Dear Dr. Rosenberg,
I have migraine headaches, and they almost always start when I’m sleeping. My neurologist says this is unusual and he suggested that I get a sleep study. What do you think they may find on a sleep study?
Answer:
Most likely, they will be looking for Sleep Apnea. Nighttime migraines are not common. However, if they do occur at night it may be the decrease in oxygen, or increase in carbon dioxide that occurs with stopping breathing that precipitates them. I think having a sleep study is an excellent idea. If they find sleep apnea and you are treated, you might find significant improvement with having migraines.
Dear Dr. Rosenberg,
My father has Parkinson’s disease. Lately, he has become progressively more sleepy during the day. This is becoming a concern for us. He sleeps at least 8 hours at night, but still can’t stay awake during the day. Do you have any ideas?
Answer:
About 30% of patients with Parkinson’s develop severe sleepiness during the day. It may be a manifestation of depression, but in many, it is a fundamental part of the disease. This is because the wakefulness promoting centers of the brain are damaged. There has been some reasonable success using medications normally prescribed for narcolepsy. In particular, a medication called Modafinil has proven to be effective. You may want to discuss this with your father’s health care provider.
Dear Dr. Rosenberg:
My Grandmother moved in with us last year after my Grandfather passed away. She falls asleep at 7pm and wakes up at anywhere from 3 to 4 am. She says she has been doing this for years. She finds this very disturbing as she feels she is sleeping when we are awake. She would like to spend more time with us. Does anything come to mind? Can we do anything about this? She is not depressed and otherwise is very normal.
Answer:
The condition you are describing is known as Advanced Sleep Phase Syndrome. It is more common in the elderly. Their biologic sleep clocks have been reset to an earlier sleep/wake time. The use of light to treat this disorder is paramount. Your Grandmother should try to avoid bright light exposure in the early morning when she awakens. That would worsen the condition. She should increase her exposure to light in the late afternoon and early evening. She should also avoid naps and consider purchasing a light box or light visor to use starting anywhere from 6pm till 8pm. These practices can be very effective in delaying sleep onset.
Dear Dr. Rosenberg:
I have high blood pressure. My doctor has been having trouble controlling it. Recently, he added a third medication called Clonidine. I now notice that I am very tired during the day. Could this be due to the new medication?
Answer:
Yes, one of the side effects of Clonidine is sedation. There have also been reports of nightmares. It is an excellent medication, but unfortunately, it can be sedating. In fact, one of the off-label uses of Clonidine is to treat insomnia in the pediatric population. Keep in mind that if you continue to take this medication, the sedating side effect may resolve on its own. If not, bring it to your doctor’s attention.
Dr. Robert Rosenberg, Board Certified Sleep Medicine Specialist, will answer readers’ questions by incorporating them in furture columns. Contact him at askthesleepdoc@yahoo.com or via mail at the Sleep Disorders Center of Sedona, 210 S. Sunset drive, suite A-1, sedona, AZ 86336.
