F.D.A. Recommends Lower Dose of Lunesta Sleeping Pill

As part of the agency’s continuing effort to reduce sleep aids’ risky side effects such as drowsiness while driving, the Food and Drug Administration has announced that people prescribed the sleeping pill Lunesta should be starting with half the current recommended dose of two milligrams.

The dosage change is based, in part, on findings from a study of 91 healthy adults ages 25 to 40. The study shows, compared to an inactive pill (placebo), Lunesta 3 mg was associated with severe next-morning psychomotor and memory impairment in both men and women 7.5 hours after taking the drug. The study found that recommended doses can cause impairment to driving skills, memory, and coordination as long as 11 hours after the drug is taken. Despite these long-lasting effects, patients were often unaware they were impaired.

Taken at bedtime, the recommended starting dose of Lunesta (eszopiclone) has been decreased from 2 milligrams to 1 mg for both men and women. The 1 mg dose can be increased to 2 mg or 3 mg if needed, but the higher doses are more likely to result in next-day impairment of driving and other activities that require full alertness. Using lower doses means less drug will remain in the body in the morning hours.
Patients currently taking the 2 mg and 3 mg doses of Lunesta should contact their health care professional to ask for instructions on how to continue to take their medicine safely at a dose that is best for them.

According to IMS Health, a health care services company, about 55 million prescriptions for sleep aids were dispensed in the United States in 2013. Lunesta represents a relatively small part of that market, with about three million pills prescribed.

It was not the first time the agency has reduced the recommended dose of sleeping pills. In January 2013, the FDA said that doses of Ambien and other sleeping pills that contain zolpidem should be halved for women. The agency also told manufacturers that labels should recommend that health care providers “consider” prescribing lower doses for men.

Drowsiness is listed as a common side effect for all insomnia drugs, along with warnings that people may still feel drowsy the next day after taking one of these products. The FDA is continuing to evaluate the risk of impaired mental alertness with the entire class of sleep drugs, including over-the-counter drugs, and will update the public as new information becomes available.

Studies show that sleepiness can impair driving performance as much or more so than alcohol; the American Automobile Association (AAA) estimates that one out of every six (16.5%) deadly traffic accidents, and one out of eight (12.5%) crashes requiring hospitalization of car drivers or passengers is due to drowsy driving.  To learn more about the dangers of poor sleep habits and how you can get a better night's sleep, visit us at the HoustonSleepNet.

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Source:
FDA News Release: May 15, 2014

Rapid-eye-movement sleep behavior disorder (REMBD) may be an indicator for Alzheimer's, Parkinson's Disease

Researchers at the University of Toronto say a sleep disorder that causes people to act out their dreams is the best current predictor of brain diseases like Parkinson's and Alzheimer's.
According to an article in Trends in Neurosciences, John Peever, MD, associate professor at the University of Toronto suggests the link occurs because brain degeneration attacks the brain circuits controlling REM sleep before it attacks those areas involved in Parkinson’s, Alzheimer’s, and other neurodegenerative conditions.

Sleep occurs in five distinct phases; the the fifth stage is REM, the the most active sleep phase in which you’re most likely to dream. The REM stage is also when you may find yourself twitching or tossing.
During normal REM sleep your brain temporarily paralyzes your muscles, but in people with REM sleep behavior disorder (REMBD) this paralysis ceases to occur; they may act out their dreams, resulting in injury to themselves and/or their bed partner.

The new research examines the idea that neurodegeneration might first affect areas of the brain that control sleep before attacking brain areas that cause more common brain diseases like Alzheimer’s. REMBD is most common in older men – 90 percent of people who develop it are male, and most are over the age of 50. Scientists already knew REMBD was associated with certain brain disorders including Parkinson’s: previous research has shown that approximately 30 percent of people diagnosed with REMBD will develop Parkinson’s within three years. However, the new study suggests that  80 to 90 percent of people who develop REM sleep behavior disorder will develop degenerative brain disease within the near future.

Medications are available for many of these conditions that can delay or slow progression of the disease when taken early enough, so REMBD could serve as an alert to do so. Once you’re diagnosed with REMBD the usual treatment is a muscle relaxant such as clonazepam (Clomid or Klonopin). However this new research suggests it’s a good idea for anyone diagnosed with REMBD to have a complete workup for Parkinson’s, Alzheimer’s, dementia, and other brain disorders.

Dr. Peever suggests that “...It’s important for clinicians to recognize RBD as a potential indication of brain disease in order to diagnose patients at an earlier stage. This is important because drugs that reduce neurodegeneration could be used in RBD patients to prevent (or protect) them from developing more severe degenerative disorders.”

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References:

Breakdown in REM sleep circuitry underlies REM sleep behavior disorder (Abstract; Trends in Neuroscience, 03/04/2014
Specific Sleep Disorder Associated with Brain Diseases: Psyche Central

Engineer in fatal Bronx train derailment had sleep apnea

The commuter train engineer at the center of last year's deadly derailment in the Bronx was found to have obstructive sleep apnea that went undiagnosed before the Dec. 1 derailment, a sleep medicine doctor said in the National Transportation Safety Board's investigation docket. Rockefeller told investigators that he felt fine that day, but experienced something like highway hypnosis as he stared straight ahead at the tracks. "I came up with that hypnotized feeling, dazed, that's what I was in," he said. "The only thing that shook me out of it was the feeling of the train. Something wasn't right with it.
" He activated the emergency brake, but it was too late. The train derailed as it headed around a sharp curve at 82 miles per hour, nearly three times the speed limit.

A report on Rockefeller's medical history revealed he had never been tested for a sleeping disorder by any of his doctors prior to the accident. He had a history of snoring but "not of choking or gasping" awake. His sleep was disrupted as much as 65 times per hour, the report stated.
Sleep apnea occurs when a person involuntarily stops breathing while asleep. Rockefeller's lawyer said that
"...He had absolutely no idea of this condition prior to the diagnosis. It was exacerbated by the change in shifts two weeks earlier."

 Excessive daytime drowsiness is a tendency to sleep at inappropriate times regardless of activity or circumstance. It can manifest itself in mild or severe forms.
Excessive daytime sleepiness is a common problem in today's society. It is so common that in some circles people almost consider it a normal aspect of a productive society. The fact is that daytime sleepiness and fatigue are leading causes of accidents, both on the job and on the road. The cost to society is estimated in billions of dollars per year. There are several common causes for increased daytime sleepiness. The simplest cause of daytime sleepiness that can be corrected results from insufficient sleep.

A common medical problem that can cause increased daytime sleepiness results from having a breathing problem during sleep. Snoring for example, is a form of obstructed breathing. Obstructive breathing can make it difficult to breathe properly during sleep and can even cause a complete blockage in the airway during which breathing stops. Breathing is re-established with a brief disruption of sleep and possibly a brief gasp or choking sound.

Another common medical problem causing frequent disruptions of sleep is called Periodic Limb Movements of Sleep. This occurs when a person has multiple brief leg movements every 20 to 60 seconds for long periods during the night. These leg movements can fragment sleep, resulting in increased daytime sleepiness. Frequently people with this problem also have what is called Restless Legs Syndrome (RLS). RLS occurs when a person is sitting still or lying in bed, which makes it difficult to keep their legs still. This frequently can keep people awake, causing insomnia. People with this problem feel that moving their legs relieves this restless sensation.

These problems are all treatable. Unfortunately, many physicians are not yet familiar with treating these conditions. Ask your doctor about treatment and feel free to have your doctor contact us for questions on diagnosis and treatment for these conditions.
If you have a problem with daytime sleepiness and you have increased your sleep length without improving your daytime sleepiness, then you should be evaluated by a Sleep Disorders Specialist. With proper care most people can obtain the treatment they need to improve this problem. Contact us today at 281-407-6222 or visit www.houstonsleep.net  for more information.