NIMHANS Sleep Disorders Clinic

 Sleep Disorders Clinic: 

 Days & Timings:

1^st and 3^rd Saturday

10.00 AM to 02.00PM

Faculty:

• Dr. Ravi Yadav 
• Dr. Sanjib Sinha 
• Dr. Srijitesh P. R.
• Dr. Rohan Mahale
• Dr Sheshagiri D. V. 

Introduction

Sleep medicine is a unique branch in Neurology devoted to the diagnosis and therapy of sleep disturbances and disorders.  Problems with sleep organization in patients  include difficulty falling asleep, less time spent in the deeper stages of sleep, early-morning awakening and less total sleep time. Specific sleep problem factors include: parasomnias, tiredness, noisy sleep, and insomnia. Sleep problem factor is differentially associated with medical history variables and measures of childhood psychopathology. Poor sleep practice such as irregular sleep-wake times and daytime napping may contribute to insomnia. Caffeine, alcohol and some medications can also interfere with sleep. Sleep disorders are more widespread among the elderly than in younger persons. Restless legs syndrome and periodic limb movement disorder can disrupt sleep. Sleep apnea can lead to excessive daytime sleepiness. Two primary factors control the physiologic need for sleep: the total quantity of sleep and the daily circadian rhythm of sleepiness and alertness. For optimal daytime alertness, humans require an average of about eight hours of sleep for a 24-hour period. Sleep deprivation causes increased sleepiness and may cause cognitive impairment. Poor sleep hygiene is responsible for sleep deprivation, which is clearly associated with an increased risk of accidents.

       Sleep-related accidents are a frequent cause of death and injury in the world. Evidence shows that self-reported sleepiness at the wheel is strong predictors of risk of accident. Researches have shown that people who have severe sleep apnea, which involves frequent breathing pauses during sleep, have three times the risk of dying due to any cause compared with people who do not have sleep apnea. This risk is represented by an adjusted hazard ratio of 3.2 after controlling for age, sex and body mass index.  By the next decade, the number of people killed in motor-vehicle crashes is expected to double to 2.3 million worldwide, of which approximately 230000 – 345000 will be due to sleepiness or fatigue. Similarly, disturbed sleep has been shown to double the risk of a fatal accident at work over a 20-year period.

Strengths in the management

1. Sleep related Movement Disorders
2. Parsomnias
3. Acute and Chronic Insomnia
4. Obstructive Sleep Apnoea
5. Sleep hygiene.
6. Central disorders of hypersomnolence
7. Evaluation and Treatment of Narcolepsy and Idiopathic hypersomnia
8. Circadian Rhythm and Sleep Disorders
9. Parkinsonian disorders and sleep problems.
10. Stroke related sleep disorders.
11. Other sleep disorders

Investigations Available

Overnight Video Polysomnography: It  is a sleep study which evaluates oxygen levels, body movements, and brain waves to find out how they disrupt sleep. Various physiological parameters including an EEG, EKG, respirations, oxygen levels, muscle tone, and eye and extremity movements are monitored. There is also a video and audio recording which provides a record of the night’s sleep. This test can diagnose many sleep disorders from sleep apnea to restless legs syndrome to parasomnias and may even be useful in ruling out other causes of insomnia.

MSLT (Multiple Sleep Latency Testing):  is also often called a nap study. During this test an individual will have scheduled nap times throughout the day, typically occur every two hours. A patient is allowed to lie in the bed for 20 minutes with the goal of falling asleep. Technician monitors for the onset of sleep and, in particular, REM sleep. After 20 minutes, the person will be awakened or told that the time for a nap has ended. Then, in two-hour intervals, this process is repeated. Typically this will be followed over a 10-hour period. This test is useful for identifying excessive daytime sleepiness. This may be present in numerous disorders, such as sleep apnea, idiopathic hypersomnia (excessive sleepiness without a cause), and narcolepsy. In particular, the early onset of REM in these sleep periods may suggest narcolepsy.

Actigraphy: is the measurement of activity with the use of a small, wristwatch-sized device. This device is used to monitor movement and can assess sleep-wake cycles, or circadian rhythms, over an extended period of time. This device helps to determine whether disruptions in the sleep-wake cycle exist, as many occur in circadian rhythm disorders such as advanced sleep phase syndrome, delayed sleep phase syndrome, or even with insomnia.

Suggestive Immobilization test: Test for early detection of Restless Leg Syndrome   (RLS) aggumentation. During the test, patients remain in bed, reclined at a 45-degree angle with their legs outstretched and eyes open. They are instructed to avoid moving voluntarily for the entire duration of the test, which is designed to last an hour and takes place in the evening before bedtime. Periodic leg movements are measured during waking with the same criteria for PLMS, except the maximal duration of EMG activity is 15 seconds. In addition, every 5 minutes during the test, the patient gives a leg discomfort score.

Maintenance of wakefulness test: This test requires that subjects lie in bed or sit in a chair in a darkened room and try to remain awake. Like the MSLT, the measure of ability to remain awake is the latency to sleep onset. The test has not been standardized: there are 20-minute and 40-minute versions, and the subject is variously sitting upright in a chair, lying in bed, or semirecumbent in bed.

Publications by the Faculty of Sleep Clinic in the field of Sleep Medicine

1. Raja P, Srijithesh PR, Mythirayee S, Yadav R. Clinicians Heuristic Impression of the Presentations of Restless Legs Syndrome: A Survey among Medical Graduate Trainees in an Academic Hospital in India. Ann Indian Acad Neurol. 2022 May-Jun;25(3):507-510. 
2. Ray S, Kutty B, Pal PK, Yadav R. Sleep and other non-motor symptoms in patients with idiopathic oromandibular dystonia and meige syndrome: A questionnaire-based study. Annals of Indian Academy of Neurology. 2021 May;24(3):351.
3. Ray S, Kumar G, Kutty B, Pal PK, Yadav R. Patients with Primary Cervical Dystonia have Significant Sleep Impairment and Polysomnographic Abnormalities. Sleep and Vigilance. 2021 Jun;5(1):119-26.
4. Mastammanavar VS, Kamble N, Yadav R, Jain S, Kumar K, Pal PK. Non‐motor symptoms in patients with autosomal dominant spinocerebellar ataxia. Acta Neurologica Scandinavica. 2020 Oct;142(4):368-76.
5. Yadav R, Jagadish A, Sheshagiri D, Kamble N, Jain S, Pal PK, Kutty B. Sleep and Polysomnographic abnormalities in Indian patients with Huntington’s disease. Parkinsonism & Related Disorders. 2020 Oct 1;79:e107-8.
6. Ray S, Pal PK, Yadav R. Nonmotor symptoms and sleep disturbances in patients with blepharospasm. Annals of Movement Disorders. 2020 Sep 1;3(3):156.
7. Mahale RR, Yadav R, Pal PK. Does quality of sleep differ in familial and sporadic Parkinson’s disease?. Annals of Movement Disorders. 2020 Sep 1;3(3):167.
8. Kamble N, Yadav R, Lenka A, Kumar K, Nagaraju BC, Pal PK. Impaired sleep quality and cognition in patients of Parkinson’s disease with REM sleep behavior disorder: a comparative study. Sleep Medicine. 2019 Oct 1;62:1-5.
9. Tamilarasan V, Mohan M, Ramanjaneya R, Sadana D, Malapaka RC, Annapandian VM, Tousheed SZ, Manjunath PH, Sagar C, Kumar H. Prevalence of cognitive impairment in patients with obstructive sleep apnea. ERJ Open Research. 2019 Apr 11;5(suppl 3).
10. Yadav R, Ray S, Kumar G, Pal PK, Kutty B. Sleep and other non motor abnormalities in Indian patients with cervical dystonia. Sleep Medicine. 2019 Dec 1;64:S427.
11. Seshagiri DV, Botta R, Sasidharan A, Pal PK, Jain S, Yadav R, Kutty BM. Assessment of sleep spindle density among genetically positive spinocerebellar ataxias types 1, 2, and 3 patients. Annals of neurosciences. 2018;25(2):106-11.
12. Nayak CS, Mariyappa N, Majumdar KK, Ravi GS, Prasad PD, Nagappa M, Kandavel T, Taly AB, Sinha S. NREM sleep and antiepileptic medications modulate epileptiform activity by altering cortical synchrony. Clinical EEG and neuroscience. 2018 Nov;49(6):417-24.
13. Seshagiri, D.V., Sasidharan, A., Kumar, G., Pal, P.K., Jain, S., Kutty, B.M. and Yadav, R., 2018. Challenges in sleep stage R scoring in patients with autosomal dominant spinocerebellar ataxias (SCA1, SCA2 and SCA3) and oculomotor abnormalities: a whole night polysomnographic evaluation. Sleep Medicine, 42, pp.97-102.
14. Saraswati N, Nayak C, Sinha S, Nagappa M, Thennarasu K, Taly AB. Comparing sleep profiles between patients with juvenile myoclonic epilepsy and symptomatic partial epilepsy: Sleep questionnaire-based study. Epilepsy & Behavior. 2017 Jan 1;66:34-8.
15. Mahale RR, Yadav R, Pal PK. Rapid eye movement sleep behaviour disorder in women with Parkinson’s disease is an underdiagnosed entity. Journal of Clinical Neuroscience. 2016 Jun 1;28:43-6.
16. Nayak CS, Sinha S, Nagappa M, Thennarasu K, Taly AB. Lack of heart rate variability during sleep-related apnea in patients with temporal lobe epilepsy (TLE)—an indirect marker of SUDEP?. Sleep and Breathing. 2017 Mar;21(1):163-72.
17. Menon N, Gupta A, Khanna M, Taly AB, Thennarasu K. Prevalence of depression, fatigue, and sleep disturbances in patients with myelopathy: Their relation with functional and neurological recovery. The Journal of Spinal Cord Medicine. 2016 Nov 1;39(6):620-6.
18. Nayak C, Sinha S, Nagappa M, Nagaraj K, Kulkarni GB, Thennarasu K, Taly AB. Study of sleep microstructure in patients of migraine without aura. Sleep and Breathing. 2016 Mar;20(1):263-9.
19. Nayak CS, Sinha S, Nagappa M, Thennarasu K, Taly AB. Effect of carbamazepine on the sleep microstructure of temporal lobe epilepsy patients: a cyclic alternating pattern-based study. Sleep Medicine. 2016 Nov 1;27:80-5.
20. Mahale RR, Yadav R, Pal PK. Rapid eye movement sleep behaviour disorder in women with Parkinson’s disease is an underdiagnosed entity. Journal of Clinical Neuroscience. 2016 Jun 1;28:43-6.
21. Menon N, Gupta A, Khanna M, Taly AB, Thennarasu K. Prevalence of depression, fatigue, and sleep disturbances in patients with myelopathy: Their relation with functional and neurological recovery. The Journal of Spinal Cord Medicine. 2016 Nov 1;39(6):620-6.
22. Donilparthi S, Yadav R, Sasidharan A, Pal P, Jain S, Kutty B. Altered sleep architecture in autosomal dominant spinocerebellar ataxias: A polysomnographic based study. Sleep Medicine. 2015 Dec 1;16:S2-199.
23. Karkare K, Sinha S, Taly AB, Rao S. Prevalence and profile of sleep disturbances in G uillain‐B arre S yndrome: a prospective questionnaire‐based study during 10 days of hospitalization. Acta neurologica scandinavica. 2013 Feb;127(2):116-23.
24. Nagappa M, Nayak C, Sinha S, Philip M, Taly AB. Relation of sleep related events and spontaneous arousals during slow wave & REM sleep in healthy individuals. Indian J Sleep Med. 2013 Jun 1;8:51-5.
25. Nayak C, Nagappa M, Sinha S, Philip M, Taly AB. Association of sleep related events and arousals during light sleep in healthy individuals. Indian Journal of Sleep Medicine (IJSM). 2013;8(3).
26. Panda S, Taly AB, Sinha S, Gururaj G, Girish N, Nagaraja D. Sleep-related disorders among a healthy population in South India. Neurology India. 2012 Jan 1;60(1):68.
27. Karthik N, Kulkarni GB, Taly AB, Rao S, Sinha S. Sleep disturbances in ‘migraine without aura’—A questionnaire based study. Journal of the neurological sciences. 2012 Oct 15;321(1-2):73-6.
28. Nagappa M, Mundlamuri RC, Satishchandra P, Pal PK. Sleep benefit in a case of episodic ataxia. Parkinsonism & related disorders. 2012 Jun 1;18(5):662-3.
29. Netto AB, Sinha S, Taly AB, Panda S, Rao S. Sleep in Wilson’s disease: A polysomnography-based study. Neurology India. 2010 Nov 1;58(6):933.
30. Kumar P, Raju TR. Seizure susceptibility decreases with enhancement of rapid eye movement sleep. Brain research. 2001 Dec 20;922(2):299-304.

 Book Chapter: 

1. Ravi Yadav, J Kalita, UK Misra. LABORATORY EVALUATION OF SLEEP DISORDERS, In Clinical Electroencephalography” 2^nd Edition, Elsevier Publishers, 2018, New Delhi. page 331-348

Research Projects

Completed Projects

Ongoing Projects