Eliminate Restless Leg Syndrome
Most patients presenting with insomnia have psychophysiological difficulty initiating and or maintaining sleep. Usually marked functional effects and somatized tension associated with sleep are evident. The patient reports extreme tiredness while being unable to sleep satisfactorally. This contrasts with the circadian disorders where, in delayed sleep-phase syndrome, the patient may not feel sleepy until late in the normal sleep period, and in advanced sleep-phase syndrome, may waken early and be unable to return to sleep. Taking a history, incorporating screening questions on restlessness, limb movements, and breathing can help to diagnose obstructive sleep apnoea syndrome, periodic limb movement disorder, and restless legs syndrome, although full polysomnographic evaluation is usually also required.(5) However, polysomnography is not essential for the diagnosis of insomnia, for which sleep diary monitoring (see ChapieL.4.1,4 ) is usually the most useful form of assessment.(2) Wrist...
Olfactory function has been assessed in other atypical parkinsonian syndromes such as MPTP-induced parkin-sonism. In this entity, olfactory function is preserved.49 Olfactory function is also preserved in two syndromes that may be associated with PD, essential tremor,50-51 and idio-pathic restless leg syndrome.52 While in sporadic forms of these syndromes, they appear to behave as independent disorders in familial forms of PD, PD and essential tremor phenotypes appear to be associated at the genetic level and possibly reflect differential expressivity of the same monogenic defect.53
The terminating Chapter 15 summarizes in a general way the medicinal chemistry of metal-centered brain diseases and indicates other neurological disorders that may involve metal ions like polyneuropathy, multiple sclerosis, macular degeneration, progressive supranuclear palsy or the restless leg syndrome which are not otherwise covered in the book because knowledge is scarce.
A step-wise assessment process is suggested to accurately determine the presence of SDB in the elderly. First, a complete sleep history should be obtained, including symptoms of SDB, symptoms of other sleep disorders (e.g., restless leg syndrome), sleep-related habits and routines and, if possible, bed-partner testimonials. Secondly, the patient's medical history, including psychiatric and medical records, should be reviewed. Particular attention should be given to associated medical conditions and medications, the use of alcohol, and evidence of cognitive impairment. Lastly, if from the evidence gathered there is reason to suspect SDB, an overnight polysomnographic recording should be obtained.
Several early studies suggested that as many as one-half of individuals with CFS have mild sleep apnea syndrome (five or more episodes per hour of apnea hypopnea), periodic leg movements or the restless leg syndrome Other studies with more stringent criteria for these disorders either did not find this result (Krupp, Jandorf, Coyle, and Mendelson 1993 Le Bon et al. 2000 Sharpley, Clements, Hawton, and Sharpe 1997). However, one recent study (Gold, Dipalo, Gold, and Broderick 2004) bearing confirmation did report a high rate of sleep disturbed breathing in patients with fibromyalgia, a pain syndrome often occurring in CFS patients.
Sleep disturbances are frequent in Parkinson disease. These disorders can be broadly categorized into those that involve nocturnal sleep and excessive daytime sleepiness. The disorders that are often observed during the night in PD include sleep fragmentation that may be due to recurrent PD symptoms, sleep apnea, Restless Leg Syndrome periodic limb movements and REM sleep behavior disorder. Excessive daytime sleepiness is also a common occurrence in PD. EDS can arise from several etiologies, and patients may have more than one etiology responsible. The causes of EDS include nocturnal sleep disorder with sleep deprivation and resulting daytime somnolence, the effect of drugs used to treat PD, and possibly neurodegeneration of central sleep wake areas. Appropriate diagnosis of the sleep disturbance affecting a PD patient can lead to specific treatments that can consolidate nocturnal sleep and enhance daytime alertness.
Restless leg syndrome and sleep apnea, a condition in which there is intermittent cessation of breathing during sleep that may be caused by a problem in the central nervous system affecting the diaphragm or a blockage in the upper airway, can benefit by weight loss if overweight and by regular exercise. Caffeine, drugs, and alcohol should be avoided and stress reduced. Food allergies or a deficiency of iron or folic acid may be a factor in restless leg syndrome taking 200 to 800 IU vitamin E can alleviate symptoms of the condition by increasing blood circulation to the legs 80 mg gingko biloba extract three times daily may be beneficial. Rhus toxicodendron or causticum are homeopathic remedies that can be beneficial for restless leg syndrome and for sleep apnea, lach-esis, or homeopathic opium.
Restless Leg Syndrome
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