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Questions posted in the
Neurology and Neurosurgery Forum have been answered by doctors from The Cleveland Clinic Foundation.
Question Title: Sleep DisorderForum: Neurology Forum
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Re: Sleep DisorderPosted by CCF Neuro MD on April 08, 1997 at 09:29:42: In Reply to: Sleep Disorder posted by Nancy S. on April 08, 1997 at 09:28:24: : This Message was posted by: Nancy - 4/6/97 1:33:27 PM Message: = Benzodiazepine class medications such as Klonapin, and dopamine agonist medications, such as Sinemet, are typically used in an alternating fashion monthly to treat the very stubborn problem of periodic movements of sleep. Often the use of one agent by itself is effective for only several weeks, but if you then switch to the other, it is also typically effective for weeks, then also wears off; luckily, if you then go back to the first medication, it is once again effective for weeks. Regarding your comments about lack of stage four sleep, unless you have a sleep study that substantiates your claims, there is no way for anyone, including doctors, to tell whether or not they have reached a particular stage of sleep during a given night. Fibromyalgia and related similar diagnoses are often associated with significant sleep disturbance, most often secondary to an underlying undiagnosed anxiety disorder or other significant psychiatric disorder, especially depression, which can cause profound disturbances in the amount of sleep as well as with sleep architecture. I am assuming that you have been appropriately screened for such. Many of the medications you have used suppress REM stage sleep; chronic daily use of Klonapin or other benzodiazepine class medications will eventually result in drug-dependent sleep and ultimately lessen the quality and quantity of sleep over time. If you have not been evaluated by a neurologist for the treatment of the periodic limb movemenets of sleep, I would highly recommend doing so, as this is often a stubborn problem requiring treatment by a physician with specific expertise in dealing with it. Given your multiple diagnoses of three syndromes closely linked to psychiatric illness, I would also strongly recommend a psychiatric evaluation if you have not already had one, as neglect of underlying anxiety or depression may result in significant improvements in the symptoms that led to your diagnoses of chronic fatigue syndrome, fibromyalgia, and myofascial pain syndrome. In response to your final inquiry regarding the "intrusion" of alpha waves on your delta waves, this does not occur. If you have an alpha rhythm, you are, by definiton, awake; therefore the appearance of alpha waves during sleep would indicate an arousal, perhaps triggered by one of your periodic movements in sleep waking you up briefly in your particular case. Also, a lousy night's sleep does not mean you failed to achieve slow (delta) wave sleep during the night--- but rather only that you had a lousy night's sleep. In the case of chronic fatigue syndrome, such a feeling is quite common. I would not advise becoming fixated on finding other reasons for your poor sleep until you have corrected the one good and obvious reason you may be getting a bad night's sleep all the time--- the periodic movements. In medicine, it is always best to treat actual problems before embarking upon searches or theories about potential problems that have not been proven to exist. I hope you find some or all of this information useful. If you would be interested in seeing a sllep specialist at the Cleveland Clinic specifically, the appointment number is 216-444-5559. Any of our sleep section physicians would be happy to evaluate you and discuss the specifics of your case in more detail.
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