Posts tagged sleep problems

In what may be the largest study of sleep problems among individuals with multiple sclerosis (MS), researchers at UC Davis have found that widely undiagnosed sleep disorders may be at the root of the most common and disabling symptom of the disease: fatigue.

Conducted in over 2,300 individuals in Northern California with multiple sclerosis, the large, population-based study found that, overall, more than 70 percent of participants screened positive for one or more sleep disorders.

The research highlights the importance of diagnosing the root causes of fatigue among individuals with MS, as sleep disorders may affect the course of the disease as well as the overall health and well-being of sufferers, the authors said.

The study “The Underdiagnosis of Sleep Disorders in Patients with Multiple Sclerosis,” is published online today in the Journal of Clinical Sleep Medicine.

“A large percentage of MS subjects in our study are sleep deprived and screened positive for one or more sleep disorders,” said Steven Brass, associate clinical professor and director of the Neurology Sleep Clinical Program and co-medical director of the UC Davis Sleep Medicine Laboratory.

“The vast majority of these sleep disorders are potentially undiagnosed and untreated,” he said. “This work suggests that patients with MS may have sleep disorders requiring independent diagnosis and management.”

Fatigue is the hallmark of multiple sclerosis, an inflammatory disease affecting the white matter and spinal cord of sufferers. MS symptoms include loss of vision, vertigo, weakness and numbness. Patients also may experience psychiatric symptoms. Disease onset generally is between the ages of 20 and 50 years. The cause of MS is not known, although it is believed to be an autoimmune condition.

Sleep disorders are known to occur more frequently among patients with MS. To gauge the extent of sleep disorders, such as obstructive sleep apnea and insomnia, Brass and his colleagues surveyed members of the Northern California Chapter of the National MS Society. Subjects were recruited in 2011.

More than 11,000 surveys were mailed to prospective participants. Of those, 2,375 met criteria and were included in the study. Consistent with the reported epidemiology of multiple sclerosis, the majority (81 percent) were female and Caucasian (88 percent). The mean age of the participants was 54.

Participants were asked to complete a 10-page survey, which included a detailed sleep history and questions assessing obstructive sleep apnea, daytime sleepiness, insomnia and restless legs syndrome.

Most of the participants - nearly 52 percent - said it took them more than one half hour to fall asleep at night, and nearly 11 percent reported taking a medication to fall asleep. Close to 38 percent of participants screened positive for obstructive sleep apnea. Nearly 32 percent had moderate to severe insomnia and nearly 37 percent had restless legs syndrome.

However, most of the participants had not been diagnosed with a sleep disorder by a physician. While nearly 38 percent reported having obstructive sleep apnea, only a little more than 4 percent reported being diagnosed by a physician with the condition. Similar statistics were seen for other sleep disorders.

“This study shows that sleep disorder frequency, sleep patterns and complaints of excessive daytime sleepiness suggest that sleep problems may be a hidden epidemic in the MS population, separate from MS fatigue,” Brass said.

(Source: ucdmc.ucdavis.edu)

Up to 70% of Parkinson’s disease (PD) patients experience sleep problems that negatively impact their quality of life. Some patients have disturbed sleep/wake patterns such as difficulty falling asleep or staying asleep, while other patients may be subject to sudden and involuntary daytime sleep “attacks.” In the extreme, PD patients may exhibit REM-sleep behavior disorder (RBD), characterized by vivid, violent dreams or dream re-enactment, even before motor symptoms appear. A review in the Journal of Parkinson’s Disease discusses the underlying causes of sleep problems in PD, as well as medications, disease pathology, and comorbidities, and describes the most appropriate diagnostic tools and treatment options.

Sleep problems in PD patients can have wide-ranging adverse effects and can worsen in later stages of the disease. Sleepiness socially isolates patients and excessive sleepiness can put patients at risk of falls or injury, and can mean patients must give up driving. Sleepiness can impair cognition and concentration, exacerbate depression, and interfere with employment. Wakefulness at night impairs daytime wakefulness and may also cause mood instabilities and can exhaust caregivers.

“Diagnosis and effective treatment and management of these problems are essential for improving the quality of life and reducing institutionalization of these patients,” says lead author Wiebke Schrempf, MD, Technische Universität Dresden, Faculty of Medicine Carl Gustav Carus, Department of Neurology, Division of Neurodegenerative Diseases, Dresden, Germany.

Dr. Schrempf and colleagues describe some of the complexities associated with treating sleep problems in PD patients, such as the worsening of sleep problems by dopaminergic medications used to treat motor symptoms. Lower doses of levodopa or dopamine agonists are able to improve sleep quality partly by reducing motor symptoms such as nighttime hypokinesia (decreased body movement), dyskinesia (abnormal voluntary movements), or tremor (involuntary shaking), which interfere with normal sleep. However, the same medications may also cause excessive daytime sleepiness. The report describes how changing medication, dose, duration of treatment, or timing of administration can improve outcomes.

The presence of other conditions common in PD patients such as depression, dementia, hallucinations, and psychosis may interfere with sleep. Unfortunately, some antidepressants can also impair sleep.

Sleep problems may also be harbingers of future neurodegenerative disease. Patients with RBD exhibit intermittent loss of normal muscle relaxation during REM sleep and engage in dream enactment behavior during which they may shout, laugh, or exhibit movements like kicking and boxing. “RBD seems to be a good clinical predictor of emerging neurodegenerative diseases with a high specificity and low sensitivity, whereas other early clinical features of PD, such as olfactory dysfunction and constipation, are less specific,” says Dr. Schrempf. “These early clues may help identify PD patients before motor symptoms appear, when disease-modifying therapies may be most beneficial.”

PD is the second most common neurodegenerative disorder in the United States, affecting approximately one million Americans and five million people worldwide. Its prevalence is projected to double by 2030. The most characteristic symptoms are movement-related, such as involuntary shaking and muscle stiffness. Non-motor symptoms, such as worsening depression, cognition, and anxiety, olfactory dysfunction, and sleep disturbances, can appear prior to the onset of motor symptoms.

(Source: alphagalileo.org)

While powerful magnetic stimulation of the frontal lobe of the brain can alleviate symptoms of depression, those receiving the treatment did not report effects on sleep or arousal commonly seen with antidepressant medications, researchers say.

“People’s sleep gets better as their depression improves, but the treatment doesn’t itself cause sedation or insomnia.” said Dr. Peter B. Rosenquist, Vice Chair of the Department of Psychiatry and Health Behavior at the Medical College of Georgia at Georgia Health Sciences University.

The finding resulted from a secondary analysis of a study of 301 patients at 23 sites comparing the anti-depressive effects of the Neuronetics Transcranial Magnetic Stimulation Therapy System to sham (placebo) treatment in patients resistant to antidepressant medications. TMS sessions were given for 40 minutes, five days a week for six weeks. Initial findings, published in the journal Biological Psychiatry in 2007, were the primary evidence in the Food and Drug Administration’s approval of TMS for depression.  The secondary review reaffirmed TMS’s effectiveness in depression but revealed no differences in rates of insomnia or sleepiness among those who got actual and sham (placebo) therapy. Patients in the treatment group were also no more likely to request medication for insomnia or anxiety.

“It’s important for us to understand the full range of the effects of any treatment we give,” said Rosenquist, corresponding author of the study in the journal Psychiatric Research. The new findings will assuage worries of sleep-related side effects and remind physicians to remain alert to residual insomnia in depressed patients they are treating with TMS, the researchers report.

Sleep problems are a common side effect of major antidepressants: some drugs sedate patients while others stimulate them and increase insomnia. Insomnia occurs in 50-90 percent of patients with major depressive disorder. Other depressed patients complain they sleep too much. The good news is that TMS does not contribute to insomnia or oversleeping.

“One of the many bad things about depression is that often patients cannot sleep. We think it’s a significant symptom,” Rosenquist said. “If patients can’t sleep, it really adds to their distress, and even increases the likelihood of suicide.  We need antidepressant treatments that patients can tolerate so that they will stay with the treatment, which takes weeks to fully achieve.  Our study adds to the evidence showing that TMS has remarkably few side effects.” Patients often seek TMS as an option or adjunct to medication to avoid medication side effects.

“Mood disorders are associated with widespread structural and functional changes in the human brain, which can be reversed with successful treatment,” Rosenquist said.  “Clinical researchers are working to find the optimal way to restore normal brain function.”

TMS targets the prefrontal cortex of the brain, involved in mood regulation as well as other higher-order functions like planning, evaluating and decision-making. In this procedure, patients sit in a recliner and receive brief pulses of a MRI strength magnet held against the front of the head. The magnetic energy of TMS causes the brain cells closest to the surface of the brain to increase their activity which in turn influences the activity of the brain as a whole.

Major Depressive Disorder affects approximately 14.8 million, or about 6.7 percent of American adults in a given year, according to the National Institute of Mental Health. It’s the leading cause of disability in ages 15 to 44. Despite the numbers, Rosenquist concedes that it’s not clear what causes depression or exactly how antidepressants and other therapies, such as TMS, work.  “It’s an important puzzle and the work continues.  We are excited to be a part of this effort at Georgia Health Sciences University.”

(Source: news.georgiahealth.edu)