Establishing a Collaborative Relationship
• Sleep Disorders • • General Principles of Treatment • Oct 06 06

A collaborative relationship between the patient and therapist is necessary because the clinical management of most sleep disorders depends on the patient’s willingness to carry out the clinician’s recommendations.

Although the therapist’s role…


 

Patient Factors in Treatment Selection
• Sleep Disorders • • General Principles of Treatment • Oct 06 06

Some sleep disorders, such as narcolepsy, are best treated pharmacologically, whereas others, such as chronic and primary insomnia, are more amenable to behavioral interventions. The management of sleep disturbances that are secondary…


 

Setting Realistic Goals and Expectations
• Sleep Disorders • • General Principles of Treatment • Oct 06 06

Before initiating treatment, it is useful to examine patients’ expectations and to set treatment goals. The goals of therapy will vary according to the nature and severity of the sleep problem and…


 

Evaluation of Sleep Disorders
• Sleep Disorders • Oct 06 06

A detailed clinical history is the most important diagnostic tool for the evaluation of sleep disorders. The clinical history should always elicit the type of complaint(s), chronology, and course; exacerbating and alleviating factors;…


 

DSM-IV Classification of Sleep Disorders
• Sleep Disorders • Oct 06 06

Sleep disorders have been included in the Diagnostic and Statistical Manual of Mental Disorders since 1987. DSM-III-R (American Psychiatric Association 1987) classified patients first according to their primary complaint of “dyssomnia” (including…


 

Developmental Aspects of Sleep-Wake Organization
• Childhood Sleep Disorders • Oct 06 06

Newborns spend 50% of their sleep time in rapid eye movement (REM) sleep (also known as active sleep or dreaming sleep) and 50% of their sleep time in non-REM (NREM) sleep (also…


 

Therapy for Obstructive Sleep Apnea
• Sleep-Related Respiratory Disorders • Oct 05 06

The first step in OSA therapy involves a search for reversible factors that worsen sleep-disordered breathing (

Fig. 67-6). For example, OSA patients should avoid ethanol and sedative…


 

Who Requires Treatment?
• Sleep-Related Respiratory Disorders • Oct 05 06

The spectrum of clinical disorders related to sleep-induced upper airway obstruction is illustrated in

Fig. 67-5. Unfortunately, we lack good prospective studies characterizing the long-term clinical consequences of simple…


 

Other Disorders Associated with Sleep-Disordered Breathing
• Sleep-Related Respiratory Disorders • Oct 05 06

About 5% of OSA patients have chronic alveolar hypoventilation with elevated arterial carbon dioxide tension while awake (

see Fig. 67-4). These patients have the so-called pickwickian…


 

Diagnosis of Obstructive Sleep Apnea
• Sleep-Related Respiratory Disorders • Oct 05 06

When OSA is suspected, polysomnography is indicated to establish the diagnosis. Standardized overnight polysomnography performed in a sleep laboratory by a trained technician is recommended as the best diagnostic approach. Polysomnography involves…


 

Risk Factors for Obstructive Sleep Apnea
• Sleep-Related Respiratory Disorders • Oct 05 06

Important risk factors for OSA include obesity, male gender, and upper airway structural abnormalities (

Fig. 67-4). The majority of OSA patients are overweight, with more than…


 

Pathophysiology of Obstructive Sleep Apnea
• Sleep-Related Respiratory Disorders • Oct 05 06

In OSA patients, upper airway obstruction during sleep occurs in the pharynx behind the soft palate or tongue base. We do not fully understand why OSA patients experience frequent pharyngeal occlusion during…


 

Clinical Evaluation of potential Sleep Apnea patients
• Sleep-Related Respiratory Disorders • Oct 05 06

It is important to take a good sleep history in any patient with risk factors or clinical features suggesting the possibility of OSA (

see Fig.…


 

Consequences of Sleep-Disordered Breathing
• Sleep-Related Respiratory Disorders • Oct 05 06

Although occasional apneas and hypopneas during sleep may be normal, prolonged exposure to frequent apneas and hypopneas results in clinical problems that define the OSA syndrome. The clinical sequelae in OSA (

 

Normal Sleep and Respiration
• Sleep-Related Respiratory Disorders • Oct 05 06

Many neurophysiologic changes occur during sleep. Normal sleep has complex architecture, with several stages of non-REM sleep alternating with periods of REM sleep. Each sleep stage is defined by characteristic electrophysiologic patterns. Normal…


 

Definitions: Apnea and Hypopnea
• Sleep-Related Respiratory Disorders • Oct 05 06

Apnea is commonly defined as airflow cessation for at least 10 seconds. Apneas may be central, mixed, or obstructive (

Fig. 67-1). During central apneas, no effort is made…


 

Taking Viagra will worsen sleep apnea
• Healthy Sleep News • Oct 05 06

According to Brazilian researchers, taking Viagra (sildenafil) at bedtime may aggravate breathing problems in patients with severe obstructive sleep apnea.

Obstructive sleep apnea is a common problem that occurs when the…


 

Effects of New Sleep Medication Appear Unlikely to Have Potential for Abuse or Cognitive Impairment
• Healthy Sleep News • Oct 03 06

In a study of 14 adults with histories of sedative abuse, the newly approved sleep medication ramelteon does not appear to…


 

Do You Think You Have a Sleep Disorder?
• Common Sleep Disorders • Oct 02 06

At various points in our lives, all of us suffer from a lack of sleep that can be remedied by making sure we have the opportunity to get enough…


 

A number of factors can make a person susceptible to sleep apnea
• Common Sleep Disorders • Oct 02 06

These factors include:

  • Throat muscles and tongue that relax more than normal while asleep
  • Enlarged tonsils and adenoids
  • Being overweight -…

 

Sleep Apnea
• Common Sleep Disorders • Oct 02 06

Sleep Apnea
In people who have sleep apnea (also referred to as sleep-disordered breathing), breathing briefly stops or becomes very shallow during sleep. This change is caused by intermittent blocking of the upper airway,…


 

Common Signs of a Sleep Disorder
• Common Sleep Disorders • Oct 02 06

Look over this list of common signs of a sleep disorders, and talk to your doctor if you have any of them:

  • It takes you more than 30 minutes…

 

How Are Sleep Disorders Diagnosed?
• Common Sleep Disorders • Oct 02 06

Depending on what your symptoms are, your doctor will gather various kinds of information and consider several possible tests when trying to decide if you have a sleep disorder:

  • Sleep…

 

Parasomnias (Abnormal Arousals)
• Common Sleep Disorders • Oct 02 06

In some people, the walking, talking, and other body functions normally suppressed during sleep emerge during certain sleep stages.

Alternatively, the paralysis or vivid images usually experienced during dreaming may persist after awakening. These…


 

Narcolepsy
• Common Sleep Disorders • Oct 02 06

Narcolepsy’s main symptom is excessive and overwhelming daytime sleepiness, even after adequate nighttime sleep. In addition, nighttime sleep may be fragmented by frequent awakenings. People who have narcolepsy often fall asleep at inappropriate times and places.

…

 
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