Cover
Preface
1. In the Second Edition
Part One: General Sleep Medicine
1. 1 The Sleep History
  1. Introduction
  2. Excessive Daytime Sleepiness
  3. Insomnia
  4. Nocturnal Disturbances
  5. Conclusions
  6. References
2. 2 Polysomnography
  1. Introduction
  2. The Use of Polysomnography: Considerations and Indications
  3. Standardisation of Video‐polysomnography
  4. Scoring Sleep Stages
  5. Sleep Related Movement Patterns
  6. Sound Registration
  7. Cardiac Function
  8. Respiratory Scoring
  9. A General Approach to Analysis and Interpretation
  10. Some Additional Pointers and Pitfalls
  11. References
  12. Further Reading
3. 3 Daytime Tests for Sleepiness and Vigilance
  1. Introduction
  2. The MSLT
  3. The MWT
  4. Sustained Attention to Response Task
  5. Normative Data
  6. Diagnostic Criteria
  7. Recommendations for Use and Interpretation
  8. References
4. 4 Diagnostic Strategies and Classification
  1. Introduction
  2. Classifications
  3. Sleep Questionnaires
  4. Reaching a Diagnosis
  5. References
5. 5 Pharmacological Treatment of Insomnia and Parasomnias
  1. Introduction
  2. Sleep‐onset and Sleep‐maintenance Insomnia
  3. Parasomnias
  4. References
6. 6 Pharmacological Treatment of Excessive Daytime Sleepiness
  1. Introduction
  2. General Aspects of Treatment
  3. Indications
  4. Amphetamine Derivatives
  5. Modafinil
  6. Caffeine
  7. Sodium Oxybate
  8. Pitolisant
  9. Selegiline
  10. Mazindol
  11. Alerting Antidepressants
  12. Acknowledgement
  13. References
7. 7 The Effects of Medication on Sleep and Wakefulness
  1. Introduction
  2. Neuropharmacology of Waking and Rapid Eye Movement Sleep
  3. Neuropharmacology of Non‐REM Sleep
  4. Appendix 7.A
  5. Further Reading
Part Two: Primary Sleep Disorders
1. 8 Narcolepsy and Other Central Disorders of Hypersomnolence
  1. Introduction
  2. Diagnostic Categories
  3. General Aspects of Symptoms, Diagnosis and Management
  4. Narcolepsy
  5. Idiopathic Hypersomnia
  6. Kleine–Levin Syndrome
  7. Insufficient Sleep Syndrome
  8. References
2. 9 Insomnia
  1. Introduction
  2. Insomnia in Neurology
  3. Clinical Pathophysiology
  4. Assessment of the Insomniac
  5. Management of Insomnia
  6. References
3. 10 Sleep‐related Breathing Disorders
  1. Sleep‐disordered Breathing
  2. Obstructive Sleep Apnoea
  3. Central Sleep Apnoea
  4. Conclusions
  5. References
4. 11 Circadian Rhythm Sleep Disorders
  1. Introduction
  2. Changes in Circadian Rhythm with Age
  3. Circadian Rhythm Sleep–Wake Disorders
  4. History and Investigations
  5. Sleep Diaries
  6. Actigraphy
  7. Polysomnography
  8. Delayed Sleep Phase Syndrome
  9. Advanced Sleep Phase Syndrome
  10. Shift Work Disorder
  11. Jet Lag Disorder – ‘East is a Beast, West is Best’.
  12. Free Running Circadian Rhythm Disorder
  13. Irregular Sleep–Wake Rhythm Disorder
  14. Conclusion
  15. References
5. 12 Parasomnias and Their Differentiation from Epilepsy
  1. Introduction
  2. Epileptic and Non‐epileptic Conditions Presenting as ‘attacks’ from Sleep
  3. Diagnosing Sleep‐related Attacks
  4. Investigations
  5. Video Analysis of Events
  6. Conclusion
  7. References
6. 13 Restless Legs Syndrome and Periodic Limb Movement Disorder
  1. Introduction
  2. Clinical Aspects
  3. Pathophysiological Aspects
  4. Diagnostic Procedures
  5. Management
  6. References
Part Three: Sleep in Neurological Disorders
1. 14 Sleep Disorders in Parkinson’s Disease and Other Parkinsonian Syndromes
  1. Introduction
  2. Clinical Epidemiology
  3. Signs and Symptoms
  4. Diagnostic Procedures
  5. Management
  6. Conclusions
  7. References
2. 15 Sleep in Dementia and Other Neurodegenerative Diseases
  1. Introduction
  2. Alzheimer’s Disease
  3. Dementia with Lewy Bodies
  4. Huntington’s Disease
  5. Hereditary Ataxias
  6. References
3. 16 Myotonic Dystrophy
  1. Introduction
  2. Myotonic Dystrophy Type 1
  3. Myotonic Dystrophy Type 2
  4. References
4. 17 Sleep Disorders in Neuromuscular Disease
  1. Introduction
  2. Sleep and Breathing
  3. Initial Clinical Approach
  4. Nocturnal Testing
  5. Surrogate Markers of Blood Gases
  6. Sleep Dysfunction in Specific Neuromuscular Diseases
  7. Management of Sleep Dysfunction in Neuromuscular Disorders
  8. References
5. 18 Headache Disorders
  1. Introduction
  2. Epidemiology
  3. Classification
  4. Diagnostic Procedures
  5. Management
  6. Conclusions
  7. References
6. 19 Sleep Epilepsies
  1. Introduction
  2. The Influence of Sleep Stages on Seizures
  3. Clinical Epidemiology
  4. Clinical Features
  5. Diagnostic Procedures
  6. Management
  7. References
7. 20 Sleep–Wake Disorders Following Traumatic Brain Injury
  1. Introduction
  2. Clinical Epidemiology
  3. Excessive Daytime Sleepiness
  4. Pleiosomnia
  5. Fatigue
  6. Insomnia
  7. Circadian Sleep–Wake Disorders
  8. References
8. 21 Sleep Disorders Associated with Stroke
  1. Introduction
  2. Clinical Presentation and Pathophysiological Relevance
  3. Diagnosis and Treatment
  4. References
9. 22 Sleep Disorders in Multiple Sclerosis and Related Conditions
  1. Introduction
  2. Fatigue Versus Sleepiness
  3. Clinical Assessment
  4. Specific Sleep Disorders in MS and Management Options
  5. Secondary Narcolepsy in MS and Neuromyelitis Optica
  6. References
10. 23 Tumours and Paraneoplastic Syndromes
  1. Sleep in Patients with Systemic Tumours
  2. Sleep in Patients with Brain Tumors
  3. Sleep in Paraneoplastic Syndromes
  4. References
Index
End User License Agreement

List of Tables

Chapter 02
1. Table 2.1 Recommended signals to be obtained during polysomnogram recording, according to the AASM manual.
2. Table 2.2 Summary of characteristics used to identify sleep stages.
3. Table 2.3 AASM criteria for scoring of respiratory events.
Chapter 03
1. Table 3.1 Guideline from the American Academy of Sleep Medicine for the performance of the MSLT.
2. Table 3.2 Guideline from the American Academy of Sleep Medicine for the performance of the MWT.
3. Table 3.3 Recommendations for the SART protocol.
Chapter 04
1. Table 4.1 Main diagnostic entities in the ICSD‐3.
2. Table 4.2 Sleep disorders classified in the ICD‐10 as ‘neurological’, together with neurological diseases that are very often accompanied by sleep disturbances; not all of which are mentioned in ICSD‐3.
3. Table 4.3 Questionnaires often used in sleep medicine.
Chapter 05
1. Table 5.1 Benzodiazepines and benzodiazepine receptor‐agonist (‘z’) hypnotic drugs.
Chapter 08
1. Table 8.1 Hypersomnias of central origin, according to ICSD‐3.
2. Table 8.2 Topics to cover in the clinical interview.
Chapter 09
1. Table 9.1 ICSD‐3 criteria for chronic insomnia disorder.
2. Table 9.2 The insomnia history.
3. Table 9.3 Tips, strategies and psycho‐education to improve sleep hygiene.
Chapter 12
1. Table 12.1 Summary of clinical and EEG/polysomnographic features of NFLE/SHE.
2. Table 12.2 Key points to clarify in the history.
Chapter 13
1. Table 13.1 Diagnostic criteria for restless legs syndrome according to ICSD‐3.
2. Table 13.2 Clinical testing for restless legs syndrome.
3. Table 13.3 Diagnostic criteria for periodic limb movement disorder.
4. Table 13.4 Definition of PLMS according to the American Academy of Sleep Medicine [4].
5. Table 13.5 Non‐ergot dopamine agonists for the treatment of restless legs syndrome.
6. Table 13.6 Key features of augmentation.
7. Table 13.7 Opioids for the treatment of restless legs syndrome. With the exception of oxycodone/naloxone opioids are not approved for RLS therapy in Europe.
Chapter 14
1. Table 14.1 Some relevant probes to assess sleep problems in Parkinson's disease and parkinsonian syndrome.
2. Table 14.2 Abnormal findings on polysomnography and Multiple Sleep Latency Test in Parkinson's disease and parkinsonian syndrome.
3. Table 14.3 Management suggestions for sleep problems in Parkinson's disease patients.
Chapter 15
1. Table 15.1 Studies evaluating the frequency of restless legs syndrome in hereditary ataxias.
Chapter 16
1. Table 16.1 Clinical manifestations in the myotonic dystrophies.
Chapter 17
1. Table 17.1 Some signs and symptoms of sleep‐disordered breathing in neuromuscular diseases.
2. Table 17.2 Management options for sleep dysfunction in neuromuscular diseases (for details, see text).
3. Table 17.3 Suggested criteria guiding the initiation of nocturnal non‐invasive positive pressure ventilation in neuromuscular disorders.
Chapter 18
1. Table 18.1 International Headache Society diagnostic criteria [3].
2. Table 18.2 Headache practitioner’s brief sleep questionnaire.
Chapter 20
1. Table 20.1 Useful ‘probes’ for sleep–wake disturbances after traumatic brain injury.
Chapter 21
1. Table 21.1 Effect of continuous positive airway pressure after stroke.
2. Table 21.2 Summary of diagnostics and treatment of sleep–wake disorders following stroke.
Chapter 23
1. Table 23.1 Sleep disturbances recognised in paraneoplastic syndromes.
2. Table 23.2 Studies reporting excessive daytime sleepiness in patients with paraneoplastic anti‐Ma2 encephalitis.

List of Illustrations

Chapter 01
1. Figure 1.1 Algorithm outlining a diagnostic approach to some of the common causes of primary and secondary insomnia that might present to neurologists.
Chapter 02
1. Figure 2.1 Polysomnogram screenshot, with a time base of 30 seconds on the upper panel and 3 minutes for the polygraphic channels, during stage R. The lower two channels are additional EMG recordings of the flexor digitorum superficialis muscles of the arm (EMG1: right FDS; EMG2: left FDS). The FDS channels clearly show abundant tonic and phasic activity indicating REM sleep without atonia fitting with an RBD diagnosis. Note that the chin EMG and standard tibalis EMG channels (Leg/R and Leg/L) show much less activity, illustrating the usefulness of adding extra EMG leads when suspecting RBD.
2. Figure 2.2 Trend analysis in position‐dependent obstructive sleep apnoea. Nearly all breathing events occur in supine position (“Back”), including snoring.
3. Figure 2.3 Polysomnogram recording with a time base of 5 minutes per page. The leg EMG channels show several PLMs. Importantly, the PLMs are followed by arousals as shown in the EEG derivations as well as indicated by repeated transient increases in heart rate.
Chapter 04
1. Figure 4.1 Polysomnography results of the patient described in Case 3.
Chapter 05
1. Figure 5.1 Graphic depiction of plasma levels of some typical hypnotic drugs, taken at 23:00 hours. The depth of shading corresponds to plasma levels.
Chapter 06
1. Figure 6.1 Schematic diagram showing diagnostic and therapeutic steps and considerations when dealing with excessive daytime sleepiness.
Chapter 07
1. Figure 7.1 During wakefulness, brainstem ascending arousal systems activate the brain by stimulation of thalamocortical transmission and of attentional processes in frontal regions, which also leads to behavioural expressions (open white arrows). The activities of different stimulating neurotransmitter systems originating in specific brainstem nuclei (including noradrenergic, dopaminergic, histaminergic and cholinergic neurons) are modulated by peptidergic systems like orexin. In this way, wakefulness can be modified by physiological conditions and circadian rhythms. Brain regions: BF, basal forebrain; DRN, dorsal raphe nuclei; Hyp., hypothalamus; LC, locus coeruleus; LDT, laterodorsal tegmental nuclei; PPT, pedunculopontine tegmental nuclei; SCN, suprachiasmatic nucleus; TMN, tuberomammillary nucleus; VLPO, ventrolateral preoptic area; vPAG, ventral periaqueductal grey. Neurochemical: 5HT, serotonin; ACh, acetylcholine; DA, dopamine; Glu, glutamate; His, histamine; NA, noradrenaline; Orx, orexin.
2. Figure 7.2 Acetylcholine is not only involved in waking, but is also important in REM sleep. Cholinergic neurons facilitate thalamocortical activation, which produces some of the characteristic cortical rhythms observed in the sleep EEG. This cortical stimulation does not lead to behavioural manifestations, because the brainstem systems that mediate motor activity are inhibited during physiological REM sleep (arrows to transparent nuclei). Muscle tone is further reduced by glutamatergic projections from the sublaterodorsal nucleus in the pons. Brain regions: BF, basal forebrain; DRN, dorsal raphe nuclei; Hyp., hypothalamus; LC, locus coeruleus; LDT, laterodorsal tegmental nuclei; PC/PB, pericoeruleus and parabranchial nuclei; PPT, pedunculopontine tegmental nuclei; PVN, paraventricular nucleus; SCN, suprachiasmatic nucleus; SLD, sublaterodorsal nucleus; TMN, tuberomammillary nucleus; VLPO, ventrolateral preoptic area; vPAG, ventral periaqueductal grey. Neurochemical: ACh, acetylcholine; GABA, gamma‐aminobutyric acid; GLU, glutamate; Mel, melatonin.
3. Figure 7.3 The light–dark cycle has an influence on sleep and wakefulness through the suprachiasmatic nucleus. This ‘biological clock’ controls the rhythmicity of melatonin release in the pineal gland through polysynaptic pathways. During light, the SCN suppresses the hypothalamic paraventricular nucleus through GABA‐ergic projections. When night falls, the suprachiasmatic nucleus becomes less active and the paraventricular nucleus is disinhibited. This leads to melatonin production in the pineal gland, mediated by sympathetic (noradrenergic) nerve projections that originate in the superior cervical ganglion. Elevated melatonin levels (together with darkness and several neurochemical factors that are not shown in the figure) cause a disinhibition of the ventrolateral preoptic area of the anterior hypothalamus. This area is relatively inactive during wakefulness, but during sleep induction it exerts an inhibitory mainly GABA‐ergic drive (ventrolateral preoptic area with connecting arrows) on all major arousing neurotransmitter systems. Brain regions: DRN, dorsal raphe nuclei; Hyp., hypothalamus; LC, locus coeruleus; LDT, laterodorsal tegmental nuclei; PPT, pedunculopontine tegmental nuclei; PVN, paraventricular nucleus; SCG, superior cervical ganglion; SCN, suprachiasmatic nucleus; TMN, tuberomammillary nucleus; VLPO, ventrolateral preoptic area; vPAG, ventral periaqueductal grey. Neurochemical: GABA, gamma‐aminobutyric acid; Mel, melatonin; NA, noradrenaline.
Chapter 08
1. Figure 8.1 Typical narcolepsy findings on a polysomnographic recording starting at 16:00 throughout the night, followed by a MSLT. Several spontaneous sleep episodes can be seen in the afternoon and early evening. There is a fragmented sleep pattern, with several awakenings throughout the night. During all episodes of the MSLT stage 2 is reached, with a mean sleep latency of 4 minutes. In addition, there are three sleep‐onset REM periods (during episodes 1, 2 and 4). Finally, a spontaneous nap occurred between MSLT episodes 1 and 2.
Chapter 09
1. Figure 9.1 The ‘3‐P' model of insomnia. Predisposing, precipitating and perpetuating factors co‐contribute to the development of chronic insomnia.
2. Figure 9.2 The vicious circle of chronic insomnia.
Chapter 10
1. Figure 10.1 Polysomnogram overview showing severe obstructive sleep apnoea. Note: Respiratory events are associated with microarousals and oxygen desaturations. Sleep is fragmented and there are frequent body position changes.
2. Figure 10.2 Obstructive sleep apnoeas. Absent airflow with attenuated but ongoing respiratory movement indicating continuing effort.
3. Figure 10.3 Microarousal at termination of obstructive apnoea.
4. Figure 10.4 Diagnostic and treatment pathway for sleep‐disordered breathing. ASV, adaptive servo ventilation (*contraindicated in left ventricular systolic failure); CPAP, continuous positive airway pressure; CSA, central sleep apnoea; MAD, mandibular advancement device; NIV, non‐invasive ventilation; OSA, obstructive sleep apnoea; O2, oxygen; PSG, polysomnography; RPG, respiratory polygraphy; SDB, sleep‐disordered breathing; Sx, symptoms; −ve, negative result.
5. Figure 10.5 Cheyne–Stokes Breathing central sleep apnoea. Note: Crescendo–decrescendo ventilation alternating with apnoeas. Airflow cessation (PFLOW and Thermistor) is associated with absent chest and abdominal deflection, indicating loss of central respiratory drive.
Chapter 11
1. Figure 11.1 A normal actogram collecting at 0.5‐minute epochs from the Actiwatch (Camntech, UK) plotted over a 48‐hour timescale to show a regular day–night pattern in a 61‐year‐old female. Arrows denote periods of intense exercise (horse riding) which occurred regularly.
2. Figure 11.2 An actogram in a patient with a 3‐year history of Parkinson’s disease who was still working and driving with few subjective sleep complaints. Sleep diaries were completed showing consolidated blocks of sleep during the night only.
Chapter 12
1. Figure 12.1 Flow chart to illustrate diagnostic process. Note that the diagnosis may be reached at any step along the process; however, further investigation is indicated if diagnostic uncertainty remains. NFLE, nocturnal frontal lobe epilepsy.
2. Figure 12.2 Diagnostic algorithm for distinguishing NFLE/SHE from parasomnias based on video recording only.
Chapter 13
1. Figure 13.1 This 90‐second epoch of a nocturnal polysomnography of a patient with periodic limb movement disorder contains seven periodic leg movements during sleep. The overall PLMs index was 48/h. The PLMs (in this epoch only present in the right leg) occur every 10–15 seconds during sleep stage 2. Each leg movement is associated with an EEG arousal.
2. Figure 13.2 Flowchart outlining a general strategy for the initation of pharmacological therapy for RLS, and management of augmentation based on clinical experience.
Chapter 16
1. Figure 16.1 Flow chart for the diagnosis and management of excessive daytime sleepiness (EDS) in MD1. BiPAP, bi‐level positive airway pressure; CPAP, continuous positive airway pressure; PSG, polysomnography.
Chapter 17
1. Figure 17.1 Abnormal overnight pulse oximetry tracing from a patient with an underlying neuromuscular disease. Note the low baseline arterial oxygen saturation (SpO2) level consistently below 90% with superimposed cyclical worsening, suggesting sleep hypoxaemia with probable rapid eye movement (REM)‐related worsening or significant REM‐predominant obstructive sleep apnoea. Full night in‐lab polysomnography is necessary to make this distinction. A similar pattern may be seen in patients with pulmonary disorders.
2. Figure 17.2 A 90‐second epoch of rapid eye movement (REM) sleep from the overnight polysomnogram of an 18‐year‐old woman with limb girdle muscular dystrophy, complaining of orthopnoea, insomnia, frequent awakenings, excessive daytime sleepiness and cognitive concerns. The recording showed mild obstructive sleep apnoea, with an Apnoea–Hypopnoea Index of 10.3/hour, and an arterial oxygen saturation (SaO2) nadir of 93%. Note paradoxical breathing (upper box) in REM sleep, with alternating movements of the chest and abdominal effort belts, accompanied by a SaO2 desaturation of 3% (lower box).
Chapter 18
1. Figure 18.1 Algorithm for sleep‐related headache.
Chapter 19
1. Figure 19.1 A 20‐second EEG epoch, showing the onset of a nocturnal frontal lobe epilepsy (NFLE) seizure.
Chapter 20
1. Figure 20.1 Frequency of traumatic brain injury‐related sleep–wake disturbances in the first prospective study in 65 consecutive traumatic brain injury patients. Sleep–wake disturbances were assessed and characterised by interviews, questionnaires, sleep laboratory examinations including polysomnography, Multiple Sleep Latency Test and actigraphy.
Chapter 21
1. Figure 21.1 Effect of CPAP treatment on cardiovascular risk. The figure shows the incidence risk for the primary composite endpoints in three randomised controlled trials [74–76] in the CPAP compared with the control group (hazard ratio or incidence density ratio, 95% confidence interval) in the intention‐to‐treat analysis and in the adherence analysis (patients with CPAP adherence ≥4 hours/day). *In the McEvoy et al. [74] study, the significant cardiovascular improvement in patients who used CPAP ≥ 4 hours/day was only achieved in the risk of a cerebrovascular event, but not in the primary composite outcome.
Chapter 22
1. Figure 22.1 A practical stepwise approach to assess sleep disturbances and fatigue in MS.
Chapter 23
1. Figure 23.1 Coronal brain MRI showing amygdalar and hypothalamic high signal (see arrows to the hypothalamus) in a FLAIR sequence in a patient with anti‐Ma2 encephalitis and testicular germinoma who presented with hypersomnia.

Edition History [John Wiley and Sons 1e, 2010]

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Library of Congress Cataloging‐in‐Publication Data

Names: Overeem, Sebastiaan, editor. | Reading, Paul, editor.
Title: Sleep disorders in neurology : a practical approach / edited by Sebastiaan Overeem, Paul Reading.
Other titles: Sleep disorders in neurology (Overeem)
Description: Second edition. | Hoboken, NJ : Wiley, 2017. | Includes bibliographical references and index. |
Identifiers: LCCN 2018007682 (print) | LCCN 2018008043 (ebook) | ISBN 9781118777244 (pdf) | ISBN 9781118777220 (epub) | ISBN 9781118777268 (cloth)
Subjects: | MESH: Sleep Wake Disorders–complications | Nervous System Diseases–complications
Classification: LCC RC547 (ebook) | LCC RC547 (print) | NLM WL 108 | DDC 616.8/498–dc23
LC record available at https://lccn.loc.gov/2018007682

Cover Design: Wiley
Cover Image: © Marjot/iStock

List of Contributors

Kirstie N. Anderson
Regional Sleep Service
Newcastle upon Tyne Hospital NHS Foundation Trust
Newcastle upon Tyne
UK

Isabelle Arnulf
Sleep Disorders Unit
Pitié‐Salpêtrière Hospital (APHP), Sorbonne University
Paris
France

Claudio L. Bassetti
Department of Neurology
Bern University Hospital
Bern
Switzerland

Christian R. Baumann
Department of Neurology
University Hospital Zurich
Zurich
Switzerland

Sushanth Bhat
JFK Neuroscience Institute
Hackensack Meridian Health‐JFK Medical Center
Edison
USA

Valérie Cochen De Cock
Department of Neurology and Sleep Disorders
Clinique Beau Soleil
Montpellier
France

Chris Derry
Department of Clinical Neurosciences
Western General Hospital
Edinburgh
UK

J. Gert van Dijk
Department of Neurology and Clinical Neurophysiology
Leiden University Medical Centre
Leiden
The Netherlands

Jeroen J.J. van Eijk
Department of Neurology
Jeroen Bosch Hospital
Den Bosch
The Netherlands

Luigi Ferini‐Strambi
Sleep Disorders Center
University Vita‐Salute San Raffaele
Milan
Italy

Joop van Gerven
Centre for Human Drug Research
Leiden
The Netherlands

Francesc Graus
Neurology Service
Hospital Clínic de Barcelona
Barcelona
Spain
and
Institut d’Investigació Biomèdiques August Pi i Sunyer (IDIBAPS)
Barcelona
Spain

Dirk M. Hermann
Department of Neurology
University Hospital Essen
Essen
Germany

Alex Iranzo
Neurology Service
Hospital Clínic de Barcelona
Barcelona
Spain
and
Institut d’Investigació Biomèdiques August Pi i Sunyer (IDIBAPS)
Barcelona
Spain
and
Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED)
Barcelona
Spain

Brigit A. de Jong
Department of Neurology
VU University Medical Center
Amsterdam
The Netherlands

Gert Jan Lammers
Department of Neurology and Clinical Neurophysiology
Leiden University Medical Centre
Leiden
The Netherlands
and
Sleep Wake Centre SEIN Heemstede
Heemstede
The Netherlands

José Enrique Martínez‐Rodríguez
Neurology Service
Hospital del Mar
IMAS
IMIM
Barcelona
Spain

Geert Mayer
Sleep Disorders Unit
Hephata Klinik
Schwalmstadt‐Treysa
Germany

Christine Norra
LWL Hospital Paderborn and Department of Psychiatry, Psychotherapy and Preventive Medicine
Ruhr University Bochum
Bochum
Germany

Sebastiaan Overeem
Centre for Sleep Medicine ‘Kempenhaeghe'
Heeze
The Netherlands
and
Eindhoven University of Technology
Eindhoven
The Netherlands

Dirk Pevernagie
Centre for Sleep Medicine ‘Kempenhaeghe'
Heeze
The Netherlands

Angelique Pijpers
Centre for Sleep Medicine ‘Kempenhaeghe'
Heeze
The Netherlands

J. Steven Poceta
Scripps Clinic Sleep Center
Division of Neurology
Scripps Clinic
La Jolla
USA

Timothy G. Quinnell
Respiratory Support and Sleep Centre
Royal Papworth Hospital
Cambridgeshire
UK

Jeanetta C. Rains
Center for Sleep Evaluation at Elliot Hospital
Manchester
USA

Paul Reading
Department of Neurology
James Cook University Hospital
Middlesbrough
UK

Gé S.F. Ruigt
Clinical Consultancy for Neuroscience Drug Development
Oss
The Netherlands

Mojca van Schie
Department of Neurology and Clinical Neurophysiology
Leiden University Medical Centre
Leiden
The Netherlands

Markus H. Schmidt
Department of Neurology
Bern University Hospital
Bern
Switzerland

Pieter Jan Simons
Centre for Sleep Medicine ‘Kempenhaeghe'
Heeze
The Netherlands

Bart Willem Smits
Department of Neurology
Maasstadziekenhuis
Rotterdam
The Netherlands

Karel Šonka
Department of Neurology
1st Medical Faculty
Charles University and General Teaching Hospital
Prague
Czech Republic

Thom P.J. Timmerhuis
Department of Neurology
Jeroen Bosch Hospital
Den Bosch
The Netherlands

Ingrid Verbeek
Centre for Sleep Medicine ‘Kempenhaeghe'
Heeze
The Netherlands

Johan Verbraecken
Department of Pulmonary Medicine and Multidisciplinary Sleep Disorders Centre
Antwerp University Hospital and University of Antwerp
Antwerp
Belgium

Marie Vidailhet
Movement Disorders Unit
Pitié‐Salpêtrière Hospital (APHP), CRICM UMR 975, and Paris 6 University
Paris
France

Thomas C. Wetter
Department of Psychiatry and Psychotherapy
University of Regensburg
Regensburg
Germany

Sue J. Wilson
Psychopharmacology Unit
Dorothy Hodgkin Building
University of Bristol
Bristol
UK

Preface

An increasingly held perception is that medical textbooks have become the extinct ‘dinosaurs’ of information transfer and education. Indeed, the global availability of knowledge and thirst for brand new data, the inevitable delays in producing written multi‐authored texts, the expense of books together with the demise of traditional libraries would all appear to support this contention. In a rapidly changing environment, therefore, books, like dinosaurs, need to evolve in parallel and certainly be clearer in their aims than previously. Edited by a sleep physician and a general neurologist with a subspecialist interest in sleep, this book was conceived as a counterpoint to the established large encyclopaedic reference volumes currently available. The intentions were to cover areas not always addressed by standard sleep medicine or, indeed, neurology textbooks, at least from a practical perspective. The book is specifically aimed at clinicians and health care professionals not specifically trained or experienced in sleep medicine who nevertheless need to manage neurologically damaged patients with increasingly recognised sleep–wake disturbances. As such, we envisage the book will serve as an easily digested and practical handy companion, rather than as an exhaustive and fully referenced factual tome.

Largely for historical reasons, most neurologists receive little formal training in academic and clinical aspects of sleep medicine. Most sleep units are run solely by physicians primarily interested in breathing‐related sleep disorders and patients under their care may have little access to neurological expertise. This may seem paradoxical given conditions such as narcolepsy that are clearly ‘neurological’ with recently defined specific neuropathology and neurochemistry. The lack of exposure to sleep medicine naturally tends to produce neurologists with an unconfident, at best, or nihilistic, at worst, approach to sleep‐related symptoms in the clinic. By necessity, the situation is changing, especially given the increasingly recognised relevance of poor sleep or impaired wakefulness to quality of life issues in chronic neurological patients. Furthermore, it is clear to most clinicians that deterioration in sleep often coincides with or even causes worsening control of many chronic neurological conditions such as epilepsy.

Most neurologists would not expect to be referred cases of primary insomnia or obvious obstructive sleep apnoea although may well encounter them incidentally. Despite their high prevalence, there is relatively little emphasis on these common sleep disorders in this book and the focus is on those specific symptoms commonly experienced by neurological patients, assuming they are asked about them.

When sleep ‘goes wrong’ it impacts highly on all aspects of a subject’s well‐being and often their carer’s. As a result, increasing attention to patient choice has appropriately led to a higher expectation that such symptoms should be taken seriously. However, many neurologists with traditional approaches might feel that sleep problems are not disabling enough to warrant detailed attention. We would counter‐argue that ‘sleep is for the brain’ and without enough of it, the brain suffers. It is perhaps worthwhile recalling somewhat distasteful experiments from the late nineteenth century demonstrating that puppies could survive longer without water than without sleep.

The reputation that neurology is a discipline in which successful therapeutic options play second fiddle to diagnostic acumen is only partly true. Perhaps counter‐intuitively, treating sleep symptoms in neurology is often particularly rewarding, patients and carers appreciating even partial improvements in controlling their sleep–wake cycle. A recurrent theme in the book is that drugs to improve sleep are often selected using ‘medicine‐based’ evidence and personal experience than the gold standard of evidence‐based medicine. Despite this, together with the relative limited armamentarium of drugs available to the sleep physician, we believe that the majority of patients can be helped with a flexible and pragmatic approach. When drugs are mentioned, their proposed use is often ‘off licence’ and any prescriber will need to take responsibility for monitoring and progress. Similarly, doses of drugs are often approximate recommendations and it is not intended to provide strict or didactic guidelines. In many of the sleep‐disordered populations covered in the book, it is appropriate to suggest long‐term therapy on the assumption spontaneous improvement is unlikely. This often needs to be emphasised to primary care physicians who are more accustomed to providing short‐term prescriptions for sleep‐related problems.

The point or threshold at which a general neurologist should engage the help of a sleep specialist clearly depends on a number of factors. However, an exchange of views and expertise in a multidisciplinary setting, if possible at an early stage, would seem to be the best approach if facilities allow. We would encourage neurologists to forge stronger links with physicians more dedicated to sleep medicine in the firm belief any ‘cross fertilisation’ will benefit both sides.

By necessity, there is some overlap in the topics covered by some of the chapters. However, given the personal and practical approach we have espoused throughout the book, we hope different perspectives will improve rather than hinder understanding and effective symptom management in sleep‐disordered neurological patients.

In the Second Edition

The second edition of our handbook incorporates the changes outlined in the third International Classification of Sleep Disorders (ICSD‐3), published in 2014. The organisation of the book has also changed such that three parts now cover ‘General Sleep Medicine’; ‘Primary Sleep Disorders’; and ‘Sleep in Neurological Disorders’. It is hoped that the book will be a useful tool for those planning to gain a formal ‘somnologist’ qualification, given the increasing availability of a certification process in Europe, for example. Indeed, one encouraging development in many countries is the realisation that sleep medicine should be recognised as an important subspeciality with a formalised curriculum and specific assessment process. Inevitably, this will encourage and incentivise those fascinated by sleep and facilitate career pathways.

Eindhoven, The Netherlands
Sebastiaan Overeem

and Middlesborough, UK, January 2018
Paul Reading

Sleep Disorders in Neurology

A Practical Approach

List of Contributors

Preface

In the Second Edition

Part One
General Sleep Medicine