SLEEP AND DEGENERATIVE NEUROLOGIC DISORDERS
Section snippets
GENERAL SLEEP COMPLAINTS
Insomnia and hypersomnia are the two major sleep complaints in neurodegenerative diseases. Other general sleep complaints include abnormal motor activity and behavior during sleep, breathing problems and snoring during sleep, and disturbances of normal sleep rhythm.
Complaints of insomnia may include difficulty in initiating sleep, repeated awakenings including early morning awakening, and insufficient or total lack of sleep.13 Excessive daytime sleepiness (EDS) or fatigue, anxiety,
Alzheimer's Disease
AD (or senile dementia of the Alzheimer's type) is the most common cerebral degenerative disorder that causes dementia. The condition usually begins in mid- or late life and is manifested by progressive intellectual deterioration associated with characteristic neuropathologic findings of senile plaques, neurofibrillary tangles, granulovacuolar degeneration, cerebral cortical atrophy, and neuronal loss in the nucleus basalis of Meynert. There are also alterations in the forebrain cholinergic as
PATHOGENETIC MECHANISMS
Pathogenetic mechanisms of sleep disturbances in neurodegenerative diseases include both direct and indirect mechanisms.15, 16 Direct structural alterations of the sleep–wake generating neurons in the brain stem and hypothalamus that change the balance between sleep and wakefulness may cause insomnia, hypersomnia, or circadian rhythm sleep disturbances. Insomnia may result from affection of the hypothalamic preoptic nuclei or the lower brain stem hypnogenic neurons in the region of the nucleus
Clinical Approach
Sleep complaints are common in degenerative diseases of the nervous system. For clinical assessment, the first step is a careful history of sleep complaints, including present and past sleep history, family history, drug and alcohol history, and medical and psychiatric histories. Sleep disturbances in neurodegenerative diseases include insomnia, hypersomnia, parasomnias, and circadian rhythm sleep disturbances. Their history also should address the question of sleep disturbances related to the
TREATMENT
Treatment of the underlying neurologic disease, if available, is the first step, as such treatment may improve the sleep disturbance. If such treatment is not available or does not resolve the problem, resolution of the condition may be difficult. Certain general principles should be applied (Table 1).2, 15, 32
The treatment of hypersomnia related to sleep-related breathing disorders may be divided into general measures, pharmacologic treatment, mechanical devices, and surgical treatment.15 The
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2012, Neurologic ClinicsAge, drugs, or disease: What alters the macrostructure of sleep in Parkinson's disease?
2012, Sleep MedicineCitation Excerpt :These findings are in contrast to a recently published PSG supported study on 62 PD patients [17], where the gender-dependence of slow wave sleep expression was not seen. However, Diederich and coworkers, as well as other previous study groups [28,29] demonstrated surprisingly high overall amounts of slow wave sleep with 14 to 19 % which contradict findings in other PD cohorts [10,11,30] and in healthy elderly males as well [25]. Whether this difference in the amount of slow wave sleep is due to methodological differences, the selection bias of subjectively sleep disordered patients, the larger number of patients investigated in our cohort, their slightly older mean age, longer disease duration, or increased disease severity needs to be clarified in further studies.
Motor Functions and Dysfunctions of Sleep
2009, Sleep Disorders Medicine: Basic Science, Technical Considerations, and Clinical Aspects: Third Edition
Address reprint requests to Sudhansu Chokroverty, MD, Department of Neurology, Cronin 4, St. Vincent's Hospital and Medical Center, 153 West 11th Street, New York, NY 10011
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From the Department of Neurology and Division of Neurophysiology, St. Vincent's Hospital and Medical Center, New York, New York; the Department of Neurology, Veterans Affairs Medical Center, Lyons, New Jersey; Department of Neurology, Robert Wood Johnson Medical School, New Brunswick, New Jersey; and New York Medical College, New York, New York