Sleep Disorders
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Sleep Disorders: Insomnia, the most common sleep disorder, is covered on its own page.  I still need to add many studies to this page.  Hopefully, I will get to it this year.

Night Terrors Treated with Paroxetine in Open Trial: 6 patients 20-40mg/d. Three complete success, three just improved. Two relapsed with d/c and did well with restart. Wilson S, et al: Adult night terrors and paroxetine. Lancet 1997;350:185, U Bristol (Ed: Open trial results are notoriously unreliable.  If using an SSRI, fluoxetine is much less expensive.  Sertraline would be my second choice if other medicines contraindicated fluoxetine.)

Sleep Apnea Increased High Blood Pressure: Sleep apnea, breathing pauses of over 10 seconds almost always with snoring, occurs in 12 million in US. Continuous positive airway pressure mask most common Rx. Wt loss important Rx. 45% increase in HBP after control for other factors. JAMA 4/12/00

Sleep Apnea’s Pre-existent Brain Damage: 38 percent of the sleep apnea patients reported a history of stuttering or speech impairment. Most of the men had struggled with word-formation problems since childhood, and some still had language difficulties as adults. 7% US with childhood stuttering. 4 percent of the U.S. population suffers from obstructive sleep apnea, which causes explosively loud snoring at night and extreme sleepiness during the day. People who suffer from the disorder constantly struggle to breathe during sleep, because their throat and mouth relax to such a degree that their airway collapses. They wake up to begin breathing, then repeat the cycle throughout the night, seriously disrupting their sleep. most common in men, the elderly, the obese and children with large tonsils. MRIs revealed dramatic gray matter loss in the brains of the men with sleep apnea. Curiously, the tissue loss occurred primarily in regions of the brain that control speech production, movement and emotion. The amount of brain damage directly correlated to the severity of the patient's disorder. The healthy men's brains ranged from 2 percent to 18 percent larger in these areas than the men with sleep apnea. Dr. Paul Macey, UCLA, 11/21/02

Sleep Apnea: CPAP Little Value in Mild to Moderate Sleep Apnea: Obstructive Sleep Apnoea Syndrome (OSAS) affects 2-4% of the middle-aged population. Meta-analyses of randomised controlled trials show that the severe presentation of the syndrome (Apnoea Hypopnoea Index >30/hr) is effectively treated with Continuous Positive Airway Pressure (CPAP). However, this review of the treatment of mild-moderate OSAS (AHI 5-30/hr) found that CPAP significantly reduced subjective daytime sleepiness (Epworth Sleepiness Scale) by only 1.2 points (p=0.001), improved objective daytime wakefulness (Maintenance of Wakefulness Test) by 2.1 mins (p=0.011), and did not affect objective daytime sleepiness (Multiple Sleep Latency Test, mean benefit -0.2 mins, p=0.6). The two significant effects were small (Effect size <0.30). The effects on sleepiness are of limited clinical significance. Continuous positive airway pressure reduces daytime sleepiness in mild-moderate obstructive sleep apnoea: meta-analysis. Marshall NS, et al. Massey University, New Zealand. Thorax 2006 Feb 7.


Narcolepsy: Hypocretins Involved: Hypocretins/orexins are newly identified peptides of hypothalamic origin. Hypocretin deficiency is involved in the sleep disorder narcolepsy, suggesting the importance of hypocretin neurotransmission for the regulation of sleep. Psychiatry Res 2002 May 15;110(1):1-7

Autoimmune Basis: Narcolepsy is widely believed to have an autoimmune basis. Cholinergic hyperactivity is a feature of narcolepsy-cataplexy. IgG was transferred from nine patients with narcolepsy and nine healthy controls to mice and assessed the effect on smooth muscle contractile responses to cholinergic stimulation. IgG from all narcolepsy patients significantly enhanced bladder contractile responses to the muscarinic agonist carbachol and to neuronally released acetylcholine compared with control IgG (p<0.0001), whereas contraction of the sympathetically innervated vas deferens was unaltered. This is direct evidence for the autoimmune hypothesis.

Narcolepsy: Gamma Hydroxybutyrate (Xyrem): The infamous date rape drug, a schedule III narcotic, has unwisely been approved by the FDA. Short half-life 30-60 min. with rebound insomnia. Highly abuse prone. Frequent anterograde amnesia. Works in 15 minutes. Most patients in FDA trials already were being treated with stimulants. 136 pt with 21 cataplexy attacks per week in DB PC on 6 g/d GHB for 4 weeks had 11 attacks/week and at 9 g/d had 5 attacks per week vs. placebo 17 attacks/week from baseline of 21 with decreased daytime sleepiness. In 7-44 month study DB PC 55 patients placebo had 21 attacks/week vs. 0 with med. Severe dependence and craving have been reported at these doses.. Cost $740 for 30 days. Med Letter 12/9/02.

Reboxetine Given to Narcolepsy Patients: In an open trial with objective sleep measures, 12 narcolepsy patients were given reboxetine 10 mg/d.  They showed increased REM sleep, increased sleep latency by 55%, decreased sleepiness scores (subjective) by 48%, and decreased cataplexy. Univ. Madrid. Stimulant and anticataplectic effects of reboxetine in patients with narcolepsy: a pilot study. Larrosa O, de la Llave Y, Bario S, Granizo JJ, Garcia-Borreguero D. Sleep 2001 May 1;24(3):282-5