Purpose of Review: The basic circuitries that regulate wake-sleep cycles are described, along with how these are affected by different disease states and how those alterations lead to the clinical manifestations of those disorders.Recent Findings: The discovery of both sleep-promoting neurons in the ventrolateral preoptic nucleus and wake-promoting neurons, such as the lateral hypothalamic orexin (also called hypocretin) neurons, has allowed us to recognize that these two populations of neurons are mutually antagonistic (ie, inhibit each other) and form a...

Purpose of Review: This article provides a framework for the clinical assessment of patients with sleep-related complaints and outlines a systematic approach to a sleep-specific history and physical examination, subjective assessment tools, and diagnostic testing modalities.Recent Findings: Physical examination findings may suggest the presence of a sleep disorder, and obstructive sleep apnea in particular, but the clinical history remains the most important element of the assessment for most sleep problems. While nocturnal polysomnography in a sleep laboratory remains the gold...

Purpose of Review: This article provides an overview of current strategies for evaluating and treating patients who experience chronic insomnia.Recent Findings: The US Food and Drug Administration (FDA) has approved several medications for the treatment of insomnia that incorporate a variety of pharmacodynamic and pharmacokinetic properties, thus allowing the development of a customized therapeutic approach. FDA-approved medications include [gamma]-aminobutyric acid-modulating benzodiazepine receptor agonists, a melatonin receptor agonist, and a histamine receptor agonist. Psychological and behavioral techniques combined as cognitive-behavioral therapy...

Purpose of Review: This review discusses the various causes of primary hypersomnias with emphasis on clinical recognition, diagnosis, and treatment options.Recent Findings: Narcolepsy is probably the most fascinating syndrome causing excessive daytime sleepiness. With increasing understanding of the hypocretin/orexin pathways and the neurotransmitters that subserve the role of wakefulness and sleep, newer therapeutic modalities with promising results are being investigated and opening new frontiers in the treatment of this rare but devastating disease.Summary: This article reviews the primary hypersomnias of...

Purpose of Review: This article introduces readers to the clinical presentation, diagnosis, and treatment of sleep-disordered breathing and reviews the associated risk factors and health consequences.Recent Findings: Sleep-disordered breathing is associated with significant impairments in daytime alertness and cognitive function as well as adverse health outcomes. The initial treatment of choice is positive airway pressure. Improvements in technology and mask delivery systems have helped to make this treatment more comfortable and convenient for many patients.Summary: Sleep-disordered breathing, particularly in the...

Purpose of Review: This article summarizes the clinical and electrophysiologic manifestations of nocturnal seizures, particularly nocturnal frontal lobe epilepsy (NFLE), parasomnias, and other disorders presenting with complex behaviors in sleep. The evaluation and treatment of patients with complex nocturnal behaviors can be challenging. While the differential diagnosis of sleep-related movements, including physiologic and pathologic phenomena, is extensive, the focus of evaluation in patients with complex nocturnal behaviors distinguishes between nocturnal seizures and parasomnias.Recent Findings: Seizures in NFLE have a wide...

Purpose: This article reviews the recent advances in understanding of the fundamental properties of circadian rhythms and discusses the clinical features, diagnosis, and treatment of circadian rhythm sleep disorders (CRSDs).Recent Findings: Recent evidence strongly points to the ubiquitous influence of circadian timing in nearly all physiologic functions. Thus, in addition to the prominent sleep and wake disturbances, circadian rhythm disorders are associated with cognitive impairment, mood disturbances, and increased risk of cardiometabolic disorders. The recent availability of biomarkers of circadian...

Purpose of Review: An understanding of the impact of sleep on neurologic disorders, and the impact of neurologic disorders on sleep, provides fresh opportunities for neurologists to improve the quality of life and functioning of their patients.Recent Findings: Sleep-disordered breathing (SDB) is a risk factor for cerebrovascular disease and should be considered in all TIA and stroke patients. Sleep disorders can amplify nociception and worsen headache disorders; and some headaches, including those related to SDB and hypnic headache, are sleep...

Purpose of Review: This article reviews the sleep-related movement disorders, including restless legs syndrome (RLS; Willis-Ekbom disease), periodic limb movement disorder, rhythmic movement disorders, sleep-related bruxism, and sleep-related leg cramps.Recent Findings: The prevalence of clinically significant RLS is 1.5% to 3.0%. The pathophysiology of RLS may involve abnormal iron transport across the blood-brain barrier and down-regulation of putaminal D2 receptors. The availability of the rotigotine patch provides an additional form of dopaminergic therapy for RLS. Calcium channel alpha-2-delta ligands (gabapentin,...

Purpose of Review: The purpose of this review is to examine how sleep disorders in children are affected by age and comorbid medical influences, and to discuss current understanding of how the clinical manifestations, pathophysiology, and treatment of common childhood sleep disorders differ from those of the adult population.Recent Findings: Recently established age-specific norms are required for accurate interpretation of polysomnograms and multiple sleep latency tests in children.Summary: Sleep disorders such as insomnia, obstructive sleep apnea, and excessive daytime somnolence...

A patient diagnosed with REM behavior sleep disorder (RBD) has as much as a 65% risk of developing an [alpha]-synucleinopathy. Currently, it is not possible to predict whether an individual will develop a disease, or, if so, which disease.The neurologist treating the patient must consider (1) the difference between disclosing a diagnosis and disclosing the risk of a diagnosis; (2) whether to disclose this risk to patients; and (3) if deciding to disclose the risk, the appropriate timing of such...

Purpose of Review: Fragmented sleep, prolonged work hours, misalignment of sleep-wake cycles, and an expectation to make medical decisions when alertness levels are reduced are pervasive in neurology residency training. Sleep loss in residency training can lead to cognitive and psychosocial impairment and accidents, compromise patient care, and reduce the trainee's quality of life. Neurology residents experience levels of hypersomnolence similar to residents in surgical specialties and have comparable subjective levels of sleepiness as persons with pathologic sleep disorders such...

The landscape of sleep medicine practice is actively evolving out of the laboratory, driven primarily by the improvement of home testing technology and the implementation of utilization management by insurance companies. This article will review a case of a patient with possible obstructive sleep apnea and discuss the history of home sleep testing and the reasons that home sleep testing will have an increasingly large role in the practices of physicians who evaluate patients with sleep disorders. Neurologists with an...