1/5. sleep disorders.humans spend approximately one third of their lives asleep. Although the same medical disorders that occur during wakefulness persist into sleep, there are many disorders that occur exclusively during sleep or are manifestations of a disturbance of normal sleep-wake physiology. The most common reason for referral to a sleep laboratory is OSA, whereas the most common sleep disorder is insomnia. Effective treatments now exist for many sleep disorders, such as OSA and RLS, and a major breakthrough in the treatment of narcolepsy seems imminent. Because all disease processes are adversely affected by insufficient sleep, it is essential that the practicing physician understand the causes and treatments of the common sleep disorders.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/5. narcolepsy in the custodial setting.A case of a detained person who suffered from narcolepsy is presented. The management of the condition in general and with particular reference to the custodial setting is discussed. The management of obstructive sleep apnoea, the commonest sleep disorder, is contrasted. Forensic physicians are often confronted with rare or unusual medical problems in the custodial setting, often having to make immediate medical decisions without access to specialist medical advice. Twenty-four hour access to internet medical resources in the custodial setting may be helpful.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/5. narcolepsy with cataplexy in early childhood.narcolepsy is a rare neurologic sleep disorder with morbidity associated with functional impairment and frequent delay in diagnosis. Symptoms typically manifest in adolescence or early adulthood, but diagnosis of narcolepsy has been reported in early childhood. diagnosis rates are as low as 50% of the total population of patients with narcolepsy and are delayed as much as 10 years after disease onset due to inadequate patient-physician communication and/or misdiagnosis. I present the complexity of diagnosing narcolepsy in early childhood in a patient with cataplexy that started soon after independent ambulation at age 10 months.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/5. The treatment of narcolepsy and cataplexy.narcolepsy may affect as many as 250,000 Americans. It involves a neurologic defect in the regulation of sleep and wakefulness. The chief symptoms are sleepiness, inappropriate sleep episodes, and cataplexy. Narcoleptic patients also frequently complain of hypnagogic hallucinations, sleep paralysis, and automatic behavior, as well as disturbed nocturnal sleep. narcolepsy usually develops in adolescence and is a life-long illness. Satisfactory treatment is not available at the present time. The current treatments of choice include general measures (such as patient and family counseling and frequent napping) and drug treatments, including methylphenidate for sleepiness and sleep episodes and imipramine for cataplexy. Medication dosages mut be adjusted for individual patients. pharmacists have a special responsibility to monitor narcoleptic patients by becoming familiar with the disease and its symptoms and by encouraging patients to follow their drug regimens and to take drug holidays under the supervision of the physician when the drug dose becomes excessive.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/5. Effective treatment of narcolepsy with codeine in a patient receiving hemodialysis.A 64-year-old man with narcolepsy could not take stimulant drugs due to coronary heart disease. In the past he noted improvement in alertness when taking codeine for pain, but this was eventually discontinued. After he developed end-stage renal disease, and because the use of stimulants in this setting may be difficult, treatment with codeine was again initiated. This resulted in dramatic improvement in alertness and substantial reduction of cataplexy. Because it is simple to use and familiar to most physicians, codeine may be the drug of choice for narcoleptic patients who are undergoing hemodialysis.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |