The authors report a new side effect of the dopamine agonists pramipexole and ropinirole: sudden irresistible attacks of sleep. Eight PD patients taking pramipexole and one taking ropinirole fell asleep while driving, causing accidents. Five experienced no warning before falling asleep. The attacks ceased when the drugs were stopped. Neurologists who prescribe these drugs and patients who take them should be aware of this possible side effect.
Having trouble falling asleep is a common experience. In fact, research suggests that almost a third of adults Trusted Source National Library of Medicine, Biotech Information The National Center for Biotechnology Information advances science and health by providing access to biomedical and genomic information. View Source experience chronic insomnia, a sleep disorder characterized by persistent difficulties in falling or staying asleep. However, for those of us without insomnia, tossing and turning in bed after a stressful day can be a familiar experience.
The first part of the cycle is non-REM sleep, which is composed of four stages. The first stage comes between being awake and falling asleep. The second is light sleep, when heart rate and breathing regulate and body temperature drops. The third and fourth stages are deep sleep. Though REM sleep was previously believed to be the most important sleep phase for learning and memory, newer data suggests that non-REM sleep is more important for these tasks, as well as being the more restful and restorative phase of sleep.
Meaning These findings suggest that the prevalence of masked asleep hypertension is high among US adults; data are needed on the cardiovascular risk reduction benefits of treating asleep hypertension.
Importance High blood pressure (BP) during sleep (asleep blood pressure) is associated with an increased risk of cardiovascular disease, but a national prevalence estimate of masked asleep hypertension (high BP while sleeping but without high BP measured in the clinic [clinic BP]) for the United States is lacking.
Main Outcomes and Measures High clinic BP was defined as clinic systolic BP (SBP)/diastolic BP (DBP) of at least 140/90 mm Hg using JNC7 and at least 130/80 mm Hg using 2017 ACC-AHA guidelines. High asleep BP was defined as mean asleep SBP/DBP of at least 120/70 mm Hg for JNC7 and at least 110/65 mm Hg for the 2017 ACC-AHA guidelines. Masked asleep hypertension was defined as high asleep BP without high clinic BP.
Conclusions and Relevance These findings suggest that the prevalence of masked asleep hypertension is high among US adults. Data are needed on the cardiovascular risk reduction benefits of treating asleep hypertension.
Narcolepsy can greatly affect daily activities. People may unwillingly fall asleep even if they are in the middle of an activity like driving, eating, or talking. Other symptoms may include sudden muscle weakness while awake that makes a person go limp or unable to move (cataplexy), vivid dream-like images or hallucinations, and total paralysis just before falling asleep or just after waking up (sleep paralysis).
In a normal sleep cycle, a person enters rapid eye movement (REM) sleep after about 60 to 90 minutes. Dreams occur during REM sleep, and the brain keeps muscles limp during this sleep stage, which prevents people from acting out their dreams. People with narcolepsy frequently enter REM sleep rapidly, within 15 minutes of falling asleep. Also, the muscle weakness or dream activity of REM sleep can occur during wakefulness or be absent during sleep. This helps explain some symptoms of narcolepsy.
Safety precautions, particularly when driving, are important for everyone with narcolepsy. Suddenly falling asleep or losing muscle control can transform actions that are ordinarily safe, such as walking down a long flight of stairs, into hazards.
New research indicates the answer is, yes. A clinical outcome trial of 69 people who underwent deep brain stimulation, or DBS, surgery at OHSU, published in the journal Neurology, indicates that those who underwent the procedure while asleep experienced better clinical outcomes in terms of communication, cognition and speech. Further, there was no demonstrable difference in improvement of slowed movement, muscle rigidity or tremor between those who underwent asleep-DBS versus those who were awake during the procedure.
Burchiel, a co-author on the paper, noted that OHSU stopped doing awake surgeries as of January 2011. The study compares patients who went through awake-DBS in 2010 with those who went through the asleep-DBS more recently. Burchiel performed the surgery in each case.
Although OHSU is in the minority right now, Burchiel believes there will be a stampede to asleep-DBS among neurosurgeons worldwide within the next few years. Burchiel carved out a reputation more than 25 years ago as the pioneer of deep brain stimulation, as the first physician to conduct the surgery in the United States. The surgery is now conducted in roughly 100 medical centers nationwide, including OHSU.
Typical deep brain stimulation procedures are performed while the patient is awake. Technological improvements in imaging have enabled neurosurgeons at OHSU to accurately map the brain before and during deep brain stimulation, allowing them to conduct the surgery while the patient is fast asleep. (OHSU/John Valls)
The goal in asleep DBS is to accurately place the electrodes at the target selected by the surgeon preoperatively. This goal is accomplished using intraoperative imaging and guidance rather than cellular recordings, allowing you to sleep through the entire procedure.
Even if you are not apprehensive about the prospect of awake brain surgery, our research has found no additional benefit that would favor awake surgery over asleep DBS surgery. As such, good candidates for awake DBS almost always make excellent candidates for asleep DBS as well. Learn more about what makes a good candidate for DBS.
Most studies that investigated outcomes after DBS asleep surgery and that found comparable results to awake surgery had no control group but rather compared their outcomes with previous studies8,13,20,21. In a retrospective study, Tsai et al.22 found that, in terms of UPDRS score improvement, levodopa equivalent of daily dose reduction and stimulation parameters did not show significant differences between groups after 5 years. Blasberg et al.13 found a significant difference in the percentage reduction of UPDRS-III motor scores due to stimulation after 3 months but not after 1 year. Using the baseline values of UPDRS and levodopa challenge as covariates, we found that the short-term UPDRS-III improvement rate in the GA group was similar to that of the LA group.
The literature on the impact of complications associated with the use of GA during asleep DBS surgery is limited. Recent studies15,17,23,24 have demonstrated that the incidence of intracerebral hemorrhages, infections, and epilepsy were similar between asleep and awake DBS surgery, which is generally consistent with our results. In this study, the volume of intracranial air was significantly lower in the GA group than that in the LA group, which is consistent with previous reports17,25. Awake DBS resulted in significantly larger cortical brain shifts25. Additionally, awake DBS surgery has the disadvantage of potential local anesthetic drug allergies26.
A literature review20 published recently revealed that there are no significant differences in cost between awake and asleep DBS surgery. In contrast, in a single academic medical center cost analysis, asleep DBS surgery was associated with lower costs in comparison with the awake procedures27. The cost was influenced by the use of iCT, iMRI, or a robot, as well as anesthesia-related expenses and postoperative incidents or complications.
Certain limitations were present in our study design. First, this study was a retrospective cohort study, which limits its external validity. Nevertheless, the patients in the two groups were consecutively recruited and returned to all postoperative follow-ups. There was no randomization for the group assignment (asleep vs. awake), which implies a selection bias. Second, we investigated robot-assisted asleep DBS surgery for PD in a single center, even though this technique is still not widely used. We insist that this is a DBS surgical method with future prospects. Third, the follow-up time for UPDRS score evaluation (including subscale scores) was 6 months on average. Long-term follow-ups are still needed for both groups. The lack of good-quality randomized clinical trials warrants further research in this field.
Compared with the awake group, the asleep group exhibited a shorter procedure duration and a similar electrode implantation accuracy and short-term motor improvement. In general, DBS surgery should still be performed with the technique that the neurosurgeon and team members are most familiar with, because this provides the patients with the best possible outcome. Robot-assisted asleep DBS surgery is a promising surgical method for PD in the future. However, high-quality epidemiological data are lacking. Thus, a prospective randomized controlled trial with a larger patient population and longer follow-up is needed to confirm the findings and conclusions of this study.
Tossing and turning, being unable to relax both physically and mentally, can leave you tired and irritable in the morning. A restless night with poor quality sleep can leave you feeling bleary-eyed and affect energy during the day. Try our range of motion-activated sleep aids to help you stay asleep for longer and enjoy a more restful slumber
Drowsy driving. Teenagers are at the highest risk for falling asleep at the wheel. Drowsy driving is the most likely to occur in the middle of the night (2:00 to 4:00 AM), but also in mid-afternoon (3:00 to 4:00 PM). 781b155fdc