Pitolisant, a new medicine for excessive sleepiness in narcolepsy
Pitolisant, a new medicine for excessive sleepiness in narcolepsy Pitolisant is a new medicine approved by the FDA for treatment of excessive sleepiness in narcolepsy. It is an H3 reverse agonist. That means that it reduces activity at the Histamine 3 receptor in the brain. Histamine is one of the brain chemicals that helps…
Do Sleep Medicine doctors edit the tech’s scoring? Overheard at an airline lounge as three gentlemen were talking while waiting for their flight after a Sleep Medicine annual meeting: Physician 1: Do you guys edit or change anything the techs have done when you review sleep testing records? Physician 2: Our software only allows me…
CPAP is often better than APAP for obstructive sleep apnea Obstructive sleep apnea (OSA) is associated with sleepiness and cardiovascular and metabolic morbidity and mortality. The standard of treatment is full, attended polysomnography (PSG) while adjusting positive airway pressure (PAP). This determines the best fixed pressure that keeps the airway open and is tolerated.…
Not Getting Enough Time in Bed Paul Smith (not his real name) is a 63-year-old accountant. He works hard, he plays hard. He is happily married, with lovely children and grandchildren. He has been a patient off and on for many years. I have seen him over the years for sleepiness, for snoring, and for…
A new medicine for daytime sleepiness was approved this year. It should arrive in pharmacies in the next few months. Its name is SunosiR (or solriamfetol). It blocks reuptake of dopamine (DA) and norepinephrine (NE) into nerve cells that release these. As a result, DA and NE levels increase in the area between nerve cells…
Continuous Positive Airway Pressure (CPAP) is the best treatment for obstructive sleep apnea (OSA). Unfortunately, only 59% of patients prescribed CPAP in the USA actually use it. Yet, being adherent to CPAP use is crucial in controlling OSA and its complications. The complications include sleepiness and fatigue, memory and concentration problems, high blood pressure, atrial…
Sleeping with half the brain – is that even possible? Yes, it is. Many birds and aquatic mammals sleep with half the brain at any time, according to Scientific American (June 2019) [https://www.scientificamerican.com/magazine/sa/2019/06-01/?redirect=1] Mammals that live in water (whales, dolphins, porpoises) might drown if they fall asleep. They cannot breathe when under water. Therefore, they…
Does SoClean really clean CPAP? Not really. Nor does Lumin. They are not cleaners. They are sanitizers. Perhaps SoClean should be renamed SoSanitize! What is cleaning? Cleaning removes dirt and other particles. The best cleaning method is soap and water. Sanitizing reduces the number of bacteria, viruses, and fungi. It does not work very well…
How should we best measure sleepiness? There is no definite way of measuring sleepiness. In part, the problem is that there is no good definition of sleepiness. Secondly, we often confuse the trait of sleepiness with the state of sleepiness. It is like the story of the elephant and the blind men, with each expert…
The FDA has a new black box warning on sleeping pills (zolpidem or AmbienR, eszopiclone or LunestaR, and zaleplon or SonataR). These can cause unusual behavior in sleep (parasomnias). Patients report walking in their sleep or eating in their sleep. This happens often enough. Rarely, patients may fall, are burned, or almost drown. They may…
Trazodone for sleep reduces worsening of memory in patients with and without cognitive impairment. Trazodone has long been my preferred medicine for patients with chronic insomnia. I also use it frequently for sleep apnea patients who are not tolerating Continuous Positive Airway Pressure (CPAP) treatment. CPAP causes arousals and awakenings and disturbs sleep, and APAP…
The FDA has recently approved a device that provides trigeminal nerve stimulation (TNS) for Attention Deficit (ADHD) in 7-12 year old children. The ophthalmic branch of the trigeminal nerve run in the forehead above the eyebrow. It is responsible for sensations (such as touch and pain) from the forehead. An electrode is placed above the…
Reducing risk of Mild Cognitive Impairment and Dementia Here are ten things you can do to reduce the risk of Mild Cognitive Impairment and Dementia. Keep your weight normal. Body mass index (BMI, based on weight and height) is the best way to determine whether your weight is normal (although it is not perfect). BMI…
Sleep Deprivation may increase risk of Alzheimer’s disease Recent research shows that sleep deprivation increases tau protein in the brain. Tau leads to the neurofibrillary tangles seen in Alzheimer’s disease. By increasing tau, sleep deprivation may increase risk of Alzheimer’s disease. During brain activity, proteins like tau are produced in nerve cells and released into…
Mild Cognitive Impairment may be prevented by better blood pressure control According to a recent study, mild cognitive impairment (MCI) may be prevented by better blood pressure control. High blood pressure, which is not well controlled, causes inflammation of the blood vessels in the brain as well as the rest of the body. The results…
Hospital prices for medical procedures used to be secret. Medicare now requires hospitals to post their prices online. Some, but not all, local hospitals have done so. Below is an interesting comparison of pricing for Sleep Medicine services between some local hospitals and us. Local hospitals maintain sleep disorders centers in office buildings separate from…
Our genes determine how much sleep we need Adults should get at least 7 hours a day of sleep (more for children and adolescents). What determines how long we sleep? Is it entirely up to us? Do the demands of school and work decide it? What role does genetics play? Evidence now suggests that our…
Changing definitions of sleep apnea – should we still treat mild sleep apnea? Whether we should treat mild sleep obstructive apnea, may depend on the definition used for scoring hypopneas. The American Academy of Sleep Medicine (AASM) scoring manual defines hypopneas. This definition has changed several times over the years, sometimes going back and forth…
Are you tired, sleepy, fatigued? You may have Idiopathic Hypersomnia. Sleep medicine doctors often ignore idiopathic hypersomnia. Many sleep medicine doctors focus exclusively on sleep apnea. Others understand and look for narcolepsy with cataplexy (now called narcolepsy type 1). Narcolepsy with cataplexy is a rare disorder. In my experience, narcolepsy without cataplexy (now called narcolepsy…
Sleep Deprivation Increases Brain Cannabinoids Most Americans do not get enough sleep (defined as more than 7 hours for adults, 8-10 hours for teenagers, more for children). When we do not get enough sleep, our brains produce cannabinoids (called endocannabinoids). Without enough sleep, we are more irritable and our brains do not function as well. We…
Obesity: Food Addiction encouraged by Big Food Companies Obesity is, at least in large part, a result of Food Addiction encouraged by Big Food Companies. Obesity is defined as Body Mass Index (BMI) greater than 30. Body Mass Index is calculated using the formula: Weight (wt.) in Kg divided by the square of height…
Can you really get by with less sleep than Bill Gates or Jeff Bezos? You cannot excel with less sleep than Bill Gates or Jeff Bezos, can you? According to the American Academy of Sleep Medicine, it is crucial to sleep 7 hours or more per night. Many people (including even doctors) pooh-pooh this advice.…
APAP does not work as well as CPAP The best treatment for obstructive sleep apnea is CPAP (Continuous Positive Airway Pressure). There is a variant of CPAP called APAP (Auto-adjusting Positive Airway Pressure). APAP does not work as well as CPAP. CPAP is a pump connected by a tube to a mask (or nasal pillows)…
Home Sleep Apnea Testing (HSAT) is Often Inconclusive Home Sleep Apnea Testing (HSAT) was designed to confirm (not to exclude) obstructive sleep apnea, in patients with high pre-test probability of moderate to severe obstructive sleep apnea, without other disorders including: 1. Significant heart or lung disorders 2. Sleep disorders, including insomnia, abnormal behavior in sleep,…
Better Sleep for the Elderly Insomnia is common in the elderly. Half of elderly adults state they sleep poorly. They often get hooked on sleeping pills. Yet, sleeping pills can be harmful, especially for the elderly. Problems associated with sleeping pills include: 1. Memory and concentration difficulties 2. Falls and fractures 3. Addiction to…
Defend Your Sleep, Shift Workers It is very important that adults get at least 7 hours of sleep each night. Get less sleep than 7 hours, and you get tired and sleepy. You are three times as likely to get into a car accident. Work place accidents increased. Attention and memory are worsened. Work performance…
Medicine Nobel Prize awarded to Sleep (Circadian Rhythm) Researchers The Nobel Prize for Medicine was awarded to three sleep researchers this week (2017). They are Jeffrey Hall and Michael Rosbash of Brandeis University in Boston, and Michael Young of Rockefeller University in New York. They have discovered the genetic secrets behind the body’s circadian (or…
10 things you can do to improve your sleep: 1. Go to bed at the same time every day 2. Get up at the same time every day 3. Get no more than 8 hours in bed every day( this is the time spent in bed, not time asleep) 4. Do not watch TV (or…
Melatonin – should you ever take it? Melatonin is much over-hyped for sleep problems. Its usefulness for insomnia is limited. However, it is clearly useful for disorders of the sleep-wake rhythm. It is useful in delayed sleep phase syndrome, shift work disorder, jet lag syndrome. For delayed sleep phase syndrome, along with behavioral treatment and…
Morning start times should be after 8:30 am The American Academy of Pediatrics, the American Academy of Sleep Medicine, and the Centers for Disease Control and Prevention agree that school morning start times should be after 8:30 am. Yet only one in six middle and high schools start after 8:30 am. High schools are particularly…
Insurance Company Hall of Shame – United Health Care Recognizing that a private health insurance companies primary purpose is to make profits for itself, most insurance companies still try to do right by their members. There should be an Insurance Company Hall of Shame for those insurance companies that do not. Many private insurance companies…
Sleepy people and people with attention deficit have increased risk of accidents Why do sleepy people and people with attention deficit (ADD, ADHD) have about an equal increase in risk of motor vehicle accidents? Normal people who are texting or using the cell phone (even hands-free) also have a higher risk of accidents. As do…
Which is the Best Mattress? Patients (and even referring physicians) often ask me which is the best mattress? Which mattress should they buy? What they want to know is which mattress will help them sleep better. There is astonishingly little scientific evidence on what makes for a good mattress. We do know that support of…
Cannot tolerate APAP? You are not alone! Are you one of those who cannot tolerate APAP (Auto-titrating Positive Airway Pressure) for sleep apnea? You are not alone! Sleep apnea is diagnosed based on finding apneas (90% decrease in airflow) and hypopneas (30% decrease in airflow plus 4% drop in blood oxygen). APAP works by supposedly…
Not getting enough sleep may set you up for brain damage We know sleep is necessary to clear toxins from the brain. Researchers just showed that even after one night of sleep deprivation, brain cells (astrocytes) that eat up connections between nerve cells become more active. This, in itself, may be an adaptive and necessary response…
Is it Necessary to Test for or Treat Sleep Apnea without other Symptoms? The US Preventive Services Task Force states it is not clear whether people without symptoms should be evaluated or treated for obstructive sleep apnea. I agree. We should not go out and test everyone for sleep apnea. We probably should not treat…
Sleep Apnea Hurts Hearts According to the National Healthy Sleep Awareness Project (full disclosure: I am the Chair of the Public Communication Workgroup, but this blog is my personal work and is not written in an official capacity), sleep apnea hurts hearts. H = heart attacks E= elevated blood pressure A = atrial fibrillation (A-fib)…
Happy Patients and Unhappy Patients Every good doctor has happy patients and unhappy patients. There are many physician review websites, and patients use these often. They check out physicians on these website before they see them. They write reviews on these websites. However, the highest rated doctors may not provide the best care. Doing the…
When and how much should we sleep? Most adults generally need 7-9 hours a day in bed (or the chair or wherever it is that they sleep), and will sleep 6-8 hours of this time. If they get less time in bed or less sleep, their performance is impaired and they may feel tired and…
Evidence Based Policy is the Best Policy – Evidence Based Knowledge is called Science Yesterday, we were at the March for Science at the Capitol in Lansing, MI. Science is fundamental to our civilization. The internet and the computer (desktop or mobile) you use to read this is a result of science. Scientific agriculture gives…
Poor Patient Compliance – Does the Physician Share Responsibility? We physicians shrug our shoulders when patients do not comply with or adhere to their treatment. Should we look at our responsibility for patient compliance and adherence? There is recent evidence that whether you become addicted to opioid painkillers depends on which physician prescribes gets you…
Fist Bumps Spread Fewer Germs than Handshakes This image shows powder transferred during a handshake, to demonstrate that the custom is far less hygienic than the modern fist bump. (Prifysgol Aberystwyth University) A fist bump is 20 times more hygienic than a traditional handshake, researchers report. Public health experts are urging handshakes to go the way…
Does the Fitbit really measure sleep? The Fitbit (and similar devices) has an accelerometer. It measures change in motion. That’s all. It does not measure brain waves, or breathing, or blood oxygen. It can tell whether there is a change in your movement. So if you are lying quietly and then start moving, it senses…
99th Percentile on Sleep Medicine Boards I retook the Sleep Medicine Board Examination this winter. The American Board of Medical Specialties requires us to retake them every 10 years now. Although I keep abreast of what is happening, I wondered how well I would do. After all, I completed my training trained 33 years ago. I…
Does Melatonin Help Insomnia? Does Melatonin really help insomnia? It is a hormone produced in the brain. We secret it continuously when it is dark outside. One purpose seems to be to signal that it is dark outside. We do not know what other purposes it has. Taking it by mouth is helpful in changing our body’s…
Tonsillectomy can be dangerous – test your child for sleep apnea before tonsillectomy for snoring Tonsillectomy or removal of the tonsils is the third most common surgery in children. There are more than half a million child tonsillectomies a year in the USA. Common reasons include repeated infections and snoring or sleep apnea (stopping breathing…
These are the top ten conditions to screen for obstructive sleep apnea. Obstructive sleep apnea is a potentially dangerous disorder that can wreck hearts and cause deaths. 1. Obesity (BMI ≥30): About one-thirds of US adults have BMI of 30 or greater. About half of those with BMI ≥30 have obstructive sleep apnea 2. …
Remember the New Jersey transit train crash in Hoboken, NJ recently? It appears the driver, Thomas Gallagher, fell asleep at the controls. After the accident, he has been diagnosed with Sleep Apnea. Sleep apnea is found in people who snore heavily. It may cause daytime sleepiness and increased risk of accidents. So, maybe sleep apnea…
Ten things to keep in mind for your snoring child: The snoring child may have sleep apnea. Here are some things to consider if your child snores. 1. Snoring is not normal in children. If your child snores, this may suggest sleep apnea, which means stopping breathing in sleep. This can lead to high…
Through most of my career in Sleep Medicine, it has not been clear why we need sleep. The answer is now becoming clear. A big reason we need sleep is to remove toxic materials from the brain. In addition to arteries and veins, the body has lymph vessels. These lymph vessels remove waste from our…
