The Science of Sleep. A quirky Indy motion picture by that title was in theaters last year. The plot concerned an odd but wildly creative and endearing fellow who ran into problems in his interpersonal relationships, in part, because he often couldn't distinguish between being awake and asleep. Wake and dream episodes mirrored each other, creating a penchant for the surreal and a personal narrative for the protagonist that wasn't quite in sync with that of the characters around him.
A sleep specialist might have diagnosed narcolepsy and a parasomnia or two. A psychiatrist or neuropsychiatrist might have diagnosed a host of other problems that run together with sleep-wake disorders. We're not sure whether our protagonist "gets the girl" at the end of the cinematographic tale. Even though he is puppy-and-kitten adorable, the girl knows he's way off his rocker, clinically speaking. Indeed, this is the gist of the closing scene of the movie.
Everyone knows how simple sleep irregularities can mess up one's mood and even one's life and conversely how a messed up mood can negatively affect sleep-wake function. And many of us have endured a dyssomnia or parasomnia at some time in our life.
Sleep dysfunction has been associated with a host of physical and psychiatric maladies in a chicken-or-egg kind of way. Now, in recognizing sleep consolidation problems, parasomnias (such as REM sleep behavior disorder and restless legs syndrome), and dyssomnias (such as circadian rhythm sleep disorder, insomnia, and narcolepsy) in persons with disorders ranging from autism to traumatic brain injury to Parkinson disease, physicians are suggesting that the primary neurological disorder will improve if the sleep-wake malady is ameliorated. The rationale is not simply that a good night's sleep will benefit a person compromised by neurological illness but that the biochemistry of sleep and of certain neurological illnesses are closely linked.
One of the more clinically relevant symposia presented at the 9th annual meeting of the American Society for Experimental Neurotherapeutics, which took place in Washington, DC, from March 8 to 10, focused on sleep and neurotherapeutics. In a fascinating overview of the biochemistry of the sleep-wake cycle, Clifford Saper, MD, PhD, James Jackson Putnam Professor of Neurology at Harvard Medical School in Boston, spoke about how the neuropeptide orexin was a key component in sleep-wake function. He noted that orexin levels are compromised when an organism is under stress (hypervigilant) and that levels decrease as a person ages, owing to the tendency of many late middle-aged and elderly persons to spend increasingly less time sleeping. His take-home message was that orexin might be a therapeutic biomarker for sleep therapy.
His presentation was followed by presentations by Beth Malow, MD, MS, associate professor of neurology at Vanderbilt University in Nashville, Tennessee, and David B. Rye, MD, PhD, associate professor of neurology at Emory University in Atlanta. Malow noted that although research is scant, sleep consolidation in patients with epilepsy appears to have a significantly beneficial impact on seizure control and that sleep irregularities and seizure activity are interrelated. Her take-home message was that more attention should be given to sleep hygiene in epilepsy research and interventions.
Rye's point, which is presented on page 25, was that dopamine(Drug information on dopamine) is integrally involved in sleep-wake function and thus a therapeutic focus on normalization of sleep-wake function in parkinsonian disorders could ameliorate daytime symptoms--motor, cognitive, and affective.
IN THIS ISSUE
We turn the spotlight on headache in this issue and present a provocative report that poor physician-patient communication is at the crux of inadequate migraine diagnosis and management. It's not that physicians aren't questioning patients about migraine symptoms; they aren't asking the right questions in a way that allows for the most efficient care. Tips are given on how to interview a patient about headache symptoms. The silver lining is that the suggested approach takes less time, is more informative, and leaves the patient more contented with the office visit than other, closed-ended diagnostic querying approaches.
We also include a comprehensive review on chronic daily headache, a mix of news features riding on the coattails of the recent International Stroke Conference, and a bit of news from the 59th annual meeting of the American Academy of Neurology.