Sleep Medicine Channel

1. During pre-study physiologic calibration, the patient is instructed to look left, right, up, and down. The primary purpose is to:

American Journal of Respiratory and Critical Care Medicine, 2026, 212(7), 1569–1584 https://doi.org/10.1093/ajrccm/aamag215 Published: May 18, 2026 Original Research | Sleep and Control of Ventilation Aroxybutynin and atomoxetine (AD109) for obstructive sleep apnea: a randomized phase 3 trial (SynAIRgy) Patrick J. Strollo Jr1,2, *, Ron Farkas3 , Luigi Taranto-Montemurro3 , John Cronin3 , Sanjay R. Patel2, , on behalf of the SynAIRgy Investigators

American Journal of Respiratory Cell and Molecular Biology, 2026, 74(7), 847–857 https://doi.org/10.1093/ajrcmb/aanag089 Minireviews: Lung Science Briefs thoracic.org Mechanisms of upper airway muscle control in sleep reveal therapeutic targets for obstructive sleep apnea Richard L. Horner1,2, , D. Andrew Wellman3 , Scott A. Sands3 , Ali Azarbarzin3, , Luigi Taranto-Montemurro

Snoring causes & management 🟣 What is snoring? ➟ Snoring is a noisy breathing sound during sleep. ➟ It happens when airflow is partly blocked and soft tissues in the throat vibrate. ➟ Occasional snoring can be harmless, but loud regular snoring may be linked with obstructive sleep apnea.

⚠️ Sleep Paralysis: 😴🛌 ➟ Sleep paralysis happens when the mind wakes up while the body is still in a temporary REM-sleep muscle paralysis state. 🧠🚫🦵 ➟ During an episode, the person may feel awake but unable to move or speak. 😶🔒 ➟ It can feel scary, but most episodes are short-lasting and pass on their own. 👻✨ #sleepmedicine #SleepDisorders #sleepapnea #sleeparalysis

🫁 Restless Leg Syndrome ➟ Restless leg syndrome, also called RLS, causes a strong urge to move the legs. #respiratorytherapist #respiratorycare #criticalcare #sleepmedicine

s41586-026-10524-5.pdf

⭐ Speaker Spotlight ⭐ How do circadian rhythms shape mental health—and what happens when they’re disrupted? Hear from invited lecturer Colleen McClung, PhD, at SLEEP 2026 as she explores the connection between circadian biology and psychiatric disorders in “Circadian Rhythms in Psychiatric Disorders.” 🗓️ Wednesday, June 17 | 1:00–2:00 p.m. 👉 Register now: https://hubs.la/Q04fhzjv0

🧠 DRUG EFFECTS ON SLEEP – RPSGT CLINICAL INSIGHTS (PART 2) Understanding sedatives, stimulants, and sleep aids is crucial for accurate PSG interpretation and patient safety. --- 💊 6. Sedative–Hypnotics 🔹 Barbiturates (⚠️ largely obsolete) • ↑ TST • ↓ Sleep latency & WASO • ↑ N2 • ↓ N1, N3, REM 🚨 Risks: • Severe respiratory depression • Airway collapse • Coma / death • High abuse potential --- 🔹 Benzodiazepines • ↑ TST & sleep efficiency • ↓ Sleep latency & WASO • ↑ N2 (spindles) • ↓ N3 & REM (dose-dependent) ⚠️ Risks: • Hypoventilation • Sleep-disordered breathing • Residual daytime sedation • Rebound insomnia --- 🔹 Non-benzodiazepines (Z-drugs) • Similar to benzos but better tolerated • ↑ TST • ↓ Sleep latency & WASO • Mild ↓ N3 & REM ⚠️ Side effects: • Dizziness • Daytime drowsiness --- 🔹 Orexin Receptor Antagonists • ↓ Sleep latency • ↑ REM time & density • ↓ REM latency ⚠️ Residual daytime sedation ✔ No major rebound effects --- ⚡ 7. Stimulants Examples: • Caffeine • Nicotine • Amphetamines Effects: • ↓ Sleep quality • ↓ N3 & REM • ↑ Sleep latency ⚠️ Side effects: • Insomnia • Anxiety • Tachycardia • EDS (secondary to poor sleep) --- 🍷 8. Alcohol ❌ Common misconception: “Helps sleep” Reality: • ↓ Sleep latency (initial) • ↑ Sleep fragmentation • ↓ N3 & REM ⚠️ Also: • ↑ OSA & apneas • ↑ PLMs • ↑ GERD & nocturia 🚨 Withdrawal: • REM rebound • Nightmares • Severe insomnia --- 💊 9. Sleep Aids (Clinical Selection) ✔ Indicated for: • Sleep-onset insomnia • Sleep-maintenance insomnia --- 🔑 Key Pharmacologic Concepts • Onset of action → how fast it works • Half-life → duration in body • Duration of action → total effect time --- 🎯 Clinical Matching • Sleep-onset insomnia → short half-life drugs • Sleep-maintenance insomnia → long half-life drugs --- ⚠️ Safety Considerations Before prescribing: ✔ Rule out OSA & primary sleep disorders ✔ Assess comorbidities (liver, kidney, age) Risks: • Falls (elderly) • Cognitive impairment • Driving impairment • Dependence & tolerance --- 🌿 OTC Sleep Aids Common: • Melatonin • Valerian • Tryptophan ⚠️ Issues: • Variable dosing • Not FDA-regulated • Risk of misuse --- 🧠 RPSGT FINAL TAKEAWAY ✔ Always review medication list before PSG ✔ Many drugs mimic sleep disorders ✔ Watch for: • REM suppression • Central apnea (opioids, sedatives) • Fragmentation (SSRIs, alcohol) ➡️ Scoring without pharmacologic context = clinical error --- #RPSGT #SleepMedicine #Polysomnography #SleepDisorders #ClinicalNeurophysiology

🧠 DRUG EFFECTS ON SLEEP – RPSGT CLINICAL INSIGHTS (PART 1) Sleep is highly sensitive to pharmacologic modulation. Many medications alter sleep architecture, continuity, and respiratory stability, which is critical in sleep study interpretation. --- 🔬 Key Neurotransmitters in Sleep Regulation Medications influence: • Dopamine • Serotonin • Histamine • Acetylcholine ➡️ Effects may include sedation, insomnia, or fragmented sleep --- 💊 1. Analgesics Non-opioids (NSAIDs, anti-inflammatory): ✔ Improve sleep by reducing pain Opioids (⚠️ High clinical relevance in sleep labs): • ↓ Deep sleep (N3) & REM • ↑ Light sleep (N1) • Respiratory depression → ↓ RR & VT • ↑ Central sleep apnea & ataxic breathing • ↑ Risk of OSA (↓ muscle tone) 🚨 Clinical impact: Poor restorative sleep + excessive daytime sleepiness (EDS) --- 💊 2. Antidepressants 🔹 TCAs • ↓ Sleep latency • ↑ TST, efficiency • ↑ N2, N3 • ↓ REM ⚠️ May worsen: • Periodic limb movements • REM behavior disorder (RBD) --- 🔹 SSRIs • ↑ Sleep fragmentation & WASO • ↑ N1 • ↓ TST, efficiency, REM (↓ up to 30%) 🧠 “Prozac eyes” → Slow eye movements beyond N1 ⚠️ Can worsen: • RBD • PLMD --- 🔹 MAOIs • Variable effects • ↓ REM • ↑ REM latency ⚠️ Withdrawal → REM rebound + nightmares --- 💊 3. Antihistamines • Strong sedation (common OTC misuse) • ↓ Sleep latency • ↑ Sleep continuity ⚠️ Side effects: • Confusion • Dry mouth • Urinary retention • Parasomnias (elderly) 🚫 Not recommended as sleep aids --- 💊 4. Antiepileptic Drugs (AEDs) • ↓ Sleep latency & awakenings • ↑ Total Sleep Time Architecture: • ↑ N3 • ↓ REM (variable) ⚠️ Side effects: • Sedation • Cognitive impairment --- ❤️ 5. Cardiovascular Medications Beta-blockers / Antiarrhythmics: • Insomnia • Nightmares • ↓ REM ACE inhibitors: • Night cough → sleep disruption Calcium channel blockers: • Drowsiness • ↑ GERD → fragmented sleep Diuretics: • Nocturia → sleep interruption • Leg cramps --- 🧠 RPSGT TAKEAWAY Medication history is ESSENTIAL before scoring: ✔ Misinterpretation risk (REM suppression, arousals) ✔ Drug-induced sleep-disordered breathing ✔ False diagnosis of insomnia or hypersomnia ➡️ Always correlate PSG findings with pharmacology

🟣 Sleep apnea is a condition where breathing repeatedly stops or becomes very shallow during sleep. ➟ The most common warning signs are loud snoring, breathing pauses during sleep, gasping or choking at night, and marked daytime sleepiness. 🟣 Common signs and symptoms ➟ Loud snoring → Loud, regular snoring is a common clue, especially in obstructive sleep apnea. ➟ Breathing stops during sleep → A partner may notice pauses in breathing followed by restarting. ➟ Gasping or choking → Some people suddenly gasp, snort, or choke during sleep. ➟ Waking up often → Sleep may be broken again and again through the night. ➟ Dry mouth or sore throat in the morning → Mouth breathing and repeated airflow changes can leave the mouth or throat dry. ➟ Morning headache → Some people wake with a headache, especially if sleep quality and breathing have been poor overnight. ➟ Very sleepy in the daytime → Daytime sleepiness is one of the biggest clues. People may feel tired, drowsy, or unintentionally fall asleep. ➟ Poor concentration → It may become harder to focus, remember things, or stay alert. ➟ Irritability or mood changes → Poor sleep can affect mood and may cause irritability. ➟ Night-time peeing → Some people wake up often to pee during the night. 🟣 When to get checked ➟ Loud snoring with daytime sleepiness ➟ Breathing pauses seen by a partner ➟ Waking up gasping or choking ➟ Morning headaches, poor concentration, or unexplained tiredness → Sleep apnea can become serious if it is not diagnosed and treated.

🟣 Restless legs syndrome (RLS) causes an uncomfortable urge to move the legs, especially during rest. ➟ The main symptom is a strong need to move the legs, often with odd sensations such as crawling, tingling, pulling, throbbing, itching, or aching. → Symptoms usually start or get worse when sitting or lying down, are worse in the evening or at night, and improve with movement. 🟣 Common signs and symptoms ➟ Urge to move the legs → This is the main symptom of RLS. ➟ Crawling or tingling feeling → The legs may feel crawling, pulling, throbbing, itching, or otherwise uncomfortable. ➟ Starts during rest → Symptoms usually begin or worsen when sitting quietly, relaxing, or lying down. ➟ Better with movement → Walking, stretching, or moving the legs often brings relief, at least for a short time. ➟ Worse at night → Symptoms are often strongest in the evening or during the night. ➟ Trouble sleeping → RLS can make it hard to fall asleep or stay asleep. ➟ Daytime tiredness → Poor sleep from RLS can leave you tired during the day. ➟ Symptoms can come and go → Some people have symptoms only sometimes, while others have them more often. 🟣 Management ➟ Keep a regular sleep routine → Good sleep habits can reduce symptom flares. ➟ Cut back on caffeine if it triggers symptoms → Caffeine can worsen symptoms in some people. ➟ Try gentle exercise → Light to moderate activity may help, but overdoing exercise can sometimes make symptoms worse. ➟ Warm baths, massage, or heat/cold → These can help some people get temporary relief. ➟ Check iron levels → Low iron is a known contributor to RLS, so treating iron deficiency can improve symptoms. ➟ Medicine may be needed in some cases → If symptoms are frequent or severe, a doctor may recommend medication. 🟣 Important point → Treating an underlying cause such as iron deficiency, kidney disease, pregnancy-related changes, or certain medicines can improve RLS symptoms. https://t.me/Sleep_Medicine

🟣 Restless legs syndrome (RLS) causes an uncomfortable urge to move the legs, especially during rest. ➟ The main symptom is a strong need to move the legs, often with odd sensations such as crawling, tingling, pulling, throbbing, itching, or aching. → Symptoms usually start or get worse when sitting or lying down, are worse in the evening or at night, and improve with movement.

Journal of Sleep Research - 2025 - Dipalma - Comparative Efficacy of Continuous Positive Airway Pressure and Mandibular.pdf

RESPIRATORY EVENTS: POLYSOMNOGRAPHY REPORTING - AASM. #sleepmedicine #SleepDisorders #sleepapnea #obstructivesleepapnea #Polysomnography #RPSGT #aasm

💤 HYPOPNEA – ORGANIZED NOTES (Sleep Study): 🧠 1️⃣ Definition A hypopnea is: ⬇️≥ 30% reduction in airflow ➡️Lasting ≥ 10 seconds 🔃Compared to pre-event baseline 💡 Key Clinical Tips: ✅️Always check signal quality first ✅️Hypopnea scoring requires context (EEG + SpO₂) ✅️When in doubt: 👉 Check full 30-second window ✅️Avoid over-reliance on desaturation alone 🎯 Takeaway 👉 Hypopnea = partial obstruction with physiological consequence 👉 Requires objective + clinical correlation 👉 Critical for AHI calculation and OSA severity classification -- #sleepmedicine #SleepDisorders #obstructivesleepapnea #Polysomnography #RPSGT #paptitration