Noninvasive Ventilation and Spinal Cord Injury
Individuals with spinal cord injury (SCI) are at increased risk of respiratory complications during wake and sleep. Sleep-disordered breathing (SDB) is commonly associated with SCI and requires an individualized approach to its management. Respiratory control plays a key role in the pathogenesis of SDB in cervical SCI. Noninvasive ventilation plays an important role in the management of respiratory complications in individuals with SCI acutely and in chronic phases. Positive airway pressure treatment may be effective in eliminating SDB and improving sleepiness symptoms, but adherence to treatment is poor and effect on long...
Source: Sleep Medicine Clinics - October 5, 2020 Category: Sleep Medicine Authors: Asil Daoud, Samran Haider, Abdulghani Sankari Source Type: research

Perioperative Care and Medication-related Hypoventilation
Cumulative evidence supports the association of adverse postoperative outcomes with obstructive sleep apnea (OSA) and obesity hypoventilation syndrome (OHS). Although current guidelines recommend preoperative screening for OSA and OHS, the best perioperative management pathways remain unknown. Interventions attempting to prevent complications in the postoperative period largely are consensus based and focused on enhanced monitoring, conservative measures, and specific OSA therapies, such as positive airway pressure. Until further research is available to improve the quality and strength of these recommendations, patients w...
Source: Sleep Medicine Clinics - October 5, 2020 Category: Sleep Medicine Authors: Kara Dupuy-McCauley, Bernardo Selim Source Type: research

Tailoring the Sleep Laboratory for Chronic Respiratory Failure
“Many seemingly mundane aspects of the sleep laboratory can have outsized effects on the quality of polysomnographic data obtained from, and care provided to, patients. This is particularly true when performing polysomnography on patients with chronic respiratory failure due to various causes. Thi s article uses a disease-based approach to review physical and protocol-based accommodations that should be considered when performing polysomnography on this patient population.” (Source: Sleep Medicine Clinics)
Source: Sleep Medicine Clinics - October 5, 2020 Category: Sleep Medicine Authors: Justin A. Fiala, John M. Coleman Source Type: research

Extubating to Noninvasive Ventilation
Weaning to noninvasive ventilation in intensive care unit and bridging the patients to home with respiratory support is evolving as the technology of noninvasive ventilation is improving. In patients with chronic obstructive pulmonary disease exacerbation, timing of initiation of noninvasive ventilation is the key, as persistently hypercapnic patients show benefits. High-intensity pressure support seems to do better in comparison to low-intensity pressure support. In patients with obesity and hypercapnia, obesity hypoventilation cannot be ruled out especially in an inpatient setting, and it is crucial that these patients a...
Source: Sleep Medicine Clinics - October 5, 2020 Category: Sleep Medicine Authors: Ashima S. Sahni, Lien-Khuong Tran, Lisa Wolfe Source Type: research

Noninvasive Ventilation Downloads and Monitoring
“Home noninvasive ventilation (NIV) is indicated for numerous conditions including neuromuscular disease, thoracic cage disorders, chronic obstructive pulmonary disease, and hypoventilation syndromes. Effective management of patients on home NIV requires clinicians to interpret data downloads from NIV devices. Clinicians must first look at adherence and factors that may impact this including mask comfort and fit. Next, leak assessment is undertaken. Once these are addressed, such information as apnea-hypopnea index, exhaled tidal volume, and percent triggered breaths help clinicians troubles hoot setting changes. Fin...
Source: Sleep Medicine Clinics - October 5, 2020 Category: Sleep Medicine Authors: Philip Choi, Veronique Adam, David Zielinski Source Type: research

Phrenic Nerve Involvement in Neuralgic Amyotrophy (Parsonage-Turner Syndrome)
Neuralgic amyotrophy is a poorly understood neuromuscular disorder affecting peripheral nerves mostly within the brachial plexus distribution but can also involve other sites including the phrenic nerve. In the classic form of the syndrome it causes proximal upper limb and neck pain on the affected side with subsequent muscle weakness that can be highly heterogeneous. Nocturnal noninvasive ventilation support is a first-line treatment after phrenic mononeuropathy. The regular monitoring of diaphragm function with spirometry and diaphragm ultrasound can help determine prognosis and inform decision-making. (Source: Sleep Medicine Clinics)
Source: Sleep Medicine Clinics - October 4, 2020 Category: Sleep Medicine Authors: Ellen Farr, Dom D ’Andrea, Colin K. Franz Source Type: research

Lifetime Care of Duchenne Muscular Dystrophy
Individuals with Duchenne muscular dystrophy (DMD) have evolving sleep and respiratory pathophysiology over their lifetimes. Across the lifespan of DMD, various sleep-related breathing disorders (SRBD) have been described, including obstructive sleep apnea, central sleep apnea, and nocturnal hypoventilation. In addition to SRBD, individuals with DMD can be affected by insomnia, chronic pain and other factors interfering with sleep quality, and daytime somnolence. The natural progression of DMD pathophysiology has changed with the introduction of therapies for downstream pathologic pathways and will continue to evolve with ...
Source: Sleep Medicine Clinics - October 4, 2020 Category: Sleep Medicine Authors: Erin W. MacKintosh, Maida L. Chen, Joshua O. Benditt Source Type: research

Management of Rare Causes of Pediatric Chronic Respiratory Failure
This article reviews pediatric-specific considerations of NiPPV therapy. Indications for NiPPV therapy can be categorized by the cause of the respiratory failure: (1) upper airway obstruction, (2) musculoskeletal and/or neuromuscular disease, (3) lower respiratory tract diseases, and (4) control of breathing abnormalities. The role of NiPPV therapy in select rare conditions (spinal muscular atrophy, congenital central hypoventilation syndrome, cerebral palsy, scoliosis, and Chiari malformations) is also reviewed. (Source: Sleep Medicine Clinics)
Source: Sleep Medicine Clinics - September 29, 2020 Category: Sleep Medicine Authors: Jenny Shi, Nawal Al-Shamli, Jackie Chiang, Reshma Amin Source Type: research

Obesity Hypoventilation
Obesity hypoventilation syndrome is the most frequent cause of chronic hypoventilation and is increasingly more common with rising obesity rates. It leads to considerable morbidity and mortality, particularly when not recognized and treated adequately. Long-term nocturnal noninvasive ventilation is the mainstay of treatment but evidence suggests that CPAP may be effective in stable patients. Specific perioperative management is required to reduce complications. Some unique syndromes associated with obesity and hypoventilation include rapid-onset obesity with hypoventilation, hypothalamic, autonomic dysregulation (ROHHAD), ...
Source: Sleep Medicine Clinics - September 24, 2020 Category: Sleep Medicine Authors: Roop Kaw, Marta Kaminska Source Type: research

Noninvasive Ventilator Devices and Modes
Noninvasive ventilation has become an increasingly common treatment strategy for patients with diverse conditions involving chronic respiratory failure. An intimate understanding of various advanced respiratory devices and modes is essential in the management of these patients. Pressure-limited modes of ventilation are more commonly used than volume modes for noninvasive ventilation owing to enhanced patient comfort and synchrony with the ventilator, as well as improved leak compensation. Common pressure modes include spontaneous/timed and pressure control, with volume-assured pressure support being an additive feature ava...
Source: Sleep Medicine Clinics - September 24, 2020 Category: Sleep Medicine Authors: Gaurav Singh, Michelle Cao Source Type: research

Tracheostomy to Noninvasive Ventilation
The number of patients experiencing prolonged mechanical ventilation is increasing over time. Patients who have a tracheostomy placed in a critical care setting have been described as having an average of 4 separate transitions between the acute care setting, long-term acute care (LTAC), and home. Transition points can be problematic if not addressed adequately; however, proactive planning can optimize patient care. Individual patient factors will determine if the patient will require long-term tracheostomy, transitioned to noninvasive positive pressure ventilation, or able to be decannulated. Patients and caregivers shoul...
Source: Sleep Medicine Clinics - September 6, 2020 Category: Sleep Medicine Authors: Jeanette Brown Source Type: research

Telemedicine in Pediatric Sleep
This article reviews how telemedicine has been explored in pediatric sleep medicine prior to the pandemic, current applications of telemedicine, challenges, and reimagining pediatric sleep within the realm of telemedicine. (Source: Sleep Medicine Clinics)
Source: Sleep Medicine Clinics - September 1, 2020 Category: Sleep Medicine Authors: Shalini Paruthi Source Type: research

Contents
Shalini Paruthi (Source: Sleep Medicine Clinics)
Source: Sleep Medicine Clinics - August 31, 2020 Category: Sleep Medicine Source Type: research

Cover 1
(Source: Sleep Medicine Clinics)
Source: Sleep Medicine Clinics - August 31, 2020 Category: Sleep Medicine Source Type: research

Cover 4
(Source: Sleep Medicine Clinics)
Source: Sleep Medicine Clinics - August 31, 2020 Category: Sleep Medicine Source Type: research

Implementation of Synchronous Telemedicine into Clinical Practice
This article outlines how to implement a synchronous telemedicine practice into an existing workflow. Telemedicine-specific considerations are discussed, as well as guidance regarding practice assessment, financial feasibility, technical considerations, and clinical guidance to translate in-person visit skills into an effective virtual visit. (Source: Sleep Medicine Clinics)
Source: Sleep Medicine Clinics - August 4, 2020 Category: Sleep Medicine Authors: Seema Khosla Source Type: research

EHR Integration of PAP Devices in Sleep Medicine Implementation in the Clinical Setting
Positive airway pressure (PAP) therapy integration is a component of electronic health record (EHR) sleep medicine optimization. EHR optimization facilitates telehealth in continuous care population health. A coordinated care plan can leverage early telehealth interventions. (Source: Sleep Medicine Clinics)
Source: Sleep Medicine Clinics - August 4, 2020 Category: Sleep Medicine Authors: Tereza Cervenka, Conrad Iber Source Type: research

Telehealth in Sleep Medicine
SLEEP MEDICINE CLINICS (Source: Sleep Medicine Clinics)
Source: Sleep Medicine Clinics - August 4, 2020 Category: Sleep Medicine Authors: Dennis hwang, Jean-louis p épin Source Type: research

Copyright
ELSEVIER (Source: Sleep Medicine Clinics)
Source: Sleep Medicine Clinics - August 4, 2020 Category: Sleep Medicine Source Type: research

Forthcoming Issues
Noninvasive Ventilation and Sleep Medicine (Source: Sleep Medicine Clinics)
Source: Sleep Medicine Clinics - August 4, 2020 Category: Sleep Medicine Source Type: research

Contributors
TEOFILO LEE-CHIONG, Jr, MD (Source: Sleep Medicine Clinics)
Source: Sleep Medicine Clinics - August 4, 2020 Category: Sleep Medicine Source Type: research

Contents
Dennis Hwang and Jean-Louis P épin (Source: Sleep Medicine Clinics)
Source: Sleep Medicine Clinics - August 4, 2020 Category: Sleep Medicine Source Type: research

Sleep Telemedicine: A Template for Other Specialties?
On March 18, 2020, the doors to our sleep center were physically closed. As with so many other sleep centers worldwide in response to COVID-19, our service transitioned completely to virtual care while care providers were moved to “work from home.” It was perhaps that moment that we felt the emotional impact that the world had changed, altering both our personal lives and sleep medicine as we knew it. This event also presented a transformative opportunity to reimagine our identity, accelerating the efforts to bring the fu ture of sleep medicine into the present. (Source: Sleep Medicine Clinics)
Source: Sleep Medicine Clinics - July 20, 2020 Category: Sleep Medicine Authors: Jean-Louis P épin, Dennis Hwang Tags: Preface Source Type: research

The Impact of Telehealth on the Organization of the Health System and Integrated Care
Sleep medicine is a rapidly developing field of medicine that is well-suited to initiatives such as Telehealth to provide safe, effective clinical care to an expanding group of patients. The increasing prevalence of sleep disorders has resulted in long waiting lists and lack of specialist availability. Telemedicine has potential to facilitate a move toward an integrated care model, which involves professionals from different disciplines and different organizations working together in a team-oriented way toward a shared goal of delivering all of a person ’s care requirements. Issues around consumer health technology a...
Source: Sleep Medicine Clinics - July 12, 2020 Category: Sleep Medicine Authors: Cliona O ’Donnell, Silke Ryan, Walter T. McNicholas Source Type: research

Telehealth, Telemedicine, and Obstructive Sleep Apnea
Obstructive sleep apnea (OSA) telehealth management may improve initial and chronic care access, time to diagnosis and treatment, between-visit care, e-communications and e-education, workflows, costs, and therapy outcomes. OSA telehealth options may be used to replace or supplement none, some, or all steps in the evaluation, testing, treatments, and management of OSA. All telehealth steps must adhere to OSA guidelines. OSA telehealth may be adapted for continuous positive airway pressure (CPAP) and non-CPAP treatments. E-data collection enhances uses for individual and group analytics, phenotyping, testing and treatment s...
Source: Sleep Medicine Clinics - July 9, 2020 Category: Sleep Medicine Authors: Sharon Schutte-Rodin Source Type: research

Impact of Telehealth on Health Economics
As part of an efficient, continuously improving care delivery system, telehealth can increase patient engagement by creating new or additional ways of communicating with patients ’ physicians. Telehealth has the potential to increase patient and primary care provider access to specialists, provide specialist support to rural providers, assist with on-going monitoring and support for patients with chronic conditions, and reduce health care expenses by maximizing the use of specialists without the need to duplicate coverage in multiple locations. Current and future physicians will need to develop competencies that will...
Source: Sleep Medicine Clinics - July 8, 2020 Category: Sleep Medicine Authors: Burton N. Melius, Walter D. Conwell Source Type: research

Current and Future Roles of Consumer Sleep Technologies in Sleep Medicine
Consumer sleep technologies have rapidly evolved from wrist-worn activity trackers to multisensory products. These technologies reflect a widespread interest in sleep health, and their ubiquitous ownership allows for remote sleep monitoring. Therefore, these technologies may play a valuable role in telemedicine. However, clinical usefulness remains contested and is limited by a lack of transparency in data acquisition and analysis, and uncertain accuracy of consumer sleep technology-derived sleep metrics. Collaboration between manufacturers, sleep scientists, and clinical sleep medicine teams is required to produce useable...
Source: Sleep Medicine Clinics - July 7, 2020 Category: Sleep Medicine Authors: Cathy Goldstein Source Type: research

Regulatory, Legal, and Ethical Considerations of Telemedicine
Sleep telemedicine practitioners must ensure their practice complies with all applicable institutional, state, and federal regulations. Providers must be licensed in any state in which they provide care, have undergone credentialing and privileging procedures at outside facilities, and avoid real or perceived conflicts of interest while providing that care. Internet-based prescribing remains limited to certain circumstances. Whether or not a malpractice insurance policy covers telemedicine depends on the insurer, especially if interstate care is provided. All telemedicine programs must protect patient health information. S...
Source: Sleep Medicine Clinics - July 6, 2020 Category: Sleep Medicine Authors: Barry G. Fields Source Type: research

Telemedicine and the Management of Insomnia
Insomnia is a significant public health concern. Cognitive behavioral therapy for insomnia (CBT-i) is considered first-line treatment. The use of telemedicine for CBT-i allows for increased access to providers for patients who are geographically remote as well as to self-directed CBT-i modalities that do not require the involvement of a therapist. Tele-CBT-i modalities include video conferencing with a CBT-i therapist in an individual or group setting or use of Web or mobile application-based CBT-i modules with varying levels of support from a therapist. Multiple studies and meta-analyses support the efficacy of tele-CBT-i...
Source: Sleep Medicine Clinics - July 2, 2020 Category: Sleep Medicine Authors: Caleb Hsieh, Talayeh Rezayat, Michelle R. Zeidler Source Type: research

Overview of Telemedicine and Sleep Disorders
Telemedicine is about more than simply using audio-visual technology to care for patients, but rather an opportunity to fundamentally improve patient access, quality, efficiencies, and experience. Regarding sleep medicine, it has the potential to drive sleep medicine ’s evolution. By enabling care across geographies and facilitating population-based management, sleep medicine is poised to take advantage of telemedicine capabilities. In this introductory chapter, we highlight issues related to sleep telemedicine, while providing a framework in which to approach this transformational journey thoughtfully. We thereby se...
Source: Sleep Medicine Clinics - July 1, 2020 Category: Sleep Medicine Authors: Jaspal Singh, Nikky Keer Source Type: research

Telemedicine Coding and Reimbursement - Current and Future Trends
Innovation in technology is redefining the world, including health care. Patients want convenient and quality interactions with their providers. The addition of telemedicine technologies and asynchronous provider-to-patient communications is creating a more connected model of health care that will improve access and the value of care while decreasing costs, as well as enabling patients to participate more directly in their own care. As new technologies and new models of care continue to emerge, providers need to continue to monitor the rapidly changing landscape of telemedicine coding and reimbursement. Telehealth coding a...
Source: Sleep Medicine Clinics - July 1, 2020 Category: Sleep Medicine Authors: Fariha Abbasi-Feinberg Source Type: research

Internet-Delivered Cognitive Behavioral Therapy for Insomnia
Chronic insomnia is preferably treated with cognitive behavioral therapy for insomnia (CBTI), but many insomnia sufferers receive medication instead, likely because of high costs, lack of knowledge about optimal insomnia treatment among physicians, and lack of CBTI-trained professionals in mental health care. A possible solution is to offer CBTI through the Internet: I-CBTI. I-CBTI is generally acceptable to patients and greatly improves insomnia symptoms. We review the state of knowledge around I-CBTI and its effects. CBTI ’s effectiveness is influenced by treatment characteristics and patient-specific factors. We r...
Source: Sleep Medicine Clinics - May 6, 2020 Category: Sleep Medicine Authors: Tanja van der Zweerde, Jaap Lancee, Annemarie Ida Luik, Annemieke van Straten Source Type: research

Prescription Drugs Used in Insomnia
The scope of this article is to review the effects on sleep of prescription drugs that are commonly prescribed for chronic insomnia in adults. The following groups are discussed: benzodiazepines and its receptor agonists, the dual orexin receptor antagonist suvorexant, melatonin and its receptor agonists, sedating antidepressants, and antipsychotics. Together with the neurobiologic and pharmacologic properties of these drugs, clinical effects are described, including subjective and objective effects on sleep duration, continuity, and architecture. Medical prescription information is given when available. Recently published...
Source: Sleep Medicine Clinics - May 6, 2020 Category: Sleep Medicine Authors: Sylvie Dujardin, Angelique Pijpers, Dirk Pevernagie Source Type: research

Hypnotic Discontinuation in Chronic Insomnia
Patients with chronic insomnia are commonly prescribed hypnotic medications. The long-term effects of chronic hypnotics are not known and discontinuation is encouraged but often difficult to achieve. A gradual taper is preferred to abrupt cessation to avoid rebound insomnia and withdrawal symptoms. Written information provided to the patient about medication discontinuation may be helpful. Cognitive behavioral therapy or behavioral therapies alone can improve hypnotic discontinuation outcomes. There is limited evidence for adjunct medications to assist in hypnotic cessation for insomnia. (Source: Sleep Medicine Clinics)
Source: Sleep Medicine Clinics - May 6, 2020 Category: Sleep Medicine Authors: Jonathan P. Hintze, Jack D. Edinger Source Type: research

Evaluation of the Sleepy Patient
Excessive daytime sleepiness is defined as the inability to maintain wakefulness during waking hours, resulting in unintended lapses into sleep. It is important to distinguish sleepiness from fatigue. The evaluation of a sleep patient begins with a careful clinical assessment that includes a detailed sleep history, medical and psychiatric history, a review of medications, as well as a social and family history. Physical examination should include a general medical examination with careful attention to the upper airway and the neurologic examination. Appropriate objective testing with a polysomnogram and a multiple sleep la...
Source: Sleep Medicine Clinics - May 6, 2020 Category: Sleep Medicine Authors: Renee Monderer, Imran M. Ahmed, Michael Thorpy Source Type: research

Subjective and Objective Assessment of Hypersomnolence
This article describes clinical approaches to assessing sleepiness. Subjective sleep scales are used in clinical settings but have significant limitations. Likewise, objective tools may have prohibitive expense, and practical administration considerations may prohibit regular use. Gold standard tests include the multiple sleep latency test and maintenance of wakefulness test. These studies are criticized for a variety of reasons but are useful in appropriate clinical context. New tools suggest novel ways to assess sleepiness and will likely be more prominent in clinical assessments over time. This article outlines subjecti...
Source: Sleep Medicine Clinics - May 6, 2020 Category: Sleep Medicine Authors: Brian James Murray Source Type: research

Pharmacologic Management of Excessive Daytime Sleepiness
Excessive daytime sleepiness (EDS) is related to medical and social problems, including mental disorders, physical diseases, poor quality of life, and so forth. According to the International Classification of Sleep Disorders, Third Edition, diseases that result from EDS are narcolepsy type 1, narcolepsy type 2, idiopathic hypersomnia, hypersomnia due to a medical disorder, and others. EDS is usually treated using amphetamine-like central nervous system stimulants or modafinil and its R-enantiomer, armodafinil, wake-promoting compounds unrelated to amphetamines; a variety of new drugs are under development. The side effect...
Source: Sleep Medicine Clinics - May 6, 2020 Category: Sleep Medicine Authors: Shinichi Takenoshita, Seiji Nishino Source Type: research

Treatment of Obstructive Sleep Apnea
Positive airway pressure (PAP) remains primary therapy for most patients with obstructive sleep apnea (OSA). CPAP, APAP, and BPAP are all reasonable therapies that can be used for patients with uncomplicated OSA across the spectrum of disease severity. BPAP should be considered for patients who are nonadherent to CPAP or APAP therapy because of pressure intolerance. Several additional factors should be considered when choosing the type of PAP device for a given patient, including associated symptoms and comorbid medical problems, cost, access to online data management and patient portals, and the portability for the device...
Source: Sleep Medicine Clinics - May 6, 2020 Category: Sleep Medicine Authors: Neil Freedman Source Type: research

Treatment of Obstructive Sleep Apnea
Patient interface preference is a key factor in positive airway pressure compliance. Local side effects are common. Proper mask fitting and patient education are important. Masks should seal well and fit comfortably. Nasal, nasal pillow, and oronasal masks can be effective interfaces. Most patients with obstructive sleep apnea prefer a nasal mask. Oronasal masks can be a useful alternative. Nasal pillows can reduce mask size and improve comfort. Oronasal masks may require a higher pressure. A significantly lower pressure may be effective with a nasal interface. Proper mask fitting requires testing the mask seal under the t...
Source: Sleep Medicine Clinics - May 6, 2020 Category: Sleep Medicine Authors: Marie Nguyen Dibra, Richard Barnett Berry, Mary H. Wagner Source Type: research

Treatment of Obstructive Sleep Apnea
Obstructive sleep apnea is a common and treatable condition, but therapeutic adherence is limited by numerous factors. Despite advances in positive airway pressure (PAP) technology and a multitude of effective pharmacologic and behavioral therapeutic interventions to overcome the most common barriers to PAP, adherence has not increased significantly over the past 30  years. This review aims to identify the most important factors that impact adherence, common barriers to treatment, and evidence-based treatment strategies to maximize the effectiveness of PAP treatment. Complications of PAP treatment and mitigation techn...
Source: Sleep Medicine Clinics - May 6, 2020 Category: Sleep Medicine Authors: Christopher J. Lettieri, Scott G. Williams, Jacob F. Collen, Emerson M. Wickwire Source Type: research

Oral Appliances in the Management of Obstructive Sleep Apnea
Obstructive sleep apnea (OSA) is a multifactorial condition, and an interdisciplinary approach to diagnosis forms the basis for effective treatment planning. Craniofacial structure and attached soft tissues and muscles play a central role in OSA. Evidence-based studies demonstrate the effectiveness of oral appliances for mandibular advancement and tongue stabilization in managing OSA, and current clinical standards of practice recommend the use of oral appliances to treat OSA when patients cannot tolerate continuous positive airway pressure (CPAP). Although effective, oral appliances are less predictable in managing OSA co...
Source: Sleep Medicine Clinics - May 6, 2020 Category: Sleep Medicine Authors: Jing Hao Ng, Mimi Yow Source Type: research

Avoiding and Managing Oral Appliance Therapy Side Effects
There is a serious need to consider all potential side effects thoughtfully before commencing individual treatment with oral appliance therapy. Although many of these side effects are self-limiting, easily corrected, or innocuous, others are difficult or impossible to correct and can affect the patient in serious ways. As this field evolves, new information is discovered, and new products are introduced at a rather rapid pace, continuing education and prudent practice are critical to ethical care in the practice of dental sleep medicine. (Source: Sleep Medicine Clinics)
Source: Sleep Medicine Clinics - May 6, 2020 Category: Sleep Medicine Authors: Thomas G. Schell Source Type: research

Positional Therapy for Positional Obstructive Sleep Apnea
Positional therapy appears to be an attractive strategy for many patients with positional obstructive sleep apnea (OSA). However, under the American Academy of Sleep Medicine OSA guidelines, positional therapy is considered as only an alternative therapy, because previous research has demonstrated poor treatment tolerance and adherence. Recent technological advances have renewed interest in positional therapy, with the invention of new sophisticated vibratory positional therapy devices. These devices have shown great promise with efficacy, markedly improved patient tolerance, and long-term adherence. We review the literatu...
Source: Sleep Medicine Clinics - May 6, 2020 Category: Sleep Medicine Authors: Mok Yingjuan, Wong Hang Siang, Tan Kah Leong Alvin, Hsu Pon Poh Source Type: research

Pharmacologic and Nonpharmacologic Treatment of Restless Legs Syndrome
This article provides an updated practical guide for the treatment of primary restless legs syndrome (RLS). Articles that appeared after the American Academy of Neurology guideline search were reviewed according to the same evidence rating schedule. We found limited evidence for nonpharmacologic treatment options. In moderate to severe primary RLS, pharmacologic options may be considered, including iron suppletion, an α2δ ligand, a dopamine agonist, a combination of an α2δ ligand and a dopamine agonist, or oxycodone/naloxone. This article includes treatment options in case of augmentation. (Source: ...
Source: Sleep Medicine Clinics - May 6, 2020 Category: Sleep Medicine Authors: Galia V. Anguelova, Monique H.M. Vlak, Arthur G.Y. Kurvers, Roselyne M. Rijsman Source Type: research

Drugs Used in Parasomnia
Patient education and behavioral management represent the first treatment approaches to the patient with parasomnia, especially in case of disorders of arousal (DOA). A pharmacologic treatment of DOA may be useful when episodes are frequent and persist despite resolution of predisposing factors, are associated with a high risk of injury, or cause significant impairment, such as excessive sleepiness. Approved drugs for DOA are still lacking. The most commonly used medications are benzodiazepines and antidepressants. The pharmacologic treatment of rapid eye movement sleep behavior disorder is symptomatic, and the most common...
Source: Sleep Medicine Clinics - May 6, 2020 Category: Sleep Medicine Authors: Paola Proserpio, Michele Terzaghi, Raffaele Manni, Lino Nobili Source Type: research

Drugs Used in Circadian Sleep-Wake Rhythm Disturbances
This article focuses on melatonin and other melatonin receptor agonists, and specifically their circadian phase shifting and sleep-enhancing properties. The circadian system and circadian rhythm sleep-wake disorders are briefly reviewed, followed by a summary of the circadian phase shifting, sleep-enhancing properties, and possible safety concerns associated with melatonin and other melatonin receptor agonists. The recommended use of melatonin, including dose and timing, in the latest American Academy of Sleep Medicine Clinical Practice Guidelines for the treatment of intrinsic circadian rhythm disorders is also reviewed. ...
Source: Sleep Medicine Clinics - May 6, 2020 Category: Sleep Medicine Authors: Helen J. Burgess, Jonathan S. Emens Source Type: research

Sleep in the Aging Population
There are normal changes to sleep architecture throughout the lifespan. There is not, however, a decreased need for sleep and sleep disturbance is not an inherent part of the aging process. Sleep disturbance is common in older adults because aging is associated with an increasing prevalence of multimorbidity, polypharmacy, psychosocial factors affecting sleep, and certain primary sleep disorders. It is also associated with morbidity and mortality. Because many older adults have several factors from different domains affecting their sleep, these complaints are best approached as a multifactorial geriatric health condition, ...
Source: Sleep Medicine Clinics - May 6, 2020 Category: Sleep Medicine Authors: Brienne Miner, Meir H. Kryger Source Type: research

Sleep, Health, and Society
This article outlines some of these downstream factors, including cardiovascular and metabolic disease risk, neurocognitive dysfunction, and mortality, as well as societal factors such as age, sex, race/ethnicity, and socioeconomics. This review also discusses societal factors related to sleep, such as globalization, health disparities, public policy, public safety, and changing patterns of use of technology. (Source: Sleep Medicine Clinics)
Source: Sleep Medicine Clinics - May 6, 2020 Category: Sleep Medicine Authors: Michael A. Grandner Source Type: research

Nonpharmacologic Management of Excessive Daytime Sleepiness
Unlike other reviews written on this topic, the focus of this article is primarily on nonpharmacologic treatments for daytime sleepiness that is not secondary to other medical or psychological conditions. To provide an appropriate background on primary excessive daytime sleepiness, what is considered optimal sleep in terms of sleep duration, sleep insufficiency, and sleep need is discussed in detail. This discussion is followed by an examination of the behavioral strategy of banking sleep. After briefly discussing behavioral interventions for sleepiness associated with narcolepsy, a new behavioral method of treating daytim...
Source: Sleep Medicine Clinics - May 6, 2020 Category: Sleep Medicine Authors: Matthew R. Ebben Source Type: research

Essentials of Sleep Medicine for the Primary Care Provider
SLEEP MEDICINE CLINICS (Source: Sleep Medicine Clinics)
Source: Sleep Medicine Clinics - May 6, 2020 Category: Sleep Medicine Authors: Teofilo Lee-Chiong Source Type: research