Edited by Sebastiaan Overeem and Paul Reading
Second Edition
This second edition first published 2018 © 2018 by John Wiley & Sons Ltd
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
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
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.
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