Transcranial Magnetic Stimulation
The aim of this article is to introduce transcranial magnetic stimulation (TMS) to dental practitioners and to explain its use in obstructive sleep apnea (OSA) and sleep bruxism (SB). In these 2 sleep disorders, TMS has proven to be a useful tool to explore pathophysiological pathways and disease mechanisms, and in a more limited way, to recruit upper airway muscles in OSA and reduce muscle activity and pain intensity in SB. Although promising, research using TMS in these conditions is still very limited and future investigations should be conducted before its clinical application can be considered. (Source: Sleep Medicine Clinics)
Source: Sleep Medicine Clinics - September 26, 2018 Category: Sleep Medicine Authors: Herrero Babiloni A, Louis De Beaumont, Gilles J. Lavigne Source Type: research
Pediatric Considerations for Dental Sleep Medicine
Pediatric obstructive sleep apnea (OSA) is a serious medical condition with numerous health consequences. Dentists are well suited to recognize and provide medical referrals for pediatric patients at risk for OSA. Timely dental sleep medicine interventions may improve signs and symptoms of OSA in growing children. Orthodontic and dentofacial orthopedic treatment may decrease obstructive respiratory events in some pediatric patients. Palatal expansion may be part of a comprehensive orthodontic treatment plan to correct a malocclusion and treat OSA. Orthognathic surgery, mandibular advancement devices, and oropharyngeal exer...
Source: Sleep Medicine Clinics - September 26, 2018 Category: Sleep Medicine Authors: Thomas R. Stark, Manuel Pozo-Alonso, Raj Daniels, Macario Camacho Source Type: research
Clinical Evaluation for Oral Appliance Therapy
This article outlines the steps dentists must take before treating obstructive sleep apnea patients with oral appliance therapy. It describes a proper clinical examination, the appropriate appliance for specific cases, patient discussion points, and the necessary history and consent forms. (Source: Sleep Medicine Clinics)
Source: Sleep Medicine Clinics - September 26, 2018 Category: Sleep Medicine Authors: Cameron A. Kuehne Source Type: research
Beyond Blowing: Oral Appliance Therapy, Surgery, and Transcranial Magnetic Stimulation
It has been my pleasure to act as editor of this issue of Sleep Medicine Clinics. (Source: Sleep Medicine Clinics)
Source: Sleep Medicine Clinics - September 25, 2018 Category: Sleep Medicine Authors: Jamison R. Spencer Tags: Preface 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 - September 18, 2018 Category: Sleep Medicine Authors: Thomas G. Schell Source Type: research
Oral Appliance Therapy and Temporomandibular Disorders
This article focuses on clinical examination to assist in maintaining stable function between jaw posture, muscle function, and temporomandibular joint stability. It describes a simple and understandable approach for assessment and management of common temporomandibular symptoms arising as side effects from use of mandibular advancement device therapy for obstructive sleep apnea. Follow-up visits are necessary to assess efficacy of sleep oral devices. An interdisciplinary approach is necessary for better treatment outcome. Qualified dentists offering this therapy should be educated and gain knowledge about diagnosis, preve...
Source: Sleep Medicine Clinics - September 18, 2018 Category: Sleep Medicine Authors: Noshir R. Mehta, Leopoldo P. Correa Source Type: research
Menstrual Cycle Effects on Sleep
Subjective and objective sleep changes occur during the menstrual cycle. Poorer sleep quality in the premenstrual phase and menstruation is common in women with premenstrual symptoms or painful menstrual cramps. There is increased sleep spindle activity from follicular to luteal phase, potentially progesterone related. Luteal phase changes also include blunted temperature rhythm amplitude and reduced rapid eye movement sleep. Women with polycystic ovary syndrome should be screened for sleep disordered breathing. Short sleep duration is associated with irregular menstrual cycles, which may impact reproductive health. Menstr...
Source: Sleep Medicine Clinics - August 9, 2018 Category: Sleep Medicine Authors: Fiona C. Baker, Kathryn Aldrich Lee Source Type: research
Impact of Shift Work on the Circadian Timing System and Health in Women
Women who do shift work are a sizable part of the workforce. Shift workers experience circadian misalignment due to shifted sleep periods, with potentially far-reaching health consequences, including elevated risk of sleep disturbances, metabolic disorders, and cancer. This review provides an overview of the circadian timing system and presents the sex differences that can be observed in the functioning of this system, which may account for the lower tolerance to shift work for women compared with men. Recent epidemiologic findings on female-specific health consequences of shift work are discussed. (Source: Sleep Medicine Clinics)
Source: Sleep Medicine Clinics - August 9, 2018 Category: Sleep Medicine Authors: Laura Kervezee, Ari Shechter, Diane B. Boivin Source Type: research
Sleep Health in Pregnancy
Using scoping review methodology, this article investigates the literature on sleep duration, continuity/efficiency, timing, daytime sleepiness/alertness, and perceived sleep quality in each trimester of a healthy pregnancy. Data suggest significant variability in sleep between women, with less evidence to support major changes in sleep health across trimesters. There is a need for further research on this topic to better inform women and their health providers. (Source: Sleep Medicine Clinics)
Source: Sleep Medicine Clinics - August 9, 2018 Category: Sleep Medicine Authors: Clare Ladyman, T. Leigh Signal Source Type: research
Sleep-Disordered Breathing in Pregnancy
Sleep-disordered breathing (SDB) in pregnancy can present as snoring and/or obstructive sleep apnea (OSA), and the prevalence is increasing due to the increase in maternal obesity. Pregnant women often present with fatigue and daytime sleepiness rather than the classic symptoms. Habitual snoring, older age, chronic hypertension, and high prepregnancy body mass index are reliable indicators of increased risk for SDB and should trigger further testing. The gold standard for diagnosis of OSA is an overnight laboratory polysomnography. Although there are no studies linking SDB to poor fetal outcomes, fetal well-being remains p...
Source: Sleep Medicine Clinics - August 9, 2018 Category: Sleep Medicine Authors: Lakshmy Ayyar, Fidaa Shaib, Kalpalatha Guntupalli Source Type: research
The Role of Circadian Rhythms in Postpartum Sleep and Mood
Women often experience sleep disturbances and worsening sleep quality throughout pregnancy and postpartum. Circadian rhythms are closely linked to sleep problems and mood disorders. This systematic review provides a summary of studies of circadian rhythms and associated sleep problems and maternal distress, among postpartum women. Articles were idenitfied through a systematic literature search. Circadian rhythm disturbances were strongly correlated with depression, social factors and mothers`s exposure to light postpartum. Future research should include larger, prospective studies as well as randomized controlled trials fo...
Source: Sleep Medicine Clinics - August 9, 2018 Category: Sleep Medicine Authors: Kari Grethe Hjorthaug Gallaher, Anastasiya Slyepchenko, Benicio N. Frey, Kristin Urstad, Signe K. D ørheim Source Type: research
Effects of Exercise on Sleep in Women with Breast Cancer
This article describes the scope and quality of evidence related to exercise interventions to improve sleep in women with breast cancer. Fifteen studies met the criteria and 12 were judged to be excellent quality. The most frequent intervention was walking, primarily during the time of chemotherapy. Eleven studies reported postintervention improvement in sleep deficiency. Most yoga, qigong, and dance intervention studies reported no differences between groups. Emerging evidence exists for the effectiveness of aerobic exercise to improve various sleep outcomes in women with breast cancer. (Source: Sleep Medicine Clinics)
Source: Sleep Medicine Clinics - August 9, 2018 Category: Sleep Medicine Authors: Ellyn E. Matthews, Dalton W. Janssen, Dilorom M. Djalilova, Ann M. Berger Source Type: research
Sleep in Women with Chronic Pain and Autoimmune Conditions
Chronic pain and sleep disturbances are intricately intertwined. This narrative review provides comments on observations related to pain, stress-immunity, and sleep. Sleep evidence is reviewed from studies of select conditions involving pain (ie, functional somatic syndromes and autoimmune) that are predominant in women. Chronic pain and poor sleep encompass persistent stress-immune activation with systemic inflammation, cellular oxidative stress, and sick behavior indicators that increase morbidity and threaten quality of life. In painful conditions, sleep impairments are nearly ubiquitous, and exaggerated combined effect...
Source: Sleep Medicine Clinics - August 9, 2018 Category: Sleep Medicine Authors: Joan L. Shaver, Stella Iacovides Source Type: research
Sleep and Sleep Disorders in the Menopausal Transition
The menopausal transition is associated with an increase in insomnia symptoms, especially difficulty staying asleep, which negatively impacts quality of life. Vasomotor symptoms are a key component of sleep disruption. Findings from polysomnographic studies are less consistent in showing disrupted sleep in menopausal transition independent of aging; further prospective studies are needed. Hormone therapy alleviates subjective sleep disturbances, particularly if vasomotor symptoms are present. However, because of contraindications, other options should be considered. Further work is needed to develop preventive and treatmen...
Source: Sleep Medicine Clinics - August 9, 2018 Category: Sleep Medicine Authors: Fiona C. Baker, Laura Lampio, Tarja Saaresranta, P äivi Polo-Kantola Source Type: research
Impact of Poor Sleep on Physical and Mental Health in Older Women
Many aspects of sleep and circadian rhythms change as people age. Older adults usually experience decrease in sleep duration and efficiency, increase in sleep latency and fragmentation, high prevalence of sleep disorders, and weakened rest –activity rhythms. Research evidence suggests that women are more likely to report aging-related sleep problems. This review presents epidemiologic and clinical evidence on the relationships between sleep deficiency and physical and mental outcomes in older women, explores potential mechanisms und erlying such relationships, points out gaps in the literature that warrant future inv...
Source: Sleep Medicine Clinics - August 9, 2018 Category: Sleep Medicine Authors: Katie L. Stone, Qian Xiao Source Type: research
Management Strategies for Restless Legs Syndrome/Willis-Ekbom Disease During Pregnancy
This article summarizes the main treatment options recommended by the consensus clinical guidelines of the International Restless Legs Syndrome Study Group and provides a short guide to the management of restless leg syndrome during pregnancy in clinical practice. (Source: Sleep Medicine Clinics)
Source: Sleep Medicine Clinics - August 9, 2018 Category: Sleep Medicine Authors: Corrado Garbazza, Mauro Manconi Source Type: research
Sleep Issues in Women's Health
SLEEP MEDICINE CLINICS (Source: Sleep Medicine Clinics)
Source: Sleep Medicine Clinics - August 9, 2018 Category: Sleep Medicine Authors: Kathryn Aldrich Lee, Fiona C. Baker Source Type: research
Sleep and Women ’s Health Across the Lifespan
In women, sleep interacts with reproductive health, and sleep disorders can emerge within the context of reproductive stages. Substantial research has occurred since the last Sleep Medicine Clinics issue about sleep in women, guest edited by Dr Helen Driver in 2008.1 However, evident from the reviews in this current issue, the field of sleep and women’s health remains an active and complex area with many unanswered questions. We are pleased to offer this broad series of reviews, showing fundamental relationships between sleep and repro ductive stages, as well as emerging knowledge about women’s sleep in s...
Source: Sleep Medicine Clinics - July 3, 2018 Category: Sleep Medicine Authors: Kathryn Aldrich Lee, Fiona C. Baker Tags: Preface Source Type: research
Impact of Traumatic Stress on Sleep and Management Options in Women
After exposure to traumatic stress, women are at greater risk than men for developing symptoms of some psychiatric disorders, including insomnia and nightmares. Sleep disturbance is one of the most refractory symptoms of posttraumatic stress disorder. Women were included in a few studies that examined efficacy of psychological or pharmacologic interventions for trauma-related sleep disturbances. Studies demonstrated preliminary evidence for efficacy of cognitive behavioral therapy for insomnia, imagery rehearsal therapy, and combinations of these techniques in treating insomnia and nightmares in trauma-exposed women. Prazo...
Source: Sleep Medicine Clinics - June 27, 2018 Category: Sleep Medicine Authors: Ihori Kobayashi, Mary Katherine Howell Source Type: research
Sleep Disorders in Women Veterans
Sleep disorders are common among women veterans and contribute to poor functioning and quality of life. Studies show that women veterans are particularly prone to insomnia, sleep-disordered breathing, and insufficient sleep. Standard cognitive behavioral therapy for insomnia (CBT-I) should be viewed as first-line therapy for insomnia disorder, and women veterans should be screened and treated for sleep-disordered breathing. Behavioral and lifestyle factors contributing to insufficient sleep should also be addressed. Challenges exist in diagnosing and treating sleep disorders in women veterans, in part because of high rates...
Source: Sleep Medicine Clinics - June 27, 2018 Category: Sleep Medicine Authors: Jennifer L. Martin, M. Safwan Badr, Salam Zeineddine Source Type: research
Pharmacologic Treatment of Sleep Disorders in Pregnancy
Pregnancy often predisposes women to new-onset sleep disturbances, as well as exacerbations of preexisting sleep disorders. The goals of treating perinatal sleep disorders include the promotion of restorative sleep and the benefits it brings to both mother and fetus. The prescribing of any sleep aid in pregnancy must include consideration of the risks and benefits for both the patient and her fetus. Although data on the perinatal use of sleep aids is limited, there may be effects on fetal development, timing and duration of delivery, and postnatal outcomes. (Source: Sleep Medicine Clinics)
Source: Sleep Medicine Clinics - May 12, 2018 Category: Sleep Medicine Authors: Laura P. McLafferty, Meredith Spada, Priya Gopalan 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 12, 2018 Category: Sleep Medicine Authors: Galia V. Anguelova, Monique H.M. Vlak, Arthur G.Y. Kurvers, Roselyne M. Rijsman 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 12, 2018 Category: Sleep Medicine Authors: Helen J. Burgess, Jonathan S. Emens Source Type: research
Sleep-Related Drug Therapy in Special Conditions: Children
Sleep disorders in children may lead to neurodevelopmental and neurocognitive deficits; it is important to diagnose and treat them properly. Apart from the existing challenges in diagnosis, another drawback is that few therapies are currently approved. In this article, a comprehensive summary of the most common pediatric sleep disorders, along with the various pharmacologic and nonpharmacologic approaches for their management, is presented. Special attention has been paid to the currently available treatment options for pediatric insomnia, obstructive sleep apnea, parasomnias, narcolepsy, and restless legs syndrome, and co...
Source: Sleep Medicine Clinics - May 12, 2018 Category: Sleep Medicine Authors: Nicholas-Tiberio Economou, Luigi Ferini-Strambi, Paschalis Steiropoulos 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 12, 2018 Category: Sleep Medicine Authors: Jonathan P. Hintze, Jack D. Edinger Source Type: research
Drugs Used in Narcolepsy and Other Hypersomnias
Narcolepsy and idiopathic hypersomnia cannot be cured; all available treatments are symptomatic. It is of paramount importance for patients, and their relatives, to be informed about the consequences of these chronic diseases and to become ready to accept the consequences of the diagnosis before starting any treatment. This facilitates the implementation of behavioral modifications and the proper use of medication to decrease the disease burden. A supportive social environment (eg, family members, friends, employer, colleagues, and patient support groups) is instrumental. Current treatment options are discussed with a focu...
Source: Sleep Medicine Clinics - May 12, 2018 Category: Sleep Medicine Authors: Gert Jan Lammers 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 12, 2018 Category: Sleep Medicine Authors: Sylvie Dujardin, Angelique Pijpers, Dirk Pevernagie Source Type: research
The regulated alternations between wakefulness and sleep states reflect complex behavioral processes, orchestrated by distinct neurochemical changes in brain parenchyma. No single neurotransmitter or neuromodulator controls the sleep-wake states in isolation. Rather, fine-tuned interactions within organized neuronal circuits regulate waking and sleep states and drive their transitions. Structural or functional dysregulation and medications interfering with these ensembles can lead to sleep-wake disorders and exert wanted or unwanted pharmacological actions on sleep-wake states. Knowledge of the neurochemical bases of sleep...
Source: Sleep Medicine Clinics - May 12, 2018 Category: Sleep Medicine Authors: Sebastian C. Holst, Hans-Peter Landolt Source Type: research
Drug-Induced Sleep-Disordered Breathing and Ventilatory Impairment
This article describes current knowledge about drug entities that have the potential to induce, aggravate, or modify sleep-disordered breathing. The drug effects on sleep-disordered breathing may vary by patient age, gender, and comorbidity. In general, the clinical relevance of drug-induced sleep-disordered breathing is increasing in sleep medicine and the evidence in the field is growing in parallel. (Source: Sleep Medicine Clinics)
Source: Sleep Medicine Clinics - May 12, 2018 Category: Sleep Medicine Authors: Ludger Grote Source Type: research
Drug Therapy in Obstructive Sleep Apnea
There are several reasons to develop a pharmacologic remedy in obstructive sleep apnea (OSA); but so far, there is no generally effective drug available. Previous attempts to find a drug in OSA therapy were serendipity driven in small pilot trials. There is growing literature on phenotyping pathophysiologic mechanisms of OSA that may be exploited in strategic drug development programs. The current review addresses potential pitfalls encountered in previous studies and highlights several drug candidates under development in the field. (Source: Sleep Medicine Clinics)
Source: Sleep Medicine Clinics - May 12, 2018 Category: Sleep Medicine Authors: Jan Hedner, Ding Zou Source Type: research
Medications and Their Effects on Sleep and Wake
SLEEP MEDICINE CLINICS (Source: Sleep Medicine Clinics)
Source: Sleep Medicine Clinics - May 12, 2018 Category: Sleep Medicine Authors: Johan Verbraecken, Jan Hedner Source Type: research
Drug-Induced Insomnia and Excessive Sleepiness
Psychotropic and nonpsychotropic drugs, which may induce or aggravate insomnia and/or daytime sleepiness, are discussed. These central nervous system effects are possible from the interactions of a drug with any of the many neurotransmitters or receptors that are involved in sleep and wakefulness. Multiple interactions between disease, sleep, comorbid sleep disorders, and direct or indirect influences of pharmacologic agents are possible. Awareness of these effects is important to adapt treatment and reach optimal results for every patient. Besides the importance for health and quality of life, effects on sleep or waking f...
Source: Sleep Medicine Clinics - March 28, 2018 Category: Sleep Medicine Authors: Ann Van Gastel Source Type: research
Medications and Their Effects on Sleep and Wake
Welcome to this issue of Sleep Medicine Clinics, which is dedicated to the topic of medications and their effects on sleep/wake mechanisms. This is a comprehensive overview of current drug therapy in different sleep disorders and of the complex relationship between drugs and sleep-wake. (Source: Sleep Medicine Clinics)
Source: Sleep Medicine Clinics - March 26, 2018 Category: Sleep Medicine Authors: Johan Verbraecken, Jan Hedner Tags: Preface 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 - March 16, 2018 Category: Sleep Medicine Authors: Paola Proserpio, Michele Terzaghi, Raffaele Manni, Lino Nobili Source Type: research
Effects of Chronic Opioid Use on Sleep and Wake
Chronic use of opioids negatively affects sleep on 2 levels: sleep architecture and breathing. Patients suffer from a variety of daytime sequelae. There may be a bidirectional relationship between poor sleep quality, sleep-disordered breathing, and daytime function. Opioids are a potential cause of incident depression. The best therapeutic option is withdrawal of opioids, which proves difficult. Positive airway pressure devices are considered first-line treatment for sleep-related breathing disorders. New generation positive pressure servo ventilators are increasingly popular as a treatment option for opioid-induced sleep-...
Source: Sleep Medicine Clinics - March 12, 2018 Category: Sleep Medicine Authors: Michelle Cao, Shahrokh Javaheri Source Type: research