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11 results

  • Chapter 21 - Time-zone transitions and sleepiness

  • from Section 2 - Sleep Disorders and Excessive Sleepiness
  • Edited by Michael J. Thorpy, Michel Billiard
  • Book:
    Sleepiness
    Published online:
    04 February 2011
    Print publication:
    27 January 2011, pp 225-237

  • Summary

    This chapter provides an overview of idiopathic hypersomnia together with a discussion on the nosological limits of the condition. It presents the history, clinical features, diagnostic procedures, treatment and differential diagnosis of idiopathic hypersomnia. All efforts to clarify demographics, pathophysiology and treatment have been hampered by the nosological uncertainty on the borders of idiopathic hypersomnia. The latest International Classification of Sleep Disorders confirmed the distinction of two forms of idiopathic hypersomnia and used a new wording of idiopathic hypersomnia with long sleep time and idiopathic hypersomnia without long sleep time. The diagnosis of idiopathic hypersomnia with long sleep time is mainly based on clinical features and on the absence of associated symptoms such as snoring or cataplexy. However, polysomnography and the multiple sleep latency test (MSLT) are indispensable to rule out other conditions. Further research is necessary to specify the limits of idiopathic hypersomnia with and without long sleep time.

  • Chapter 13 - Kleine–Levin syndrome

  • from Section 2 - Sleep Disorders and Excessive Sleepiness
  • Edited by Michael J. Thorpy, Michel Billiard
  • Book:
    Sleepiness
    Published online:
    04 February 2011
    Print publication:
    27 January 2011, pp 136-146

  • Summary

    This chapter presents the methodology, normative data, results from clinical populations and problems associated with the objective measures of sleepiness. The multiple sleep latency test (MSLT) is used in the diagnosis of narcolepsy and the hypersomnias. The maintenance of wakefulness test (MWT) has been used by the FAA and state departments of transportation as a means of screening pilots and commercial drivers for ability to maintain alertness in sedentary work settings. Less research supports the Oxford Sleepiness Resistance (OSLER) and pupillography tests, but the OSLER, which attempts to measure sleep onset without traditional measurement of either performance or EEG, holds promise as a simpler but still time-consuming measure. The tests measure more than a single sleep system and almost certainly reflect the summation of numerous sources of state and trait arousal in addition to the effects of circadian time, prior wakefulness and numerous underlying sleep and arousal pathologies.

  • Chapter 37 - Sodium oxybate for the treatment of excessive sleepiness

  • from Section 4 - Therapy of Excessive Sleepiness
  • Edited by Michael J. Thorpy, Michel Billiard
  • Book:
    Sleepiness
    Published online:
    04 February 2011
    Print publication:
    27 January 2011, pp 421-429

  • Summary

    Dopamine cell death attending Parkinson's disease (PD) profoundly alters the sleep-wake state which can be classified into disturbances of: nocturnal movement, and thalamocortical arousal state. Diurnal rhythms in the content, turnover, release and behavioral responsiveness of the brain's principal dopamine systems are well established. Clinicians have long relied upon the wake-promoting effects of dopaminomimetics inclusive of traditional psychostimulants. Apart from the neurobiological substrates governing PD, genetic and disease factors may also influence expression of sleepiness and sleep onset rapid-eye-movement sleep (SOREMs). The utility of the multiple sleep latency test (MSLT), and other objective and subjective measures of sleepiness in PD has been reviewed. The clinician treating sleepiness in the parkinsonian patient is in the unenviable position of weighing the potential positive impact of dopaminomimetics upon sleep as it relates to daytime motor function, against the real possibility of adverse effects upon daytime alertness.

  • Case 13 - Screaming at night

  • from Part IV - Parasomnias
  • Edited by Antonio Culebras
  • Book:
    Case Studies in Sleep Neurology
    Published online:
    10 November 2010
    Print publication:
    23 September 2010, pp 86-91

  • Summary

    This chapter discusses the case of an 11-year-old Asian-American girl who was admitted for treating sleep disturbances, excessive daytime sleepiness (EDS) and paroxysmal weakness in the sleep center. It presents the clinical history, examination, follow-up, treatment, diagnosis, and the results of the procedures performed on the patient. Nocturnal video-polysomnography (PSG) followed by a multiple sleep latency test (MSLT) were ordered. She went into REM sleep, without going into any other sleep stages at the beginning of the MSLT in three of the five naps. The diagnosis was narcolepsy with cataplexy. Sodium oxybate was administered and titrated twice nightly, which helped further decrease her cataplexy to once or twice daily. Cataplexy may take the form of prolonged waxing and waning, with partial or complete muscle atonia, called status cataplecticus. Schizophreniamay be co-morbid or an intrinsicmanifestation of narcolepsy. Obesity is frequently observed in association with narcolepsy, contributing to sleepiness.

  • Case 23 - Noisy breathing during sleep

  • from Part IV - Parasomnias
  • Edited by Antonio Culebras
  • Book:
    Case Studies in Sleep Neurology
    Published online:
    10 November 2010
    Print publication:
    23 September 2010, pp 156-162

  • Summary

    This chapter discusses the case of a 27-year-old male who was admitted to the hospital with right arm numbness. It presents the clinical history, examination, follow-up, treatment, diagnosis, and the results of the procedures performed on the patient. His vital signs were normal. There was mild expiratory wheezing at the bases bilaterally related to an upper respiratory infection. There was reduced sensation to light touch, pinprick and vibration in the right upper extremity in C6-C7 distribution. MRI of the brain showed multiple small hyperintense lesions in white matter throughout both cerebral hemispheres and the brainstem. An overnight sleep study followed by a multiple sleep latency test (MSLT) revealed REM sleep without atonia and abundant myoclonic jerks in REM sleep. A diagnosis was made of probable parasomnia overlap disorder in the context of multiple sclerosis. Parasomnia overlap disorder responds favorably to the administration of clonazepam.

  • Case 14 - Violent sleep behavior resulting in subdural hemorrhage

  • from Part IV - Parasomnias
  • Edited by Antonio Culebras
  • Book:
    Case Studies in Sleep Neurology
    Published online:
    10 November 2010
    Print publication:
    23 September 2010, pp 92-100

  • Summary

    This chapter presents the clinical history, examination, follow-up, treatment, diagnosis, and the results of the procedures performed on a 25-year old patient who was admitted for the evaluation of insomnia. The specialist made a diagnosis of narcolepsy with possible cataplexy and decided not to pursue a CSF hypocretin analysis in light of the diagnostic certainty of the polysomnography (PSG) results. The multiple sleep latency test (MSLT) showed the presence of REM sleep in all four naps with a latency of 5 minutes. He prescribed modafinil 200 mg to be taken in the morning, a dose that could be increased to 400 mg if necessary. Narcolepsy is a life-long disorder presenting with excessive daytime sleepiness (EDS) and, ironically, with fragmented sleep that may lead to an erroneous diagnosis of insomnia. In addition to modafinil, patients may respond favorably to the administration of methylphenidate and dexedrine.

  • Case 15 - Amnestic nocturnal behavior

  • from Part IV - Parasomnias
  • Edited by Antonio Culebras
  • Book:
    Case Studies in Sleep Neurology
    Published online:
    10 November 2010
    Print publication:
    23 September 2010, pp 103-109

  • Summary

    This chapter discusses the case of a 17-year-old girl who was admitted for the evaluation of excessive daytime sleepiness (EDS). It presents the clinical history, examination, follow-up, treatment, diagnosis, and the results of the procedures performed on the patient. She suffered developmental delay, and was later diagnosed with mild mental retardation. Nocturnal polysomnography (PSG) and a multiple sleep latency test (MSLT) were carried out. The diagnosis was childhood-onset narcolepsy with cataplexy. The parents declined CSF testing for hypocretin. The onset of narcolepsy may occur with any of the four cardinal symptoms (excessive sleepiness, sleep paralysis, hypnagogic hallucinations and cataplexy), the most frequent being EDS. Childhood onset of narcolepsy is uncommon, but has been reported. The usual age of onset is mid- to late teens up to mid-20s. Occasionally patients may become ill after the age of 40.

  • 2 - Evaluation and testing of the sleepy patient

  • from SECTION 1 - NORMAL SLEEP
  • Edited by Harold R. Smith, University of California, Irvine, Cynthia L. Comella, Birgit Högl
  • Book:
    Sleep Medicine
    Published online:
    08 August 2009
    Print publication:
    10 April 2008, pp 25-46

  • Summary

    Sleep disturbances can affect people throughout their life span, and the frequency of sleep disturbances increases as we age. People with sleep disturbances may complain of difficulty falling asleep or maintaining sleep, abnormal behaviors during the night, daytime sleepiness or fatigue. Asking about typical bedtime rituals, sleep times and habits is a good place to start in the assessment of any sleep disorder. Many people who present with the classic symptom of insomnia may have more than one problem with sleep. Sleep disorders such as obstructive sleep apnea (OSA), parasomnias, narcolepsy, and nocturnal seizures sometimes require formal evaluation in the sleep laboratory. The most commonly used techniques used in recording and evaluating sleep disorders include the polysomnogram (PSG), the multiple sleep latency test (MSLT), and under special circumstances, the maintenance of wakefulness test (MWT).

  • Accidents and Sleepiness in a Military Setting

  • PE Hesla
  • Journal:
    Prehospital and Disaster Medicine / Volume 17 / Issue S1 / March 2002
    Published online by Cambridge University Press:
    17 February 2017, p. S38
    Print publication:
    March 2002
    • Article
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  • Time-of-day variations in different measures of sleepiness (MSLT, pupillography, and SSS) and their interrelations

  • HEIDI DANKER-HOPFE, SUSANNE KRAEMER, HANS DORN, ANDREA SCHMIDT, INGRID EHLERT, WERNER M. HERRMANN
  • Journal:
    Psychophysiology / Volume 38 / Issue 5 / September 2001
    Published online by Cambridge University Press:
    25 September 2001, pp. 828-835
    Print publication:
    September 2001

  • The aim of the present study is to analyze how well physiological measures of sleepiness derived from pupillography and the Multiple Sleep Latency Test correlate with a subjective measure, the Stanford Sleepiness Scale (SSS) score. The results are based on data from 12 healthy participants, who underwent these tests every 2 hr from 7:00 a.m. until 11:00 p.m. Sleep latencies were correlated with four different variables derived from pupillography and the SSS score. The results indicate that the physiologically based variables correspond very well. This is reflected by similar patterns of time-of-day variations, a good agreement at the group level, and correlations at the individual level, whereas the SSS shows a quite different pattern of variation. The two physiological measures of sleepiness seem to reflect the same aspect of the level of tonic central nervous activation, which is not correlated with the subjective feeling of sleepiness.

  • Sleep and Alertness in Children with ADHD

  • Michel Lecendreux, Eric Konofal, Manuel Bouvard, Bruno Falissard, Marie-Christine Mouren-Siméoni
  • Journal:
    The Journal of Child Psychology and Psychiatry and Allied Disciplines / Volume 41 / Issue 6 / September 2000
    Published online by Cambridge University Press:
    19 October 2000, pp. 803-812
    Print publication:
    September 2000

  • Objective: To evaluate sleep and alertness and to investigate the presence of possible underlying sleep/wake disorders in children with attention-deficit/hyperactivity disorder (ADHD). Method: After 3 nights of adaptation in a room reserved for sleep studies in the department of child psychiatry, children underwent polysomnography (PSG) followed by the Multiple Sleep Latency Test (MSLT) and reaction time tests (RT) during the daytime. Thirty boys diagnosed as having ADHD (DSM-IV), aged between 5 and 10 years, and 22 age- and sex-matched controls participated in the study. All children were medication-free and showed no clinical signs of sleep and alertness problems. Results: No significant differences in sleep variables were found between boys with ADHD and controls. The mean latency period was shorter in children with ADHD. Significant differences were found for MSLT 1, 2 and 3 (p<.05). Mean reaction time was longer in children with ADHD, with significant differences in all tests (p<.05). Number and duration of sleep onsets measured by the MSLT correlated significantly with the hyperactivity-impulsivity and inattentive- passivity indices of the CTRS and CPRS. Conclusion: Children with ADHD were more sleepy during the day, as shown by the MSLT, and they had longer reaction times. These differences are not due to alteration in the quality of nocturnal sleep. The number of daytime sleep onsets and the rapidity of sleep-onsets measured as MSLT were found to be pertinent physiological indices to discriminate between ADHD subtypes. These results suggest that children with ADHD have a deficit in alertness. Whether this deficit is primary or not requires further studies.