Extreme sports performance for more than a week with severely fractured sleep.

PURPOSE: Severely fractured sleep is mostly portrayed negatively, but investigations in extreme sports show that humans can maintain performance with a minimum of sleep. With two cases of long-lasting extreme sports performances, we demonstrate that severely fragmented sleep does not necessarily lead to a deterioration of physical and cognitive performance. METHODS: We performed continuous polysomnography on a 34 year-old skier for 11 days and nights during a world record attempt in long-term downhill skiing and monitored a 32 year-old cyclist during the Race Across America for 8.5 days via sleep and activity logs. RESULTS: The skier slept fractured fashion in 15-16 naps with a daily average of 6 h consisting of 77% in sleep stage 1 and 2, 11% in stage 3, and 13% in stage REM. The cyclist slept a total of 7 h and 52 min in 8.5 days, split up into 11 short naps and 6 sleep periods. The average duration of napping was 8.8 min and of sleep 64.2 min. CONCLUSIONS: These two cases demonstrate that outstanding performances are possible with severely fractured sleep and/or sleep deprivation. In well-trained athletes, breaking new recordsis possible despite extreme sleep habits.

Sleep medicine is coming of age in military medicine : Report from the Military Health System Research Symposium (2017) in Kissimmee, Florida.

In August 2017, the US Military Health System held its sixth annual Research Symposium for medical researchers from the US Army, Navy, Air Force, and Public Health Service. The symposium provides a collaborative environment for academia, industry, and military researchers who address advancement in areas of Combat Casualty Care, Military Operational Medicine, Clinical and Rehabilitative Medicine, and Military Infectious Diseases. This year, Sleep Medicine received substantial attention with presentations scattered throughout the program, poster presentations as well as a scheduled breakout session with podium presentations. A brief description of the breakout session follows.

SpO2 and Heart Rate During a Real Hike at Altitude Are Significantly Different than at Its Simulation in Normobaric Hypoxia.

Rationale: Exposures to simulated altitude (normobaric hypoxia, NH) are frequently used in preparation for mountaineering activities at real altitude (hypobaric hypoxia, HH). However, physiological responses to exercise in NH and HH may differ. Unfortunately clinically useful information on such differences is largely lacking. This study therefore compared exercise responses between a simulated hike on a treadmill in NH and a similar field hike in HH. Methods: Six subjects (four men) participated in two trials, one in a NH chamber and a second in HH at an altitude of 4,205 m on the mountain Mauna Kea. Subjects hiked in each setting for 7 h including breaks. In NH, hiking was simulated by walking on a treadmill. To achieve maximal similarity between hikes, subjects used the same nutrition, clothes, and gear weight. Measurements of peripheral oxygen saturation (SpO2), heart rate (HR) and barometrical pressure (PB)/inspired oxygen fraction (FiO2) were taken every 15 min. Acute mountain sickness (AMS) symptoms were assessed using the Lake-Louise-Score at altitudes of 2,800, 3,500, and 4,200 m. Results: Mean SpO2 values of 85.8% in NH were significantly higher compared to those of 80.2% in HH (p = 0.027). Mean HR values of 103 bpm in NH were significantly lower than those of 121 bpm in HH (p = 0.029). AMS scores did not differ significantly between the two conditions. Conclusion: Physiological responses to exercise recorded in NH are different from those provoked by HH. These findings are of clinical importance for subjects using simulated altitude to prepare for activity at real altitude. Trial registration: Registration at DRKS. (Approval No. 359/12, Trial No. DRKS00005241).

Differences in sleep habits, study time, and academic performance between US-born and foreign-born college students.

PURPOSE: To inform the design of a sleep improvement program for college students, we assessed academic performance, sleep habits, study hours, and extracurricular time, hypothesizing that there would be differences between US-born and foreign-born students. METHODS: Questionnaires queried participants on bedtimes, wake times, nap frequency, differences in weekday and weekend sleep habits, study hours, grade point average, time spent at paid employment, and other extracurricular activities. Comparisons were made using chi square tests for categorical data and t tests for continuous data between US-born and foreign-born students. RESULTS: Of 120 participants (55 % women) with racial diversity (49 whites, 18 blacks, 26 Hispanics, 14 Asians, and 13 other), 49 (41 %) were foreign-born. Comparisons between US-born and foreign-born students showed no differences in average age or gender though US-born had more whites. There were no differences between US-born and foreign-born students for grade point averages, weekday bedtimes, wake times, or total sleep times. However, US-born students averaged 50 min less study time per day (p = 0.01), had almost 9 h less paid employment per week (14.5 vs 23.4 h per week, p = 0.001), and stayed up to socialize more frequently (63 vs 43 %, p = 0.03). Foreign-born students awakened an hour earlier and averaged 40 min less sleep per night on weekends. CONCLUSIONS: Cultural differences among college students have a profound effect on sleep habits, study hours, and extracurricular time. The design of a sleep improvement program targeting a population with diverse cultural backgrounds must factor in such behavioral variations in order to have relevance and impact.

Early Empowerment Strategies Boost Self-Efficacy to Improve Cardiovascular Health Behaviors.

BACKGROUND: Self-efficacy, defined as confidence in the ability to carry out behavior to achieve a desired goal, is considered to be a prerequisite for behavior change. Self-efficacy correlates with cardiovascular health although optimal timing to incorporate self-efficacy strategies is not well established. We sought to study the effect of an empowerment approach implemented in the introductory phase of a multicomponent lifestyle intervention on cardiovascular health outcomes. DESIGN: Prospective intervention cohort study. METHODS: Patients in the Integrative Cardiac Health Project Registry, a prospective lifestyle change program for the prevention of cardiovascular disease were analyzed for behavioral changes by survey, at baseline and one year, in the domains of nutrition, exercise, stress management and sleep. Self-efficacy questionnaires were administered at baseline and after the empowerment intervention, at 8 weeks. RESULTS: Of 119 consecutive registry completers, 60 comprised a high self-efficacy group (scoring at or above the median of 36 points) and 59 the low self-efficacy group (scoring below median).  Self-efficacy scores increased irrespective of baseline self-efficacy but the largest gains in self-efficacy occurred in patients who ranked in the lower half for self-efficacy at baseline. This lower self-efficacy group demonstrated behavioral gains that erased differences between the high and low self-efficacy groups. CONCLUSIONS: A boost to self-efficacy early in a lifestyle intervention program produces significant improvements in behavioral outcomes.  Employing empowerment in an early phase may be a critical strategy to improve self-efficacy and lower risk in individuals vulnerable to cardiovascular disease.

Fatigued on Venus, sleepy on Mars-gender and racial differences in symptoms of sleep apnea.

OBJECTIVE: Clinical guidelines for the care of obstructive sleep apnea (OSA) recommend evaluation of daytime sleepiness but do not specify evaluation of fatigue. We studied how subjects with and without OSA experience fatigue and sleepiness, examining the role of gender and race. DESIGN, SETTING, PATIENTS: Consecutive subjects entering our heart health registry completed validated questionnaires including Berlin Questionnaire for OSA, Fatigue Scale, and Epworth Sleepiness Scale. Data analysis was performed only with Whites and Blacks as there were too few subjects of other races for comparison. RESULTS: Of 384 consecutive subjects, including 218 women (57 %), there were 230 Whites (60 %) and 154 Blacks (40 %), with average age of 55.9 ± 12.8 years. Berlin Questionnaires identified 221 subjects (58 %) as having high likelihood for OSA. Fatigue was much more common in women (75 %) than in men (46 %) with OSA (p < 0.001), while frequency of fatigue was similar in women (30 %) and men (29 %) without OSA (p = 0.86). In multivariate analysis, men with OSA were sleepier than women; Black men with OSA had higher Epworth scores (mean ± SD, 12.8 ± 5.2) compared to White men (10.6 ± 5.3), White women (10.0 ± 4.5), and Black women (10.5 ± 5.2), p = 0.05. These gender differences were not related to the effects of age, body mass index, perceived stress, sleep duration, or thyroid function. CONCLUSIONS: Women report fatigue more commonly with OSA than men. Men experience sleepiness more commonly with OSA than women. The findings suggest that evaluation of sleep disorders must include an assessment of fatigue in addition to sleepiness to capture the experience of women.

The actual role of sodium cromoglycate in the treatment of asthma--a critical review.

INTRODUCTION: Despite international consensus and clearly written guidelines urging wider use of corticosteroids or combinations of inhaled short- and long-acting ß-agonists (SABA and LABA) and corticosteroids in persistent asthma, prescribing patterns and compliance rates fall far short of recommendations. OBJECTIVES: The failure to use steroids more aggressively is due, in part, to their side effects, even with inhaled forms of the drug. There is a role for expanded use of sodium cromolyn in asthma. Its potent anti-inflammatory effects, lack of side effects, and acceptable dosing and method of delivery, as well as its special role in exercise-induced asthma, make it a very suitable choice in the initial therapy for control of asthma. CONCLUSION: Compared to SABA and LABA, cromoglycates alone are unsuspicious of being used to enhance physical performance.

Comparison of adjustable and fixed oral appliances for the treatment of obstructive sleep apnea.

STUDY OBJECTIVES: To compare the efficacy of adjustable and fixed oral appliances for the treatment of OSA. METHODS: Retrospective review of consecutive patients with OSA treated with either adjustable or fixed oral appliances. Polysomnography was conducted before and during therapy. Effective treatment was defined as an apnea-hypopnea index (AHI) < 5 events/h or < 10 events/h with resolution of sleepiness (Epworth < 10). We compared efficacy rates between fixed and adjustable appliances and sought to identify factors associated with greater success. RESULTS: We included 805 patients, 602 (74.8%) treated with an adjustable and 203 (25.2%) a fixed oral appliances. Among the cohort, 86.4% were men; mean age was 41.3 ± 9.2 years. Mean AHI was 30.7 ± 25.6, with 34.1% having mild (AHI 5-14.9), 29.2% moderate (AHI 15-29.9), and 36.8% severe (AHI ≥ 30) OSA. Successful therapy was significantly more common with adjustable appliances. Obstructive events were reduced to < 5/h in 56.8% with adjustable compared to 47.0% with fixed appliances (p = 0.02). Similarly, a reduction of events to < 10 with resolution of sleepiness occurred in 66.4% with adjustable appliances versus 44.9% with fixed appliances (p < 0.001). For both devices, success was more common in younger patients, with lower BMI and less severe disease. CONCLUSIONS: Adjustable devices produced greater reductions in obstructive events and were more likely to provide successful therapy, especially in moderate-severe OSA. Fixed appliances were effective in mild disease, but were less successful in those with higher AHIs. Given these findings, the baseline AHI should be considered when selecting the type of oral appliance.

Early to bed, early to rise! Sleep habits and academic performance in college students.

PURPOSE: Prior studies have placed emphasis on the need for adequate total sleep time for student performance. We sought to investigate the relative importance of total sleep time compared to the timing of sleep and wakefulness for academic performance. METHODS: We performed a questionnaire-based survey of college students in October 2007. The questionnaire gathered detailed information on sleep habits including naps, reasons for missing sleep, academic performance, study habits, time spent working outside of school, and stimulant use. RESULTS: Compared to those with the lowest academic performance, students with the highest performance had significantly earlier bedtimes (p = 0.05) and wake times (p = 0.008). Napping tended to be more common among high performers (p = 0.07). Of importance, there were no significant differences in total sleep time with or without naps, weekend sleep habits, study time, gender, race, reasons for staying up at night, nor in use of caffeinated beverages, over-the-counter stimulant pills, or use of prescription stimulants. CONCLUSIONS: Timing of sleep and wakefulness correlated more closely with academic performance than total sleep time and other relevant factors. These findings have important implications for programs intended to improve academic performance by targeting sleep habits of students.

Sedative use during continuous positive airway pressure titration improves subsequent compliance: a randomized, double-blind, placebo-controlled trial.

BACKGROUND: The initial experience with continuous positive airway pressure (CPAP) may predict subsequent compliance. In a retrospective study, we found that premedication with nonbenzodiazepine sedative-hypnotic agents during CPAP titration polysomnography independently predicted short-term compliance. To validate these findings, we conducted a prospective clinical trial to assess whether premedication with eszopiclone prior to CPAP titration would improve short-term CPAP compliance. METHODS: Subjects in this randomized, double-blind, placebo-controlled trial received 3 mg of eszopiclone or matching placebo prior to undergoing CPAP titration polysomnography. We compared the quality of CPAP titrations and objective measures of compliance during the first 4 to 6 weeks of therapy between the two groups. RESULTS: We enrolled 117 subjects, and 98 subjects completed the protocol (eszopiclone, 50 subjects; placebo, 48 subjects). Other than there being more women in the eszopiclone group, the groups were similar at baseline. Compared with placebo, premedication with eszopiclone significantly improved mean (+/- SD) sleep efficiency (87.8 +/- 5.8% vs 80.1 +/- 10.5%, respectively; p = 0.002) and mean total sleep time (350.9 +/- 33.6 min vs 319.7 +/- 48.7 min, respectively; p = 0.007). A trend toward improved sleep latency (19.4 +/- 16.1 min vs 31.8 +/- 30.4 min, respectively; p = 0.08) and the number of residual obstructive events observed at the final CPAP pressure (6.4 +/- 7 events/h vs 12.8 +/- 14.6 events/h, respectively; p = 0.08) during polysomnography was found. Eszopiclone significantly improved CPAP compliance. Among subjects premedicated with eszopiclone, CPAP was used on a higher percentage of nights (75.9 +/- 20.0% vs 60.1 +/- 24.3%, respectively; p = 0.005) and for more hours per night (4.8 +/- 1.5 h vs 3.9 +/- 1.8 h, respectively; p = 0.03). CONCLUSIONS: Premedication with eszopiclone on the night of CPAP titration improved the quality of CPAP titration and led to significantly greater short-term compliance. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT00507117.

Effects of surgical weight loss on measures of obstructive sleep apnea: a meta-analysis.

OBJECTIVE: Limited evidence suggests bariatric surgery can result in high cure rates for obstructive sleep apnea (OSA) in the morbidly obese. We performed a systematic review and meta-analysis to identify the effects of surgical weight loss on the apnea-hypopnea index. METHODS: Relevant studies were identified by computerized searches of MEDLINE and EMBASE (from inception to March 17, 2008), and review of bibliographies of selected articles. Included studies reported results of polysomnographies performed before and at least 3 months after bariatric surgery. Data abstracted from each article included patient characteristics, sample size who underwent both preoperative and postoperative polysomnograms, types of bariatric surgery performed, results of preoperative and postoperative measures of OSA and body mass index, publication year, country of origin, trial perspective (prospective vs retrospective), and study quality. RESULTS: Twelve studies representing 342 patients were identified. The pooled mean body mass index was reduced by 17.9 kg/m(2) (95% confidence interval [CI], 16.5-19.3) from 55.3 kg/m(2) (95% CI, 53.5-57.1) to 37.7 kg/m(2) (95% CI, 36.6-38.9). The random-effects pooled baseline apnea hypopnea index of 54.7 events/hour (95% CI, 49.0-60.3) was reduced by 38.2 events/hour (95% CI, 31.9-44.4) to a final value of 15.8 events/hour (95% CI, 12.6-19.0). CONCLUSION: Bariatric surgery significantly reduces the apnea hypopnea index. However, the mean apnea hypopnea index after surgical weight loss was consistent with moderately severe OSA. Our data suggest that patients undergoing bariatric surgery should not expect a cure of OSA after surgical weight loss. These patients will likely need continued treatment for OSA to minimize its complications.

Pneumatic compression devices are an effective therapy for restless legs syndrome: a prospective, randomized, double-blinded, sham-controlled trial.

BACKGROUND: Pharmacotherapy for restless legs syndrome (RLS) may be ineffective or complicated by side effects. Uncontrolled series using pneumatic compression devices (PCDs) have been shown to reduce symptoms of RLS. We sought to assess the efficacy of PCDs as a nonpharmacologic treatment for RLS. METHODS: We performed a prospective, randomized, double-blinded, sham-controlled trial of individuals with RLS. Subjects wore a therapeutic or sham device prior to the usual onset of symptoms for a minimum of 1 h daily. Measures of severity of illness, quality of life, daytime sleepiness, and fatigue were compared at baseline and after 1 month of therapy. RESULTS: Thirty-five subjects were enrolled. Groups were similar at baseline. Therapeutic PCDs significantly improved all measured variables more than shams. Restless Legs Severity Score improved from 14.1 +/- 3.9 to 8.4 +/- 3.4 (p = 0.006) and Johns Hopkins Restless Legs Scale improved from 2.2 +/- 0.5 to 1.2 +/- 0.7 (p = 0.01). All quality of life domains improved more with therapeutic than sham devices (social function 14% vs 1%, respectively; p = 0.03; daytime function 21% vs 6%, respectively, p = 0.02; sleep quality 16% vs 8%, respectively, p = 0.05; emotional well-being 17% vs 10%, respectively, p = 0.15). Both Epworth sleepiness scale (6.5 +/- 4.0 vs 11.3 +/- 3.9, respectively, p = 0.04) and fatigue (4.1 +/- 2.1 vs 6.9 +/- 2.0, respectively, p = 0.01) improved more with therapeutic devices than sham devices. Complete relief occurred in one third of subjects using therapeutic and in no subjects using sham devices. CONCLUSION: PCDs resulted in clinically significant improvements in symptoms of RLS in comparison to the use of sham devices and may be an effective adjunctive or alternative therapy for RLS. TRIAL REGISTRATION: Clinicaltrials.gov Identifier: NCT00479531.

Utility of split-night polysomnography in the diagnosis of upper airway resistance syndrome.

PURPOSE: Split-night polysomnography can both establish the diagnosis and titrate continuous positive airway pressure (CPAP) during a single study in patients with sleep-disordered breathing. We sought to determine if split-night polysomnography could be effectively used in upper airway resistance syndrome (UARS) without diminishing diagnostic accuracy or success of CPAP titration. METHODS: Consecutive patients diagnosed with UARS were included. Split-night studies were performed in patients meeting predefined criteria. We compared data between those undergoing traditional and split-night polysomnography. RESULTS: We included 100 consecutive patients (41.2 +/- 7.4 years, 54% men). Forty-six underwent split-night polysomnography. Groups were similar at baseline. There were no differences in polysomnography or success rate of CPAP titration. Among those not undergoing split-night studies, the mean time between diagnostic polysomnography and CPAP titration was 71.9 +/- 49.0 days. CONCLUSIONS: Split-night polysomnography can be effectively utilized to diagnose UARS and initiate CPAP therapy. This practice can reduce the number of studies needed and obviate the inherent delay in initiating CPAP therapy.

Persistence of obstructive sleep apnea after surgical weight loss.

STUDY OBJECTIVES: Weight loss may reduce the severity of obstructive sleep apnea (OSA), but persistence of OSA following surgical weight loss has not been defined. We sought to clarify the impact of bariatric surgery on OSA. We hypothesized that, despite substantial weight loss and reductions in the apnea-hypopnea index (AHI), many will have persistent disease. METHODS: Consecutive patients referred for preoperative sleep evaluation underwent polysomnography before and 1 year following bariatric surgery. We compared the effects of weight loss on body mass, OSA, and continuous positive airway pressure requirements. We defined OSA severity using the AHI (normal < 5 events per hour, mild 5 to 14 events per hour, moderate 15 to 29 events per hour, and severe 30 or more events per hour). We identified predictors of OSA severity following weight loss and assessed compliance with therapy. RESULTS: Twenty-four patients (aged 47.9 +/- 9.3 years; 75% women) were enrolled. At baseline, all subjects had OSA, the majority of which was severe. Weight loss reduced body mass index from 51.0 +/- 10.4 kg/m2 to 32.1 +/- 5.5 kg/m2 (p < 0.001) and the AHI from 47.9 +/- 33.8 to 24.5 +/- 18.1 events per hour (p < 0.001). At follow-up, only 1 patient (4%) experienced resolution of OSA. The majority (71%) had moderate or severe disease. The most important predictor of the follow-up AHI was the baseline AHI (R2 = 0.603). All patients with residual OSA required continuous positive airway pressure to ablate apneic events, but the required pressures decreased from 11.5 +/- 3.6 cm H2O to 8.4 +/- 2.1 cm H20 (p = 0.001). Only 6 patients were compliant with continuous positive airway pressure therapy at the follow-up visit. CONCLUSIONS: Surgical weight loss reduces the AHI, but many patients have residual OSA one year after bariatric surgery.

Eszopiclone improves overnight polysomnography and continuous positive airway pressure titration: a prospective, randomized, placebo-controlled trial.

STUDY OBJECTIVES: To assess whether premedication with eszopiclone would improve sleep duration and continuity during polysomnography, thereby improving the quality of diagnostic and CPAP titration studies. DESIGN: Prospective, double-blinded, placebo-controlled trial SETTING: Academic, multidisciplinary sleep center. PATIENTS: 226 adult subjects undergoing polysomnography for suspected sleep disordered breathing; 113 received eszopiclone and 113 received placebo. INTERVENTIONS: Subjects received eszopiclone 3 mg or matching placebo before polysomnography. We compared sleep latency, efficiency, total sleep time, and apnea-hypopnea index between these groups. We also compared rates of inadequate studies, defined as insufficient sleep time (< 120 min or sleep efficiency < or = 70%) or incomplete CPAP titrations (> or = 5 events/h on the highest CPAP or complete intolerance). MEASUREMENTS AND RESULTS: Eszopiclone premedication significantly improved a number of measured variables. Eszopiclone reduced sleep latency (21.7 +/- 27.1 vs. 32.6 +/- 38.2 min, P = 0.014), improved sleep efficiency (87.6% +/- 10.8% vs. 78.1% +/- 15.6%, P < 0.001), reduced wake after sleep onset (39.2 +/- 31.9 vs. 64.5 +/- 45.4 min, P <0.001) and prolonged sleep time (346.5 +/- 53.1 vs. 312.2 +/- 64.2 min, P < 0.001). Sleep efficiencies < or = 70% were more common with placebo than medication (21.2% vs. 7.1%, P = 0.004). Eszopiclone facilitated improved CPAP titrations with fewer residual events (5.7 +/- 10.3 vs. 11.9 +/- 19.6, P = 0.02) and fewer incomplete titrations (31.1% vs. 48.0%, P = 0.04). Poor quality studies (46.0% vs. 26.5%, P = 0.004) were more common with placebo than with eszopiclone. There was a trend for more non-usable studies with placebo (7.1% vs. 2.7%, P = 0.22). Side effects were uncommon and did not differ between groups. CONCLUSION: Pretreatment with eszopiclone improves the quality of polysomnography and CPAP titration and decreases the need to repeat studies. Given the ever-growing demand for polysomnography and the need to improve efficiency, the routine use of nonbenzodiazepines as premedication for polysomnography should be considered.

Presence and treatment of air hunger in severely ill patients.

Air hunger at end-of-life poses challenges to providers who attempt to comfort while not diminishing mental capacities. We examined the presence, methods of assessment, and treatment of air hunger. This observational study prospectively screened 198 consecutive medicine admissions for increased risk of near-term death. These patients in turn were screened for dyspnea. Patients screening positive were assessed on admission and the next day with the Visual Analog Scale (VAS), modified Borg Scale, and the American Thoracic Society (ATS) Shortness of Breath Scale. Additionally, resident physician opinions of patient dyspnea level were assessed using the same tools. Treatments focused on alleviating air hunger were recorded. Thirty-nine percent of patients were at risk for near-term death and of these, 53% (95% CI: 41-65%) reported air hunger. All dyspnea scales improved to a statistically and clinically significant degree (Borg p=0.007, VAS p<0.0005, ATS p=0.008). There was statistically significant agreement between Borg-VAS and between Borg-ATS with a trend toward significance with ATS-VAS. Physician assessment of dyspnea showed poor agreement with patients. A median of three treatments were received by patients but dyspnea improvement did not correlate with the type, number, or specific combination of therapies. Dyspnea is common near end-of-life. Borg or VAS scales appear useful in assessing terminal dyspnea and can be employed in assessing terminal air hunger. No individual treatment or combination of treatments significantly improved patients' dyspnea. However, air hunger significantly improved with hospitalization.

Sequential compression devices for treatment of restless legs syndrome.

Restless legs syndrome (RLS) is a common disorder that presents with irresistible urges to move the legs and motor restlessness, worsening in the evening. RLS commonly causes insomnia and associated daytime symptoms. Treatment of first choice for RLS is usually medication, but medications are often ineffective or poorly tolerated. An effective nonpharmacologic therapy would be highly desirable. Here we review RLS and its treatment and present data from a pilot study on the effect of a novel treatment for this condition. The objective of this study was to determine the therapeutic effect of pneumatic sequential compression devices (SCDs) on RLS symptoms. We performed an uncontrolled, prospective interventional study using SCDs on a convenience sample of adults reliably diagnosed with RLS. Patients were asked to wear the SCD for an hour each evening before the usual time of onset of restless legs symptoms. Before and after 1-3 months of SCD therapy, patients completed validated questionnaires to assess RLS severity, daytime sleepiness, and impact of RLS on quality of life in the domains of social function, daily task function, sleep quality, and emotional well-being. Compliance with SCD therapy was measured using patient-recorded logs. Of 10 patients (7 women; age range, 37-80 yr; mean age, 56 yr), symptomatic for a mean of 68 months (range, 12-360 mo), 1 could not tolerate wearing the SCD and withdrew from the protocol after 3 days. The remaining 9 patients complied with therapy 58%-100% of nights (mean, 82%). Three patients experienced complete resolution of RLS and 6 patients had improvement of symptoms. Group severity score improved from 24/40 to 8/40 (p = 0.001). Epworth Sleepiness Scale score improved from 12/24 to 8/24 (p = 0.05). Every quality of life score improved: social function from 74% to 96% (p = 0.04), daily task function 63% to 80% (p = 0.05), sleep quality 27% to 63% (p = 0.003), and emotional well-being from 49% to 83% (p = 0.02). In this group of patients, wearing the SCD in the evening for an hour improved symptoms of RLS and improved quality of life, with complete resolution of symptoms in 3 of 10 patients.