmacologic treatments of each hypersomnia are described.
Topics: Disorders of Excessive Somnolence; Humans; Narcolepsy; Sleepiness; Wakefulness
PubMed: 36150809
DOI: 10.1016/j.jsmc.2022.06.012 -
Child Development Mar 2022Reciprocal relations between sleep and adjustment were investigated. Participants included 246 adolescents (M = 15.80 years; 67.5% White, 32.5% Black/African...
Reciprocal relations between sleep and adjustment were investigated. Participants included 246 adolescents (M = 15.80 years; 67.5% White, 32.5% Black/African American; 53% female, 47% male) at Time 1 (data collected 2012-2013), 227 at Time 2 (M = 16.78 years) and 215 at Time 3 (M = 17.70 years). Sleep-wake variables were measured with self-reports (sleepiness) and actigraphy (average sleep minutes and efficiency, variability in sleep minutes and efficiency). Adolescents reported on depression and anxiety symptoms, and parents reported on externalizing problems. Greater variability in sleep duration and efficiency as well as sleepiness predicted adjustment problems (range of R : 36%-60%). Reciprocal relations were supported mostly for sleepiness (range of R : 16%-32%). Results help understand bidirectional relations between sleep and adjustment.
Topics: Actigraphy; Adolescent; Anxiety; Female; Humans; Male; Self Report; Sleep; Sleep Wake Disorders; Sleepiness
PubMed: 34757645
DOI: 10.1111/cdev.13703 -
Journal of Clinical Sleep Medicine :... Oct 2023We conducted a retrospective study to investigate the efficacy and safety of switching from other hypnotics, including benzodiazepines and Z-drugs, suvorexant,...
STUDY OBJECTIVES
We conducted a retrospective study to investigate the efficacy and safety of switching from other hypnotics, including benzodiazepines and Z-drugs, suvorexant, ramelteon, mirtazapine, trazodone, and antipsychotics, to lemborexant, a dual orexin receptor antagonist, for 3 months.
METHODS
Clinical data obtained from the medical records of 61 patients treated at the Horikoshi Psychosomatic Clinic between December 2020 and February 2022 were analyzed, including the Athens Insomnia Scale, Epworth Sleepiness Scale, and Perceived Deficits Questionnaire-5. The primary outcome was the mean change in Athens Insomnia Scale score after 3 months. Secondary outcomes were the mean changes in the Epworth Sleepiness Scale and Perceived Deficits Questionnaire-5 scores over 3 months. We also compared pre- and post-diazepam equivalents.
RESULTS
The mean Athens Insomnia Scale score decreased over 3 months after switching to lemborexant (1 mo: -2.98 ± 5.19, < .001; 2 mo: -3.20 ± 5.64, < .001; 3 mo: -3.38 ± 5.61, < .001). Mean Epworth Sleepiness Scale score did not change from baseline to 1 month (-0.49 ± 3.41, = 0.27), 2 months (0.082 ± 4.62, = .89), or 3 months (-0.64 ± 4.80, = .30). Mean Perceived Deficits Questionnaire-5 score did improve from baseline to 1 month (-1.17 ± 2.47, = .004), 2 months (-1.05 ± 2.97, = .029), and 3 months (-1.24 ± 3.06, = .013). There was also a reduction in the total diazepam equivalent (baseline vs 3 mo: 14.0 ± 20.2 vs 11.3 ± 20.6, < .001).
CONCLUSIONS
Our study showed that, by switching to lemborexant from other hypnotics, the risks associated with benzodiazepines and Z-drugs may be reduced.
CITATION
Horikoshi S, Miura I, Suzuki Y, et al. Switching to lemborexant for the management of insomnia in mental disorders: the SLIM study. . 2023;19(10):1753-1758.
Topics: Humans; Sleep Initiation and Maintenance Disorders; Retrospective Studies; Sleepiness; Hypnotics and Sedatives; Orexin Receptor Antagonists; Benzodiazepines; Diazepam
PubMed: 37243798
DOI: 10.5664/jcsm.10668 -
Neurophysiologie Clinique = Clinical... Apr 2024The transition from wakefulness to sleep is a progressive process that is reflected in the gradual loss of responsiveness, an alteration of cognitive functions, and a... (Review)
Review
The transition from wakefulness to sleep is a progressive process that is reflected in the gradual loss of responsiveness, an alteration of cognitive functions, and a drastic shift in brain dynamics. These changes do not occur all at once. The sleep onset period (SOP) refers here to this period of transition between wakefulness and sleep. For example, although transitions of brain activity at sleep onset can occur within seconds in a given brain region, these changes occur at different time points across the brain, resulting in a SOP that can last several minutes. Likewise, the transition to sleep impacts cognitive and behavioral levels in a graded and staged fashion. It is often accompanied and preceded by a sensation of drowsiness and the subjective feeling of a need for sleep, also associated with specific physiological and behavioral signatures. To better characterize fluctuations in vigilance and the SOP, a multidimensional approach is thus warranted. Such a multidimensional approach could mitigate important limitations in the current classification of sleep, leading ultimately to better diagnoses and treatments of individuals with sleep and/or vigilance disorders. These insights could also be translated in real-life settings to either facilitate sleep onset in individuals with sleep difficulties or, on the contrary, prevent or control inappropriate sleep onsets.
Topics: Humans; Wakefulness; Sleepiness; Sleep; Brain; Cognition
PubMed: 38460284
DOI: 10.1016/j.neucli.2024.102954 -
Neurophysiologie Clinique = Clinical... Apr 2024Excessive daytime sleepiness (EDS) is multifactorial. It combines, among other things, an excessive propensity to fall asleep ("physiological sleepiness") and a... (Review)
Review
Excessive daytime sleepiness (EDS) is multifactorial. It combines, among other things, an excessive propensity to fall asleep ("physiological sleepiness") and a continuous non-imperative sleepiness (or drowsiness/hypo-arousal) leading to difficulties remaining awake and maintaining sustained attention and vigilance over the long term ("manifest sleepiness"). There is no stand-alone biological measure of EDS. EDS measures can either capture the severity of physiological sleepiness, which corresponds to the propensity to fall asleep, or the severity of manifest sleepiness, which corresponds to behavioral consequences of sleepiness and reduced vigilance. Neuropsychological tests (The psychomotor vigilance task (PVT), Oxford Sleep Resistance Test (OSLeR), Sustained Attention to Response Task (SART)) explore manifest sleepiness through several sustained attention tests but the lack of normative values and standardized protocols make the results difficult to interpret and use in clinical practice. Neurophysiological tests explore the two main aspects of EDS, i.e. the propensity to fall asleep (Multiple sleep latency test, MSLT) and the capacity to remain awake (Maintenance of wakefulness test, MWT). The MSLT and the MWT are widely used in clinical practice. The MSLT is recognized as the "gold standard" test for measuring the severity of the propensity to fall asleep and it is a diagnostic criterion for narcolepsy. The MWT measures the ability to stay awake. The MWT is not a diagnostic test as it is recommended only to evaluate the evolution of EDS and efficacy of EDS treatment. Even if some efforts to standardize the protocols for administration of these tests have been ongoing, MSLT and MWT have numerous limitations: age effect, floor or ceiling effects, binding protocol, no normal or cutoff value (or determined in small samples), and no or low test-retest values in some pathologies. Moreover, the recommended electrophysiological set-up and the determination of sleep onset using the 30‑sec epochs scoring rule show some limitations. New, more precise neurophysiological techniques should aim to detect very brief periods of physiological sleepiness and, in the future, the brain local phenomenon of sleepiness likely to underpin drowsiness, which could be called "physiological drowsiness".
Topics: Humans; Sleepiness; Disorders of Excessive Somnolence; Sleep; Wakefulness; Polysomnography
PubMed: 38401239
DOI: 10.1016/j.neucli.2023.102938 -
Current Aging Science 2023In 2016, a mini-issue of Current Aging Science (CAS) entitled "Effects of Aging on Circadian and Sleep Timing" has been published to report the state of the art in the...
In 2016, a mini-issue of Current Aging Science (CAS) entitled "Effects of Aging on Circadian and Sleep Timing" has been published to report the state of the art in the studies of the effects of aging on the circadian and sleep regulating processes. The emphasis has been given to the regulatory processes involved in age-specific problems with sleep timing, continuity, and duration. Such problems can serve as targets for novel treatments for geriatric and sleep disorders. In the following 6 years, some new findings provided further insight into the previously recognized age-specific problems and highlighted new questions of research on the relation of aging to the regulatory mechanisms underlying circadian rhythmicity, sleep, and sleepiness. The theoretic framework of one of the directions of this research regards the interaction between the competing drives for sleep and wake as one of the basic features of regulatory processes underlying circadian rhythms, including such rhythms as the sleep-wake cycle and the diurnal variation in alertnesssleepiness levels. Here, earlier and more recently highlighted questions of the research in this framework were briefly reviewed.
Topics: Humans; Aged; Sleepiness; Self-Assessment; Sleep; Wakefulness; Circadian Rhythm; Aging; Sleep Wake Disorders
PubMed: 36503388
DOI: 10.2174/1874609816666221209151012 -
Journal of Neurology Nov 2023Sleep abnormalities have been reported in Charcot-Marie-Tooth disease (CMT), but data are scanty. We investigated their presence and correlation in a large CMT patients'...
BACKGROUND
Sleep abnormalities have been reported in Charcot-Marie-Tooth disease (CMT), but data are scanty. We investigated their presence and correlation in a large CMT patients' series.
METHODS
Epworth Sleepiness Scale (ESS) and Pittsburgh Sleep Quality Index (PSQI) were administered to CMT patients of the Italian registry and controls. ESS score > 10 indicated abnormal daytime somnolence, PSQI score > 5 bad sleep quality. We analyzed correlation with disease severity and characteristics, Hospital Anxiety and Depression Scale (HADS), Modified Fatigue Impact Scale (MFIS), Body Mass Index, drug use.
RESULTS
ESS and PSQI questionnaires were filled by 257 and 253 CMT patients, respectively, and 58 controls. Median PSQI score was higher in CMT patients than controls (6 vs 4, p = 0.006), with no difference for ESS score. Abnormal somnolence and poor sleep quality occurred in 23% and 56% of patients; such patients had more frequently anxiety/depression, abnormal fatigue, and positive sensory symptoms than those with normal ESS/PSQI. Moreover, patients with PSQI score > 5 had more severe disease (median CMT Examination Score, CMTES, 8 vs 6, p = 0.006) and more frequent use of anxiolytic/antidepressant drugs (29% vs 7%, p < 0.001).
CONCLUSIONS
Bad sleep quality and daytime sleepiness are frequent in CMT and correlated with anxiety, depression and fatigue, confirming that different components affect sleep. Sleep disorders, such as sleep apnea and restless leg syndrome, not specifically investigated here, are other factors known to impact on sleep quality and somnolence. CMT patients' management must include sleep behavior assessment and evaluation of its correlated factors, including general distress and fatigue.
Topics: Humans; Sleep Quality; Sleepiness; Charcot-Marie-Tooth Disease; Disorders of Excessive Somnolence; Sleep; Fatigue; Surveys and Questionnaires; Sleep Wake Disorders
PubMed: 37540277
DOI: 10.1007/s00415-023-11911-y