Sleep Disorders and Sleep Deprivation: An Unmet Public

Sleep Disorders and Sleep Deprivation: An Unmet Public Health Problem
http://www.nap.edu/catalog/11617.html
CONSEQUENCES OF CHRONIC SLEEP LOSS AND SLEEP DISORDERS 93
son’s disease and other parkinsonian syndromes, such as multiple systems
atrophy and progressive supranuclear palsy. The ability to ameliorate the
symptoms of REM sleep behavioral disorder with dopaminergic agonist
drugs suggests that it may be an early sign of damage to the dopaminergic
system (Trampus et al., 1991).
Treatment
Treating sleep disturbances associated with Parkinson’s disease is complicated
owing to the different actions associated with dopaminergic medications.
Medications used to treat this disorder often include dopamine
precursors (levodopa/carbidopa) and dopamine agonists (pramipexole and
ropinirole). When used in low doses, these medications can promote sleep,
but high doses may cause increased nocturnal wakefulness, decreased SWS,
and decreased sleep continuity (Leeman et al., 1987; Monti et al., 1988;
Cantor and Stern, 2002). In contrast, excessive daytime sleepiness, including
sleep attacks, has also been described in association with dopamine
agonists (Paus et al., 2003); therefore, many patients with Parkinson’s disease
require daytime stimulants such as modafinil or amphetamine to relieve
excessive sleepiness.
Other classes of medication used to treat Parkinson’s disease include
monoamine oxidase-B inhibitors (selegiline), presynaptic relating agents
(amatadine, anticholingeric agents), and catechol-O-methyltransferase
(COMT) inhibitors (hyoscyaine, benztropine). All may potentially affect
sleep (Chrisp et al., 1991), particularly with regard to decreasing REM sleep,
but the sleep effects of these medications remain to be well described
(Kaakkola, 2000).
Epilepsy
Manifestations and Prevalence
Epilepsy refers to a group of various disorders characterized by abnormal
electrical activity in the brain that manifests itself in individuals as a
loss of or impaired consciousness and abnormal movements and behaviors.
Sleep, sleep deprivation, and seizure activity are tightly intertwined.
After stroke and Alzheimer’s disease, epilepsy is the third most common
neurological disorder in the United States, with incidence between 1.5 to
3.1 percent (Shouse and Mahowald, 2005). It is estimated that sleeprelated
epilepsy may affect as many as 10 percent or more of epileptic
individuals (AASM, 2005). Sixty percent of individuals who suffer partial
complex localization related seizures—21.6 percent of the general epileptic
population—exhibit convulsions only during sleep (Janz, 1962).
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