The Sleep Disorders Toolkit

While the pathophysiology of idiopathic hypersomnia is unknown, emerging science suggests that nighttime sleep dysfunction may contribute to daytime sleepiness in patients with idiopathic hypersomnia. A systematic review and meta-analysis that included 10 studies found that, on average, several sleep architecture hallmarks were different in patients with idiopathic hypersomnia relative to controls. In addition to nighttime sleep dysfunction, other physiological changes have been observed in some patients with idiopathic hypersomnia and theorized as possible contributors to its pathophysiology including: This episode is produced by Sleep Review and is episode 5 of a 5-part series sponsored by Jazz Pharmaceuticals. Visit Jazzpharma.com and SleepCountsHCP.com for more information. In episode 5, listen as Sleep Review’s Sree Roy and neurologist-sleep specialist Isabelle Arnulf, MD, PhD, discuss: Listen to Episode 1: Symptoms of Idiopathic Hypersomnia Listen to Episode 2: Diagnosis of Idiopathic Hypersomnia Listen to Episode 3: Differential Diagnosis of Idiopathic Hypersomnia Listen to Episode 4: Burden of Idiopathic Hypersomnia

People with idiopathic hypersomnia face a significant disease burden. Idiopathic hypersomnia is associated with challenges that impact daily living activities, such as limitations at school, work, interpersonal relationships, and social activities. Various impairments include Public health and safety are also impacted, as more severe causes of sleepiness can be cause for accidents. Management strategies may not address the underlying sleep dysfunction associated, resulting in suboptimal symptom management. Patient survey and registry data suggest patients continue to experience symptoms of idiopathic hypersomnia and residual disease burden. This episode is produced by Sleep Review and is episode 4 of a 5-part series sponsored by Jazz Pharmaceuticals. Visit Jazzpharma.com and SleepCountsHCP.com for more information. In episode 4, listen as Sleep Review’s Sree Roy and pulmonologist-sleep specialist Richard K. Bogan, MD, discuss:

This episode also provides valuable advice for sleep techs dealing with patients wanting to use mouth tape during in-lab sleep studies. DeNike underlines the importance of ensuring patients have a healthy nasal passageway and clarifies the role of mouth tape as a supportive accessory, not a standalone treatment. This episode is sure to provide you with a deeper understanding of mouth taping during sleep, armed with expert advice and valuable insights, whether you're a sleep professional or someone simply interested in optimizing your sleep health. In this episode, we answer the questions:

The differential diagnosis of idiopathic hypersomnia is challenging for several reasons. Its hallmark symptom, excessive daytime sleepiness, is a common symptom of many disorders, and ts ancillary symptoms also overlap with other disorders. A lack of validated biomarkers adds to the challenge. Assessing for key symptoms and medical history is a first step to help identify patients presenting with excessive daytime sleepiness who may have idiopathic hypersomnia. From there, there are several symptoms that can differentiate the diagnosis of idiopathic hypersomnia from other disorders such as sleep apnea or narcolepsy. These include: This episode is produced by Sleep Review and is episode 3 of a 5-part series sponsored by Jazz Pharmaceuticals. Visit Jazzpharma.com and SleepCountsHCP.com for more information. In episode 3, listen as Sleep Review’s Sree Roy and neurologist-sleep specialist Yves Dauvilliers, MD, PhD, discuss: Listen to Episode 1: Symptoms of Idiopathic Hypersomnia Listen to Episode 2: Diagnosis of Idiopathic Hypersomnia

Sleep specialist Indira Gurubhagavatula, MD, MPH, is our guest and chair of the Count on Sleep Tool Development and Surveillance Workgroup for The Obstructive Sleep Apnea: Indicator Report, which provides an in-depth analysis of the symptoms, risk factors, prevalence, and burden of obstructive sleep apnea and serves as a resource for both the public and the health care communities on the importance of diagnosis and long-term treatment. Gurubhagavatula and Sleep Review editor Sree Roy discuss the hidden risks of obstructive sleep apnea—the mortality and morbidity that makes obstructive sleep apnea (OSA, for short) particularly insidious. We discuss obstructive sleep apnea’s links to vehicle crashes, treatment-resistant hypertension, impaired brain function, erectile dysfunction and female sexual dysfunction, type 2 diabetes, and early death. We also discuss treatments for obstructive sleep apnea and how healthcare providers can screen patients to intervene early for patients at risk of obstructive sleep apnea. Specifically, this episode about the hidden risks of obstructive sleep apnea provides answers to:

The International Classification of Sleep Disorders, 3rd ed, lists the criteria needed for a diagnosis idiopathic hypersomnia. For a diagnosis of idiopathic hypersomnia, the following must be met: o excessive daytime sleepiness daily for at least 3 months o cataplexy is not present o multiple sleep latency test (MSLT) shows <2 or no sleep-onset REM periods (SOREMPs) if the rapid eye movement (REM) latency on the preceding polysomnogram (PSG) was ≤15 minutes o insufficient sleep syndrome is ruled out And at least one of the following: o MSLT shows a mean sleep latency of ≤8 minutes o Total 24-hour sleep time is ≥660 minutes (typically 12-14 hours) on 24-hour PSG monitoring (performed after correction of chronic sleep deprivation), or by wrist actigraphy in association with a sleep log (averaged over at least 7 days with unrestricted sleep) o Hypersomnolence and/or MSLT findings are not better explained by another sleep disorder, other medical or psychiatric disorders, or use of drugs or medication Additional supportive features can include: o Severe and prolonged sleep inertia o High sleep efficiency (>90%) o Long, unrefreshing naps (>1 hour) This episode is produced by Sleep Review. It is episode 2 of a 5-part series sponsored by Jazz Pharmaceuticals. Visit Jazzpharma.com and SleepCountsHCP.com for more information. In episode 2, listen as Sleep Review’s Sree Roy and neurologist-sleep specialist Margaret S. Blattner, MD, PhD discuss: o What are some barriers to diagnosing idiopathic hypersomnia? o Objective sleep testing is needed to diagnosis idiopathic hypersomnia. What polysomnography and multiple sleep latency test findings support a diagnosis of idiopathic hypersomnia? o What are some best practices for conducting a PSG and MSLT for a patient with suspected idiopathic hypersomnia? o What are some of the additional commonly seen supportive features of idiopathic hypersomnia?

Excessive daytime sleepiness is an essential feature of idiopathic hypersomnia, but other key symptoms and aspects of the medical history are crucial when evaluating patients who present with excessive daytime sleepiness. Patients with idiopathic hypersomnia commonly report the following symptoms in addition to excessive daytime sleepiness: severe and prolonged sleep inertia, long and unrefreshing naps, prolonged sleep time, and cognitive dysfunction. Knowing the key symptoms and utilizing sleep testing can increase a healthcare professional’s confidence in his/her diagnosis of idiopathic hypersomnia. The Idiopathic Hypersomnia Severity Scale is a 14-item questionnaire that is a clinical tool designed specifically to measure patients’ idiopathic hypersomnia symptoms and provide a touchpoint that might be useful for patient identification, follow-up visits, and idiopathic hypersomnia management. This episode is produced by Sleep Review. It is episode 1 of a 5-part series sponsored by Jazz Pharmaceuticals. Visit Jazzpharma.com and SleepCountsHCP.com for more information. In episode 1, listen as Sleep Review’s Sree Roy and sleep specialist Logan Schneider, MD, discuss: To dive even deeper: https://sleepreviewmag.com/sleep-disorders/hypersomnias/idiopathic-hypersomniaIdiopathic hypersomniaSleep Med ClinIdiopathic hypersomnia severity scalePrecision medicine for idiopathic hypersomniaSleep Med ClinSubjective symptoms in idiopathic hypersomnia: beyond excessive sleepinessJ SleepMeasurement of symptoms in idiopathic hypersomnia: The Idiopathic Hypersomnia Severity ScaleNeurologyIdiopathic Hypersomnia Severity Scale to better quantify symptoms severity and their consequences in idiopathic hypersomniaJ Clin Sleep Med

Join Sleep Review’s Sree Roy in conversation with sleep expert Russell P. Rosenberg, PhD, and primary care physician Paul Doghramji, MD, FAAFP about managing insomnia in primary care. They share insights from an expert consensus group and answer the questions: For more information on insomnia in primary care, visit: A 2023 Update on Managing Insomnia in Primary Care: Insights From an Expert Consensus Grouphttps://sleepreviewmag.com/insomnia/https://www.thensf.org/do-i-have-insomnia/

A large proportion of mental health professionals misunderstand the nature of sleep problems in mental health patients, according to sleep specialist Barry Krakow, MD, who has worked in the field of sleep research and clinical sleep medicine for more than 30 years. Such professionals view sleep issues as a symptom of mental health disorders, rather than as a distinct disorder that needs to be addressed. Healthcare professionals fail to understand that treating sleep problems can help to alleviate mental health issues. The sleep medicine community itself also struggles with how to serve the mental health community. Many sleep centers are still discounting or ignoring the significance of upper airway resistance syndrome (UARS). According to Krakow, many sleep doctors are uncomfortable treating patients with mental health conditions, such as PTSD, depression, or anxiety, and will refer them to therapists or psychiatrists rather than addressing their sleep problems. This lack of understanding and training in the connection between sleep disorders and mental health leads to patients not receiving proper treatment and being left with the impression that sleep medicine cannot help them. Sleep medicine needs to recognize that insomnia and sleep-disordered breathing are prevalent in this population and that effective treatments, such as advanced PAP machines, are available. With regard to bureaucracy surrounding treating mental health patients, Krakow advises that sleep centers can implement efficiencies using modern technology, and offer reimbursable services, such as PAP Naps, to assist with the business aspects. Krakow's new book Life Saving Sleep: New Horizons in Mental Health Treatment explores the link between sleep and mental health, and how the quality of sleep is often overlooked in mental health treatment. Mental health patients with sleep complaints are typically prescribed medication to help them sleep, without addressing the quality of their sleep. Many patients are unable to describe the quality of their sleep beyond the number of hours they sleep each night. For further information: https://barrykrakowmd.com/ https://www.lifesavingsleep.com/ https://fastasleep.substack.com/ Follow Sleep Review on LinkedIn, Facebook, Twitter, & YouTube.

For #sleepawarenessweek (March 12-18, 2023), Sleep Review is joined by sleep psychologist Jade Wu, PhD, DBSM. She is the author of Hello Sleep: The Science and Art of Overcoming Insomnia Without Medications. She is also a Mattress Firm Sleep Advisor. Sleep Review’s Sree Roy and Dr. Wu discuss common #sleep myths including: -What is the most damaging sleep myth you have heard? -What is one sleep myth that you previously believed, but was disproven over your career? -Have you seen other sleep physicians perpetuate certain sleep myths? -Do those who move around in their sleep get worse rest? -Does the brain truly “shut off” when we go to sleep? -Do dreams only occur during REM sleep? -Do scents, such as lavender essential oil in a diffuser, benefit sleep in any way? -Do eye masks and/or earplugs benefit sleep? -Is over-the-counter melatonin a good place to start if you’re having sleep problems? Dr. Wu recommends the following resources for further information:American Academy of Sleep Medicine: https://sleepeducation.org/sleep-disorders/obstructive-sleep-apnea/ Society of Behavioral Sleep Medicine: https://sleepeducation.org/sleep-disorders/obstructive-sleep-apnea/ Hypersomnia Foundationhttps://www.hypersomniafoundation.org/ Pediatric Sleep Councilwww.babysleep.com Follow Sleep Review on LinkedIn, Facebook, Twitter, & YouTube.

While the US Department of Health and Human Services recommends a sodium intake of less than 2,300 mg/day, about 9 of 10 American adults exceed that limit. Increased sodium intake is believed to have a direct effect on a variety of negative cardiovascular outcomes such as coronary heart disease, left ventricular hypertrophy, and stroke. Recognizing the impact of dietary sodium on diseases like hypertension and CVD, the FDA recently released voluntary guidance for industry on the target mean and upper concentrations for sodium in commercially processed, packaged, and prepared foods. The guidance was intended to provide a measurable voluntary goal to help Americans to reduce their average sodium intake by 12% over the next 2.5 years, and plans for further iterative reductions in the future. In addition to daily dietary (food and drink) sodium, both prescription and over-the-counter medications can contribute to increasing patients’ total sodium intake per day. Additionally, other risk factors—such as smoking the absence of physical activity, and poor sleep hygiene—that contribute to developing cardiovascular conditions can be modified by maintaining a healthy and balanced lifestyle. This episode is produced by Sleep Review. It is episode 5 of a 5-part series sponsored by Jazz Pharmaceuticals. Visit Jazzpharma.com and NarcolepsyLink.com for more information. In episode 5, listen as Sleep Review’s Sree Roy and cardiologist-sleep specialist Barbara Hutchinson, MD, PhD, FACC, discuss:

The prevalence of certain comorbidities is higher in people with narcolepsy compared with matched controls—both at diagnosis and at prolonged follow up. Comorbidities that are more prevalent in patients with narcolepsy include psychiatric and sleep conditions, as well as cardiovascular and cardiometabolic conditions. Hypocretin (orexin) dysfunction in patients with narcolepsy may partially explain the increased risk of certain comorbidities in these patients. An increased prevalence of cardiovascular and cardiometabolic conditions, such as hypertension, obesity, diabetes, and hypercholesterolemia have been reported in people with narcolepsy compared with matched controls. One interview study of 320 patients with narcolepsy and 1,464 age-matched individuals from the general population identified that the odds of heart disease in patients with narcolepsy (5.9%) were twice that compared to the age-matched general population (2.9%) (AOR, 2.07 [95% CI, 1.22 to 3.51]). By an average age of 38 (mean age during study), an increased incidence of cardiovascular comorbidities has been observed among patients with narcolepsy compared with matched non-narcolepsy controls. This episode is produced by Sleep Review and is episode 4 of a 5-part series sponsored by Jazz Pharmaceuticals. Visit Jazzpharma.com and NarcolepsyLink.com for more information. In episode 4, listen as Sleep Review’s Sree Roy and cardiologist-sleep specialist-intensivist Younghoon Kwon, MD, MS, FACC, discuss:

For supporting material on this episode, visit: The increased frequency of comorbidities among people with narcolepsy should be thoroughly reviewed while creating individualized management strategies. Comorbidities that are more prevalent in patients with narcolepsy include psychiatric and sleep conditions, as well as cardiovascular and cardiometabolic conditions. Hypocretin dysfunction in patients with narcolepsy may partially explain the increased risk of certain comorbidities in these patients. An increased prevalence of cardiovascular and cardiometabolic conditions, such as hypertension, obesity, diabetes, and hypercholesterolemia have been reported in people with narcolepsy compared with matched controls. One interview study of 320 patients with narcolepsy and 1464 age-matched individuals from the general population identified that the odds of heart disease in patients with narcolepsy (5.9%) were twice that compared to the age-matched general population (2.9%) (AOR, 2.07 [95% CI, 1.22 to 3.51]). By an average age of 38 (mean age during study), an increased incidence of cardiovascular comorbidities has been observed among patients with narcolepsy compared with matched non-narcolepsy controls. This episode is produced by Sleep Review and is episode 3 of a 5-part series sponsored by Jazz Pharmaceuticals. Visit Jazzpharma.com and NarcolepsyLink.com for more information. In episode 3, listen as Sleep Review’s Sree Roy and neurologist-sleep specialist W. Chris Winter, MD, discuss: What comorbidities do you typically see in patients who are newly diagnosed with narcolepsy? What about comorbidities that tend to develop over time in people with narcolepsy? What health conditions do you screen for when you have a patient who is newly diagnosed with narcolepsy? How, if at all, does the existence or emergence of comorbidities impact decision making? Can you share any best practices for monitoring the emergence and management of narcolepsy-related comorbidities? What other specialists and healthcare professionals do you recommend sleep physicians develop reliable referrals with to adequately manage comorbidities in their patients with narcolepsy? Are there any particular screening tools such as specific questionnaires that you'd recommend to other sleep physicians for this demographic?

For most people with narcolepsy, management plans require implementation of ongoing pharmacological therapy to keep symptoms under control. Patients may also need substantial lifestyle adjustments, such as maintaining nocturnal sleep hygiene and regular scheduling of daytime naps. Narcolepsy management plan development should consider balance between the tolerance to available medications and impact of certain comorbidities associated with the disorder. The prevalence of certain comorbidities is higher in patients with narcolepsy compared with matched controls; this is true both at diagnosis and at prolonged follow up. The increased frequency of comorbidities among patients with this condition should be thoroughly reviewed while creating individualized management strategies. Comorbidities that are more prevalent in patients with narcolepsy include psychiatric and sleep conditions, as well as cardiovascular and cardiometabolic conditions. This episode is produced by Sleep Review and is episode 2 of a 5-part series sponsored by Jazz Pharmaceuticals. Visit Jazzpharma.com and NarcolepsyLink.com for more information. In episode 2, listen as Sleep Review’s Sree Roy and pulmonologist-sleep specialist Richard K. Bogan, MD, discuss: What comorbidities you need to consider when determining whether a patient is an appropriate candidate for a given pharmacotherapy? Why are these important in management decisions? Can you share any best practices for monitoring the emergence and management of narcolepsy related comorbidities? What sleep lifestyle changes are typically incorporated into a narcolepsy management plan?

Mayoor Patel, DDS, MS, is the owner of Atlanta-based Craniofacial Pain and Dental Sleep Center of Georgia and co-editor of the new textbook Dental Sleep Medicine: A Clinical Guide. He speaks with Sleep Review about medical and dental comorbidities of obstructive sleep apnea, continuing education for dentists, and offers several resources for dentists who want to learn about sleep medicine. Sree Roy of Sleep Review and Patel discuss: How did this book, Dental Sleep Medicine: A Clinical Guide, come about? Why should dentists have a basic knowledge of sleep medicine? What are some of the most common medical comorbidities of obstructive sleep apnea? What are some of the most common dental comorbidities and risk factors of sleep apnea? How can dentists learn to conduct a basic screening for obstructive sleep apnea? How does oral appliance therapy for sleep apnea work?

For supporting material on this podcast, visit: https://sleepreviewmag.com/sleep-disorders/hypersomnias/narcolepsy/narcolepsy-across-the-lifespan/ Narcolepsy is a chronic sleep disorder for which there is no known cure. The onset of symptoms can begin at any age but frequently occurs during childhood or adolescence. This condition continues to impact patients throughout their lifetime. Management plans require implementation of ongoing pharmacological therapy to keep the symptoms under control for most patients, and patients may need substantial lifestyle adjustment such as maintaining nocturnal sleep hygiene and regular scheduling of daytime naps. Narcolepsy management plan development should consider balance between the tolerance to available medications and impact of certain comorbidities associated with the disorder. This episode is produced by Sleep Review. It is episode 1 of a 5-part series sponsored by Jazz Pharmaceuticals. Visit Jazzpharma.com and NarcolepsyLink.com for more information. In episode 1, listen as Sleep Review’s Sree Roy and neurologist-sleep specialist Michael Thorpy, MB, ChB, discuss: Since narcolepsy starts at a young age and there is no cure as of yet, what are the long-term management implications? What are the key symptoms of narcolepsy, and how and when do they typically manifest? Do narcolepsy symptoms evolve over the course of a lifetime? What can you typically accomplish with an individualized management plan? How often do you reassess narcolepsy patients to determine whether their management plan needs to be adjusted? Are there specific guidelines that you recommend to the physicians in the audience with regard to managing narcolepsy?

Temitayo Oyegbile-Chidi, MD, PhD, became board chair of the National Sleep Foundation board of directors, on July 1, 2022. She speaks with Sleep Review about advocating for sleep on Capitol Hill, sleep health equity concerns, Drowsy Driving Prevention Week, and more. Sree Roy of Sleep Review and Oyegbile-Chidi discuss: -You are a neurologist as well as a sleep and epilepsy specialist. How did your interest develop in understanding sleep disorders in relation to co-existent neurologic and psychiatric conditions? -What areas of sleep health interest you most? -Where can we improve for sleep health equity? -What projects or initiatives is NSF working on that you'd like to highlight? -You've won a Sleep Health Policy Advocacy Award from the National Sleep Foundation. What are some ways that can other healthcare professionals advocate for better sleep? To dive deeper: https://sleepreviewmag.com/tag/national-sleep-foundation/

Jennifer L. Martin, PhD, became president of the American Academy of Sleep Medicine (AASM) board of directors on June 6, 2022. She speaks with Sleep Review about the challenges faced by people with insomnia disorder in accessing cognitive behavioral therapy for insomnia (CBT-I) and pharmaceuticals to treat the sleep disorder, as well as posits several solutions. Sree Roy of Sleep Review and Martin discuss: -What is a psychologist’s role in sleep medicine? -How is the AASM collaborating with other stakeholders to identify and prioritize strategies to increase access to high-quality care for insomnia disorder? -How can sleep medicine overcome reimbursement challenges when it comes to insomnia? -Other goals for her 1-year AASM presidency term

Mitchell Levine, DMD, ABDSM, was recently installed as president of the American Academy of Dental Sleep Medicine (AADSM). In an interview with Sree Roy of Sleep Review, he discusses how COVID has changed the practice of dental sleep medicine, the role of telehealth, a consensus statement about oral appliance compliance, oral appliance monitoring sensors, what he wants to see in dental sleep medicine research, and what he hopes will have changed in dental sleep by the end of his 2-year term. More Webinar Info: https://aadsm.cnf.io/ For more Sleep Review Content: https://info.medqor.com/srsubform

Ben Wipper is a current medical student at Harvard Medical School. He graduated from Williams College in 2019, and over the past two years has been a part of the Sleep Disorders Clinical Research Program at Massachusetts General Hospital in Boston. Ben has co-authored numerous peer-reviewed research articles relating to restless legs syndrome and other sleep disorders. Link to the study the interview was about: https://www.sciencedirect.com/science/article/pii/S1389945722000120?via%3Dihub Sleep Disorder Clinical Research Program: https://www.massgeneral.org/psychiatry/research/sleep-disorders-clinical-research-program For more great coverage from Sleep Review, subscribe to our newsletter: https://info.medqor.com/srsubform