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At Sandhills Neurologists, we believe in active patient involvement, and giving patients access to information so that, together, we can make the most appropriate treatment decisions. This information does not replace direct advice from a physician. It is simply meant to be supplemental to a diagnosis. Should you have any questions, contact us at (844) 435-7867.

Sleep Disorders

OSA occurs when your airway is partially or completely occluded during sleep. This occlusion causes a cessation of airflow (apnea) or a decrease in airflow (hypopnea). This occlusion can be caused by an enlarged tongue or tonsils, excess fatty tissue in the airway, an enlarged uvula or weakening of the muscles in the back of the throat.

Signs and Symptoms of Sleep Apnea

  • Lack of Energy
  • High Blood Pressure
  • Frequent Nighttime Urination
  • Morning Headaches
  • Obesity
  • Large Neck Size (> 17 inches for men and 15 inches for women)
  • Excessive Daytime Sleepiness
  • Irregular Breathing During Sleep
  • Snoring

What happens to your body during apnea?

    • Heart Rate Increases
    • Blood Pressure Goes Up
    • Blood Oxygen Level Drops
    • Adrenaline Surges
    • Brain Reacts with a Wake-up Response (arousal)
    • You are Prevented from Experiencing Deep Sleep


What are the treatment options for sleep apnea?

Continuous Positive Airway Pressure

The most common and effective method of OSA is Continuous Positive Airway Pressure (CPAP).

CPAP is a small bedside device that sits at your bedside that delivers positive airway pressure through a mask that you wear during sleep. The air acts as an air splint to keep your airway open.

Oral Appliances

Oral appliances have been shown to work with patients with mild to moderate obstructive sleep apnea. The oral device works to thrust the lower jaw forward and help keep the tongue from occluding the airway.

Uvulopalatopharyngoplasty (UPPP)

Uvulopalatopharyngoplasty (UPPP) is a procedure that removes excess tissue in the throat to make the airway wider. This sometimes can allow air to move through the throat more easily when you breathe, reducing the severity of obstructive sleep apnea (OSA). The tissues that are removed may include:

  • The soft fingerlike tissue that hangs down from the back of the roof of the mouth into the throat (uvula).
  • Part of the roof of the mouth (soft palate).
  • Excess throat tissue, tonsils, and adenoids.


Provent is a prescription only therapy for the treatment of obstructive sleep apnea (OSA). It is an effective option for patients who are noncompliant with their prescribed CPAP.

What is narcolepsy?

Narcolepsy is a chronic disorder of the central nervous system characterized by the brain’s inability to control sleep-wake cycles. At various times throughout the day, people with narcolepsy experience irresistible and sudden bouts of sleep, which can last from a few seconds to several minutes.

These sleep episodes can occur at any time. People may unwillingly fall asleep while at work or at school, when having a conversation, playing a game, eating a meal, or, most dangerously, when driving an automobile or operating other types of machinery.

Narcolepsy is considered to be a disorder involving the loss of control of the normal boundaries between the sleeping and waking states. It affects both males and female equally and most often starts in childhood or adolescence. In most cases, symptoms first appear when people are between the ages of 7 and 25

People with narcolepsy experience various types of day- and nighttime sleep problems that are associated with REM sleep disturbances that tend to begin subtly and may change dramatically over time.

The most common symptoms, include:

  • Excessive Daytime Sleepiness (EDS)
  • Cataplexy — a sudden loss of muscle tone that leads to feelings of weakness and a loss of voluntary muscle control.
  • Sleep paralysis — temporary inability to move or speak while falling asleep or waking up
  • Hallucinations

Only 10 to 25 percent of affected individuals, however, display all four of these major symptoms during the course of their illness. Narcolepsy cannot yet be cured. Yet symptoms may be controlled in most individuals with active drug treatment.

An Overview of Insomnia

Insomnia is a sleep disorder that is characterized by difficulty falling and/or staying asleep. People with insomnia have one or more of the following symptoms:

  • Difficulty falling asleep
  • Waking up often during the night and having trouble going back to sleep
  • Waking up too early in the morning
  • Feeling tired upon waking

Types of Insomnia

There are two types of insomnia: primary insomnia and secondary insomnia.

  • Primary insomnia: Primary insomnia means that a person is having sleep problems that are not directly associated with any other health condition or problem.
  • Secondary insomnia: Secondary insomnia means that a person is having sleep problems because of something else, such as a health condition (like asthma, depression, arthritis, cancer or heartburn); pain; medication they are taking; or a substance they are using (like alcohol).

Acute Vs. Chronic Insomnia

Insomnia also varies in how long it lasts and how often it occurs. It can be short-term (acute insomnia) or can last a long time (chronic insomnia). It can also come and go, with periods of time when a person has no sleep problems. Acute insomnia can last from one night to a few weeks. Insomnia is called chronic when a person has insomnia at least three nights a week for a month or longer.

Causes of Insomnia

Causes of acute insomnia can include:

  • Significant life stress (job loss or change, death of a loved one, divorce, moving).
  • Illness.
  • Emotional or physical discomfort.
  • Environmental factors like noise, light, or extreme temperatures (hot or cold) that interfere with sleep.
  • Some medications (for example those used to treat colds, allergies, depression, high blood pressure and asthma) may interfere with sleep.
  • Interferences in normal sleep schedule (jet lag or switching from a day to night shift, for example).

Causes of chronic insomnia include:

  • Depression and/or anxiety.
  • Chronic stress.
  • Pain or discomfort at night.

Symptoms of Insomnia

Symptoms of insomnia can include:

  • Sleepiness during the day.
  • General tiredness.
  • Irritability.
  • Problems with concentration or memory.

Diagnosing Insomnia

If you think you have insomnia, talk to your health care provider. An evaluation may include a physical exam, a medical history, and a sleep history. You may be asked to keep a sleep diary for a week or two, keeping track of your sleep patterns and how you feel during the day. Your health care provider may want to interview your bed partner about the quantity and quality of your sleep. In some cases, you may be referred to a sleep center for special tests.

Treatment for Insomnia

Acute insomnia may not require treatment. Mild insomnia often can be prevented or cured by practicing good sleep habits If your insomnia makes it hard for you to function during the day because you are sleepy and tired, you may try melatonin supplement or your health care provider may prescribe sleeping pills for a limited time. Rapid onset, short–acting drugs can help you avoid effects such as drowsiness the following day. Avoid using over-the-counter sleeping pills for insomnia since they may have undesired side effects and tend to lose their effectiveness over time.

Treatment for chronic insomnia includes first treating any underlying conditions or health problems that are causing the insomnia. If insomnia continues, your health care provider may suggest multimodality approach  using cognetive behavioral therapy with or without transcranial magnetic stimulation . Behavioral approaches help you to change behaviors that may worsen insomnia and to learn new behaviors to promote sleep. Techniques such as relaxation exercises, sleep restriction therapy, and reconditioning may be useful. common-sleep-problem/insomnia/insomnia-multi-modality-approach

To learn about pain and sleep, please click on the links below:

Back Pain and Sleep
Pain and Sleep

Common Neurological Conditions

A migraine is a very painful type of headache. People who get migraines often describe the pain as pulsing or throbbing in one area of the head. During migraines, people are very sensitive to light and sound. They may also become nauseated and vomit.

Migraine is three times more common in women than in men. Some people can tell when they are about to have a migraine because they see flashing lights or zigzag lines or they temporarily lose their vision.

Many things can trigger a migraine. These include

  • Anxiety
  • Stress
  • Lack of food or sleep
  • Exposure to light
  • Hormonal changes (in women)

The medical community used to believe migraines were linked to the opening and narrowing of blood vessels in the head. Now they believe the cause is related to genes that control the activity of some brain cells. Medicines can help prevent migraine attacks or help relieve symptoms of attacks when they happen. Also, for many people, treatments to relieve stress can also help.

Migraine Treatment

Dementia is a word for a group of symptoms caused by disorders that affect the brain. It is not a specific disease. People with dementia may not be able to think well enough to do normal activities, such as getting dressed or eating. They may lose their ability to solve problems or control their emotions. Their personalities may change. They may become agitated or see things that are not there.

Memory loss is a common symptom of dementia. However, memory loss by itself does not mean you have dementia. People with dementia have serious problems with two or more brain functions, such as memory and language.

Many different diseases can cause dementia, including Alzheimer’s disease and stroke. Drugs are available to treat some of these diseases. While these drugs cannot cure dementia or repair brain damage, they may improve symptoms or slow it down.

Like static on a telephone line, peripheral nerve disorders distort or interrupt the messages between the brain and the rest of the body.

There are more than 100 kinds of peripheral nerve disorders that can affect one, or multiple nerves. Some are the result of other diseases, such as diabetic nerve problems. Others, like Guillain-Barre syndrome, occur after a virus infection. Still others are the result of nerve compression, such as carpal tunnel syndrome or thoracic outlet syndrome.

Peripheral nerve disorders can appear after an injury and some people are born with the disorder. Symptoms often start gradually, and get progressively worse. They include:

  • Numbness
  • Pain
  • Burning or tingling
  • Muscle weakness
  • Sensitivity to touch

Treatment aims to treat any underlying problem, reduce pain and control symptoms.

Multiple sclerosis (MS) is a nervous system disease that affects the brain and spinal cord. It damages the material that surrounds and protects nerve cells. This damage slows down, or blocks, messages between the brain and body, leading to the symptoms of MS, including:

  • Visual disturbances
  • Muscle weakness
  • Trouble with coordination and balance
  • Sensations such as numbness, prickling, or “pins and needles”
  • Thinking and memory problems

No one knows exactly what causes MS. Some experts believe it may be an autoimmune disease, which happens when the body attacks itself.

Multiple sclerosis affects women more than men and often begins between the ages of 20 and 40. While the disease is typically mild, some people lose the ability to write, speak or walk.

There is no cure for MS, but medicines may slow it down and help control symptoms. Physical and occupational therapy may prove beneficial.

Parkinson’s disease is a disorder that affects nerve cells, or neurons, in an area of the brain responsible for controlling muscle movement. In Parkinson’s, neurons that make a chemical called dopamine die or do not work properly. Dopamine normally sends signals that help coordinate your movements. No one knows what damages these cells. Symptoms of Parkinson’s disease may include:

  • Trembling of hands, arms, legs, jaw and face
  • Stiffness of the arms, legs and trunk
  • Slowness of movement
  • Poor balance and coordination

As symptoms get worse, people with the disease may have trouble walking, talking or performing simple tasks. They may also have problems such as depression, sleep problems or issues with chewing, swallowing or speaking.

Parkinson’s usually begins around age 60, but it can start earlier. It is more common in men than in women. While there is no cure for Parkinson’s disease, a variety of medicines may help reduce symptoms.

Tremors are unintentional trembling or shaking movements in one or more parts of your body. Most tremors occur in the hands. They may also appear in the arm, head, face, vocal cord, trunk and leg. Tremors are most common in middle-aged and older adults, but anyone can have a tremor.

Tremors commonly occur in otherwise healthy people. Yet sometimes nerve diseases such as Parkinson’s disease, an overactive thyroid, or certain medicines may induce tremors. Heavy drinking is also a risk factor for tremors. Some tremors are inherited and run in families. While others have no known cause.

There is no cure for most tremors. Treatment often depends on their root cause. In many cases, medicines and surgical procedures may reduce or stop tremors and improve muscle control. Tremors are not life threatening. However, they can be embarrassing and/or make it hard to perform everyday tasks.

Back pain is one of the most common medical problems, affecting 8 out of 10 people at some point during their lives. Back pain can range from a dull, constant ache to a sudden, sharp pain. Acute back pain comes on suddenly and usually lasts from a few days to a few weeks. Back pain is called chronic if it lasts for more than three months.

Most back pain goes away on its own, though it may take a while. Taking over-the-counter pain relievers and resting can help. Yet staying in bed for more than one to two days can make it worse.

If your back pain is severe or doesn’t improve after three days, you should call your health care provider. Always get medical attention if you have back pain following an injury.

Epilepsy is a brain disorder that causes people to have recurring seizures. The seizures happen when clusters of nerve cells in the brain send out the wrong signals. People may have strange sensations and emotions or behave strangely. They may have violent muscle spasms or lose consciousness.

Epilepsy has many possible causes, including illness, brain injury and abnormal brain development. In many cases, the cause is unknown.

Doctors use brain scans and other tests to diagnose epilepsy. It is important to start treatment right away. While there is no cure for epilepsy, medicines may control seizures for most people.

When medicines fail to work effectively, surgery or implanted devices such as vagus nerve stimulators may help. Special diets may help some children with epilepsy.

A stroke is a medical emergency. Strokes happen when blood flow to the brain stops. Within minutes, brain cells begin to die. There are two kinds of stroke. The more common kind, called ischemic stroke, is caused by a blood clot that blocks or plugs a blood vessel in the brain. The other, called hemorrhagic stroke, is caused by a blood vessel that breaks and bleeds into the brain. “Mini-strokes” or transient ischemic attacks (TIAs), occur when the blood supply to the brain is briefly interrupted.

Symptoms of stroke include:

  • Sudden numbness or weakness of the face, arm or leg (especially on one side of the body)
  • Sudden confusion, trouble speaking or understanding speech
  • Sudden trouble seeing in one or both eyes
  • Sudden trouble walking, dizziness, loss of balance or coordination
  • Sudden severe headache with no known cause

If you have any of these symptoms, get to your nearest hospital immediately to begin treatment. Acute stroke therapies try to stop a stroke while it is happening by quickly dissolving the blood clot or by stopping the bleeding. Post-stroke rehabilitation helps individuals overcome disabilities that result from stroke damage. Drug therapy with blood thinners is the most common treatment for stroke.

The pattern of how a person walks is called the gait and gait abnormalities are unusual and uncontrollable walking patterns that are often due to diseases or injuries to the legs, feet, brain, spinal cord, or inner ear.

Examples of walking abnormalities:

  • Propulsive gait — a stooped, stiff posture with the head and neck bent forward
  • Scissors gait — legs flexed slightly at the hips and knees like crouching, with the knees and thighs hitting or crossing in a scissors-like movement
  • Spastic gait — a stiff, foot-dragging walk caused by a long muscle contraction on one side
  • Steppage gait & 38212 — a foot drop where the foot hangs with the toes pointing down, causing the toes to scrape the ground while walking, requiring someone to lift the leg higher than normal when walking
  • Waddling gait — a duck-like walk that may appear in childhood or later in life

Abnormal gait may be caused by diseases in many different areas of the body.

General causes may include:

  • Arthritis of the leg or foot joints
  • Conversion disorder (a psychological disorder)
  • Foot problems (such as a callus, corn, ingrown toenail, wart, pain, skin sore, swelling, or spasms)
  • Fracture
  • Injections into muscles that causes soreness in the leg or buttocks
  • Infection
  • Injury
  • Legs that are different lengths
  • Myositis
  • Shin splints
  • Shoe problems
  • Tendonitis
  • Torsion of the testes

The carpal tunnel is a narrow passageway of ligament and bones at the base of your hand. It contains nerve and tendons. Sometimes, thickening from irritated tendons or other swelling narrows the tunnel and causes the nerve to be compressed. Symptoms usually start gradually. As they worsen, grasping objects can become difficult.

What causes the problem? Some people have smaller carpal tunnels than other people do. Other causes include performing assembly line work, wrist injury, or swelling due to certain diseases, such as rheumatoid arthritis.

Women are three times more likely to have carpal tunnel syndrome than men. Treatment includes resting your hand, splints, pain and anti-inflammatory medicines, and surgery.

Sciatica refers to pain, weakness, numbness, or tingling in the leg. It is caused by injury to or pressure on the sciatic nerve. Sciatica is a symptom of another medical problem, not a medical condition on its own.

Sciatica occurs when there is pressure or damage to the sciatic nerve, a nerve that starts in the lower spine and runs down the back of each leg.

Common causes of sciatica include:

  • Slipped disk
  • Piriformis syndrome (a pain disorder involving the narrow muscle in the buttocks)
  • Pelvic injury or fracture
  • Tumors

Sciatica pain can vary widely. It may feel like a mild tingling, dull ache, or a burning sensation. In some cases, the pain is severe enough to make a person unable to move.

The pain most often occurs on one side. Some people have sharp pain in one part of the leg or hip and numbness in other parts. The pain or numbness may also be felt on the back of the calf or on the sole of the foot. The affected leg may feel weak.

Situations where sciatica pain may get worse:

  • After standing or sitting
  • At night
  • When sneezing, coughing, or laughing
  • When bending backwards or walking more than a few yards, especially if caused by spinal stenosis

Muscle disorders have the potential to cause weakness, pain or even paralysis. There may be no known cause for a muscle disorder. Although some known causes include:

  • Injury or overuse, such as sprains or strains, cramps or tendinitis
  • Genetics, such as muscular dystrophy
  • Some cancers
  • Inflammation, such as myositis
  • Diseases of nerves that affect muscles
  • Infections
  • Certain medicines

Innovative Approaches

The device, called Cefaly®, is the first device of its kind to receive U.S. Food and Drug Administration (FDA) approval for the preventative treatment of migraine headaches. It’s a small, portable and battery-operated device, positioned in the center of a patient’s forehead. It transmits a low-voltage electrical signal through the skin to the underlying Trigeminal nerve terminals. Stimulation of the Trigeminal nerve, which plays a role in many migraines, results in a decrease in the frequency and intensity of migraines.

The staggering cost of migraine headaches is revealed by studies which show that 13 percent of adults in the U.S. population have migraines, and 2-3 million suffer chronic illness. It is most prevalent during the peak productive years, between the ages of 25 and 55, thus interfering with education, career and social activities. According to World Health Report, among adults of all ages, migraine is one of the top 20 causes of disability.

FDA approval of this device came at the heels of a 2014 study done  in Belgium . This randomized double blinded clinical trial implemented in five university clinics in Belgium showed significant improvement in patients who regularly used the device in comparison to those who were given a sham device. Another patient satisfaction study with 2,313  patients in France showed promising results. In the US, a study with 10,000 patient showed more than 94% success rate, with less than 6% of patients returning their units. Today, worldwide, there are more than 100,000 Cefaly units in use by migraine patients. This symbolic milestone, illustrates that Cefaly® has indeed found a way to help migraineurs control, even eliminate, their migraines.

Cefaly® is manufactured by a company in Belgium. The patient positions the device in the center of the forehead, just above the eyes using a self-adhesive electrode. Patients are able to start, stop, and alter the sessions with a single button interface. The device is currently indicated for patients 18 years of age and older and should only be used once per day for 20 minutes.

Cefaly® is virtually risk free and hassle free. The user may feel a tingling or massaging sensation where the electrode is applied. Some patients complain of sleepiness and minor discomfort from the using the device. A select few people have reported allergic reactions to the electrodes. No other side effects have been reported.

At Sandhills Neurologists, we are excited to bring drug-free migraine relief to many of our chronic patients. If you suffer from severe migraines or tension headaches, or would like to decrease your drug consumption, talk to your primary care physician or call our office at 910 235 0595 to make an appointment. A medical prescription is necessary to purchase the device. We  are convinced of the efficacy of this device and are offering a 60-day money back guarantee.

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