treatment

The treatment of Narcolepsy including Sodium Oxybate (Xyrem) and Modafinil

Narcolepsy is one of the most complex of non-respiratory Sleep Disorders, consisting of a tetrad was Excessive Daytime Sleepiness, Cataplexy, Sleep Paralysis and Hypnagogic Hallucinations. Once we’ve diagnosed Narcolepsy, treatment for your Narcolepsy comes in many forms including :

Behavioral Therapy

Good sleep hygiene is crucial in managing Narcolepsy symptoms in the long term. Adequate sleep at night is important, daytime timed-naps can be useful.

Medications

Many medications can be used to treat Narcolepsy, each with their own pros and cons.

CNS stimulants such as Methylphenidate (Ritalin, Concerta) and dextroamphetamine (dexamphetamine, dexamfetamine) work well but have long term complications. Pemoline is less commonly used due to the potential side effects.

Modafinil and Armodafinil (Modavigil, Nuvigil) are generally better-tolerated than amphetamine-based medications, and with less side effects. These still however require longterm vigilance.

Sodium oxybate (Xyrem, metabolite of gamma-aminobutyric acid) has been used in the USA since 2002, and has been used by our clinic since it’s Australian approval in late 2014. We have the largest known group of patients in South Australia on treatment, with impressive symptomatic results. We provide continuous regular clinical monitoring in conjunction with patients’ General Practitioners, to ensure optimal titration of treatment modalities based on the patient’s current clinical status.

At Adelaide Sleep, we routinely counsel, diagnose, and treat all aspects of Narcolepsy and Idiopathic Hypersomnia. We have experience in all medications used for Narcolepsy and Narcolepsy-like conditions. If you’d like to know more, contact us now.

© APSS 2018

The Diagnosis of Narcolepsy and the MSLT

Narcolepsy is one of the most interesting of Sleep Disorders in the International Classification of Sleep Disorders (ICSD-3). It is characterised by the classic tetrad was Excessive Daytime Sleepiness, Cataplexy, Sleep Paralysis and Hypnagogic Hallucinations. The addition of Sleep disruption makes the Narcolepsy pentad. The most often used test for this diagnosis is the in-hospital Multiple Sleep Latency Test (MSLT).

Whilst the symptom of sleepiness is helpful, sleepiness is a symptom of many sleep disorders. Some Narcoleptics are not aware of how sleepy they really are. Objective testing is crucial.

A Multiple Sleep Latency Test (MSLT) involves an overnight sleep study, followed by timed nap opportunities the following day. A urinalysis is also part of the testing process. Depending on the overnight and subsequent-daytime testing, and in the absence of another sleep disorder, a diagnosis of Narcolepsy (or Idiopathic Hypersomnia) can be confidently made.

A home sleep study (also known as an ambulatory sleep study) will never be able to diagnose Narcolepsy.

Measuring CSF Hypocretin levels are useful when an MSLT is not possible.

Here at Adelaide Sleep, we look after all aspects of Narcolepsy including the counselling, diagnosis, and treatment of all Narcolepsy symptoms. If you’d like to know whether you have Narcolepsy or one of the Narcolepsy-like conditions, call us now and see one of our doctors.

© APSS 2018

The History of Narcolepsy – Excessive sleepiness in evolution

Central Disorders of Hypersomnolence encompass conditions including Narcolepsy and Idiopathic Hypersomnia – at here at the best Adelaide Sleep clinic in Adelaide, we manage all these conditions.

Narcolepsy was first described the 1870’s were it was associated with Cataplexy and Postencephalitic Narcolepsy. With these reports from over a century ago, it was the first known primary sleep disorder to be described, identified and the symptomatology reported. It was from here that the classic tetrad was Excessive Daytime Sleepiness, Cataplexy, Sleep Paralysis and Hypnagogic Hallucinations was coined. Fragmented sleep is also a common symptom that is often overlooked.

Our understanding of Narcolepsy progressed with the development of treatments such as Methylphenidate in the 1950’s – known to ameliorate some Narcolepsy symptoms.

In the following decade of the 1960’s came tricyclic antidepressants (TCAs) and their use in cataplexy, at around the time we discovered sleep-onset REM periods (SOREMPs).

The first consensus for the definition fo Narcolepsy was ratified in the 1970’s under the International Classification of Sleep Disorders (ICSD). The following decade saw the first documented association of Human Leukocyte Antigen (HLA)-DR2 and Narcolepsy (Honda et al, Sleep 1986).

With the 1990’s came the discovery of Hypocretin 1 and the Hypocretin Receptor 2 Gene. Today we can diagnose Narcolepsy with the Multiple Sleep Latency Test (MSLT) and CSF Hypocretin levels.

At Adelaide Sleep, we have experts who are trained in specifically counselling, diagnosing, and treating Narcolepsy and all Sleep Disorders. We treat the whole spectrum fo sleep disorders, and pride ourselves on being able to differentiate and treat each of these separately.

If you believe you may have Narcolepsy or one of the Narcolepsy-like conditions, we can help. Call us now for an appointment.

© APSS 2018

Showcasing the Burnside Sleep Centre

Your sleep study produces over 1,000 pages of data – and that’s why we prefer a local Adelaide centre with staff who are well trained with higher degrees. We prefer not to rely on computer-automation, someone who won’t outsource your important medical data to interstate- or overseas-groups.

That’s why our Sleep Studies are performed at the Burnside War Memorial Hospital.

Burnside Sleep Centre (BSC) is an independent purpose-built six-bed facility within Burnside Hospital, catering to the sleep needs of our community. It’s location is perfect for sleep studies : free parking overnight surrounding the hospital, in a quiet inner-city suburb.

Designed with the comforts of home in mind, each private sleep study room comes with Wifi, a king-single bed, sound proofing, its own ensuite and TV.

BSC staff continue to participate in regular National Quality Control programs (both in-house, and national Q-Sleep), and hold regular meetings with their medical Sleep Committee.

BSC is also one of the very few Sleep Laboratories to offer the full range of Sleep Tests, including :

•  Diagnostic sleep studies
•  CPAP titration studies
•  BiLevel PAP studies
•  Adaptive- or Auto- Servo Ventilation (ASV) titration studies
•  Supplementary Oxygen titration, Carbon Dioxide (TcCO2) monitoring
•  Multiple Sleep Latency Testing (MSLT)
•  Maintenance of Wakefulness Testing (MWT).
•  Specialising in sleep studies for adolescents, adults, and the elderly.

At Adelaide Sleep, in conjunction with BSC, the doctor who sees you is also the doctor who analyses and interprets your complex sleep study. Both Adelaide Sleep doctors and BSC do not have any affiliation with CPAP outlets, CPAP sales, or vested interest in particular treatments.

This is why we believe the Burnside Sleep Centre is the premiere Sleep Centre for diagnostic testing, and we’re excited to refer our sleep studies to Burnside Hospital.

Contact us now for an appointment.

© APSS 2017

Rapid Access to Sleep Services

We’re delighted to announce that our Adelaide Sleep clinic and sleep study services have been extended!

We now have more sessions available and can consult you within days.

Similarly, our sleep study (polysomnography) sessions have increased to almost every night of the week. We can accommodate your schedule much easier and sooner.

With our Rapid Access Sleep Services, we’ll be able to see you, study your sleep, and start treatment immediately.
And for our country patients travelling into Adelaide, we can even see you the following morning with your sleep study results, and start treatment that same day.

For local Adelaideans, your Sleep Study reports are often released to yourself and / or your referrer within 24-48hours of your sleep study.

At Adelaide Sleep, we don’t think it’s fair to make you wait days, weeks, months to have your sleep study. You shouldn’t have to wait for your results either. See us now.

© APSS 2016

Urgent recall : Resmed ASV machines could increase mortality risk in heart failure

Central Sleep Apnoea (CSA) in the setting of Heart Failure usually presents as Cheyne Stokes Respiration (CSR) on a sleep study. One of the ways to attempt to correct CSR is with a particular kind of PAP machine called “ASV”… Auto Servo Ventilation.

ASV machines map your breathing, and apply particular pressures on a breath-to-breath basis.

Today, Resmed released an Urgent Recall of their ASV machines because of an apparent safety concern.

Preliminary analysis of their data suggests an exceedingly high risk of cardiovascular death (33.5% higher) in those with Heart Failure using ASV, compared to those not on ASV.

At Adelaide Sleep, we keep abreast of all new Sleep Developments. All of our patients are consulted before and after their sleep studies, and before and after their treatment commencement, as per the current recommendations by the Australasian Sleep Association (ASA). We do not believe in direct-CPAP-outlet sales, nor do we believe in direct-to-consumer-sleep-study services. By seeing a Medical Specialist, you would’ve had a face-to-face medical consultation regarding your ASV machine.

If you believe that you are on an ASV machine, and would like to speak to a Medical Specialist regarding this, contact us now.

Addit : Philips Respironics have also released a statement echoing that of Resmed – caution in prescribing and using their BiPAP autoSV / BiPAP autoSV Advanced therapy machines and algorithm, in the at-risk group.

© APSS 2015

OSA, poor sleep linked to memory loss, poor concentration

We have long known that a poor night’s sleep will impair your next-day functioning, but in recent times we’ve had ever-increasing evidence that many Sleep Disorders are truly to blame. Sleep deprivation, poor sleep, and constantly-disrupted sleep will impair your skills the next day.

A recent article (Varga et al, J Neurosci. 2014) looked at one of the most common sleep disorders and it’s effects on how your brain functions.

Those with Obstructive Sleep Apnoea (OSA) were found to have poorer memory and spatial navigation… compared to when they had treatment for their OSA. Their cognition was slower, memory recall slower.

Consulting with our Adelaide sleep doctors, we’ve learnt that this is not surprising, given that :

•  OSA is usually much worse in REM sleep
•  OSA can inherently reduce your REM sleep
•  OSA can dramatically reduce your sleep efficiency
•  Recurrent OSA can starve your brain of oxygen throughout the night
•  Constant pauses in breathing will keep waking you up in the night
•  Disrupted sleep will cause memory loss, poor concentration

When you translate this to the real world, this means mistakes and reduced productivity during the day, lapses in concentration during time-critical events, and recurrent micro-sleeps as you try and catch up on lost sleep.

“My concentration and ‘snappiness’ isn’t what it used to be”
“I keep forgetting my keys and people’s names”
“I need to write everything down now”

Don’t let poor sleep deprive you of the important things in life, call us now.

© APSS 2015

Fixing Sleep in teenagers and adolescents

Sleep problems exist at every age group, and that’s why we’re delighted to remind everyone that we not only consult adults, but also adolescents above the age of 14years. The sleep needs of your Teenager should be as tailored to them as it would to any Adult. Sleep in Teenagers is unique.

Adolescents aren’t just ‘little adults’. Their problems are specific in their age group, and are well and truly above and beyond a simple ‘sleep apnoea’ test. They shouldn’t be treated just like any other adult.

In the younger age group, there is a higher propensity for Central Hypersomnias (including Narcolepsy and Idiopathic Hypersomnolence). They’re more likely to experience NREM parasomnias, sleep walking and sleep talking, night terrors and arousal disorders. Their Circadian Rhythm is more likely to be reflective of Delayed Sleep Phase Syndrome, or Free Running Rhythm (now known as Non-24-Hour Sleep-Wake Rhythm).

Increasingly we’re seeing more and more of those with Periodic Limb Movements or The Restless Legs Syndrome too.

Home sleep studies are restricted to those above 18yo, and often have no consultation with any specialist of any kind. That’s why we prefer in-hospital studies, and our specialists will always personally see you with the results.

We’re accredited to see more than just adults, and we routinely perform Sleep Studies on those under the age of 18.

If you want your Sleep needs taken seriously, no matter what age you are, give us a call and we’ll put you in contact with our Adelaide Sleep Specialist.

© APSS 2014