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Restless Leg Syndrome is usually characterized by an achy, crawly, restless, irresistable urge to move the lower extremities (legs) although may even be a painful, crampy sensation. And may also involve the arms, feet and hands. It occurs more frequently in those over 60 years of age, (although may occur at any age, even childhood) is more common in females than males, and also more common in diabetics, pts with renal (kidney) insufficiency, pregnancy, rheumatoid arthritis, chronic back pain syndromes, B-12 and folate deficiency, and iron deficiency anemia. Restless leg syndrome occurs more frequently in the evening, and is relieved with movement.. Although Restless Leg Syndrome (RLS) can occur anytime throughout the day.
RLS is usually associated with Periodic Limb Movement Disorder (PLMD). PLMD is characterized as frequent leg/limb movements that occur during sleep and may result in periodic arousals throughout sleep that may result in daytime fatigue and excessive daytime sleepiness.
Diagnosis of above disorders may require a overnight sleep study.
Treatment includes moderate exercise, caffeine and tobacco cessation, hot baths or showers 1 to 2 hours before sleep. Pharmocologic therapy may include Dopamine agonists such as Ropinirole or pramipexole. Other treatments may include Gabapentin, tramadol, and supplementation of iron for iron deficiency anemia .
If you have any questions, please see your primary care physician or a sleep physician..

thank you.

Dr. Jeffrey,,, Diplomate of the American Board of Sleep Medicine
Diplomate , American Board of Medical Subspecialties

Insomnia is the most common sleep symptom presenting to a Sleep Physician. As our society has become increasingly fast paced, (a so to speak 24/7 society), we have become sleep deprived. Not only do we as a society obtain an inadequate amount of sleep, our sleep quality has declined as well. Our society on the whole has become rush, rush and pushing for the next best thing. One and done and onto the next thing quickly, this occuring in business and in our home life. Thus , we as a society are more stressed, and resulting in the inability to go to sleep (sleep initiation insomnia) or the inability to stay asleep (sleep maintence insomnia) .
Once insomnia begins, it tends to perpetuate itself, with less and less quality and quantity of sleep, resulting first in daytime fatigue. Other symptoms of chronic insomnia are inability to concentrate, memory loss, mood changes, irritability, short tempered, and eventually excessive daytime sleepiness and possibly even depression.. Although it is to note insomnia may be the first symptom of depression.
Insomnia may also be associated with obstructive sleep apnea, central sleep apnea, and restless leg syndrome/periodic limb movement disorder.
In most cases of insomnia there is usually an inciting event, ie illness or death in the immediate family, stressors in marriage or at work. Again ,once insomnia starts. the cycle may be self perpetuating and diffucult to break,called psychophysiologic insomnia. Even with the pre “bedtime ritual” ie watching TV, reading , brushing teeth, just the thought of laying down and trying to go to sleep results in anxiety and a “heightened tension” that is the predrome of insomnia each night.
Treatment may include cessation of caffeine, hot baths 2 hours before sleep, exercise 6 to 8 hours before bedtime, sleeping in a cool , dark, quiet environment, turning the alarm clock away, as not to ruminate on it, which perpetuates insomnia. Other treatment options include regular bedtimes and waketimes, small meals containing trytophan one hour before bedtime, relaxation techniques. Other proven and effective therapies include Sleep Restriction, Progressive Muscle Relaxation, and Cognitive Behavioral Therapy ( Please see A Sleep Physician for discussion and treatment concerning these techniques).
Other options include melatonin (for sleep initiation insomnia), or other hypnotics “sleeping pills” which include Ambien, Lunesta, Restoril etc. It is to note hypnotics should be used only short term for insomnia, as they can be associated with tolerance and potentially addictive. Also they may have serious side effects. You should discuss hypnotics (sleeping pills) with your primary care MD or Sleep physician before starting these medications or before any of above recommendations are tried or instituted. I use hypnotics (sleeping pills) short term only and as a last resort .
I would like to reiterate that insomnia may be the first symptom of depression and you should discuss your insomnia with your primary care physician and/or a Sleep Physician.

THANK YOU,

DR. JEFFREY

Sleep apnea in children can occur at any age. From children between 4 and 18 the most common cause of obstructive sleep apnea is tonsillar hypertrophy (enlarged tonsils). Obesity is on the rise in children and is certainly a contriting factor as well. Most common symptoms are snoring, insomnia, restless sleep, possiby periods of breathing cessation, or shallow respirations, and enuresis (bed wetting). Children may also present with daytime symptoms ADD, ADHD, or fatigue, loss of concentration, poor grades in school, aggressive behavior. Treatment in children may include tonsillectomy , wt loss, or CPAP. Please consult your primary care MD, pediatrician or sleep MD if you suspect your child may have sleep apnea.

Obstructive sleep apnea affects 5 to 10% of the population, or up to 30,000,000 people in the US alone. We have discussed some of the symptoms before, including excessive daytime sleepiness, fatigue, waking up unrefreshed. The most common compIaint I hear from a patient is “feels like I have never been to bed, when I wake up in the morning”. The spouse is usually the first one to complain of restless sleep, heavy snoring and pauses in breathing by the bed partner. Treatment of sleep apnea usually results in the patient and the spouse sleeping much better.

Symptoms of sleep apnea are numerous, from severe symptomatolgy as Congestive Heart Failure, difficult to treat Hypertension , Pulmonary Hypertension, increased risk of motor vehicle accidents, Heart Attacks and Strokes ,as well as sudden unexplained death in severe cases of obstructive sleep apnea.. Milder symptoms may consist of pedal edema, or “feet and leg swelling”, frequent urination at night, restless sleep and insomnia, impotence, difficult to control diabetes and fatigue .

Effective treatment for sleep apnea, usually consists of CPAP, or (C)ontinuous (P)ositive (A)irway
(P)ressure. CPAP works as a pneumatic splint to keep the airway open at night and is a very effective treatment in most cases for obstructive sleep apnea. Other options for mild obstructive sleep apnea include surgical options or anti-snoring devices.
If you suspect you or your spouse may have obstructive sleep apnea discuss this with your Primary Doctor or a Sleep Specialist MD/DO.

Thank You,

Dr. Jeffrey

    1800CPAP.COM has put together a team of dedicated professionals; knowledgeable personnel who understand the seriousness and life threatening consequences of untreated sleep apnea. I can promise you that we will work diligently and in a time efficient manner to supply your much needed CPAP equipment without delay.

     As a sleep physician that has treated thousands of patients with sleep apnea over 15 years, I realize, as they do, how critically important it is to have a CPAP supply company that is reliable and trustworthy. and expedient. I assure you, we are that company. 

    The repercussions of untreated sleep apnea (OSA) may result in sudden cardiac death, arrhythmias, MI’s(heart attacks), strokes, pulmonary hypertension (associated with increase in leg and feet swelling), impotence, uncontrolled diabetes and uncontrolled hypertension ( high blood pressure).  Also left untreated, sleep apnea has been related to depression, fatigue, excessive daytime sleepiness, loss time at work and poor work productivity, as well as automobile accidents.

     I believe, as do the dedicated employees at 1800CPAP.COM, that the treatment of sleep apnea requires a multistep approach. 1800CPAP.com will offer educational information and links to guide you along the way. I personally, will answer questions that may arise as well. 

        Thank you, 

               Dr. Jeffrey

     Board Certified in Sleep Medicine:   American Academy of Sleep Medicine

     Board Certified in Sleep Medicine:   American Board of Internal Medicine (Subspecialties)

     Board Certified in Pulmonary Medicine

     Board Certified in Internal Medicine.

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