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Tue, Nov. 12

Many treatment options exist for Pick's disease

Dear Dr Rosenberg,

My dad was diagnosed with a form of dementia called Pick's Disease. He has been under treatment for a year. The problem is he can't stay asleep and many nights can't fall asleep. Any ideas as to what is causing this and what can be done?

A: Pick's Disease also called Frontotemporal Dementia is a degenerative disease of the brain. Like many of the dementing diseases such as Alzheimer's disease, there is a high incidence of Insomnia. There are several common causes, one being a side effect of the medications used to treat the dementia. These medications increase a neurotransmitter in the brain called Acetylcholine which increases alertness, but unfortunately can cause Insomnia. Some of these patients may actually be suffering from Restless Leg Syndrome, but are unable to communicate symptoms to their family or Health Care Providers. Another possibility with this population is damage to the internal brain clock called the Suprachiasmatic Nucleus. This results in a loss of the normal sleep wake cycle. Depression is also common in these patients, which can cause early morning awakenings. Each of these is different and requires specific therapy. I would recommend you bring this to the attention of your Health Care Provider, especially since these are all treatable conditions.

Dear Dr Rosenberg,

I have a severe curvature of my spine called Scoliosis. It is the result of having had polio as a child. Recently, my doctor had my oxygen checked while I slept. I wore a little oxygen meter on my finger. He told me my oxygen was very low while asleep. Now they want me to go to a sleep lab. The doctor told me I will most likely be placed on a machine called a BIPAP. I thought Sleep Labs were for people with Sleep Apnea, so why do I need to go?

A: First of all, your low oxygen levels may indicate that your ability to breathe becomes impaired with sleep. People such as yourself with severe Scoliosis have a diminished ability to breathe because of a stiff chest wall. BIPAP is a non-invasive method of supporting breathing while asleep that is administered simply via a face mask. It is imperative to have the levels of pressure and supplemental oxygen if needed, adjusted by trained technicians while you are sleeping. This is why your physician is sending you to a Sleep Lab to be studied.

Dear Dr Rosenberg,

My seven-year-old daughter can't fall asleep before 3 a.m. I asked my doctor to prescribe sleeping pills for her and he refused to do so. I have been thinking about trying over the counter Tylenol PM for her. What do you think?

A: I agree with your physician. Prescription sleeping aides are not approved for children. Tylenol PM contains the antihistamine Benadryl and I would be very cautious due to its side effects. I recommend you take a look at her sleep hygiene. Things such as too much TV, computer games, stimulating physical activities, caffeinated drinks and not having a calming bedtime routine may be the problem. Finally, underlying sleep disorders such as Restless Leg Syndrome should be considered if this does not resolve.

Dear Dr Rosenberg,

I have a headache upon awakening most mornings. It feels like there is a tight band around my head. They usually go away in about 45 minutes. I snore and my wife says it's getting louder. I thought the headaches were due to my mattress being too firm. My wife has read that Sleep Apnea can cause headaches. Is this true?

A: I think your wife is on to something. Sleep Apnea can cause headaches. We know if left untreated, Sleep Apnea can worsen all types of headaches such as Migraines and Cluster Headaches. However, there is a particular type of headache directly due to Sleep Apnea, which is called a Sleep Apnea Headache. We think it is a result of repetitive drops in oxygen and

increases in carbon dioxide as a result of breath holding. These headaches are noted upon arising and are short lived, no more than 30 to 45 minutes after awakening. They are highly suggestive of Sleep Apnea and usually go away within a few days of treatment. I would suggest you bring these headaches and the fact that you snore to the attention of your Health Care Provider.

Dr. Rosenberg will answer individual reader questions by incorporating them in future columns. Contact him at askthesleepdoc@yahoo.com or via mail at the Sleep Disorders Center of Prescott Valley, 3259 N. Windsong Dr., Prescott Valley, AZ 86314.

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