In my neurological practice, the most common sleep disorder by far is Insomnia. Insomnia is generally defined as either difficulty initiating sleep, difficulty maintaining sleep, or early-morning awakening with inability to return sleep. In order to make the diagnosis of insomnia, there must be some impairment of daytime functioning. This may include fatigue, difficulty concentrating or memory impairment, mood disturbances or irritability, poor motivation, headaches or even simply concerns or worries about sleep. The prevalence can range from 10%-15% in the general population. However, in a neurology clinic setting, that number is likely to be closer to 50%. Insomnia is particularly prevalent in patients with headaches, epilepsy, neurodegenerative disorders as well as multiple
sclerosis. Studies suggest that insomnia may contribute to medical conditions such as hypertension and glucose intolerance while comorbid conditions such as depression and anxiety are common.
An evaluation of insomnia must include a thorough history, both from the patient as well as the bed partner or roommate. Helpful tools may include sleep logs/diaries, sleep questionnaires, psychological and mood inventories and actigraphy. An actigraphy unit is a hi-tech, medical device that functions as a movement and sleep detector. It is worn at the wrist, like a watch, and is a useful tool to objectively monitor sleep-wake activity while communicating the data to the doctor’s computer. The patient wears it for 3-7 days, or longer, and it can aid in the diagnosis of insomnia subtypes and circadian rhythm disorders. After wearing the actigraphy device for the designated period of time, the patient will return to the office and the doctor will read and analyze the report that was generated by the actigraphy. Following the digital information generated from the report, an individualized, custom made, plan of action will be put into place to assist the patient with developing healthy sleep patterns.
There are four primary components for treatment of insomnia. The first is optimal sleep hygiene, which means developing good sleep habits to promote healthy sleep. This includes limiting caffeine and alcohol use, as well as exercising regularly.
The second is utilization of cognitive behavioral therapy (CBT). Behavioral therapies include stimulus control (associating the bedroom with sleep), sleep restriction and relaxation therapy. The cognitive component is learning to get rid of negative thoughts regarding sleep. One of the current challenges is the limited availability of qualified nurses who are skilled at administering CBT for insomnia.
The third component is the judicious use of sleep modulating agents. This may include non-specific agents (temazepam) and specific agents (Ambien); one exciting new development is the brand new FDA-approved agent called suvorexant, an antagonist of hypocretin, the neurochemical which is often found deficient in narcolepsy. The fourth component is adequately treating comorbid conditions such as depression.
A comprehensive, neurological evaluations by a board certified neurologist is needed to rule out sleep conditions which may present as insomnia, such as sleep apnea, circadian rhythm disorders, restless legs syndrome and narcolepsy. Contributing medical and psychiatric conditions, as well as medications’ side effects must be identified as possible triggers. Once insomnia is diagnosed, a combination treatment using all four components discussed above is recommended for best results. Gardens Neurology is setting in motion and looking forward to putting together an insomnia center which will effectively treat all patients suffering from this disabling sleep condition. Insomnia is often inadequately treated and we are trying to reverse that trend and offer the newest medical as well as holistic treatments.
How nice will it be to say “good night, sleep tight” and know that even if the bed bugs bite, we will wake up in the morning after a good night sleep…
Insomnia is a very common disorder with important negative health consequences. Dr. David Silvers, and the staff at Gardens Neurology, are proud to announce the opening of an insomnia center for adults and adolescents 13 years of age and older. With our recent office expansion at 3401 PGA Blvd., and the addition of a qualified, CBT trained, nurse practitioner, Gardens Neurology will start evaluating and treating patients for insomnia. All patients will initially be screened by Dr. David Silvers for secondary causes of insomnia. Following a thorough initial consultation,
a trained nurse practitioner will evaluate all patients with insomnia by taking an in-depth history, instructing patients on keeping a sleep diary and utilizing a hi-tech wrist actigraphy device. Once all studies have been completed, and with Dr. Silvers’ supervision, our providers will manage and follow patients with insomnia using a multimodal approach which will include:
• Sleep hygiene education
• Cognitive-behavior therapy for insomnia (CBT-I)
• Appropriate use of sleep promoting agents
• Addressing comorbid conditions including anxiety and depression
Another important addition to our facility is offering patients with cognitive disorders special therapy through cognitive remediation. Many conditions can cause memory loss, but with cognitive remediation and therapy, improvements are possible.
Our expanded neruology center also treats patients suffering from a wide scope of neurological issues. Some of Dr. Silvers’ expertise include mild cognitive issues, Parkinson’s Disease, headaches, multiple sclerosis, stroke, epilepsy, peripheral neuropathy, movement disorders, Alzheimer’s Disease, neuromuscular disorders and concussion.
Dr. Silvers is board certified in neurology, neuromuscular medicine and electrodiagnostic medicine. All EMG’s and EEG’s that are ordered by Dr. Silvers are performed in the comfort of our office.
David Silvers, M.D.
Board Certified in Neurology,
and Neuromuscular Medicine
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3401 PGA Blvd., Suite 430
Palm Beach Gardens, FL 33410