Complementary And Alternative Medicine Practitioners
Insomnia can be treated by using some complementary and alternative techniques like yoga and meditation. Massage therapy might also be useful. What these techniques have in common is that they are able to help you relax and release any tension that might be disturbing your sleep. They also eliminate the need for medicinal solutions as medicine is not always the best approach for all problems.
You may even be advised to try an integrative approach by your psychologist. Sometimes it is the best way to achieve sustainable growth and a greater sense of well-being. Some services like Estadt Psychological offer free consultations and can answer your questions about how therapy or even a more integrated approach can help you.
What Does A Neurologist Do On Your First Visit
A neurologist is a medical expert responsible for the diagnosis and treatment of various nerve-related ailments. This includes disorders that affect the brain and the functionality of the nervous system. Although they are certified medical doctors, they do not perform any major surgical procedures. Then what does a neurologist do on your first visit? That is the main focus of discussion in this article.
Chief Complaint: Excessive Daytime Sleepiness
Sleepiness and sudden sleep attacks during the daytime have a negative impact on performance and may be indicative of abnormal sleep regulation or disturbed sleep at night. Sleepiness can be measured using the Epworth Sleepiness Scale and be objectively determined after a night in the sleep laboratory using the Multiple Sleep Latency Test . Especially in patients with comorbidities such as cancer or multiple sclerosis, it can be difficult to distinguish it from daytime tiredness and/or fatigue .
Diagnostic flowchart for daytime sleepiness/daytime tiredness. The diagnoses are only examples, comorbid causes may be present. ASPS/DSPS, advanced/delayed sleep phase syndrome DDx, differential diagnosis MS, multiple sclerosis Non24, non24-hour sleepwake disorder PLMD, periodic leg movement disorder RLS, restless legs syndrome SRBD, sleep-related breathing disorders
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Treating Comorbid Sleep Neurological Disorders
The range of sleep disorders neurologists treat is wide and includes insomnia, sleep apnea, restless legs syndrome, and narcolepsy.
Primary sleep disorders are caused by endogenous abnormalities in the mechanisms regulating the sleep-wake cycle. Secondary sleep disorders stem from comorbid conditions, including neurodegenerative diseases such as Parkinsons disease or Alzheimers disease, or psychiatric disorders that can cause disruptions in normal sleep-wake mechanisms.1
At least 40 million Americans suffer from long-term sleep disorders each year, according to the National Institutes of Health. An additional 20 million experience occasional sleeping problems.2
More Americans are seeking help for sleep-related issues, said Andrew Westwood, MD, assistant professor of the clinical neurology division of epilepsy and sleep disorders at Columbia University Medical Center in New York City.
It is an emerging problem because the population is aging, so the incidence and diagnosis of dementia is increasing in the clinic, Westwood said. But also the importance of sleep is becoming well known within the general population, so people are really taking steps to evaluate their sleep. In the past people wouldnt look at it so carefully.
Icipation Of Patient Groups
Deutsche Alzheimer Gesellschaft e.V., Selbsthilfe Demenz, Friedrichstr. 236, 10,969 Berlin.
Deutsche Multiple Sklerose Gesellschaft, Bundesverband e.v. DMSG, Krausestr. 50, 30,171 Hannover.
Deutsche Parkinson Vereinigung – Bundesverband – e.V., Moselstraße 31, 41,464 Neuss.
Deutsche Epilepsievereinigung e.V., Bundesgeschäftsstelle, Zillestraße 102, 10,585 Berlin.
Deutsche Migräne- und Kopfschmerzgesellschaft, Migräne- und Kopfschmerzklinik Königstein Ölmühlweg 31, 61,462 Königstein im Taunus.
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Types Of Sleep Disturbances
In neuropsychiatric conditions, sleep disturbance most commonly manifests as insomnia, hypersomnia, nightmares, or circadian dysregulation, although some conditions are associated with increased risk for other sleep disorders .
Insomniaproblems falling or staying asleep despite adequate opportunity for sleepoccurs in all neuropsychiatric disorders, with sleep-onset problems occurring more frequently in GAD and ASD, and sleep maintenance problems, especially early morning awakenings, more common in MDD. Hypersomnia, which is excessive sleepiness despite a sleep period of 7 hours or more, appears in seasonal affective disorder and SSD. Individuals with BPD have reduced sleep need during manic phases and insomnia or hypersomnia during depressive phases. Nightmares and associated fear of going to sleep reflect the re-experiencing symptoms and hypervigilance seen in PTSD.1 Circadian dysregulation, which reflects changes in the timing of sleep-wake and other behavioral rhythms, occurs in BPD, SSD, ADHD, ASD, and neurodegenerative conditions. It often results from irregular, inappropriate, or inadequate timing of zeitgebers that regulate circadian rhythms, such as exposure to light, engagement in activities, and scheduling of meals and social events.5
What Is A Neurologists Role
As doctors specializing in the nervous system, most neurologists see and treat patients experiencing persistent neurological disorders. They are often consultants recommended by primary care physicians who think a patient may have a neurological condition. While they specialize in the nervous system, they are not surgeons unless they are also a neurosurgeon. On the other hand, they can consult or work closely with a neurosurgeon with their patients.
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Where To Get Treatment For Insomnia
The sleep experts at Comprehensive Neurology and Medicine have more than 30 years experience diagnosing and successfully treating thousands of patients throughout Maryland for insomnia and other sleep disorders. Dr. Konrad Bakker is is board certified in sleep medicine by the American Board of Sleep Medicine as well as board certified in sleep by the American Board of Psychiatry and Neurology. Dr. Bakker has extensive experience treating patients seeking help for all sleep disorders. He uses a variety of treatment modalities including cognitive behavioral treatment for insomnia, CPAP, dental appliances and Inspire . Sarah E. Jamieson is a physicians assistant with specialized training and experience in the diagnosis and treatment of insomnia. Together, Dr. Bakker and Ms. Jamieson will listen to you carefully and develop a personalized treatment plan to help you get the sleep you need to restore your physical and mental health as well as your overall quality of life. Call us today at 694-0900 to schedule an appointment. Virtual appointments are also available, allowing you to receive a medical consultation via our own phone or computer in the comfort of your home.
Ners Encouraged Early Bedtimes
In a randomized controlled trial investigating partner-assisted interventions for insomnia, Dr. Mellor and colleagues studied 31 bed partners of patients seeking treatment for insomnia. At baseline, partners completed the Family Accommodation Scale for OCD, Beck Anxiety Inventory, and Dyadic Adjustment Scale. Patients with insomnia completed the Insomnia Severity Index and other questionnaires at baseline and kept a sleep diary for one week prior to treatment initiation.
Approximately 74% of bed partners encouraged an early bedtime or late wake time, which directly contradicts the principles of cognitive behavioral therapy for insomnia . In addition, 42% of bed partners encouraged doing other things in bed, such as reading or watching TV, and 35% encouraged naps, caffeine, or reduced daytime activities. About 11% encouraged their partners to take sleep medication or alcohol to improve sleep. About 56% of bed partners reported that their partner becomes distressed when they do not provide assistance with their insomnia.
Half of bed partners adjusted their own sleep. Furthermore, 39% of bed partners adjusted their family routine, and half modified their leisure activities in response to their partners insomnia. Approximately 17% modified their work schedule. The bed partners who attempted to be helpful experienced more anxiety, even though the patients with insomnia perceived the relationship to be more satisfying.
Search And Selection Of Scientific Literature
Search used medline, pubmed, embase, web of science und Cochrane database. Search included years 11/200912/2018 and was restricted to adult population. Search terms were insomnia in neurologic disease, insomnia in central neurologic diseases, and insomnia and respective neurological diseases).
Articles had to contain at least one definition of insomnia according to recent classification systems. All randomized, controlled studies with > 5 patients were included. If studies with high evidence were lacking, studies of lower evidence were included, if they met the selection criteria. Evidence classification was perfomed according to standardized European Procedures . Levels of recommendation are A-D. Literature was categorized independantly by two experts according to Oxford Centre for Evidence-based Medicine Levels of Evidence .
Insomnias Impact On The Endocrine System
Hormone production occurs during sleep. Testosterone production requires at least 3 hours of uninterrupted sleep, which is about the time of your first R.E.M. episode. Waking up throughout the night impairs the ability to produce the hormones needed to stay healthy and functioning properly. Children and adolescents who dont get enough sleep dont produce adequate amounts of the growth hormone that helps the body build muscle mass and repair cells and tissues.
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Central Disorders Of Hypersomnolence
Narcolepsy and idiopathic hypersomnia are disorders typically associated with excessive daytime tiredness and fall into the category of central disorders of hypersomnolence. The primary symptom is always excessive daytime sleepiness and/or prolonged sleep not explained by other sleep disorders or other medical conditions. Another central symptom, which is also used to distinguish between two types of narcolepsy, is cataplexy . Facultative symptoms include hypnagogic/hypnopompic hallucinations, sleep paralysis, automatic behaviors, and fragmented sleep at night .
The overall prevalence of narcolepsy is 2550 per 100 000 population, with an incidence of 0.8/100 000 . The pathogenesis of the two types of narcolepsy is not fully understood. Given the strong HLA association , autoimmunity is assumed to be involved in the pathogenesis however, the diagnostic significance of typing is limited to a supporting role, due to the prevalence of the marker in the general population . Pathophysiologically, there is a disturbance of the hypocretin/orexin system and the histamine system. Reduced hypocretin levels in cerebrospinal fluid were found in over 80% of patients with type 1 narcolepsy . CFS hypocretin-1 levels below 110 pg/mL are considered diagnostic of type 1 narcolepsy. This may be a starting point for the development of future biological treatments .
What Is The First Step To Initiate When You Have Been Diagnosed With Insomnia
The most important step to finding a solution for your insomnia is to get to the root of it. Have a conversation about it with your family and inquire as to whether your insomnia may potentially be hereditary or genetic. Consult a specialist or psychiatrist to determine if it is acute or chronic .
Have a question about
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Signs And Symptoms Of Insomnia
- Regularly have trouble falling asleep or staying asleep each night
- Feel tired most mornings when you should be feeling refreshed after a good nights rest
- Feel sleepy and lethargic throughout the day, wishing you could just lie down and take a nap when you need to be alert and productive at work, while driving and at home
- Have trouble concentrating and focusing on tasks when you need to be mentally alert
- Have trouble learning and remembering important information
- Are frequently moody and irritable
. theres a good chance that you are suffering from insomnia. The good news is that insomnia can be treated. The highly-trained sleep specialists at Comprehensive Neurology and Sleep Medicine have successfully helped thousands of sleep-deprived patients throughout Maryland sleep better and restore their physical and mental health and overall quality of life.
# What Are Some Ways To Get Better Sleep
Here are a few activities that you can follow for a sound sleep:
- Follow a routine, i.e. try to go to bed and wake up at a fixed time. Stay away from the screen before bedtime as the blue light emanating from them messes with the circadian rhythm, thus disrupting sleep.
- Exercise and eat light food in the evening.
- Sleep has become a multi-billion dollar industry and there are several apps that promise a
- good nights sleep. You can try them.
- If sleep still evades you, its better to read a boring book than tossing and turning in bed.
- In the end, do remember, equal amounts of work, play and sleep are crucial for a good quality life.
With inputs from Dr. Sudipto Chatterjee, Psychiatrist, Parivartan Trust
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Insomnia In Neurodegenerative Movement Disorders
The recommendations are restricted to Parkinsons disease , atypical Parkinson syndromes, and spinocerebellar ataxia .
Sleep disorders in neurodegenerative diseases affect up to 90% of all patients. Sleep disorders in neurodegenerative diseases can precede motor symptoms by years and may exhibit unfavorable impact on quality of life and cognition . Insomnia is the most frequently associated sleep disorder . 3560% fulfill the criteria of chronic insomnia .
To screen for sleep problems and score their severity in PD the task force of the Movement Disorder Society recommends the use of the following scales and questionnaires: Parkinsons disease sleep scale , Pittsburgh sleep quality index and SCOPA-Sleep .
In PD patients the amplitude of the rhythmic expression of clock genes such as per 2 as well as the transcription factor bmal 1 was reduced, supposedly influencing gene transcription and inflammatory processes. These changes of circadian processes might be a consequence of the ongoing neurodegenerative process but may also contribute to disease progression itself . Analyses of a national data banks in Great Britain and Taiwan showed a prodromal incidence risk of insomnia for clinical manifestation of PD of 1,38 .
Many Bed Partners Of People With Insomnia Offer Suggestions That Contradict Behavioral Treatment Strategies
BOSTONIn an attempt to be supportive, bed partners of patients with insomnia may engage in behaviors that unintentionally perpetuate insomnia, according to preliminary results presented at the 31st Annual Meeting of the Associated Professional Sleep Societies. Bed partners also may make accommodations that affect their own sleep and life outside of work.
It is possible that partners are unwittingly perpetuating insomnia symptoms in the patient with insomnia, said Alix Mellor, PhD, a postdoctoral research fellow and coordinator of the Researching Effective Sleep Treatments project in the School of Psychological Sciences at Monash University in Victoria, Australia. It is therefore important for more data to be collected to determine whether insomnia treatments may better benefit patients and their partners by proactively assessing and addressing bed partner behaviors in treatment programs.
Alix Mellor, PhD
Relationship problems and mismatched bedtimes and wake times within couples have been linked to insomnia. Research in disorders such as obsessivecompulsive disorder and depression indicates that partners can reinforce maladaptive behaviors inadvertently. No data have documented the specific behaviors engaged in by partners of individuals with insomnia, however, and these behaviors might perpetuate the disorder.
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Tips For A Good Night Sleep
For a good night sleep, you must avoid alcohol, tobacco, decongestants, coffee, tea, chocolate and caffeinated soda.
Try to reduce the stress factor in your life by practicing stress relieving techniques like deep breathing, yoga and meditation.
Keep only 30 minutes aside for worrying about your problems. Once the time is up, dont think about your problems for the rest of the day or night.
Drinking a glass of warm milk or eating a light snack like cheese crackers before going to bed is recommended for a good night sleep.
It is better that you avoid taking a nap in the afternoon if you are having trouble sleeping in the nights.
How Does Daridorexant Work Differently From Other Common Medications For Insomnia
Daridorexant acts on different brain systems than some other common insomnia medications. For example, many such as zolpidem work on the GABA brain chemical system. GABA is an important brain chemical that promotes sleep., Other medications work on different brain chemicals associated with sleep such as melatonin and histamine.
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Why You Should See A Neurologist For Sleep Problems
Do you have problems falling asleep? Or maybe you fall asleep and then wake up multiple times later in the night? Do you also struggle with issues like restless leg syndrome that prevents you from getting quality sleep? If any of this sounds like something you experience on a regular basis, then you may have a sleeping disorder.
Sleep disorders are characterized by problems with the quality, timing, and amount of sleep, especially when these problems result in daytime sleepiness or distress. There are different types of sleep disorders that can have both physical and emotional causes. Some of the most common sleep disorders include: insomnia, narcolepsy, restless leg syndrome , and sleep apnea.
When it comes to seeking the proper diagnosis and treatment for sleeping disorders, not many people know where to go. Because there are different medical professionals that offer treatment for sleeping disorders, it can be tough to know which professional to see. Here are some medical professionals that can treat sleeping disorders:
Your Primary Care Physician May Or May Not Manage Sleep Issues
The primary care physician is usually considered a generalist who will refer patients with specific medical conditions out to specialist for disease management however, many of these doctors are now managing many medical conditions, such as diabetes and hypertension themselves without referring to a specialist. This also applies to sleep.
Some physicians will manage the sleep issues of their patients. Some doctors will screen all of their new patients for sleep issues and incorporate sleep assessments into their new patient intake forms . This doctor will ask how your sleeping. Better yet, she may ask your bed partner how youre sleeping. Are you snoring? Gasping for air at night? Do you stop breathing during the night? These are all signs of sleep disorder. This doctor will then order a sleep study . After your sleep study, she will receive the results and contact you to discuss next steps. If you have a sleep disorder like sleep apnea, this may include ordering CPAP therapy to treat your disease .
With this type of doctor, you wont need to see a specialist. Its worth asking your primary care physicians office staff if he or she manages sleep disorders. If not, you may wish to ask for a referral to a specialist or find one on your own .
Now well talk about which specialists will manage sleep issues.
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