Sleep Disorder Early Sign Of Parkinson’s Disease

People with a sleep disorder that causes them to kick or cry out during their sleep may be at greater risk of developing dementia or Parkinson’s disease.

The sleep disorder is called REM sleep behavior disorder. People with the disorder do not have the normal lack of muscle tone that occurs during REM sleep, often known as the dream stage of sleep. Instead, they have excessive muscle activity such as punching, kicking, or crying out, essentially acting out their dreams.

The study involved 93 people with this type of sleep disorder who had no signs of a neurodegenerative disease, such as dementia or Parkinson’s disease. The participants were followed for an average of five years. During that time, 26 of the people developed a neurodegenerative disease. Fourteen developed Parkinson’s disease, 11 developed dementia and were diagnosed with either Alzheimer’s disease or Lewy body dementia. One person developed multiple system atrophy, a rare disorder that affects movement, blood pressure and other body functions.

The estimated five-year risk of developing a neurodegenerative disease was 18 percent, with the 10-year risk at 41 percent and the 12-year risk at 52 percent.

“These results are obviously of great interest to people who have this sleep disorder and their physicians and families,” said study author Ronald B. Postuma, MD of McGill University in Montreal, Canada, who carried out the studies at the sleep disorders center at the Sacre Coeur hospital, University of Montreal. Postuma is also a member of the American Academy of Neurology. “The results may help us better understand how these neurodegenerative diseases develop. They also suggest that there may be an opportunity for protecting against the progression to disease, perhaps even preventing it before the symptoms can appear.”

Postuma noted that the study involved only people with no known cause for the REM sleep behavior disorder. The disorder can also be caused by narcolepsy or rare brainstem abnormalities. REM sleep disorder from these causes does not necessarily carry the risk of developing a neurodegenerative disease, he said

Tags: parkinson, sleep, sleep country, sleep disorder, sleep number bed

Insomnia in women with breast cancer linked to heart rate

This study is the first to analyze both hormonal and autonomic responses in metastatic breast cancer patients suffering from insomnia.

Westchester, Ill. –A study in the October 15 issue of the Journal of Clinical Sleep Medicine shows that respiratory sinus arrhythmia (RSA) is a significant predictor of insomnia in women with breast cancer and confirmed that longer nocturnal wake episodes were associated with a flatter diurnal cortisol slope.

Results of this study confirmed a relationship between frequent awakenings and abnormal cortisol (a steroid hormone that regulates blood pressure), rhythms in metastatic breast cancer, thus concluding that a disrupted cortisol rhythm may have serious medical implications in women with breast cancer.

With the addition of demographics, disease severity and psychological variables, findings suggest that Vagal regulation, assessed via RSA, an important marker of parasympathetic tone, is the most consistent and significant predictor of sleep continuity disturbance. Diminished RSA has been associated with both worse medical and psychiatric health. Previous studies suggest that RSA is associated and may even be predictive for insomnia in healthy subjects.

“It was surprising to see that the strongest association was between a parasympathetic nervous system dysregulation and sleep problems even after we considered patients’ age, their disease severity, type of treatment and psychological variables such as pain and stress,” said the study’s lead author, Oxana Palesh, PhD, Research Assistant Professor at the University of Rochester Cancer Center.

Insomnia symptoms were associated with a lower baseline of RSA. Lower RSA is associated with decreased parasympathetic functioning in insomniacs, and weakened parasympathetic functioning is associated with increased stress and decreased emotional regulation.

The study included 99 women who had metastatic breast cancer or recurrent breast cancer and who were over the age of 45. Thirty-nine patients took antidepressant medications in this study, and 19 took medications specifically prescribed for treating disrupted sleep during study baseline. Participants collected saliva for cortisol measurement for two days, completed questionnaires, wore actigraphs to monitor their sleep-wake cycles for three days, and participated in the Trier Social Stress Task (TSST) approximately one-to-two weeks after the cortisol baseline collections. The TSST is a standardized social and cognitive stress test. Demographic and cancer diagnosis history was collected from the women through self-report.

Heart rate dysregulation (diminished or low respiratory sinus arryhthmia) during a stress task was associated with four objective measures of sleep disruption: sleep efficiency, wake after sleep onset, average number of awakenings and average length of waking episode.

Estimates from two nights of actigraphy indicate that participants spent about eight hours in bed and had wakefulness after sleep onset (WASO) of more than 71 minutes. They also had an average of 15 wake episodes each night with an average duration of 4.81 minutes.

While demographics explained some portion of the development of sleep disruption, four of the six sleep parameters examined (Sleep efficiency, wakefulness after sleep onset, mean number of waking episodes and average length of waking episodes) were best explained by low RSA.

In healthy people, cortisol levels peak early in the morning and level-out by the end of the day. However, in one-third to two-thirds of women with metastatic breast cancer, circadian rhythms are disrupted and diurnal cortisol slopes are either flattened, have multiple peaks, or are elevated at the end of the day. In the non-cancer population, evidence shows that people with insomnia have an elevated response to stress in general. Psychiatric disorders, including major depression, are linked with hypothalamic-pituitary-adrenal axis (HPA) dysregulation. Past research has linked insomnia to activation of the stress-response system, which results in an increased level of cortisol.

Sleep disruption is two to three times more common in cancer patients than in the general population; these disturbances may exacerbate concurrent cancer and/or treatment related symptoms such as fatigue, mood disturbance, and gastrointestinal distress, psychiatric illness and may lead to reduce quality of life and overall health.

According to Palesh, one of the best interventions for regulation of autonomic functioning is diaphragmatic breathing. Any number of stress management techniques would be effective, including biofeedback treatment, hypnosis, visualization exercises, meditation, progressive muscle relaxation and yoga.

Military Families Asking Congress to Investigate Seroquel

Families of several soldiers who died while taking the very potent anti-pyschotic drug known as Seroquel say the government is not being up front about the drug’s risks and they are now asking asking Congress to investigate this drug.
Many questions remain unanswered with Seroquel treatment.

It is currently unclear how many soldiers have died while taking Seroquel, or if the drug definitely contributed to the deaths. However, the drug’s potential side effects, including diabetes, weight gain and uncontrollable muscle spasms, have resulted in thousands of lawsuits.

Physicians interviewed about the success of AstraZeneca’s second-best-selling product said they began prescribing Seroquel because it was the only drug that offered relief from the nightmares and anxiety of PTSD.

“By accident, some people were giving them Seroquel for anxiety or depression, and the veterans said, ‘This is the first time I have slept six or seven hours straight all night. Please give me more of that.’ And the word spread,” said Dr. Henry Nasrallah of the University of Cincinnati, who has treated PTSD patients for more than 25 years.

Seroquel is approved to treat schizophrenia, bipolar disorder and depression, but it has not been endorsed by the Food and Drug Administration as a treatment for insomnia. However, psychiatrists are permitted to prescribe approved drugs for other uses in a common practice known as “off-label” prescribing.

Most of the soldiers and veterans seeking treatment for PTSD do so at hospitals run by the VA or the Defense Department.The VA’s spending on Seroquel has increased more than 770 percent since 2001. In that same time frame, the number of patients covered by the VA increased just 34 percent.

Seroquel has been the VA’s second-biggest prescription drug expenditure since 2007, behind the blood-thinner Plavix. The agency spent $125.4 million last fiscal year on Seroquel, up from $14.4 million in 2001. Spending on Seroquel by the Department of Defense, has increased nearly 700 percent since 2001, to $8.6 million last year, according to purchase records.

The drug, approved in 1997, is AstraZeneca’s second-best-selling product, with U.S. sales of $4.2 billion last year. But that success has been marred by allegations that the company illegally marketed the drug and minimized its risks. In fact, AstraZeneca agreed to pay $520 million in April to settle federal allegations that its salespeople pitched Seroquel for numerous off-label uses, including insomnia.

Meanwhile the military families are devastated and are asking Congress to investigate this potentially deadly drug Seroquel.

Tags: congress, insomnia, investigate, military families, seroquel, us congress

Sutter clinic to help kids with sleeping disorders

A pediatrician told ValJean Anderson her toddler son’s linguistic delays might stem from hidden seizures, something she feared but that seemed like a logical explanation.

Instead, a pediatric neurologist diagnosed her son with severe sleep apnea.

“I didn’t have any clue a 2-year-old could suffer from sleep apnea,” Anderson, 29, said. “I thought it was something that happened with old age, when everything starts to sag.”

Adacus Anderson has snored his whole life, a symptom of blocked airways, leading to poor-quality sleep and possibly affecting his ability to learn to put words together.

The doctor, Amer Khan of the Sutter Neuroscience Medical Group, said children’s sleep disorders are routinely under- and misdiagnosed because parents and doctors do not suspect them.

Today, he is launching the Pediatric Sleep Disorders Program at Sutter Medical Center, a first for the region.

“Problems at night translate into problems during the day,” he said. “Sleep disorders are often misdiagnosed as ADD because they affect behavior, and school and sport performance.”

In 1970, a Stanford University doctor founded America’s first sleep clinic. Since then, Americans have become obsessed with sleep, spawning a commercial industry of Ambien and lavender-scented eye masks. Each night, sleep clinics across the country glue dozens of electrodes to patients in an attempt to cure their insomnia.

But adults often assume that children do not have sleeping problems. That is not true: About 5 percent of children have sleep apnea, roughly the same proportion as adults, said Dr. Rafael Pelayo, a pediatric sleep specialist at Stanford University.

Sutter’s new program involves a group of specialists, including a facial surgeon and pulmonologist, who will collaborate to handle kids’ sleep disorders.

“For a long time, pediatricians who suspect sleeping disorders have not had anybody to refer the problem to,” Khan said.

For Adacus, the sleep apnea might be why he zones out up to 10 times a day. Doctors originally suspected seizures, but it could just be because he is tired. Being tired also could contribute to the linguistic delays. At 2, he knows only a few words, preferring to babble instead.

Another underdiagnosed disorder is narcolepsy, which affects about 1 percent of kids, Khan said.

Paula Bertoncin of Forest Hills said her son Drew, 14, has slept excessively since infancy. She was thankful to have a sleeping baby, until he got older and kept sleeping.

What Bertoncin calls the “sleeping prince” problem worsened when Drew hit puberty.

“One day I got a call from his school and they said, ‘We can’t wake your son up,’ ” she said. “I was thinking, oh my God, did my kid get into drugs? Is he staying up all night playing Xbox?”

After Khan diagnosed Drew with narcolepsy, Bertoncin said, she was able to piece together other family mysteries.

“I think it runs on both sides of Drew’s family,” she said. “His father drank coffee 24/7 and smoked, because he needed the high to stay awake. My dad’s the same way, and we always thought it was his allergy medications.”

Drew started a medication last week that will regulate his sleeping cycle, and Bertoncin said she already sees a difference.

“When I called for him to wake up this morning, he didn’t look like a drunken sailor,” she said. “I think sleep disorders are a hidden secret.”

Tags: Ambien, Electrodes, Facial Surgeon, First Sleep, Logical Explanation, Medical Group, Pediatric Neurologist, Pediatricians, Pulmonologist, Sleep Apnea, Sleep Clinic, Sleep Clinics, Sleep Disorders, Sleeping Disorders, Sleeping Problems, Sport Performance, Stanford University, Toddler Son, University Doctor, Valjean

AASM On Sleep Medications And Insomnia Treatment

Insomnia and Sleep Medications

Insomnia occurs when people have trouble falling asleep or staying asleep, and it is a common sleep compliant. While a brief case of insomnia can arise due to temporary stress, excitement or other emotion, more than 20 million Americans report having a chronic form of insomnia that keeps them from sleeping well nearly every night. As a result, the insomnia, which is a serious and often debilitating condition, can lead to severe daytime fatigue, poor performance at school and work, physical symptoms such as headaches, and in some cases depression.

People suffering from insomnia need to know that there are effective insomnia treatments and their sleep can improve. The American Academy of Sleep Medicine recommends that people who experience insomnia see a sleep medicine specialist or primary care physician for proper diagnosis and to discuss treatment options before treatment with medications is undertaken. This evaluation should also look for specific causes of insomnia such as restless legs syndrome or depression.

Sleep medications are often used for the short-term treatment of insomnia and, on occasion, for more chronic insomnia. Medications that currently are available by prescription are known to improve sleep by reducing the amount of time it takes to fall asleep, increasing sleep duration and/or reducing the number of awakenings during sleep. While modern hypnotics are considered safe, individuals should be aware that, like all medications, side effects may occur in a minority of patients. These side effects can include sleep walking, sleep eating and other complex sleep behaviors as well as difficulty with memory.

RECOMMENDATIONS FOR PATIENTS

Behavioral therapies and medications have been shown to be effective therapies for insomnia. Behavioral therapies use nonpharmacologic methods to improve sleep and are effective and long lasting. Sleep medications are effective and safe treatments for insomnia when used properly and judiciously by a patient who is under the supervision of a sleep medicine or primary care physician.

The American Academy of Sleep Medicine offers the following recommendations for individuals who use sleep medications:

 

• Read carefully the package insert and all information provided by your physician and pharmacist for your sleep medication. This information will help guide you in the safe use of the medication.

 

• Especially read the package insert and all information to learn the side effects of the medication.

 

• Adhere strictly to the indicated use of your sleep medication. Do not take it for purposes other than to sleep.

 

• Follow the prescription carefully and do not take more than the dosage your doctor prescribes.

 

• Allow time for a full night of sleep when using sleep medication to avoid morning or daytime drowsiness.

 

• Avoid combining sleep medication with alcohol.

 

• Ask your doctor any questions you have about the intended use, dosage and side effects. Communication with your physician will help ensure safe use of the medication.

 

• Inform your doctor right away of any problems you have while taking a sleep medication.

 

• Make your doctor aware of any other medications, prescriptions or over-the-counter, that you use. Mixing medications may cause adverse effects.

 

• Make your doctor aware of other medical conditions, including other sleep disorders, you may have. Sleep medications can be dangerous when treating sleep disruption that may arise from another disorder.

 

• Visit www.SleepEducation.com for more information about insomnia, treatment options and to find a sleep center.

RECOMMENDATIONS FOR PHYSICIANS

The American Academy of Sleep Medicine is committed to educating sleep medicine and primary care physicians about treatment options for insomnia. Behavioral therapies and medications have been shown to be effective therapies for insomnia. The American Academy of Sleep Medicine offers the following recommendations for primary care physicians who see patients with insomnia:

 

• Read the practice guidelines for chronic insomnia created by the American Academy of Sleep Medicine.

 

• Become intimately familiar with sleep medications you prescribe, including the indications for use and side effects.

 

 

• Educate your patients about the sleep medicine you are prescribing to them, including the indications for use, dosage and side effects. Ensure your patients fully understand the intended use and potential effects.

Tags: chronic insomnia, insomnia, insomnia treatment, medications, sleep medications

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