Latest news with #AASM
Medscape
24-07-2025
- Health
- Medscape
Telehealth Isn't a Luxury — It's a Necessity
This transcript has been edited for clarity. Hello, and thank you for joining me today. I'm Dr Alison Kole. I'm boarded in pulmonary critical care and sleep medicine, and I have been practicing for over a decade. I also am the creator and host of the Sleep is My Waking Passion podcast and the medical director of the Oak Health Center Concierge Sleep Telemedicine Program. Today I want to speak directly to you about a critical issue that's occurring in sleep medicine, which is the future of telehealth. There's a lot at stake, and decisions made now will impact patient care for years to come. Some of you may not be aware, but the American Academy of Sleep Medicine [AASM] issued a position statement in February of 2025, urging for the consideration of permanent telehealth services. During the COVID-19 pandemic, emergency waivers allowed for widespread use of telehealth, including coverage for both video- and audio-only visits. This expansion was a lifeline for both patients and providers, and was able to ensure that care continued despite unprecedented times. However, these were temporary waivers and the waivers are set to expire. So, there is a real danger that coverage and reimbursement for telehealth, especially in sleep medicine, could be rolled back. You can think of the AASM's position statement as a call to action. Without permanent coverage in adequate reimbursement, millions could lose access to essential sleep care. And this isn't just a theoretical concern. If telehealth goes away, access will be cut off for many who cannot easily reach in-person services due to a variety of reasons, including geography, mobility, work, or technology barriers. So, why is it that sleep telemedicine is so especially suited to telehealth? There are several reasons for your consideration. Perhaps one of the most obvious reasons is that in order to diagnose sleep disorders, many of us can usually do that without much of a physical exam. Most of our assessments are dependent upon history, sleep diaries, and sleep study data. It's not necessarily a hands-on exam, so this makes remote care both practical and effective in sleep. There's also a couple of other reasons, including our ability to do remote patient monitoring. Most of our CPAP devices allow us to be able to track and see if a patient is being compliant with therapy, but also are they getting effective therapy so that we can triage and make adjustments remotely without the patient needing to come into the office for that. And last but not least, 12% of Americans are living with chronic insomnia in this country. The number-one recommended treatment is cognitive-behavioral therapy for insomnia. This is a series of visits to a behavioral health specialist that can be time-consuming, and there is data that demonstrate that digital cognitive-behavioral therapy for insomnia platforms performs almost equivocally to that of in-person visits. There are several benefits to sleep telehealth access, and these include access, equity, safety, and cost. So, let's get into it. Expanded access: What do I mean? Well, telehealth bridges gaps for rural patients, those with mobility challenges, and people who live far from specialty centers. It also allows sleep specialists, such as myself, to serve patients across state lines. With regard to health equity, audio-only telehealth happens to be crucial for patients without reliable internet or smart devices. Cutting this option would disproportionately harm lower-income, elderly, and rural populations. There's also a patient and public safety issue worth considering. Many sleep patients happen to be at higher risk for drowsy driving. Telehealth eliminates the need for these patients to travel, which directly reduces accident risk. This protects not only the patient but also the public. And lastly, there is an economic value to sleep telemedicine services because treating sleep disorders like obstructive sleep apnea saves the healthcare system billions by preventing complications related to chronic comorbid conditions. These include hypertension, heart disease, and diabetes. Telehealth adds further savings by reducing travel time off from work and no-show rates. If telehealth goes away, you're looking at a loss of access, worsening health disparities, reduced public safety and patient safety, as well as higher costs of care for patients. Telemedicine is not a luxury; it's a necessity for modern, equitable, and effective care. As primary care providers, you play a crucial role in advocating for and utilizing these services to ensure your patients get the care they need when and where they need it. If you'd like to check out the completed episode with my interview featuring Dr K. Praveen Vohra, the lead author of the AASM position statement, please check out my YouTube channel,
National Geographic
24-07-2025
- Health
- National Geographic
Is it possible to take too much melatonin? We asked the experts.
Melatonin is a widely used supplement, touted for its sleep inducing effects. However, experts say the benefits only apply in certain situations—and as a result, it has been banned from being sold over the counter in various other countries including the United Kingdom, where it is only available as a prescription medication. Photograph by Rebecca Hale, National Geographic If you've ever taken a melatonin supplement as a last-ditch attempt to save your sleep, you're in good company: Research suggests people in the U.S. have steadily reached for more melatonin over the past couple of decades, and an American Academy of Sleep Medicine (AASM) survey estimates that roughly two-thirds of U.S. adults have used some form of melatonin to help them drift off. The appeal is undeniable: Your brain naturally makes this hormone to regulate your sleep-wake cycle. The synthetic form of melatonin usually found in supplements is a relatively low-risk substance for adults, plus it's available over the counter. Package this into a trendy bottle brimming with colorful gummies (with plenty of endorsements from 'wellness' influencers), and you're giving the chronically exhausted a glimmer of hope for better rest. 'People can become quite desperate,' says Jade Wu, a behavioral sleep medicine psychologist and the author of Hello Sleep. 'I don't blame them for trying whatever they can. And they're trying really hard to not abuse prescription medication.' (What's in melatonin—and is it giving you nightmares?) When a low dose of those melatonin gummies doesn't actually stop them from tossing and turning, many of these sleep-deprived people are mainlining higher and higher doses. But Wu, among other sleep experts, says melatonin is a widely misunderstood hormone. Taking it as a supplement night after night doesn't necessarily translate to better sleep—and for most people, neither does taking larger amounts of it. Which begs the question: Are we taking melatonin too often, and at too high of doses? Here's what the science says so far. How melatonin influences sleep Your body relies on two systems to help you sleep, says Joshua Tal, a clinical psychologist specializing in sleep therapy in New York City. The first is your homeostatic sleep drive, or sleep pressure, a physiological process that kicks in after you wake up. As the day progresses, it drives your need for sleep, a bit like hunger drives your need for food, Tal explains. Melatonin influences the second system: the circadian rhythm, or your body's internal clock. The average adult needs about eight hours of sleep each day; your circadian rhythm organizes when you achieve this rest. (Are you a 'lark' or an 'owl'? Your body clock holds the answer.) 'While the homeostatic drive promotes how much sleep we need, the circadian rhythm optimizes our ability to achieve that sleep at nighttime,' says sleep medicine specialist David Nelson Neubauer, an associate professor of psychiatry and behavioral sciences at Johns Hopkins Bayview Medical Center. As you get closer to your typical bedtime, a small part of your brain—the suprachiasmatic nucleus, or 'the master timekeeper,' per Neubauer—regulates the release of melatonin into your bloodstream via your pineal gland. This suppresses your alertness, which indirectly helps you doze off because your body is being told it's time to be less active. Your melatonin levels stay high throughout the night, and then start to subside in the early morning hours. What we often misunderstand about melatonin Prescription sleep medications, including benzodiazepines like Valium and 'Z' drugs like Ambien, are sedatives; they have a deeply tranquilizing effect. They're easy to misuse and notoriously habit-forming when taken long-term. (Your brain 'washes' itself at night. Sleep aids may get in the way.) By contrast, a melatonin supplement may facilitate the processes that help you fall asleep, but it won't make you stay asleep. 'A lot of people think of melatonin as a kind of sleeping pill, but it is not sedating,' Neubauer says. 'It is more of a signal to your circadian rhythm.' Taking melatonin can work 'phenomenally well' if you have to get to bed at odd hours—say, if you're a night shift worker trying to sleep during the day or a traveler suffering from jet lag, says James K. Wyatt, director of the Section of Sleep Disorders and Sleep-Wake Research at Rush University Medical Center in Chicago. It can also be effective for people with a circadian rhythm disorder or delayed sleep phase who have trouble falling asleep early enough to wake up during typical morning hours. Otherwise, for the average person, Wyatt says a melatonin supplement probably won't do much to improve sleep. While studies have yielded mixed results, Tal notes their findings suggest melatonin likely works no better than a placebo for insomnia (when you have trouble falling asleep, staying asleep, or both). Both the AASM and the American College of Physicians also maintain there's not enough evidence to recommend melatonin supplements as a safe or initial treatment for insomnia. Can you take 'too much' melatonin? Much of the data scientists have on melatonin is based on a low dose of around 0.3 to 1 milligram, which is close to what our bodies naturally produce. The average supplement claims to offer between 3 to 5 milligrams, which may seem high at first. 'Nearly every drug has a 'dose response curve.' The bigger the dose, the bigger the effect,' Wyatt explains. But melatonin's curve is pretty flat because it doesn't work like a typical sleep medication in the body. Taking 3 milligrams versus 0.3 milligrams of melatonin, for instance, is 'mostly irrelevant from a clinical point of view,' Neubauer notes. So taking a higher dose likely won't make a difference in helping you fall asleep. (Some exceptions: Studies suggest higher doses may be beneficial for children with autism and folks with Parkinson's disease.) (More parents are using sleep aids for their kids. Experts say they shouldn't.) Yet supplements can pack a lot more—or less—melatonin than their bottles claim. One 2023 analysis found that, of 25 melatonin gummies on the market, a majority were stuffed with much more melatonin than what was listed on the label. One brand claimed to offer 3 mg per serving, but actually contained 10 mg; another melatonin/CBD hybrid contained no melatonin at all but exceeded its proposed level of CBD. A slightly larger dose of melatonin (think: a serving size difference in the single digits) likely won't be harmful for most adults, but people also tend to have a more-is-more mentality with supplements, Wu notes. All the sleep experts interviewed for this article say they've had patients who came to them after taking high doses of melatonin, sometimes upwards of 30 mg a night, which can up the risk of unpleasant side effects like headaches, grogginess, nausea, dizziness, and vivid dreams or nightmares—not exactly soothing. As for whether it's possible to 'overdose' on melatonin? There's no scientific consensus on what that exact amount would be for adults. Taking a high dose like 30 mg and up probably won't make you feel great, but it's very rarely life-threatening. (The story is different for children, who can end up in the hospital due to more serious toxicity risks.) Given a lack of longitudinal data, we also don't know whether there are negative long-term effects of taking melatonin, Wyatt says. Ideally, scientists would regularly give the same group of study participants melatonin or a placebo, follow them over decades, and document the effects. But funding this research is expensive and tough to pull off even for strictly regulated prescription medications, let alone a supplement, he notes. What to keep in mind if you're melatonin-curious It's never a bad idea to support your body's natural production of melatonin, Neubauer says. To do that without supplements, opt for dim and warm lighting at nighttime, avoid screens before bed if they're overstimulating to you, and do your best to get a dose of natural sunlight shortly after you wake up, as well as throughout the day. (Light pollution is harming our health.) If taking a supplement makes sense for your situation because you travel a lot or work the night shift, know that the U.S. Food and Drug Administration doesn't regulate melatonin in the same way it rigorously regulates drugs, which opens the door for flashy marketing claims that aren't scientifically up to snuff, according to Pieter Cohen, an associate professor of medicine who researches the safety of supplements at Harvard Medical School. That's why he recommends looking for a product that's been independently tested by a third-party lab, like USP or NSF. The good news is, melatonin supplements don't pose the same risk for physical dependency like sleep medications do, Tal says. So you could try melatonin without experiencing physical withdrawal symptoms or rebound insomnia when you stop taking it. But there's a flipside to be aware of: Experts agree that you can become psychologically dependent on having a gummy each night (or doing any pre-sleep ritual, for that matter). Many sleep problems are rooted in anxiety about falling and staying asleep, Tal explains. So when you take something that promises to ease that process—whether it be melatonin or another 'natural' sleep aid—you give yourself the mental greenlight to relax and doze off, creating a positive association between that behavior and snoozing away. This powerful placebo effect is not necessarily harmful unless it's potentially masking a bigger problem. If you have undiagnosed sleep apnea, for example, you could be delaying a more effective treatment plan if you head for the supplement aisle before your doctor's office, Neubauer says. The same goes for insomnia: The gold-standard treatment is cognitive behavioral therapy for insomnia, not medication or supplements, Wyatt notes. 'Melatonin is not a panacea for all sleep problems, and it could even backfire depending on what your actual sleep problem is,' Wu says. 'So let's slow down from the quick fixes and figure out what the issue is in the first place. That's where a sleep professional can be really helpful.'
Yahoo
23-06-2025
- Health
- Yahoo
Have Sleep Apnea Or Suspect You Do? Certain Pillows Might Help
The experts consulted for this story do not necessarily endorse the products ahead unless otherwise noted. Sleep apnea — a disorder in which one's breathing is interrupted for seconds or minutes at a time during sleep — affects people of all ages, genders and body types, according to Dr. Indira Gurubhagavatula, a sleep medicine physician and spokesperson for the American Academy of Sleep Medicine (AASM). Yet more than 80% of sleep apnea cases remain undiagnosed, she said. 'The most common symptom of sleep apnea is loud, persistent snoring,' Gurubhagavatula noted. However, because of the unconscious nature of sleep, it can be tricky to determine whether you snore, much less experience sleep apnea episodes, unless a family member, roommate or partner notices. However, if you notice yourself waking up gasping or choking, or even frequently using the bathroom at night, these can all constitute sleep apnea symptoms, too. The interruptions in breathing that occur with sleep apnea 'lead to frequent drops in blood oxygen levels, severely disrupting sleep quality,' explained Chelsie Rohrscheib, a neuroscientist and head sleep expert at Wesper. The consequences of such diminished sleep quality can be dire, affecting daytime hours and the broader constitution of one's life emphasized Gurubhagavatula. 'For about half of those with sleep apnea, symptoms worsen when sleeping on their back,' explained Rohrscheib. This is called positional sleep apnea, she noted, and occurs because sleeping on your back can actually block your airway. Specifically, gravity can cause your tongue to fall into the throat during sleep, obscuring the airway, both experts said. 'Patients with positional sleep apnea often benefit from sleeping on their side or elevating their head,' added Rohrscheib. 'For people with mild sleep apnea, sleeping with a firm, elevated pillow might improve their respiration, as softer pillows that are thinner tend to promote airway blockage.' If you suspect you may have sleep apnea, seek evaluation by your doctor or a specialist from an AASM-accredited sleep center. A healthcare professional can order you a sleep study, which often can be done right at home. 'Those with positional sleep apnea may still experience breathing disruptions, though typically to a lesser degree than when sleeping on their back,' Rohrscheib noted, and 'not everyone with sleep apnea will see improvements by changing their sleep position.' It's best to consult with a sleep specialist about whether positional therapy makes sense for you. Tempurpedic Switching to a side sleeping position with an appropriate pillow can be helpful if you have mild or positional sleep apnea, in which the disorder worsens during back sleeping. 'Typically, someone with positional sleep apnea will benefit more from a pillow that allows them to sleep comfortably on their sides, such as a medium firm memory foam pillow," said Rohrscheib. Based on Rohrscheib's advice, we selected Tempurpedic's beloved memory foam pillow, which is designed to comfortably support your head and neck during side sleeping. $119+ at Tempurpedic Large: $66 at Amazon Amazon This popular contoured side sleeping pillow is another solid option based on Rohrscheib's recommendation. It's so important for any good side pillow to support the space between your shoulder and head as closely as possible, yet that distance is unique to each person depending on their particular physical makeup, according to sleep brands like Tempurpedic. After all, shorter folks may have different head-to-shoulder widths than taller people. As a result, it can be advantageous to choose an adjustable pillow, like this one. Oeko-Tex-certified and made out of memory foam, the pillow provides four different heights for you to choose from to help achieve optimal profile support while helping minimize neck strain. Another plus is that this option comes in a travel size for easy portability. $37+ at Amazon Amazon For folks with positional sleep apnea, "The simple practice of sleeping on their side or stomach can help keep the airway open throughout the night," noted Gurubhagavatula. A concave contoured pillow, like this bestselling one that HuffPost selected, may help side sleeping feel comfier by providing additional support. Made with memory foam, the pillow is designed to ergonomically cradle the head at a 15-degree angle while supporting the natural curve of the neck and shoulders. This option features convenient removable inserts, too, so you can adjust it to your ideal side profile width. If you'd like the pillow to be even taller than the available inserts allow, the company says you can even contact them for an additional insert. $40 at Amazon Amazon Both Gurubhagavatula and Rohrscheib recommended wedge pillows for folks with mild or positional sleep apnea, since this kind of pillow helps encourage sleeping with the upper body elevated. "A wedge pillow that allows [patients] to sleep at a 45-degree angle ... reduces the risk of soft tissue blockage in the back of the throat" and thus helps improve respiration, explained Rohrscheib. Based on the experts' input, we think this bestselling memory foam wedge pillow is a great option. Available in tons of different sizes, including options that span your whole headboard, the adjustable pillow is plenty versatile (and surprisingly chic thanks to its Jacquard pillow cover). It's designed to help with snoring and encourage more comfortable sleep, but can also be used for back support while reading or watching TV or for elevating your feet or legs after a long day. $37 at Amazon Amazon If you already know you have sleep apnea and use a CPAP machine to assist with nighttime breathing, you might benefit from a pillow that's designed specifically with CPAPs in mind. "There are ... pillows made for sleep apnea patients that use other therapies, like CPAP," noted Rohrscheib. This Contour CPAP Max pillow, which HuffPost selected, is one such option. The adjustable, orthopedic pillow sports side cutouts to help minimize leaks from your mask and prevent your mask from moving around. Its concave center cradles your head while providing facial support to help facilitate comfortable airflow and side positioning. With the pillow's three removable layers, you can add and subtract inserts to achieve an ideal height for your side profile. Available in original and cooling versions, the pillow even has a tether for attaching your machine's hose to further minimize shifting of your mask. Original: $60 at Amazon Cooling: $60 at Amazon Amazon This popular, firm Lunderg memory foam pillow, which HuffPost also chose, is also designed for folks with sleep apnea who use CPAP machines. Designed to reduce mask air leaks, the pillow's two sides offer different thickness levels to accommodate differing side profiles; the pillow also comes with an additional removable insert for further customization. The piece also includes two pillowcases (one of which is cooling)! $79 at Amazon $79 at Walmart Amazon In previous HuffPost reporting, a sleep medicine physician recommended using a full-body pillow to make side and stomach sleeping easier while providing additional pressure-relieving support. Based on this advice, we selected this popular adjustable full-body pillow from Pharmedoc. The piece is customizable, so you can opt for its full U-shaped style, or detach one of its legs for a C-shape, and use the removed part for additional support between your legs or behind your head. It also comes with a heat-absorbing cooling cover. $40 at Amazon Amazon A sleep medicine physician also previously told HuffPost that a small pillow in between the knees can help align the spine for more comfortable side sleeping. Based on this suggestion, we think this orthopedic knee pillow from Luna is a solid option. Contoured into an hourglass shape and made with memory foam, the knee pillow is designed to support your body while adapting to your particular shape and maintaining breathability with its cooling fabric. Designed to help align the spine, the sleep tool helps reduce pressure in the neck and shoulders while distributing your weight more evenly in the side sleeping position. $21+ at Amazon The Highest-Rated Pillows On Amazon For Every Type Of Sleeper The Very Best Pillows For Stomach Sleepers, According To Experts If You're Desperate For Better Sleep, This $30 Gadget Could Be A Game-Changer
Los Angeles Times
16-06-2025
- Health
- Los Angeles Times
Restless Legs Syndrome: What Works and What Doesn't
Restless Legs Syndrome (RLS) (also known as Willis Ekbom disease) is more than just an annoying urge to move your legs—it's a neurological condition and a sleep disorder that can seriously disrupt sleep and daily life. An irresistible urge to move, especially in the evening or when lying down, is often paired with uncomfortable sensations—such as tingling, aching, or crawling—that are a hallmark of the condition and are only relieved by movement. These symptoms of restless legs are most noticeable during periods of rest or inactivity. For many, this cycle of discomfort leads to poor sleep, irritability, and fatigue that affects their overall well-being. RLS often begins in middle age, but it can develop earlier or later. People may develop RLS due to genetic factors or underlying medical conditions. In addition, periodic limb movement disorder is a related sleep disorder that can further disrupt sleep in those with RLS. The good news? RLS is treatable. The 2025 clinical guidelines from the American Academy of Sleep Medicine (AASM) recommend a personalized treatment approach, combining medications, iron therapy, and lifestyle modifications [1]. Let's explore the latest evidence and strategies to help patients get relief and better rest. Iron plays a surprisingly central role in RLS. Low ferritin levels—an indicator of iron storage—are strongly linked to symptom severity. Iron deficiency is a common underlying cause of RLS. When ferritin levels fall below 75 ng/mL, the AASM recommends initiating oral iron therapy with ferrous sulfate [1]. Diagnosis of RLS often involves taking a thorough medical history, using a sleep diary to track symptoms and sleep patterns, and evaluating for other sleep conditions. Blood tests are used to check for iron deficiency and to rule out other causes such as kidney failure and sleep apnea. Why? Because restoring iron stores can significantly reduce or even eliminate RLS symptoms in many cases. This is especially important in children, pregnant women—who are at increased risk for RLS due to iron and folate deficiencies—and adults who don't require other medications. Think of iron as the body's fuel for dopamine production—something that RLS patients tend to lack. If the tank's empty, symptoms flare. For those with absorption issues or extremely low levels, intravenous (IV) iron may be an option under medical supervision. But in most cases, a daily iron supplement can be a simple, effective starting point. Dopaminergic medications have long been the go-to treatment for RLS. Drugs like ropinirole, pramipexole, and rotigotine are dopamine agonist medications that mimic dopamine, specifically the brain chemical dopamine, which is a chemical messenger dopamine involved in muscle movement and sensory regulation. These drugs work by increasing dopamine levels in the brain and acting on dopamine receptors to relieve symptoms. They can be very effective—especially in the early stages of treatment. Ropinirole, in particular, is FDA-approved and backed by three robust clinical trials. These studies showed notable improvements in the International RLS Rating Scale (IRLS) and Clinical Global Impressions-Improvement Scale (CGI-I) at an average dose of 2 mg/day over 12 weeks [2] [3]. But there's a catch. Over time, some patients experience 'augmentation'—a worsening of symptoms, either earlier in the day or in new body parts. Others may develop side effects like nausea, dizziness, impulse control disorder (such as compulsive gambling or shopping), daytime drowsiness, or weight gain. Symptoms occur when side effects or augmentation develop, and certain medications—including antipsychotic drugs and anti seizure medications—can interact with dopaminergic agents or worsen RLS symptoms. Some medications can worsen symptoms, worsen RLS, or make RLS symptoms worse, so monitoring is needed to prevent symptoms worse and worsening symptoms. Because of these risks, the 2025 AASM guideline recommends limiting dopaminergic agents to carefully selected patients and emphasizing routine monitoring [1]. For many, these medications still play an important role in treating RLS, especially in severe RLS cases, but with caution and close follow-up to treat RLS, relieve symptoms, and ensure that treating RLS does not lead to further complications. When dopamine agonists aren't suitable—due to side effects, contraindications, or comorbidities like end-stage renal disease (ESRD)—other medication classes come into play. These medications are also used to treat periodic limb movement disorder, a related sleep disorder. Periodic limb movement and periodic limb movements are common in RLS and can disrupt sleep, making their management important for overall sleep quality. Patients with developing RLS in middle age or those with early onset (before age 45) may particularly benefit from these alternatives. Gabapentin and gabapentin enacarbil (a longer-acting version) are particularly helpful in RLS patients with sleep disturbances or pain. These alpha-2-delta ligands work by calming nerve activity and improving sleep quality. They act on the central nervous system, nervous system, and may affect the spinal cord to help control symptoms [6]. They're a go-to choice for people who can't tolerate dopamine drugs or who are at high risk for augmentation. In rare, severe cases, extended-release oxycodone may be prescribed. But opioids are considered a last resort due to concerns around tolerance, dependence, and long-term safety [1]. There is also an increased risk of adverse effects, including dependence and other complications. That said, for patients with refractory RLS who have exhausted other options, carefully monitored opioid use can provide much-needed, though often only temporary relief. Guidelines for these medications are developed by a combined task force of experts in the field of clinical sleep medicine, ensuring recommendations are evidence-based and up to date. Medications aren't the only answer. In fact, combining drug therapy with non-pharmacological treatments often leads to the best outcomes—especially for those with mild to moderate RLS or who want to minimize medication use. Simple lifestyle changes—such as improving sleep hygiene, adjusting daily routines, and avoiding triggers—can also play a key role in managing RLS symptoms. A 2019 systematic review highlighted several low-risk interventions with emerging benefits [4] [5]: For ESRD patients, cool dialysate and intradialytic stretching have been shown to reduce RLS severity during dialysis sessions. While more large-scale studies are needed, these approaches offer accessible, often cost-effective ways to support conventional treatments. RLS is one of several sleep disorders, and consulting a sleep specialist may be helpful for complex or persistent cases. Whether you're starting iron therapy, trying ropinirole, or exploring non-drug therapies, ongoing monitoring is essential. Symptoms may wax and wane, and medications can lose effectiveness or cause side effects over time. Regular follow-up visits allow healthcare providers to: For many patients, managing RLS becomes a long-term balancing act—but one that's highly achievable with the right support and care plan. Restless Legs Syndrome may not be dangerous, but it can take a serious toll on sleep, mental health, and quality of life. Fortunately, there are more treatment options than ever—ranging from iron supplements and dopamine agonists to gabapentin, opioids, and innovative non-drug therapies. What matters most is a personalized, evidence-based approach. For patients, that means partnering with a knowledgeable provider, staying open to a combination of treatments, and committing to regular check-ins. Relief is possible—and better sleep is well within reach. [1] Winkelman, J. W., Berkowski, J. A., DelRosso, L. M., Koo, B. B., Scharf, M. T., Sharon, D., Zak, R. S., Kazmi, U., Falck-Ytter, Y., Shelgikar, A. V., Trotti, L. M., & Walters, A. S. (2025). Treatment of restless legs syndrome and periodic limb movement disorder: an American Academy of Sleep Medicine clinical practice guideline. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine, 21(1), 137–152. [2] Harrison, E. G., Keating, J. L., & Morgan, P. E. (2019). Non-pharmacological interventions for restless legs syndrome: a systematic review of randomised controlled trials. Disability and rehabilitation, 41(17), 2006–2014. [3] Bega, D., & Malkani, R. (2016). Alternative treatment of restless legs syndrome: an overview of the evidence for mind-body interventions, lifestyle interventions, and neutraceuticals. Sleep medicine, 17, 99–105. [4] Ferini-Strambi L. (2009). Treatment options for restless legs syndrome. Expert opinion on pharmacotherapy, 10(4), 545–554. [5] Chen, J. J., Lee, T. H., Tu, Y. K., Kuo, G., Yang, H. Y., Yen, C. L., Fan, P. C., & Chang, C. H. (2022). Pharmacological and non-pharmacological treatments for restless legs syndrome in end-stage kidney disease: a systematic review and component network meta-analysis. Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association, 37(10), 1982–1992. [6] Anguelova, G. V., Vlak, M. H. M., Kurvers, A. G. Y., & Rijsman, R. M. (2020). Pharmacologic and Nonpharmacologic Treatment of Restless Legs Syndrome. Sleep medicine clinics, 15(2), 277–288.
Medscape
13-06-2025
- Health
- Medscape
Rapid Rx Quiz: Sleep Apnea Devices
CPAP (continuous positive airway pressure), along with other devices such as APAP (automatic positive airway pressure) and BiPAP (bilevel positive airway pressure), have been the mainstay in treating obstructive sleep apnea (OSA) for decades. Despite their proven effectiveness, patients can struggle with discomfort or intolerance of these treatments, which can lead to suboptimal adherence. As a result, alternative devices have been developed to address the needs of individuals who cannot tolerate traditional therapy, offering other approaches to maintaining airway patency and managing related health outcomes. What do you know about devices for sleep apnea? Test yourself with this brief quiz. Current clinical practice guidelines from the AASM recommend the use of either APAP or CPAP in OSA treatment in adults. No clinically meaningful differences were found in outcomes of APAP treatment vs CPAP treatment, and benefits and harm were similar between the two modalities. Patient tolerance and symptom response should guide the choice of one over the other. APAP or CPAP are recommended over BiPAP for initial treatment of OSA in adults. BiPAP might provide an expiratory pressure that is too low to prevent obstructive breathing. However, BiPAP therapy for OSA might be appropriate in certain patients, such as those who have not responded to treatment with APAP and CPAP or those who require very high pressures (> 20 cm H2O). Learn more about sleep-disordered breathing and CPAP. According to current guidelines from the AADSM, patients should be seen by their dentist for a follow-up evaluation within 30 days after appliance insertion. During the first year, patients should be re-evaluated every 6 months, and at least once annually after that to assess treatment efficacy and adherence. At these visits, the treating dentist should use the same standardized tools and questionnaires employed during the initial evaluation to monitor symptoms and treatment response. Adjustment of the oral appliance depends on several factors, including the patient's mandibular range of motion, OSA severity, comfort, and observed changes in symptoms. A collaborative protocol between the treating dentist and the patient's medical provider should be in place to support objective and coordinated assessment. Learn more about oral appliance therapy for OSA. The implantable hypoglossal nerve stimulator received US Food and Drug Administration (FDA) approval in 2014 for the treatment of moderate to severe OSA in patients who have not responded to or cannot tolerate PAP therapy. As hypoglossal nerve stimulation has been shown to be most efficacious in those with a BMI < 32, an adult with moderate OSA and a BMI of 28 probably would be a good candidate for this treatment approach. Hypoglossal nerve stimulation has not been approved in patients aged < 18 years, so a boy aged 15 years would not be a candidate. Also, the stimulator is contraindicated in patients with central sleep apnea. The safety of hypoglossal nerve stimulation has not been established in pregnant patients and should not be undertaken. Learn more about upper airway evaluation in snoring and OSA. An external tongue muscle stimulator device was cleared by the FDA in 2020. Intended for use 20 min/d for 6 weeks and then twice per week subsequently, the device requires far less patient time commitment than some other OSA therapy devices. The tongue muscle stimulator is designed to be used while awake for 20-minute increments. It is indicated for snoring and mild OSA and is not indicated to treat OSA with an apnea-hypopnea index (AHI) > 15. The device is approved only for adults aged ≥ 18 years. Learn more about macroglossia. EPAP devices are noninvasive, valve-based devices for the treatment of mild to moderate OSA. They function by creating resistance during expiration, generating back pressure that helps keep the upper airway open during sleep. Unlike CPAP therapy, which provides constant pressure during both inhalation and exhalation, EPAP devices are passive and provide pressure only during expiration. These devices do not require batteries or power sources. They resemble nasal pillows, like those used with many CPAP machines. Unlike oral appliances, EPAP devices do not require custom fitting. Monthly calibration is also not needed. Learn more about pathologic conditions associated with OSA.
