December 2024

NEUROSCIENCES

UPDATES IN NEUROLOGY: SLEEP DISORDERS: WHAT THE NON-SLEEP NEUROLOGIST NEEDS TO KNOW

COVID-19 and SLeep

CASE 1: A 52-year-old female comes to your clinic because of insomnia after a recent SARS-CoV-2 infection.
 
Here’s what you need to know:

  • Fatigue, brain fog and sleep disturbance are among the most common symptoms of post-acute sequelae of SARS-CoV-2 infection (PASC).
  • On average, patients experienced 6 neurologic symptoms, with brain fog being the most common.
  • A high percentage of patients reported fatigue and insomnia.
  • Patients experienced significant impairments in all quality-of-life areas and performed worse on attention tasks compared to the general U.S. population.
  • Patients with neuro-PASC had:
    • Lower sleep efficiency (less restful sleep)
    • Longer sleep latency (took longer to fall asleep)
    • Later sleep midpoint (shifted sleep schedule)
  • Self-reported cognitive issues were linked with higher levels of fatigue, anxiety and depression.
  • Measured disruptions in sleep, such as wakefulness after sleep onset and sleep inefficiency, were associated with poorer performance in attention and processing speed tasks.
 
Read the study.
Read about the RECOVER-SLEEP trial at Northwestern Medicine.

Cannabis and Sleep

CASE 2: An 82-year-old male comes to your clinic because of insomnia and says, “My friend said that I should try THC gummies.”
 
Here’s what you need to know: 
 
  • While cannabis has been legalized in many states either for medical or recreational use, nationally it remains a Schedule I drug.
  • There are no cannabis-derived products that have been approved by the Food and Drug Adminstration for use in sleep disorders.  
  • “Dosages,” particularly for smoked/vaped cannabis, can be quite variable.
  • Some individuals may see short-term benefits; however, these effects are variable and typically do not last long.
  • More large-scale clinical trials are needed to determine which individuals may benefit from specific cannabis derivatives.
  • Cessation can lead to significant withdrawal symptoms that impact sleep quality.
  • Cognitive behavioral therapy should still be considered the first-line treatment for insomnia.
  • If medication or supplement options are needed, at this stage we have safer, more effective options than cannabis products.

obstructive sleep apnea

CASE 3: A 46-year-old patient with poorly controlled hypertension requiring 3 antihypertensives brings you their recent sleep study results, which indicate obstructive sleep apnea (OSA).
 
Here’s what you need to know:
 
There are multiple consequences of OSA:
  • Daytime fatigue and sleepiness
  • Cardiovascular problems: hypertension, coronary artery disease, cardiac arrhythmias, congestive heart failure and heart disease
  • Premature death
  • Stroke
  • Metabolic issues: increased risk of Type 2 diabetes and obesity
  • Cognitive decline: difficulty concentrating and increased risk of accidents
  • Mood changes: depression and anxiety
  • GERD and gastrointestinal issues
  • Sexual dysfunction
 
The preferred therapy for an individual patient with OSA depends on a combination of factors, including their symptoms, medical comorbidities, the severity of their sleep apnea (Apnea-Hypopnea Index and hypoxemic burden) and willingness to comply with a certain therapy. In general, the treatment options are as follows:
 
  • Positive airway pressure
  • Mandibular advancement device
  • Hypoglossal nerve stimulator
  • Medication
  • Positional therapy
  • Weight loss
Sabra M. Abbott, MD, PhD
Associate Professor of Neurology
Program Director, Sleep Medicine Fellowship
Director, Circadian Medicine Clinic
Northwestern Medicine

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