The Sleep Disorders Toolkit

Sleep Review

From Sleep Review Magazine comes "The Sleep Disorders Toolkit", a podcast meticulously crafted for sleep apnea and sleep medicine professionals. Distinguished for its depth and precision, each episode offers rigorous analyses, driven by the leading voices in the industry. Practitioners will find themselves immersed in both foundational knowledge and the very latest advances in sleep disorder management. This isn’t just content; it's a deep dive into the intricacies and nuances of sleep medicine. For those dedicated to the pursuit of excellence in sleep health, The Sleep Disorders Toolkit emerges as the paramount resource, elevating standards and shaping the future of sleep medicine. read less
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Episodes

Pathophysiology of Idiopathic Hypersomnia
Aug 17 2023
Pathophysiology of Idiopathic Hypersomnia
While the pathophysiology of idiopathic hypersomnia is unknown, emerging science suggests that nighttime sleep dysfunction may contribute to daytime sleepiness in patients with idiopathic hypersomnia. A systematic review and meta-analysis that included 10 studies found that, on average, several sleep architecture hallmarks were different in patients with idiopathic hypersomnia relative to controls.Total sleep time and percent of REM sleep were increased in patients with idiopathic hypersomnia compared with controls.Sleep-onset latency and percent of slow-wave sleep were decreased in patients with idiopathic hypersomnia compared with controls.Sleep efficiency and REM latency were similar between patients with IH and controls.In addition to nighttime sleep dysfunction, other physiological changes have been observed in some patients with idiopathic hypersomnia and theorized as possible contributors to its pathophysiology including:Dysfunction of the GABAergic systemAutonomic system dysfunctionAltered functional or regional connectivity in the brainCircadian system dysfunctionDysfunction of energy metabolismThis episode is produced by Sleep Review and is episode 5 of a 5-part series sponsored by Jazz Pharmaceuticals. Visit Jazzpharma.com and SleepCountsHCP.com for more information. In episode 5, listen as Sleep Review’s Sree Roy and neurologist-sleep specialist Isabelle Arnulf, MD, PhD, discuss:Science doesn’t fully understand the pathophysiology of idiopathic hypersomnia. Research has revealed potential clues, however. For example, idiopathic hypersomnia is associated with changes in sleep staging and architecture. What does emerging science suggest are differences in nighttime sleep?How might the arousal index differ in idiopathic hypersomnia versus in people without it, and why might that matter?In addition to nighttime sleep dysfunction, other physiological changes have been observed in some patients with idiopathic hypersomnia and theorized as possible contributors to its pathophysiology. What is the GABAergic system and its possible role?What are some emerging findings surrounding idiopathic hypersomnia and autonomic system dysfunction?What is the evidence that supports the idea of altered functional or regional connectivity in the brain in people with idiopathic hypersomnia?There were fascinating studies done on skin fibroblasts, suggesting that circadian period length may be different in people with idiopathic hypersomnia versus in people without it. What role might circadian rhythm dysfunction have in idiopathic hypersomnia?What has science discovered about the possible role of dysfunction of energy metabolism in idiopathic hypersomnia?What further research would you like to see conducted on the pathophysiology of idiopathic hypersomnia?Listen to Episode 1: Symptoms of Idiopathic HypersomniaListen to Episode 2: Diagnosis of Idiopathic HypersomniaListen to Episode 3: Differential Diagnosis of Idiopathic HypersomniaListen to Episode 4: Burden of Idiopathic Hypersomnia
Burden of Idiopathic Hypersomnia
Aug 10 2023
Burden of Idiopathic Hypersomnia
People with idiopathic hypersomnia face a significant disease burden. Idiopathic hypersomnia is associated with challenges that impact daily living activities, such as limitations at school, work, interpersonal relationships, and social activities. Various impairments include Impacts on attention and cognition, which can be characterized as “brain fog”The burden of memory problems and a feeling of the mind going blank or making a mistake in a habitual activityPublic health and safety are also impacted, as more severe causes of sleepiness can be cause for accidents. Management strategies may not address the underlying sleep dysfunction associated, resulting in suboptimal symptom management. Patient survey and registry data suggest patients continue to experience symptoms of idiopathic hypersomnia and residual disease burden. This episode is produced by Sleep Review and is episode 4 of a 5-part series sponsored by Jazz Pharmaceuticals. Visit Jazzpharma.com and SleepCountsHCP.com for more information. In episode 4, listen as Sleep Review’s Sree Roy and pulmonologist-sleep specialist Richard K. Bogan, MD, discuss: What are some limits that people with idiopathic hypersomnia can experience in their daily living activities?How do people with idiopathic hypersomnia commonly describe "brain fog," and what are some of the real-life consequences it?How does prolonged sleep inertia place a burden on the people with idiopathic hypersomnia who experience this symptom?What do you see as the burden of idiopathic hypersomnia on public health and safety?Beyond medications, how is idiopathic hypersomnia typically managed to control for symptoms as much as possible?How do you determine when therapy for idiopathic hypersomnia has been optimized, and what symptoms may remain at this point?
Differential Diagnosis of Idiopathic Hypersomnia
Aug 3 2023
Differential Diagnosis of Idiopathic Hypersomnia
The differential diagnosis of idiopathic hypersomnia is challenging for several reasons. Its hallmark symptom, excessive daytime sleepiness, is a common symptom of many disorders, and ts ancillary symptoms also overlap with other disorders. A lack of validated biomarkers adds to the challenge. Assessing for key symptoms and medical history is a first step to help identify patients presenting with excessive daytime sleepiness who may have idiopathic hypersomnia. From there, there are several symptoms that can differentiate the diagnosis of idiopathic hypersomnia from other disorders such as sleep apnea or narcolepsy. These include:Sleep inertia: sleep inertia is common in patients with idiopathic hypersomnia but can also be reported by individuals with mood disordersPatients with idiopathic hypersomnia often find naps to be long and unrefreshing, while patients with narcolepsy generally find short naps to be restorativeIf a patient has prolonged nighttime sleep, long sleeper syndrome should be considered; in contrast to patients with idiopathic hypersomnia, long sleepers feel refreshed and do not have daytime sleepiness and difficulty awakening if they are allowed to sleep as long as they needCognitive complaints, often described as "brain fog" are common symptoms of idiopathic hypersomnia but also can occur in patients with various sleep-wake disorders (including narcolepsy type 1 and insufficient sleep syndrome)This episode is produced by Sleep Review and is episode 3 of a 5-part series sponsored by Jazz Pharmaceuticals. Visit Jazzpharma.com and SleepCountsHCP.com for more information. In episode 3, listen as Sleep Review’s Sree Roy and neurologist-sleep specialist Yves Dauvilliers, MD, PhD, discuss:Idiopathic hypersomnia can be particularly challenging to diagnose because of its lack of specific biomarkers, as well as its symptoms resembling those of other disorders. How do you differentiate idiopathic hypersomnia from hypersomnias of a specific cause, such as narcolepsy type 1 and type 2, insufficient sleep syndrome, or hypersomnia due to a neurodegenerative disease?A minority of people simply need to sleep longer than most, even 10 hours or more, to feel refreshed. How do you determine if that applies to a given person, who may not have a sleep disorder at all?How do you differentiate idiopathic hypersomnia from hypersomnia comorbid to psychiatric disorders, such as prolonged sleep time tied to depression?At what point in ruling out other disorders should objective sleep testing, such as polysomnography and multiple sleep latency testing, be done?Why is idiopathic hypersomnia sometimes confused with sleep-breathing disorders? When would you recommend a CPAP trial to address possible apneas, hypopneas, or respiratory-event related arousals?How do you distinguish chronic fatigue syndrome from idiopathic hypersomnia?Listen to Episode 1: Symptoms of Idiopathic Hypersomnia Listen to Episode 2: Diagnosis of Idiopathic Hypersomnia
The Hidden Risks of Obstructive Sleep Apnea
Aug 1 2023
The Hidden Risks of Obstructive Sleep Apnea
Sleep specialist Indira Gurubhagavatula, MD, MPH, is our guest and chair of the Count on Sleep Tool Development and Surveillance Workgroup for The Obstructive Sleep Apnea: Indicator Report, which provides an in-depth analysis of the symptoms, risk factors, prevalence, and burden of obstructive sleep apnea and serves as a resource for both the public and the health care communities on the importance of diagnosis and long-term treatment. Gurubhagavatula and Sleep Review editor Sree Roy discuss the hidden risks of obstructive sleep apnea—the mortality and morbidity that makes obstructive sleep apnea (OSA, for short) particularly insidious. We discuss obstructive sleep apnea’s links to vehicle crashes, treatment-resistant hypertension, impaired brain function, erectile dysfunction and female sexual dysfunction, type 2 diabetes, and early death. We also discuss treatments for obstructive sleep apnea and how healthcare providers can screen patients to intervene early for patients at risk of obstructive sleep apnea. Specifically, this episode about the hidden risks of obstructive sleep apnea provides answers to: What is obstructive sleep apnea, also known as OSA for short?What do you think is the most troubling risk of not treating obstructive sleep apnea?How has treatment-resistant hypertension been linked to OSA?How can the impaired brain function linked to OSA manifest in patients?What evidence is out there that erectile dysfunction and female sexual dysfunction can be tied to OSA?How has obstructive sleep apnea been linked to diabetes?The worst link in my view is that obstructive sleep apnea has been linked to an earlier death. Why is that?Treatment of sleep apnea typically involves a device, such as a CPAP machine or an oral appliance, though surgery can be an option for some patients. Is there any evidence that treating OSA can alleviate some of sleep apnea morbidities or mortality?With all of this evidence in mind, what should healthcare providers do to help identify patients who are likely to have obstructive sleep apnea?What should any patients listening to this podcast do if they think they have symptoms of obstructive sleep apnea?
Diagnosis of Idiopathic Hypersomnia
Jul 27 2023
Diagnosis of Idiopathic Hypersomnia
The International Classification of Sleep Disorders, 3rd ed, lists the criteria needed for a diagnosis idiopathic hypersomnia.For a diagnosis of idiopathic hypersomnia, the following must be met:o excessive daytime sleepiness daily for at least 3 monthso cataplexy is not presento multiple sleep latency test (MSLT) shows o insufficient sleep syndrome is ruled outAnd at least one of the following:o MSLT shows a mean sleep latency of ≤8 minuteso Total 24-hour sleep time is ≥660 minutes (typically 12-14 hours) on 24-hour PSG monitoring (performed after correction of chronic sleep deprivation), or by wrist actigraphy in association with a sleep log (averaged over at least 7 days with unrestricted sleep)o Hypersomnolence and/or MSLT findings are not better explained by another sleep disorder, other medical or psychiatric disorders, or use of drugs or medicationAdditional supportive features can include:o Severe and prolonged sleep inertiao High sleep efficiency (>90%)o Long, unrefreshing naps (>1 hour)This episode is produced by Sleep Review. It is episode 2 of a 5-part series sponsored by Jazz Pharmaceuticals. Visit Jazzpharma.com and SleepCountsHCP.com for more information.In episode 2, listen as Sleep Review’s Sree Roy and neurologist-sleep specialist Margaret S. Blattner, MD, PhD discuss:o What are some barriers to diagnosing idiopathic hypersomnia?o Objective sleep testing is needed to diagnosis idiopathic hypersomnia. What polysomnography and multiple sleep latency test findings support a diagnosis of idiopathic hypersomnia?o What are some best practices for conducting a PSG and MSLT for a patient with suspected idiopathic hypersomnia?o What are some of the additional commonly seen supportive features of idiopathic hypersomnia?
Symptoms of Idiopathic Hypersomnia
Jul 20 2023
Symptoms of Idiopathic Hypersomnia
Excessive daytime sleepiness is an essential feature of idiopathic hypersomnia, but other key symptoms and aspects of the medical history are crucial when evaluating patients who present with excessive daytime sleepiness. Patients with idiopathic hypersomnia commonly report the following symptoms in addition to excessive daytime sleepiness: severe and prolonged sleep inertia, long and unrefreshing naps, prolonged sleep time, and cognitive dysfunction.Knowing the key symptoms and utilizing sleep testing can increase a healthcare professional’s confidence in his/her diagnosis of idiopathic hypersomnia.The Idiopathic Hypersomnia Severity Scale is a 14-item questionnaire that is a clinical tool designed specifically to measure patients’ idiopathic hypersomnia symptoms and provide a touchpoint that might be useful for patient identification, follow-up visits, and idiopathic hypersomnia management.This episode is produced by Sleep Review. It is episode 1 of a 5-part series sponsored by Jazz Pharmaceuticals. Visit Jazzpharma.com and SleepCountsHCP.com for more information.In episode 1, listen as Sleep Review’s Sree Roy and sleep specialist Logan Schneider, MD, discuss:The symptom of idiopathic hypersomnia that people are most familiar with is excessive daytime sleepiness. Will you define and briefly explain this core symptom?But excessive daytime sleepiness is not the only symptom typically reported by people with idiopathic hypersomnia. Prolonged sleep time is another common symptom. What can this mean over the course of a 24-hour day?Sleep inertia, that feeling of difficulty waking up, can happen to all of us. How can sleep inertia differ in people with idiopathic hypersomnia versus in those without it?Are naps generally restorative for people with idiopathic hypersomnia? Does length matter?What ancillary cognitive symptoms are commonly reported with idiopathic hypersomnia?In 2019, the Idiopathic Hypersomnia Severity Scale was developed to measure the severity, frequency, and functional impact of the key symptoms of excessive daytime sleepiness, prolonged nighttime sleep, and sleep inertia. What do you think is the clinical utility of this questionnaire?To dive even deeper:https://sleepreviewmag.com/sleep-disorders/hypersomnias/idiopathic-hypersomniaTrotti LM. Idiopathic hypersomnia. Sleep Med Clin. 2017;12(3):331-44.Dauvilliers Y. Idiopathic hypersomnia severity scale. 2018.Arnulf I, Leu-Semenescu S, Dodet P. Precision medicine for idiopathic hypersomnia. Sleep Med Clin. 2019;14(3):333-50.Vernet C, Leu-Semenescu S, Buzare MA, Arnulf I. Subjective symptoms in idiopathic hypersomnia: beyond excessive sleepiness. J Sleep Res. 2010;19(4):525-34.Dauvilliers Y, Evangelista E, Barateau L, et al. Measurement of symptoms in idiopathic hypersomnia: The Idiopathic Hypersomnia Severity Scale. Neurology. 2019;92(15):e1754-62.Rassu AL, Evangelista E, Barateau L, et al. Idiopathic Hypersomnia Severity Scale to better quantify symptoms severity and their consequences in idiopathic hypersomnia. J Clin Sleep Med. 2022;18(2):617-29.
What Doctors Get Wrong About Sleep and Mental Health with Barry Krakow
Mar 27 2023
What Doctors Get Wrong About Sleep and Mental Health with Barry Krakow
A large proportion of mental health professionals misunderstand the nature of sleep problems in mental health patients, according to sleep specialist Barry Krakow, MD, who has worked in the field of sleep research and clinical sleep medicine for more than 30 years. Such professionals view sleep issues as a symptom of mental health disorders, rather than as a distinct disorder that needs to be addressed. Healthcare professionals fail to understand that treating sleep problems can help to alleviate mental health issues. The sleep medicine community itself also struggles with how to serve the mental health community. Many sleep centers are still discounting or ignoring the significance of upper airway resistance syndrome (UARS). According to Krakow, many sleep doctors are uncomfortable treating patients with mental health conditions, such as PTSD, depression, or anxiety, and will refer them to therapists or psychiatrists rather than addressing their sleep problems. This lack of understanding and training in the connection between sleep disorders and mental health leads to patients not receiving proper treatment and being left with the impression that sleep medicine cannot help them. Sleep medicine needs to recognize that insomnia and sleep-disordered breathing are prevalent in this population and that effective treatments, such as advanced PAP machines, are available. With regard to bureaucracy surrounding treating mental health patients, Krakow advises that sleep centers can implement efficiencies using modern technology, and offer reimbursable services, such as PAP Naps, to assist with the business aspects. Krakow's new book Life Saving Sleep: New Horizons in Mental Health Treatment explores the link between sleep and mental health, and how the quality of sleep is often overlooked in mental health treatment. Mental health patients with sleep complaints are typically prescribed medication to help them sleep, without addressing the quality of their sleep. Many patients are unable to describe the quality of their sleep beyond the number of hours they sleep each night. For further information: https://barrykrakowmd.com/ https://www.lifesavingsleep.com/ https://fastasleep.substack.com/ Follow Sleep Review on LinkedIn, Facebook, Twitter, & YouTube.
Sodium Intake and Other Modifiable Cardiovascular Risk Factors
Mar 7 2023
Sodium Intake and Other Modifiable Cardiovascular Risk Factors
While the US Department of Health and Human Services recommends a sodium intake of less than 2,300 mg/day, about 9 of 10 American adults exceed that limit. Increased sodium intake is believed to have a direct effect on a variety of negative cardiovascular outcomes such as coronary heart disease, left ventricular hypertrophy, and stroke. Recognizing the impact of dietary sodium on diseases like hypertension and CVD, the FDA recently released voluntary guidance for industry on the target mean and upper concentrations for sodium in commercially processed, packaged, and prepared foods. The guidance was intended to provide a measurable voluntary goal to help Americans to reduce their average sodium intake by 12% over the next 2.5 years, and plans for further iterative reductions in the future. In addition to daily dietary (food and drink) sodium, both prescription and over-the-counter medications can contribute to increasing patients’ total sodium intake per day. Additionally, other risk factors—such as smoking the absence of physical activity, and poor sleep hygiene—that contribute to developing cardiovascular conditions can be modified by maintaining a healthy and balanced lifestyle. This episode is produced by Sleep Review. It is episode 5 of a 5-part series sponsored by Jazz Pharmaceuticals. Visit Jazzpharma.com and NarcolepsyLink.com for more information. In episode 5, listen as Sleep Review’s Sree Roy and cardiologist-sleep specialist Barbara Hutchinson, MD, PhD, FACC, discuss:The FDA recently released guidance on voluntary target concentrations for sodium, in commercially processed packaged and prepared foods. What are your thoughts on this reduced goal for sodium intake, in terms of impact on cardiovascular risk?What are some links between high sodium intake and adverse cardiovascular outcomes?What should people be aware of with regard to medication use and sodium intake?How should cardiovascular risk be discussed when determining the management plan for sleep disorders?Can you share an example of modifying a sleep disorder patient's management plan, due to an emerging cardiovascular risk or disease?Beyond sodium intake, what are some of the other modifiable cardiovascular risk factors that everyone, regardless of whether they have a sleep disorder or not, should be aware of?
Reducing Risk of Cardiovascular Comorbidities in People with Narcolepsy
Feb 22 2023
Reducing Risk of Cardiovascular Comorbidities in People with Narcolepsy
The prevalence of certain comorbidities is higher in people with narcolepsy compared with matched controls—both at diagnosis and at prolonged follow up.Comorbidities that are more prevalent in patients with narcolepsy include psychiatric and sleep conditions, as well as cardiovascular and cardiometabolic conditions.Hypocretin (orexin) dysfunction in patients with narcolepsy may partially explain the increased risk of certain comorbidities in these patients.An increased prevalence of cardiovascular and cardiometabolic conditions, such as hypertension, obesity, diabetes, and hypercholesterolemia have been reported in people with narcolepsy compared with matched controls. One interview study of 320 patients with narcolepsy and 1,464 age-matched individuals from the general population identified that the odds of heart disease in patients with narcolepsy (5.9%) were twice that compared to the age-matched general population (2.9%) (AOR, 2.07 [95% CI, 1.22 to 3.51]). By an average age of 38 (mean age during study), an increased incidence of cardiovascular comorbidities has been observed among patients with narcolepsy compared with matched non-narcolepsy controls.This episode is produced by Sleep Review and is episode 4 of a 5-part series sponsored by Jazz Pharmaceuticals. Visit Jazzpharma.com and NarcolepsyLink.com for more information. In episode 4, listen as Sleep Review’s Sree Roy and cardiologist-sleep specialist-intensivist Younghoon Kwon, MD, MS, FACC, discuss:Narcolepsy is linked with multiple cardiovascular risk factors and comorbidities. Can you inform our audience to any of the specifics of the cardiovascular burden among patients with narcolepsy?Why is it that patients with narcolepsy commonly present with cardiovascular comorbidities? Is there a potential mechanistic link between narcolepsy and these conditions?Does sleep disruption itself impact cardiovascular risk? If so, what is the evidence for the connection between sleep disruption that's a hallmark of narcolepsy and increased cardiovascular risk?How do you balance narcolepsy management with the management of cardiovascular health factors, both in terms of lifestyle and pharmacotherapy?Are there any published studies about narcolepsy and cardiovascular risk that you'd recommend for additional information?
Handling Comorbidities Linked With Narcolepsy
Nov 29 2022
Handling Comorbidities Linked With Narcolepsy
For supporting material on this episode, visit: The increased frequency of comorbidities among people with narcolepsy should be thoroughly reviewed while creating individualized management strategies. Comorbidities that are more prevalent in patients with narcolepsy include psychiatric and sleep conditions, as well as cardiovascular and cardiometabolic conditions. Hypocretin dysfunction in patients with narcolepsy may partially explain the increased risk of certain comorbidities in these patients. An increased prevalence of cardiovascular and cardiometabolic conditions, such as hypertension, obesity, diabetes, and hypercholesterolemia have been reported in people with narcolepsy compared with matched controls. One interview study of 320 patients with narcolepsy and 1464 age-matched individuals from the general population identified that the odds of heart disease in patients with narcolepsy (5.9%) were twice that compared to the age-matched general population (2.9%) (AOR, 2.07 [95% CI, 1.22 to 3.51]). By an average age of 38 (mean age during study), an increased incidence of cardiovascular comorbidities has been observed among patients with narcolepsy compared with matched non-narcolepsy controls.This episode is produced by Sleep Review and is episode 3 of a 5-part series sponsored by Jazz Pharmaceuticals. Visit Jazzpharma.com and NarcolepsyLink.com for more information. In episode 3, listen as Sleep Review’s Sree Roy and neurologist-sleep specialist W. Chris Winter, MD, discuss:What comorbidities do you typically see in patients who are newly diagnosed with narcolepsy?What about comorbidities that tend to develop over time in people with narcolepsy?What health conditions do you screen for when you have a patient who is newly diagnosed with narcolepsy?How, if at all, does the existence or emergence of comorbidities impact decision making?Can you share any best practices for monitoring the emergence and management of narcolepsy-related comorbidities?What other specialists and healthcare professionals do you recommend sleep physicians develop reliable referrals with to adequately manage comorbidities in their patients with narcolepsy?Are there any particular screening tools such as specific questionnaires that you'd recommend to other sleep physicians for this demographic?
Developing A Narcolepsy Management Plan
Nov 15 2022
Developing A Narcolepsy Management Plan
For most people with narcolepsy, management plans require implementation of ongoing pharmacological therapy to keep symptoms under control. Patients may also need substantial lifestyle adjustments, such as maintaining nocturnal sleep hygiene and regular scheduling of daytime naps. Narcolepsy management plan development should consider balance between the tolerance to available medications and impact of certain comorbidities associated with the disorder. The prevalence of certain comorbidities is higher in patients with narcolepsy compared with matched controls; this is true both at diagnosis and at prolonged follow up. The increased frequency of comorbidities among patients with this condition should be thoroughly reviewed while creating individualized management strategies. Comorbidities that are more prevalent in patients with narcolepsy include psychiatric and sleep conditions, as well as cardiovascular and cardiometabolic conditions.This episode is produced by Sleep Review and is episode 2 of a 5-part series sponsored by Jazz Pharmaceuticals. Visit Jazzpharma.com and NarcolepsyLink.com for more information.In episode 2, listen as Sleep Review’s Sree Roy and pulmonologist-sleep specialist Richard K. Bogan, MD, discuss:What comorbidities you need to consider when determining whether a patient is an appropriate candidate for a given pharmacotherapy?Why are these important in management decisions?Can you share any best practices for monitoring the emergence and management of narcolepsy related comorbidities?What sleep lifestyle changes are typically incorporated into a narcolepsy management plan?
Narcolepsy Across the Lifespan
Nov 1 2022
Narcolepsy Across the Lifespan
For supporting material on this podcast, visit: https://sleepreviewmag.com/sleep-disorders/hypersomnias/narcolepsy/narcolepsy-across-the-lifespan/Narcolepsy is a chronic sleep disorder for which there is no known cure. The onset of symptoms can begin at any age but frequently occurs during childhood or adolescence. This condition continues to impact patients throughout their lifetime. Management plans require implementation of ongoing pharmacological therapy to keep the symptoms under control for most patients, and patients may need substantial lifestyle adjustment such as maintaining nocturnal sleep hygiene and regular scheduling of daytime naps. Narcolepsy management plan development should consider balance between the tolerance to available medications and impact of certain comorbidities associated with the disorder.This episode is produced by Sleep Review. It is episode 1 of a 5-part series sponsored by Jazz Pharmaceuticals. Visit Jazzpharma.com and NarcolepsyLink.com for more information.In episode 1, listen as Sleep Review’s Sree Roy and neurologist-sleep specialist Michael Thorpy, MB, ChB, discuss: Since narcolepsy starts at a young age and there is no cure as of yet, what are the long-term management implications?What are the key symptoms of narcolepsy, and how and when do they typically manifest?Do narcolepsy symptoms evolve over the course of a lifetime?What can you typically accomplish with an individualized management plan?How often do you reassess narcolepsy patients to determine whether their management plan needs to be adjusted?Are there specific guidelines that you recommend to the physicians in the audience with regard to managing narcolepsy?