Neurologic clinics
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Irrespective of diagnosis, chronic daily, morning, or "awakening" headache patterns are soft signs of a sleep disorder. Sleep apnea headache may emerge de novo or may present as an exacerbation of cluster, migraine, tension-type, or other headache. ⋯ Sleep disturbance (e.g., sleep loss, oversleeping, schedule shift) is an acute headache trigger for migraine and tension-type headache. Snoring and sleep disturbance are independent risk factors for progression from episodic to chronic headache.
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Insomnia is a common disorder, with individual and societal consequences. Advances have been made in the understanding of insomnia and its treatment options. However, cognitive behavioral therapy and Food and Drug Administration-approved pharmacologic therapies have limitations, the former primarily involving access and the latter involving potential side effects. Further research is needed to optimize management strategies.
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Sleep disturbance is common after traumatic brain injury (TBI). Insomnia, fatigue, and sleepiness are the most frequent post-TBI sleep complaints with narcolepsy (with or without cataplexy), sleep apnea (obstructive or central), periodic limb movement disorder, and parasomnias occurring less commonly. ⋯ Treatment is disorder-specific and includes the use of medications, continuous positive airway pressure, or behavioral modifications. Unfortunately, treatment of sleep disorders associated with TBI often does not improve sleepiness or neuropsychologic function.
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Sleep is characterized by changes in neural firing and chemistry compared with wakefulness. Many neurologic diseases affect pathways that regulate control of sleep state and some primary sleep disorders have abnormalities of this circuitry. ⋯ Recent findings have expanded understanding of the control of sleep state, and will facilitate development of novel therapeutics to assist patients with a variety of disorders of sleep and wakefulness. Treatment of sleep and wake disorders can assist patients with a variety of neurologic problems.