Clinical Services The Singapore Neurology & Sleep Center provides diagnosis and treatment for a range of Neurological & Sleep Disorders: Neurological Problems Sleep Problems Headaches: Migraines, Tension Type and other headaches Stroke & Stroke-like episodes eg Numbness or Weakness on one side Peripheral Nerve and Muscle Disorders presenting with Numbness or Weakness of the limbs, or Pain Parkinson’s disease and other Movement Disorders like Tremors Epilepsy and other types of Seizure-like Disorders Dementia and other types of Memory or Thinking Problems Vertigo and other types of Dizziness Sleep Deprivation and Impaired Daytime Functioning Insomnia: Difficulty Falling or Staying Asleep or Unrefreshing Sleep Snoring and Obstructive Sleep Apnoea (OSA) Abnormal Behaviours in Sleep eg Sleep Walking, Sleep Talking Excessive Daytime Sleepiness, including Narcolepsy Sleeping Pill Dependence and Difficulty Sleeping Without Drugs Circadian Rhythm Sleep Disorders like Shift Work Disorder, Jet Lag Your Brain & Sleep Normal brain function and sleep are closely related. Many brain diseases can affect sleep, and poor sleep can affect our well our brain works. The reason why humans need sleep is not well understood although the most probable one appears to be that sleep is needed for rest, repair and restoration of the mind and body. It is also likely that memory and learning are consolidated during sleep. Much of what we do know comes from sleep deprivation experiments. When we do not get enough sleep, we become very sleepy, irritable and our mood is affected. Brain function is particularly disturbed with slowed mentation and difficulty thinking, and impaired performance in tasks requiring close attention. Neurologists and sleep experts generally agree that good sleep is essential to optimal intellectual performance, besides being an important time for resting the body. Enough good quality sleep on a regular basis helps us to achieve our full brain potential. Common Neurological Disorders: • Dementia (including Alzheimer’s Disease) • Back and Neck Pain • Dizziness and Vertigo • Epilepsy • Headache (including Migraines) and Nerve Related Pain • Infection & Other Inflammatory Conditions of the Brain, Spine & Nerves • Movement Disorders (including Parkinson’s Disease) • Multiple Sclerosis • Nerve and Muscle Disease • Stroke Sleep Disorders Sleep Medicine is a relatively new field of medicine spanning multiple disciplines. The range of healthcare professionals involved in the management of sleep disorders includes Neurologists, Respiratory physicians, Psychiatrists, Psychologists, ENT surgeons, Sleep Technologists and Respiratory Therapists. Sleep disorders are conditions occurring around and during sleep which disturb normal sleep. Sleep is an important time for rest and restoration of the mind and body. When sleep is disrupted, our health is impaired. Sleep disorders affect the brain and physical functioning, and often worsen existing conditions such as diabetes, high blood pressure, heart disease, stroke and depression. People who do not get enough sleep are also at risk of more frequent accidents, and poorer performance at school or work. People at risk for sleep problems include those with irregular work and sleep schedules, poorly managed stress, depression and anxiety, chronic pain, and diseases of the brain such as stroke, Parkinson’s disease and dementia. The most common problems seen in clinic are insomnia and obstructive sleep apnoea (OSA). Insomnia refers to a difficulty falling or staying asleep or a perception of unrefreshing sleep. In OSA there is blockage to the upper airways during sleep, which causes sleep disruption due to difficulty breathing at night. This may present most commonly as snoring, or excessive daytime sleepiness due to the poor quality sleep that results when breathing is interrupted during sleep. All of these conditions are treatable, but unfortunately are often overlooked because many people are not aware of the significant negative impact of these sleep disorders on health. For example, untreated OSA can lead to increased risk of heart attacks, stroke, and worsening blood pressure and blood sugar control. Treatment for sleep disorders depends on the underlying cause which is established during the Sleep consultation. A sleep study may be needed in some cases for the diagnosis. Treatment options include medication, cognitive-behavioural therapy, continuous positive airway pressure (CPAP), oral appliances and surgery for OSA. A sleep study involves staying overnight in the sleep laboratory and being hooked up to a machine which is monitored by sleep technologists. Sleep patterns can be studied in the laboratory using machines which record brainwave activity, breathing, heart rate and limb movements during sleep. The prognosis for sleep disorders is generally very good if diagnosed and treated early. People who have difficulty getting enough sleep without sleeping pills, or who are sleepy and tired in spite of sleeping 6-8 hours a day are encouraged to seek medical attention. Besides being vital for peak brain performance, enough good quality sleep on a regular basis is an essential component for optimal mental and physical health. Different Types of Sleep Problems 1. Insomnia: Difficulty falling or staying asleep at night Recurrent awakenings Early morning waking Restless sleep due to physical discomfort, or disturbing dreams Symptoms of depression, anxiety or psychological stress 2. Excessive Daytime Sleepiness: Difficulty staying awake in the classroom or at work Falling asleep at the wheel Poor concentration or attention due to feeling sleepy and tired in the daytime Narcolepsy-A rare sleep disorder characterized by sudden sleep attacks and loss of muscle tone 3. Snoring & Sleep Apnoea: Loud snoring which disturbs sleep Difficulty breathing during sleep eg. choking, gasping for air Breathing which stops during sleep (“apnoea”) Waking up feeling unrefreshed Morning headaches 4. Sleep Disturbances Related to Brain Disease (eg. Parkinson’s Disease, Stroke): Difficulty staying asleep at night Restless and noisy behaviour at night Sleeping in the day and awake at night Acting out dreams, injuring self or others Uncomfortable and restless legs sensations at bedtime (Restless Legs Syndrome) 5. Sleep Disturbances Related to Other Medical Conditions: Muscle aches and joint pains eg. Fibromyalgia, arthritis Frequent urination at night Difficulty breathing due to heart or lung problems Chronic pain eg. Headaches, cancer pain 6. Abnormal Behaviour or Movements in Sleep: Sleep walking Sleep talking Acting out dreams Restless Legs Syndrome Seizures during sleep 7. Circadian Rhythm Sleep Disorders: This refers to sleep disturbance which occurs when our body clock is out-of-synch with the external environment. Examples are the sleeping problems associated with shift work, long distance air travel (Jet Lag), sleeping too early (usually older people) or too late (usually teenagers), and broken sleep spread out throughout the day During Your Visit: What to Bring & What to Expect Please bring along your referral letter and all old medical records, copies of blood test results, any doctor’s reports, and X-Rays, CT Scans, MRI scans etc. Any past medical information you have may provide helpful background to the current medical problem. You may be asked to fill out questionnaires for basic health information (including sleep habits and mood) before being seen by a Neurologist, who specialises in evaluating and managing Neurological & Sleep disorders. After consultation, if necessary, you may be scheduled for various tests. Patients with nerve and muscle disorders may undergo a Nerve Conduction Study (NCS) with Electromyography (EMG) or needle electrode examination which are electrical tests of nerve and muscle function. Patients with a seizure disorder may require an electroencephalogram (EEG) which is another electrical test which records brain wave activity and helps to assess if abnormal brain discharges are present. Patients with sleep disorders may be scheduled for a sleep study, so that sleep patterns can be observed and recorded by the sleep technologist. This night-time sleep study, known as a Polysomnogram (PSG), may be followed by a daytime nap study known as the Multiple Sleep Latency Test (MSLT). Upon completion of your tests, your doctor will discuss with you the test results and recommended treatment. Tests of Brain, Sleep, Nerve & Muscle Function 1. Nerve Conduction Study & Electromyography (EMG): Electrical testing of nerve and muscle function. 2. Electroencephalography (EEG):Recording of brain wave activity to assess if abnormal brain discharges are present 3. Polysomnogram (Sleep Study): Recording of multiple physiological parameters during sleep to determine the cause and/or effects of sleep disturbances A full polysomnogram measures the following body functions during sleep: – Nasal airflow – Respiratory effort – Blood oxygen level – Snoring – Heart rate and rhythm (ECG) – Electrical activity in the brain (EEG) – Eye and muscle movement 4. Continuous Positive Airway Pressure (CPAP) Titration Study This is an investigation where pressurized air administered through a nasal mask is titrated upward until breathing in sleep improves to normal during the sleep study. An optimal pressure that holds open the upper airway (like a pneumatic splint) is then determined. 5. Video-EEG Monitoring: This is performed to study abnormal behaviours such as epileptic seizures or other abnormal body movements during sleep. 6. Multiple Sleep Latency Test (MSLT): This is a daytime sleep study conducted to assess the severity of excessive daytime sleepiness. During the MSLT, the brain waves, heart rate, muscle activity and eye movements are recorded in 4-5 naps of 20-minute duration spread throughout the morning and afternoon, 2 hours apart.