• Total sleep time and percent of REM sleep were increased in patients with idiopathic hypersomnia compared with controls.
• Sleep-onset latency and percent of slow-wave sleep were decreased in patients with idiopathic hypersomnia compared with controls.
• Sleep efficiency and REM latency were similar between patients with IH and 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:

• Dysfunction of the GABAergic system
• Autonomic system dysfunction
• Altered functional or regional connectivity in the brain
• Circadian system dysfunction
• Dysfunction of energy metabolism

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:

• Science doesn’t fully understand the pathophysiology of idiopathic hypersomnia. Research has revealed potential clues, however. For example, idiopathic hypersomnia is associated with changes in sleep staging and architecture. What does emerging science suggest are differences in nighttime sleep?
• How might the arousal index differ in idiopathic hypersomnia versus in people without it, and why might that matter?
• 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. What is the GABAergic system and its possible role?
• What are some emerging findings surrounding idiopathic hypersomnia and autonomic system dysfunction?
• What is the evidence that supports the idea of altered functional or regional connectivity in the brain in people with idiopathic hypersomnia?
• There were fascinating studies done on skin fibroblasts, suggesting that circadian period length may be different in people with idiopathic hypersomnia versus in people without it. What role might circadian rhythm dysfunction have in idiopathic hypersomnia?
• What has science discovered about the possible role of dysfunction of energy metabolism in idiopathic hypersomnia?
• What further research would you like to see conducted on the pathophysiology of idiopathic hypersomnia?

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

• • Impacts on attention and cognition, which can be characterized as “brain fog”
  • The burden of memory problems and a feeling of the mind going blank or making a mistake in a habitual activity

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: 

• • What are some limits that people with idiopathic hypersomnia can experience in their daily living activities?
  • How do people with idiopathic hypersomnia commonly describe "brain fog," and what are some of the real-life consequences it?
  • How does prolonged sleep inertia place a burden on the people with idiopathic hypersomnia who experience this symptom?
  • What do you see as the burden of idiopathic hypersomnia on public health and safety?
  • Beyond medications, how is idiopathic hypersomnia typically managed to control for symptoms as much as possible?
  • How do you determine when therapy for idiopathic hypersomnia has been optimized, and what symptoms may remain at this point?

• What exactly is mouth taping during sleep?
• How has the practice of mouth taping during sleep evolved in popularity over the years?
• Is there any evidence that mouth taping is useful for healthy sleepers, that is, people without any sleep disorders?
• Is there any evidence that mouth taping is useful for people with any sleep disorders, perhaps as an add-on to a device such as an oral appliance for sleep apnea?
• What dangers are associated with mouth taping during sleep?
• What is your advice to sleep techs for how to handle the situation of an in-lab sleep study patient who wants to use mouth taping during an in-lab sleep study?
• What is your evidence to sleep medicine professionals if their patients confide in them that they using mouth tape, either with or without their prescribed device, to treat a sleep disorder?

• • Sleep inertia: sleep inertia is common in patients with idiopathic hypersomnia but can also be reported by individuals with mood disorders
  • Patients with idiopathic hypersomnia often find naps to be long and unrefreshing, while patients with narcolepsy generally find short naps to be restorative
  • If a patient has prolonged nighttime sleep, long sleeper syndrome should be considered; in contrast to patients with idiopathic hypersomnia, long sleepers feel refreshed and do not have daytime sleepiness and difficulty awakening if they are allowed to sleep as long as they need
  • Cognitive complaints, often described as "brain fog" are common symptoms of idiopathic hypersomnia but also can occur in patients with various sleep-wake disorders (including narcolepsy type 1 and insufficient sleep syndrome)

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:

• • Idiopathic hypersomnia can be particularly challenging to diagnose because of its lack of specific biomarkers, as well as its symptoms resembling those of other disorders. How do you differentiate idiopathic hypersomnia from hypersomnias of a specific cause, such as narcolepsy type 1 and type 2, insufficient sleep syndrome, or hypersomnia due to a neurodegenerative disease?
  • A minority of people simply need to sleep longer than most, even 10 hours or more, to feel refreshed. How do you determine if that applies to a given person, who may not have a sleep disorder at all?
  • How do you differentiate idiopathic hypersomnia from hypersomnia comorbid to psychiatric disorders, such as prolonged sleep time tied to depression?
  • At what point in ruling out other disorders should objective sleep testing, such as polysomnography and multiple sleep latency testing, be done?
  • Why is idiopathic hypersomnia sometimes confused with sleep-breathing disorders? When would you recommend a CPAP trial to address possible apneas, hypopneas, or respiratory-event related arousals?
  • How do you distinguish chronic fatigue syndrome from idiopathic hypersomnia?

Listen to Episode 1: Symptoms of Idiopathic Hypersomnia Listen to Episode 2: Diagnosis of Idiopathic Hypersomnia

• What is obstructive sleep apnea, also known as OSA for short?
• What do you think is the most troubling risk of not treating obstructive sleep apnea?
• How has treatment-resistant hypertension been linked to OSA?
• How can the impaired brain function linked to OSA manifest in patients?
• What evidence is out there that erectile dysfunction and female sexual dysfunction can be tied to OSA?
• How has obstructive sleep apnea been linked to diabetes?
• The worst link in my view is that obstructive sleep apnea has been linked to an earlier death. Why is that?
• Treatment of sleep apnea typically involves a device, such as a CPAP machine or an oral appliance, though surgery can be an option for some patients. Is there any evidence that treating OSA can alleviate some of sleep apnea morbidities or mortality?
• With all of this evidence in mind, what should healthcare providers do to help identify patients who are likely to have obstructive sleep apnea?
• What should any patients listening to this podcast do if they think they have symptoms of obstructive sleep apnea?

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?

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:

• The symptom of idiopathic hypersomnia that people are most familiar with is excessive daytime sleepiness. Will you define and briefly explain this core symptom?
• But excessive daytime sleepiness is not the only symptom typically reported by people with idiopathic hypersomnia. Prolonged sleep time is another common symptom. What can this mean over the course of a 24-hour day?
• Sleep inertia, that feeling of difficulty waking up, can happen to all of us. How can sleep inertia differ in people with idiopathic hypersomnia versus in those without it?
• Are naps generally restorative for people with idiopathic hypersomnia? Does length matter?
• What ancillary cognitive symptoms are commonly reported with idiopathic hypersomnia?
• In 2019, the Idiopathic Hypersomnia Severity Scale was developed to measure the severity, frequency, and functional impact of the key symptoms of excessive daytime sleepiness, prolonged nighttime sleep, and sleep inertia. What do you think is the clinical utility of this questionnaire?

To dive even deeper:

• https://sleepreviewmag.com/sleep-disorders/hypersomnias/idiopathic-hypersomnia
• Trotti LM. Idiopathic hypersomnia. Sleep Med Clin. 2017;12(3):331-44.
• Dauvilliers Y. Idiopathic hypersomnia severity scale. 2018.
• Arnulf I, Leu-Semenescu S, Dodet P. Precision medicine for idiopathic hypersomnia. Sleep Med Clin. 2019;14(3):333-50.
• Vernet C, Leu-Semenescu S, Buzare MA, Arnulf I. Subjective symptoms in idiopathic hypersomnia: beyond excessive sleepiness. J Sleep Res. 2010;19(4):525-34.
• Dauvilliers Y, Evangelista E, Barateau L, et al. Measurement of symptoms in idiopathic hypersomnia: The Idiopathic Hypersomnia Severity Scale. Neurology. 2019;92(15):e1754-62.
• Rassu AL, Evangelista E, Barateau L, et al. Idiopathic Hypersomnia Severity Scale to better quantify symptoms severity and their consequences in idiopathic hypersomnia. J Clin Sleep Med. 2022;18(2):617-29.

• What are the challenges that prevent insomnia from being diagnosed in the primary care setting?
• Can you provide practical advice on how to fit in insomnia screening and diagnosis into primary care settings?
• In what circumstances should primary care physicians refer patients to sleep specialists?
• What are best practices for CBT-I in primary care settings?
• Why is trazodone so frequently prescribed and is it a good choice for insomnia patients?
• What is novel about dual orexin receptor antagonists?

For more information on insomnia in primary care, visit:

• A 2023 Update on Managing Insomnia in Primary Care: Insights From an Expert Consensus Group
• https://sleepreviewmag.com/insomnia/
• https://www.thensf.org/do-i-have-insomnia/

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.

-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.

• The FDA recently released guidance on voluntary target concentrations for sodium, in commercially processed packaged and prepared foods. What are your thoughts on this reduced goal for sodium intake, in terms of impact on cardiovascular risk?
• What are some links between high sodium intake and adverse cardiovascular outcomes?
• What should people be aware of with regard to medication use and sodium intake?
• How should cardiovascular risk be discussed when determining the management plan for sleep disorders?
• Can you share an example of modifying a sleep disorder patient's management plan, due to an emerging cardiovascular risk or disease?
• Beyond sodium intake, what are some of the other modifiable cardiovascular risk factors that everyone, regardless of whether they have a sleep disorder or not, should be aware of?

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:

• Narcolepsy is linked with multiple cardiovascular risk factors and comorbidities. Can you inform our audience to any of the specifics of the cardiovascular burden among patients with narcolepsy?
• Why is it that patients with narcolepsy commonly present with cardiovascular comorbidities? Is there a potential mechanistic link between narcolepsy and these conditions?
• Does sleep disruption itself impact cardiovascular risk? If so, what is the evidence for the connection between sleep disruption that's a hallmark of narcolepsy and increased cardiovascular risk?
• How do you balance narcolepsy management with the management of cardiovascular health factors, both in terms of lifestyle and pharmacotherapy?
• Are there any published studies about narcolepsy and cardiovascular risk that you'd recommend for additional information?

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?

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?

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?

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?

-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/

-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

More Webinar Info:
https://aadsm.cnf.io/

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https://info.medqor.com/srsubform

Sleep Disorder Clinical Research Program:
https://www.massgeneral.org/psychiatry/research/sleep-disorders-clinical-research-program

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You can visit https://savestandardtime.com/ and follow @savestandard on Twitter and other social media for more information. You can also text “SST” to 50409 to remind lawmakers they can end Daylight Saving Time with permanent Standard Time.

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Wallace B. Mendelson, MD, the author of the new book Understanding Sleeping Pills, shares 3 broad issues to be aware of with regard to nonprescription products.

Outlined in today’s episode is the standard process used in the office of Jeff Rodgers, DMD, DABDSM, to guide the patient from initial consultation to successful treatment.