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What is Hypersomnia?

Hypersomnia — also known as excessive daytime sleepiness (EDS) — is a condition that causes people to feel tired and drowsy during the day when they need to be awake and alert. People with hypersomnia can feel excessively sleepy even after they have slept for a long time and have trouble concentrating on important tasks because they are so tired.

Two Types of Hypersomnia

Hypersomnia is categorized as two different types: 1. In primary hypersomnia the only symptom is excessive sleepiness and fatigue. There are no other medical conditions present. 2. In secondary hypersomnia other medical conditions are present and contributing to excessive daytime sleepiness. Related contributing conditions can include sleep apnea, Parkinson’s disease, kidney failure, and chronic fatigue syndrome.

What Causes Hypersomnia?

Sleep apnea can be one underlying cause of hypersomnia, because it disrupts normal breathing patterns while sleeping, thereby prompting people to wake up repeatedly throughout the night. Certain medications as well as drug and alcohol use can also trigger hypersomnia. Low thyroid function and head injury can also lead to hypersomnia.

Who Is At Risk For Hypersomnia?

People who suffer from sleep apnea, kidney disease, heart disease, abnormal brain functioning, depression, and low thyroid levels are at risk for developing hypersomnia. Smoking, drinking and certain medications can also lead to hypersomnia. Men are more likely than women to have hypersomnia, according to The American Sleep Association. (1)

What Are The Symptoms Of Hypersomnia?

People with hypersomnia say their main symptoms are feeling constantly tired during the day when they need to be awake and alert. No matter how much they sleep, they never feel completely rested. They also have difficulty waking from long periods of sleep.

How Is Hypersomnia Diagnosed?

Hypersomnia is diagnosed using a specialized machine called a polysomnogram that monitors brain activity, eye movements, heart rate, oxygen levels and breathing function. Patients may also be asked to record their sleep patterns in a sleep diary and to rate their overall level of sleepiness using the Epworth Sleepiness Scale. Your doctor may also prescribe a multiple sleep latency test where you will take a monitored nap during the day. The test measures the types of sleep you experience.

How Is Hypersomnia Treated?

Hypersomnia can be treated with stimulating medications such as amphetamine, methylphenidate, and modafinil that are designed to help patients stay awake and alert. Some people are able to overcome hypersomnia by making lifestyle changes in their daily routines and sleep habits, including:

• Refraining from alcohol and drug use;
• Improving one’s diet to ensure you are getting the proper nutrients to maintain energy levels naturally;
• Establishing a regular time to go to bed and wake up each morning.

Where to Find a Good Hypersomnia Doctor

The sleep experts at Comprehensive Neurology and Medicine have more than 30 years experience diagnosing and successfully treating thousands of patients throughout Maryland for hypersomnia, insomnia, and other common sleep disorders. Dr. Konrad Bakker 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. Sarah E. Jamieson is a physician’s assistant with specialized training and experience in the diagnosis and treatment of hypersomnia and other sleep disorders. Together, Dr. Bakker and Ms. Jamieson will listen to you carefully and develop a personalized treatment plan to help you overcome RLS so that you can get the sleep you need and enjoy a better quality of life. Call us today at (301) 694-0900 to schedule an appointment. Virtual appointments are also available, allowing you to receive a hypersomnia consultation via our own phone or computer in the comfort of your home.

Information about Insomnia

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(1) https://www.sleepassociation.org/sleep-disorders/more-sleep-disorders/hypersomnia/

Sleep Apnea: A Serious Health Condition

Sleep apnea is a common sleep disorder that affects approximately 22 million Americans. If left untreated, sleep apnea can lead to serious and life-threatening health problems, including:

• high blood pressure,
• chronic heart failure,
• atrial fibrillation,
• stroke, and other cardiovascular problems;
• type 2 diabetes; and
• depression.

People who suffer from sleep apnea are accident prone because of the persistent drowsiness they feel due to lack of sleep. Many traffic accidents and accidents with heavy machinery are caused by people with sleep apnea.

Types of Sleep Apnea?

Sleep apnea is a condition that disrupts normal healthy breathing patterns while you are asleep. It can often go undetected because it only happens while you are sleeping. There are three kinds of sleep apnea: 1. Obstructive Sleep Apnea (OSA) is caused by a blockage of the airway, usually when the tongue collapses against the soft palate and the soft palate collapses against the back of the throat during sleep, and the airway is closed. Obesity is linked to OSA due to fatty tissue obstruction of the airways. 2. Central Sleep Apnea is less common than Obstructive Sleep Apnea, It causes your breathing to stop and start while sleeping and occurs when the brain does not transmit signals to the breathing muscles. 3. Complex Sleep Apnea is a combination of Obstructive Sleep Apnea and Central Sleep Apnea. Atrial fibrillation, family history of complex/central sleep apnea, heart failure, male gender, renal failure, and stroke are factors that are associated with complex sleep apnea.

Risk Factors for Obstructive Sleep Apnea

People most at risk for developing Obstructive Sleep Apnea are: 1. Overweight. Fat deposits around your upper airway can obstruct your breathing. 2. Male. Men are two to three times more likely to have sleep apnea than women. 3. Older. Sleep apnea occurs more frequently in older adults. 4. Smokers. Smoking can increase the amount of inflammation and fluid retention in the upper airway, thereby constricting one’s ability to breathe freely. Other OSA risk factors include: 1. Large neck circumference. 2. Family history. Having family members with sleep apnea might increase your risk. 3. Use of alcohol, sedatives or tranquilizers that relax the muscles in your throat and can worsen obstructive sleep apnea. 4. Nasal congestion.

Risk Factors for Central Sleep Apnea

People most at risk for developing Central Sleep Apnea are: 1. Middle-aged or older. 2. Male. 3. Experiencing heart disorders. 4. Using narcotic pain medications. 5. People who have had a stroke.

When To See A Doctor

If you have difficulty falling asleep, staying asleep, or feeling refreshed when you wake up, a consulting with a trained sleep doctor or sleep specialist can determine whether you have sleep apnea or another kind of sleep disorder that requires treatment. Dr. Konrad Bakker, M.D. and Sarah E. Jamieson, PA-C, will listen to you carefully, run the appropriate diagnostic tests for your symptoms, and develop a personalized treatment plan to help you get the sleep and rest you need to restore your health and happiness.

Information about Hypersomnia

What is Narcolepsy?

Narcolepsy is a sleep disorder characterized by abnormal nightly sleep cycles leading to excessive daytime sleepiness. It affects an estimated 135,000 – 200,000 Americans. People with narcolepsy typically wake up frequently during the night and fall asleep or lose muscle control suddenly and without wanting to during daytime activities like driving, eating, walking or talking. Narcolepsy can:

• make people more susceptible to having accidents while driving or operating machinery;
• interfere with psychological, social, and cognitive function and development;
• inhibit one’s ability to enjoy social activities and perform well at school and at work.

If you or a loved one are showing signs or symptoms of narcolepsy, the sleep disorder specialists at Comprehensive Neurology and Sleep Medicine can provide the diagnostic testing and treatments needed to restore normal sleep cycles and protect your health, well-being and safety.

Narcolepsy Signs and Symptoms

People with narcolepsy typically report that they:

• Often experience overwhelming feelings of sleepiness during daytime hours, no matter how long they have slept the previous night;
• Experience unusual sensations as they are falling asleep;
• Sometimes experience sleep paralysis and are unable to move as they fall asleep or when they first awake;
• Often have vivid dreams or involuntary leg movements that wake them up during the night;
• Sometimes experience a sudden loss of muscle control or collapse when laughing or feeling angry, stressed or excited. This is known as cataplexy.

In a normal sleep cycle, rapid eye movement (REM) sleep starts about 60 to 90 minutes after falling asleep. Dreams occur during REM sleep, and the brain keeps muscles limp during this sleep stage, which prevents people from acting out their dreams. People with narcolepsy frequently enter REM sleep within 15 minutes of falling asleep. Also, the muscle weakness or dream activity of REM sleep can occur during wakefulness or be absent during sleep.

Types of narcolepsy

There are two major types of narcolepsy: Individuals with Type 1 narcolepsy have low levels of a brain hormone (hypocretin) or report experiencing cataplexy (muscle weakness and loss of voluntary muscle control) and excessive daytime sleepiness on a special nap test. Individuals with Type 2 narcolepsy experience excessive daytime sleepiness but usually do not have muscle weakness triggered by emotions. They usually also have less severe symptoms and have normal levels of the brain hormone hypocretin.

What causes narcolepsy?

The causes of narcolepsy are not known or completely understood. Nearly all people with narcolepsy who have cataplexy have extremely low levels of the hypocretin hormone, which regulates REM sleep and keeps people from feeling excessively sleepy during the day. People who have narcolepsy without cataplexy typically have normal levels of hypocretin. Current research suggests that factors contributing to narcolepsy include:. Autoimmune disorders. Researchers believe that in individuals with narcolepsy, the body’s immune system selectively attacks the hypocretin-containing brain cells because of a combination of genetic and environmental factors. Family history. Up to 10 percent of individuals diagnosed with narcolepsy with cataplexy report having a close relative with similar symptoms. Brain injuries. Traumatic injury to parts of the brain that regulate wakefulness and REM sleep can trigger narcolepsy.

Narcolepsy Diagnosis and Treatment

Narcolepsy diagnosis and treatment starts with a physical exam to determine if there are any other neurological conditions that are causing or contributing to this sleep disorder. You may also be asked to keep a sleep journal noting the times of sleep and symptoms over a one- to two-week period. Although narcolepsy’s major symptoms can be present in other sleep disorders as well, cataplexy almost never occurs in any other diseases. Two specialized tests are also required to confirm a diagnosis of narcolepsy: Polysomnogram (PSG or sleep study). The PSG is an overnight diagnostic sleep study that measures the quality of a person’s sleep by measuring the body’s involuntary functions during sleep, such as breathing and heart rate. It can tell us whether REM sleep occurs early in the sleep cycle and if the patient’s symptoms could be caused by another condition such as sleep apnea. Multiple sleep latency test (MSLT). The MSLT assesses daytime sleepiness and is used to diagnose narcolepsy. It consists of a series of 20-minute naps, during which the patient tries to fall asleep. The test is given every two hours throughout the day, with each nap lasting about 20 minutes. During each nap, sensors and electrodes record data on body functions (heartbeat, breathing, eye movement, etc).

Narcolepsy Treatments

Although there is no cure for narcolepsy, some of the symptoms can be treated with medicines such as Provigil, Nuvigil or other stimulants. The following lifestyle changes can also help people cope with narcolepsy:

• Take short regularly scheduled naps.
• Keep a regular sleep schedule. A regular bedtime and wake-up time usually helps people sleep better.
• Avoid smoking, especially at night.
• Exercise at least 20 minutes per day and at least 4 or 5 hours before bedtime.
• Avoid large, heavy meals right before bedtime.
• Relax before bed. A warm bath before bedtime can help you feel sleepy.

Where to Find a Good Narcolepsy Doctor

The sleep experts at Comprehensive Neurology and Medicine have more than 30 years experience diagnosing and successfully treating thousands of patients throughout Maryland for narcolepsy and other sleep disorders. Dr. Konrad Bakker 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. He has extensive experience treating patients seeking help for narcolepsy, insomnia, restless legs syndrome and other common sleep disorders. Sarah E. Jamieson is a physician’s 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 treatmet 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 (301) 694-0900 to schedule an appointment. Virtual appointments are also available, allowing you to receive a narcolepsy consultation via our own phone or computer in the comfort of your home.

Information about REM Sleep Disorder

Do You Suffer From Insomnia?

Insomnia is a common sleep disorder that affects millions of Americans each year. In fact, 1 in 4 Americans complain that they have trouble falling asleep and staying asleep through the night. People experiencing chronic sleeplessness typically report having a poor quality of life. Performance at work and at school, the ability to make important decisions, and relationships all suffer when you aren’t getting the sleep you need on a nightly basis.

Signs and Symptoms of Insomnia

If you:

• Regularly have trouble falling asleep or staying asleep each night;
• Feel tired most mornings when you should be feeling refreshed after a good night’s 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;

…. there’s 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.

How Sleeplessness Affects Your Physical and Mental Health

On average, adults need between 7 and 9 hours of sleep every night to maintain their health. Getting enough sleep is just as important to your health as getting enough food, air and water. Getting less than 7 hours sleep night after night leads to health consequences for your entire body and mind. Sleep is a time when critically important biological processes take place that maintain the health of your cardiovascular system, central nervous system, digestive system, endocrine system, immune system, and respiratory system.. Sixteen different research studies have linked long term sleep deprivation and sleeplessness to early death and the development of common chronic diseases. (1)

Insomnia’s Impact on the Cardiovascular System

Sleep plays a vital role in maintaining heart health as well as the health of blood vessels that regulate your blood sugar, blood pressure, and inflammation levels. Lack of sleep increases the risk of heart disease, heart attack and stroke.

Insomnia’s Impact on the Central Nervous System

During sleep, pathways form between nerve cells (neurons) in your brain that help you remember new information you’ve learned. A sleep-deprived brain loses its ability to function at its best. Sleep-deprived people often report feelings of impatience, irritability and moodiness. Decision-making processes and creativity are also impaired when you feel overly-tired and sleepy.

Insomnia’s 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 don’t get enough sleep don’t produce adequate amounts of the growth hormone that helps the body build muscle mass and repair cells and tissues.

Insomnia’s Impact on the Immune System

Sleep is also a time when your immune system produces protective antibodies and infection-fighting substances that protect your body from illnesses caused by harmful bacteria and viruses. Poor sleep habits interfere with your immune system’s ability to fight off illness or recover quickly when you do get sick.

Insomnia’s Impact on the Digestive System

Sleep deficits also affect the body’s ability to maintain proper levels of leptin and ghrelin — the two hormones that control appetite. Leptin tells your brain that you’ve had enough to eat, while gherkin stimulus appetite. When you sleep poorly, your body’s leptin levels decrease and ghrelin levels increase — which encourage late-night snacking and the weight gain that comes with overeating and poor eating habits. Sleep deprivation can make you feel too tired to exercise. Long-term lack of exercise can lead to excessive weight gain because you’re not burning enough calories and not building muscle mass. Sleep deprivation also causes your body to release less insulin after you eat. Insulin helps to reduce your blood sugar (glucose) level. Sleep deprivation also lowers the body’s tolerance for glucose and is associated with insulin resistance. These disruptions can lead to diabetes mellitus and obesity.

Insomnia’s Impact on the Respiratory System

Obstructive Sleep Apnea (OSA) is a common sleep disorder that disrupts normal breathing patterns, causing one to wake up throughout the night. OSA can lead to respiratory infections like the common cold and flu and make existing respiratory diseases and lung diseases worse.

What Causes Insomnia?

Insomnia can be triggered by various physical and psychological factors. Possible causes for insomnia include:

• Psychological issues – bipolar disorder, depression, anxiety disorders, or psychotic disorders.
• Medical conditions – chronic pain, chronic fatigue syndrome, congestive heart failure , angina, acid-reflux disease ( GERD ), chronic obstructive pulmonary disease, asthma , sleep apnea, Parkinson’s and Alzheimer’s diseases, hyperthyroidism , arthritis , brain lesions, tumors, stroke.
• Hormonal imbalances or fluctuations.
• Watching TV or using computers before going to bed at night.

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 [mandibular advancement splint] and Inspire ( hypoglossal nerve stimulator implant/pacemaker for sleep apnea). Sarah E. Jamieson is a physician’s 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 (301) 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.

Information about Narcolepsy

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Sources: (1) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2864873/

Treatment Options

We provide treatment and disease management for new and ongoing neurological conditions. Every patient is unique, and therefore every treatment plan is individualized based on past medical history, test results and the patient’s personal preferences. For chronic conditions, this often entails tailoring medications so that your health is optimized through prescription adjustments; prescribing a new medication based on updated information, or possibly re-evaluating all of your medications to ensure we are using the latest pharmacology. We can often offer immediate relief for some conditions by performing treatments in our office. If the required treatment is outside our area of specialty, we refer out to the appropriate provider.

Sleep Disorder Treatment

Sleep study results are available approximately five days after the tests have been performed. Once complete, you will again meet with your provider at CNSM to develop an individualized treatment plan. Treatment options vary depending on diagnosis, but may include:

Sleep Apnea – There are five treatment options for sleep apnea: CPAP, a dental appliance, weight loss, or two surgical procedures (UPPP).

The preferred treatment option for obstructive sleep apnea (OSA) by the American Academy of Sleep Medicine is CPAP. CPAP is a medical device that delivers pressurized air via a facial/nasal mask to keep the airway open. Another option is for a dental appliance to be formed by your dentist to advance the jaw and open the airway during sleep. Weight loss is another method, as a significant drop in body weight (10-15%) can decrease the severity of sleep apnea by 50%. Inspire, an implant is newly approved by the FDA. It works through the stimulation of the hypoglossal nerve resulting in an open, unobstructed airway. Lastly, an ear, nose, and throat specialist may complete a surgery called an uvulopharyngopalatoplasty, or UPPP, to enlarge the airway and decrease the severity of sleep apnea.

Narcolepsy is typically treated with pharmaceuticals such as Provigil, Nuvigil or other stimulants.

Insomnia is treated with traditional medication, Cognitive Behavioral Therapy (CBT), adjustments to sleep patterns, or a combination of the therapies. CBT for insomnia is a non-medication approach to the treatment of insomnia. CBT includes the modification of behaviors and beliefs about sleep. This is a tailored treatment plan designed to meet each patient’s specific needs regarding sleep behaviors.

Restless Leg Syndrome (RLS) can be overcome simply through medications such as Mirapex and Requip. When indicated, iron supplements may also be prescribed.

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Some of the treatment options we provide include:

Insomnia

Cognitive Behavioral Therapy (CBT): Adjustments to sleep patterns or a combination of the therapies. CBT for insomnia is a non-medication approach to the treatment of insomnia. CBT includes the modification of behaviors and beliefs about sleep. This is a tailored treatment plan designed to meet each patient’s specific needs regarding sleep behaviors.

Diagnostic Testing

Dr. Bakker, Sarah E. Jamieson PA-C or your referring physician will likely order diagnostic tests or procedures to help us gain a better understanding of your condition. Some of the testing will be performed in our center and others may need to be done at an outside laboratory, radiology center or even the hospital. Most of the external test results will take a few to several days to be returned to us. We understand that you may be on “pins and needles” when waiting for test results so as soon as we have them, we will call to schedule an appointment to review your results with you and determine the next steps in your treatment plan

Some of the more common diagnostic tests are listed below:

Polysomnogram (PSG) – Conducted at a sleep center, a polysomnogram is a diagnostic sleep study that measures the quality of a person’s sleep by measuring the body’s involuntary functions during sleep, such as breathing and heart rate. This study typically lasts one night. A typical polysomnogram records the following data:

• Brain waves (electrodes placed on the scalp)
• Eye movement (electrodes placed on the face, by the eyes)
• Chin muscle tone (electrodes placed on or under the chin)
• Heart rate and rhythm (electrodes placed on the chest)
• Leg movements (electrodes placed on the legs)
• Breathing (breathing sensor placed near the nose and mouth)
• Breathing effort (two small belts placed loosely around the chest and abdomen)
• Oxygen level (small sensor attached to the finger)
• Audio and video taping

CPAP Titration Study – Conducted at a sleep center, a CPAP titration study is a sleep study used to determine the appropriate pressure to be used with a CPAP machine. During the night of a CPAP titration study, data will be recorded as during a PSG; however, a CPAP mask will be added at the beginning of the night. Through the night, the pressure released from the CPAP machine will be progressively increased, or titrated, until it is shown that the patient reaches restful sleep without interruption due to abnormal breathing patterns. This study typically lasts one night.

Split Night Study – Conducted at a sleep center, a split night study is a combination of a PSG and a CPAP titration study. A PSG is completed for the first 2 hours of the study. If significant sleep apnea is noted, then a CPAP titration study will be initiated.

Multiple Sleep Latency Test (MSLT) – Conducted at a sleep center, an MSLT assesses daytime sleepiness and is used to diagnose narcolepsy. This test may be performed after a PSG. The MSLT consists of a series of 20-minute naps, during which the patient tries to fall asleep. The test is given every two hours throughout the day, with each nap lasting about 20 minutes. During each nap, sensors and electrodes record data on body functions (heartbeat, breathing, eye movement, etc).

Blood Work – Blood tests may be ordered to identify an iron deficiency, thyroid abnormality or other abnormalities which can be linked to poor sleep.