Sleep Disorders Medicine

 

Description:

Since publication of the first edition in 1994, the second edition in 1999, and the third edition in 2009, many new advances in sleep medicine have been made and warrant a fourth edition.  This comprehensive text features 19 additional chapters and covers basic science, technical and laboratory aspects and clinical and therapeutic advances in sleep medicine for beginners and seasoned practitioners.   With the discovery of new entities, many new techniques and therapies, and evolving basic science understanding of sleep, Sleep Disorders Medicine, Fourth Edition brings old and new knowledge about sleep medicine together succinctly in one place for a deeper understanding of the topic.  Neurologists, internists, family physicians, pediatricians, psychiatrists, psychologists, otolaryngologists, dentists, neurosurgeons, neuroscientists, intensivists, as well as those interested in advancing their knowledge in sleep and its disorders, will find this edition to be an invaluable resource to this bourgeoning field.

 

 

Table of contents:

 

Basic Science of Sleep

1 Introduction to the Topic

References

2 Overview of Normal Sleep

Historical Perspective

Definition of Sleep

The Moment of Sleep Onset and Offset

Sleep Architecture and Sleep Profile

The Ontogeny of Sleep

Sleep Habits

Sleep Need and Requirement

Sleep and Dreams

Phylogeny of Sleep

Circadian Sleep–Wake Rhythm

Chronobiology, Chronopharmacology, and Chronotherapy

Cytokines, Immune System, and Sleep Factors

Theories of the Function of Sleep

References

3 Sleep Deprivation and Excessive Daytime Sleepiness

Circadian Rhythm and Homeostasis

Sleep Deprivation and Sleepiness

Sleep Deprivation Experiments

Total Sleep Deprivation

Partial Sleep Deprivation

Selective REM Sleep Deprivation

Stage 4 Sleep Deprivation

Summary

Consequences of EDS Resulting from Sleep Deprivation or Sleep Restriction

Performance and Productivity at Work or School

Higher Cerebral Functions

Quality of Life and Social Interaction

Increased Morbidity and Mortality

Short-term Consequences

Long-term Consequences

Sleep Deprivation and Obesity

Sleep Duration and Hypothalamo-pituitary Hormones

Sleep Duration and Mortality

Sleep Duration and Abnormal Physiologic Changes

Sleep Restriction and Immune Responses

Sleep Restriction and Cardiovascular Disease

Summary

Causes of Excessive Daytime Sleepiness

Physiologic Causes of Sleepiness

Pathologic Causes of Sleepiness

Neurologic Causes of EDS

EDS Associated with General Medical Disorders

Primary Sleep Disorders Associated with EDS

Substance-induced Hypersomnia Associated with EDS

References

4 Effects of Sleep Deprivation and Sleepiness on Society and Driving

Introduction

Conceptualizing the Effects of Sleep in the Context of Society

Health Effects of Sleep Deprivation

Effects Across Age Groups

Effects Across Racial/Ethnic Groups

Effects for Men and Women

Effects According to Relationship Status

Effects Across Different Occupations

Impact on Driving Accidents

Conclusions and Future Directions

References

5 Neurobiology of REM Sleep, NREM Sleep Homeostasis, and Gamma Band Oscillations

Introduction

Wakefulness

EEG Profile of Wakefulness

Recent Neuroscience Technologies for Sleep Investigations

Gamma Band Oscillations (GBO)

Neural Mechanisms of GBO

GBO During Wake

Early Investigations of Wake-Regulating Neural Circuitry

Wake-Promoting Neurotransmitters

Acetylcholine

Serotonin

Noradrenaline

Dopamine

Histamine

Orexin

Gamma-Aminobutyric Acid (GABA) and Glutamate

Subcortical Modulation of GBO

NREM Sleep

EEG Profile of NREM Sleep

Sleep Spindles

Delta Slow Wave Activity (1  lessthan  4 Hz)

GBO During NREM Sleep

NREM Sleep-Active Neurotransmitters: GABA and Galanin

The Circadian Drive to Sleep

NREM Sleep Homeostasis

Metabolic Homeostasis

Synaptic Homeostasis

Rem Sleep

EEG Profile of REM Sleep

Pontine-Geniculate-Occipital Cortex (PGO) Waves

Theta Rhythmicity During REM Sleep

REM Sleep-Related Neurotransmitters

Acetylcholine

GABA and Glutamate

Melanin Concentrating Hormone

The Reciprocal Interaction Model of REM Sleep Regulation

Summary

Acknowledgments

References

6 Basic Circadian Timing and Sleep-Wake Regulation

The Circadian Timing System

Origin and Definition of Circadian Rhythms

Neurolocalization of Circadian Rhythms: The Mammalian Central Clock

Genesis of Circadian Rhythms: The Mammalian Molecular Clockwork

Organization of the Circadian System: A Hierarchical Multioscillatory System

Communication Within the Circadian System: The Neural and Endocrine Pathways

Synchronization of the Circadian System: External and Internal Factors

The Photic Factor: Molecular and Behavioral Effect

The Non-photic Factors: Focus on Melatonin, Activity, Sleep and the Serotonergic System

The Circadian System in Humans: Specificities and Methods of Investigation

Circadian Regulation of the Sleep-Wake Cycle

The Sleep-Wake Cycle

The Two-Process Model

The Homeostatic Process

The Circadian Process

Wake Maintenance Zones and Sleep Propensity Zones (The Interaction)

Brain Regions Implicated in Sleep Regulation

Chronotype

Conclusion

References

7 Neurotransmitters, Neurochemistry, and the Clinical Pharmacology of Sleep

Overview

Stimulating Transmitter Systems

Dopamine and Norepinephrine

Pharmacology

Sleep Effects

Histamine

Orexin

Glutamate

Inhibitory Transmitter Systems

GABA

Adenosine

Glycine

Regulating Transmitter Systems

Acetylcholine

Serotonin

Melatonin

Clinical Pharmacology and Summary

References

8 Neurobiology of NREM Sleep and Thermoregulation in Sleep

Introduction

Sleep-Related Changes in Body Temperature Regulation

Interactions Between Circadian Rhythms in Sleep and Body Temperature

Effects of Environmental and Body Temperature on Sleep

Hypothalamic Regulation of Sleep and Body Temperature

Thermoregulatory Control of Human Sleep

References

9 Phylogeny of Sleep

The Definition of Sleep

Model Organisms in the Study of Sleep

Optimal Sleep and Mortality

Pharmacological Development

Sleep Disorders

Narcolepsy

Sleep Apnea

Restless Legs Syndrome (RLS)

Unusual Sleep Disorders

Conclusions

Considerations in the Use of Model Organisms

Treatments for Human Sleep Disorders Resulting from the Use of Model Organisms

Phylogenetic Studies and Human Sleep

References

10 Sleep and Anesthesia: Different States with Shared Pathophysiological Traits

Introduction

Clinical Correlates: Anesthesia, Sleep and Breathing

Conclusions

References

11 Physiological Changes of Sleep

Changes in the Central Somatic Nervous System During Sleep

Autonomic Nervous System and Sleep

Central Autonomic Network

Autonomic Changes During Sleep

Clinical Relevance

Respiration and Sleep

Functional Neuroanatomy of Respiration

Control of Ventilation During Wakefulness

Control of Ventilation During Sleep

Changes in Ventilation

Upper Airway Reflexes, Receptors and Resistance

Summary and Conclusions

Physiological Changes in the Neuromuscular System

Changes in Limb and Cranial Muscles

Upper Airway Muscles and Sleep

Nasal Muscles

Genioglossus Muscle

Mechanism of Mild Muscle Hypotonia in NREM Sleep

Mechanism of Muscle Atonia or Hypotonia in REM Sleep (See also Chap. 39)

REM Sleep-Related Alterations in Respiratory Muscle Activity

Summary and Clinical Relevance

Physiological Changes in the Heart and Circulation During Sleep

Heart Rate

Cardiac Output

Systemic Arterial Blood Pressure

Pulmonary Arterial Pressure

Baroreflex Function

Peripheral Vascular Resistance

Systemic Blood Flow

Cerebral Blood Flow

Summary and Clinical Implications

Gastrointestinal Physiology During Sleep

Esophageal Function

Gastric Acid Secretion

Gastric Motility

Intestinal Motility

Summary and Clinical Relevance

Thermal Regulation in Sleep

Changes in Body Temperature and Circadian Rhythm (See also Chap. 8…)

Role of REM Sleep in Thermal Regulation

Mechanism of Thermoregulation in Sleep

Clinical Relevance

Endocrine Regulation in Sleep

Growth Hormone

Adrenocorticotropic Hormone and Cortisol Secretion

Prolactin Secretion

Gonadotropic Hormone (Gonadotropin)

Thyroid-Stimulating Hormone

Melatonin

Miscellaneous Hormones

Clinical Relevance

References

12 Sleep and Immune Regulation

Introduction

Experimental

Field and Population Studies

Clinical Trials/Intervention Studies

Conclusion

References

13 Sleep and Memory Consolidation

Introduction

Delineations and Definitions

Memory Categories

Memory Stages

Summary

Behavioral Studies of Sleep and Memory

Human Studies of Declarative Memory

Human Studies of Procedural Memory

Motor Skill Learning

Perceptual Learning

Summary

Animal Studies

Summary

Sleep Deprivation

Napping

Sleep-Dependent Brain Plasticity

Neuroimaging Studies

Modification of Post-training Sleep and Brain Activation

Overnight Reorganization of Memory Representations

Summary

Electrophysiologic Studies

Cellular Studies

Molecular Studies

Summary

Unresolved Questions

Antidepressants, Sleep, and Memory

State Versus Trait

Contributions of Sleep Micro- and macrostructure

Summary

Acknowledgments

References

14 Dreaming and Sleep Disorder

A Short History of Dream Study

REM Sleep and Neuroconsciousness Theories

Defining Dreaming

The Neurochemistry of REM Sleep and Dreaming

REM Sleep and Dreaming

The Sleep/Dream States—REM Sleep Dreaming

The Sleep/Dream States—Sleep Onset

The Sleep/Dream States—Stage 2 Dreaming

The Sleep/Dream States—Deep Sleep

Dreamless Sleep?

Dreaming in Other Sleep and Psychiatric Disorders

Post-traumatic Stress Disorder

The Future of Dream Science

References

15 Study Design and Analysis in Sleep Medicine

Introduction

Classification of Research Designs

Observational Studies

Interventional Studies

Factors Involved in Determining Validity

Basics of Statistical Analysis in Clinical Research

Variables in Clinical Studies

Descriptive Statistics

Real or Chance: Hypothesis Testing

P-values, Confidence Intervals, and Measures of Effect Size

Examining Groupwise Differences in Quantitative Parameters

Analysis of Variance (ANOVA)

Measures of Association with Quantitative Variables: Correlation and Regression

Measures of Association with Categorical Variables

Logistic Regression

Time-to-event Analysis

Using Questionnaire-type Instruments

Evaluating Agreement Between or Among Observers

Specialized Diagnostic Biostatistical Procedures

Concluding Remarks

References

Technical Considerations

16 Instrumentation, Electronics, and Signal Analysis

Introduction

Definitions and Circuit Analysis

Charge

Power Sources

Resistors and Resistance

Capacitors and Capacitance

Inductors and Inductance

Cartesian Plane

Ohm’s Law

Power

Kirchhoff’s Voltage and Current Laws

Frequency and Period

Decibels, Logarithms, Gain, and Bode Plots

Filters

Time Constants

Differential Amplifiers and Polarity Convention

Analog-to-Digital Conversion

Nyquist Theorem

Conclusion

References

17 An Overview of Polysomnographic Technique

Introduction

Clinical Indications for PSG

Patient Contact

Prestudy Questionnaire

Recording Parameters

Understanding the Equipment

PSG Amplifiers

Gain and Sensitivity

Filters

Bit Resolution and Sampling Rates

Time Scale

The Study

Electrode and Sensor Application Process

Electroencephalography

Electrooculography

Electromyography

Electrocardiography

Patient Ground and System Reference Electrodes

Electrode Impedances

Physiologic Calibrations

Monitoring and Recording

Troubleshooting and Artifact Recognition

50 or 60 Hz Artifact

Muscle Artifact

ECG Artifact

Slow Frequency Artifacts

Artifacts in the ECG Channel

Artifacts Caused by a Faulty System Reference

Artifacts in the Respiratory and Oximetry Channels

Using Filters to Correct Artifacts

Ending the Study

Perspective on Polysomnography

Appendix 17.1: Template for 24-h Sleep–Wake Log

Appendix 17.2: Subjective Evaluation of Sleepiness

Linear Analog Scale/Introspective Measure of Sleepiness

Appendix 17.3: Suggested Montages for Recording Sleep-Related Seizure Activity

Appendix 17.4: Measuring the Head for C3, C4, O1, and O2

References

18 Electroencephalography, Electromyography, and Electro-oculography: General Principles and Basic T

Physiologic Basis of EEG

Methods of EEG Recording

Electrode Placement, Channels, and Montages

Differential Amplification and Sensitivity

Polarity Convention

Filters

Analog and Digital Systems

Advantages and Limitations of Digital Recording Systems

Spectral Analysis

Electro-oculography

Electromyographic Recordings in Sleep Disorders

Special Techniques for Physiological Characterization of Abnormal Movements

Interpreting the EEG

Describing EEG Activity

Normal Waking Rhythms

Normal Sleep EEG

Normal Sleep EEG in Pediatrics

Abnormal EEG

Slowing

Epileptiform Activity

Epileptiform Patterns in Sleep

Nonepileptiform Patterns Mimicking Epileptiform Discharges

Benign Sharp Transients Seen During Sleep and Wakefulness

Epileptiform-like Patterns Without Epileptogenic Significance

Artifacts

Summary

References

19 Electrocardiography: Principles and Applications in Sleep Medicine

Normal Cardiac Rhythm

Cardiac Arrhythmias

Supraventricular Arrhythmias

Sinus Tachycardia

Sinus Bradycardia

Sinus Arrhythmia

Premature Atrial Contractions

Multifocal Atrial Tachycardia

Atrial Fibrillation

Atrial Flutter

Automatic Versus Re-entrant Tachycardia

Paroxysmal Atrial Tachycardia

Sick Sinus Syndrome

Aberrant Supraventricular Conduction

Ventricular Arrhythmias

Premature Ventricular Contractions

Ventricular Bigeminy

Ventricular Tachycardia

Ventricular Fibrillation

Torsades de Pointes

Accelerated Idioventricular Rhythm

Brugada Syndrome

Pacemaker Rhythm

Intracardiac Recordings

Signal-Averaged Electrocardiogram

Management of Arrhythmias Detected During Sleep

References

20 Evaluation and Monitoring of Respiratory Function

Evaluation of Baseline Pulmonary Function and Physiology

Testing of Baseline Respiratory Function and Physiology

Chest X-ray/CT Chest

Spirometry/Pulmonary Function Testing

Spirometry

Lung Volumes

Diffusing Capacity

Arterial Blood Gas

Monitoring of Respiratory Function During Sleep

Airflow Monitoring

Pneumotachometer

Nasal Thermocouple/Thermistor

Intranasal Pressure/Transducer

Respiratory Inductance Plethysmography

Snore Monitoring

Esophageal Balloon Manometry

Pulse Oximetry Monitoring

Carbon Dioxide Monitoring

Expired End-tidal CO2 Monitoring

Transcutaneous CO2 Monitoring

Classification and Scoring of Respiratory Events

References

21 Neuroimaging in Normal and Abnormal Sleep

Introduction

Neuroimaging in Normal Human Sleep

Functional Neuroimaging of Normal Human Sleep

NREM Sleep

REM Sleep

Brain Reactivity to External Stimulation During Sleep

Sleep and Brain Plasticity

Alertness, Performance, and Sleep Deprivation

Cognitive Challenges

Personal Vulnerability to Sleep Deprivation

Sleep Deprivation in Depression

Instrumental Manipulation of Sleep Deprivation Effects

Summary

Neuroimaging in Sleep Disorders

Idiopathic Insomnia

Narcolepsy

Anatomic Neuroimaging Studies of Narcolepsy

Functional Neuroimaging Studies of Narcolepsy

Neurotransmission in Narcolepsy

Brain Response to Drug Probe in Narcolepsy

Summary

Recurrent Hypersomnia

Obstructive Sleep Apnea Syndrome (OSAS)

Functional Neuroimaging Studies of OSAS

Anatomic Neuroimaging Studies of OSAS

Summary

Restless Legs Syndrome and Periodic Limb Movements

Restless Legs Syndrome

Periodic Limb Movements

Summary

Sleepwalking

REM Sleep Behavior Disorder

Functional Neuroimaging Studies of RBD

Neurotransmission in RBD

Anatomic Neuroimaging Studies of RBD

Summary

Conclusions

Acknowledgments

References

22 Multiple Sleep Latency Test

Introduction

Multiple Sleep Latency Test Methods

Recording Montage

General Procedures

Specific Procedures

Ending a Test

Scoring and Interpretation

Sources of Error

Reliability and Validity

Reliability

Validity

Determinants of Daytime Sleepiness

Quantity and Continuity of Sleep

CNS Acting Drugs

Sleep Disorders

Evaluation of Therapeutic Interventions

Modifications of the Multiple Sleep Latency Test

Multiple Sleep Latency Test Norms

References

23 Maintenance of Wakefulness Test

Introduction

History and Development

Protocol

Interpretation

Special Populations

Utility for Specific Indications

Limitations

Summary

References

24 Scoring of Normal Sleep and Arousals

Introduction to Sleep Stage Scoring

Technical Specifications

Scoring Stages of Sleep

Stage Wake

Stage N1 Sleep

Stage N2 Sleep

Stage N3 Sleep

Stage REM Sleep

End Scoring Stage R Sleep

Transitions Between Stage N2 and Stage R

Major Body Movements

Arousals

Pediatric Scoring Rules

Sleep Stage Changes Across the Night

References

25 Scoring of Sleep-Related Breathing Events

Introduction

Scoring Centricity

The spectrum of arousal phenomena on the EEG

Sleep State Modulates Respiration

Is an Arousal Necessary to Enable Airway Opening and Respiratory Recovery?

Event Cycle Characteristics

Event Cycle Length

Event Cycle Timing

Ultra-Short Respiratory Events

Ultra-Long Respiratory Events

Assessing Event Significance in Stable NREM Sleep—Periods of Stable Breathing

Assessing Event Significance in REM Sleep

NREM Versus REM Dominance

Ataxic Respiration

Loop Gain—A Concept Relevant to Understanding Scoring Approaches and Limitations

Assessing Pathological Respiratory Chemoreflex Activation: Cheyne–Stokes Respiration and Central H

Treatment-Emergent Central Sleep Apnea (TE-CSA) and Complex Sleep Apnea

Titration Versus Diagnostic Data

Oximetry Analysis

Capnometry Analysis and Hypoventilation

Adaptive Ventilation

Recognition and Scoring of Respiratory Abnormality During Adaptive Ventilation

Home Sleep Testing—Cardiopulmonary Recordings or Autonomic Activation-Based Approaches

Scoring Approaches to Positive Pressure Therapy Data

Therapy Waveform Analysis—Continuous and Non-adaptive Positive Pressure Therapy

Waveform Analysis—Adaptive Bilevel Ventilation

Waveform Analysis—Ventilators

Other Evidence of Suboptimal Therapy of Sleep Respiration

Summary

References

Clinical Topics

26 Approach to the Patient with Sleep Complaints

Introduction

Categories of Sleep Disorders

Clinical Characteristics of Common Sleep Complaints

Etiologic Diagnosis

Method of Clinical Evaluation

History

Sleep History

Sleep Questionnaire

Sleep Log or Sleep Diary

Drug and Alcohol History

Psychiatric History

Medical and Neurologic History

History of Past Illnesses

Family History

Physical Examination

Subjective Measures of Sleepiness

Clinical Phenomenology

Obstructive Sleep Apnea Syndrome

Narcolepsy-Cataplexy Syndrome

Idiopathic Hypersomnia

Insomnia

Restless Legs Syndrome

Parasomnias

Sleepwalking (Somnambulism)

Sleep Terror (Pavor Nocturnus)

Confusional Arousals

REM Sleep Behavior Disorder

Nightmares

Sleep-Related Eating Disorders

Catathrenia (Expiratory Groaning)

Sleep-Related Movement Disorders

Rhythmic Movement Disorder

Sleep-Related Leg Cramps

Bruxism (Tooth Grinding)

Laboratory Investigations

Polysomnographic Study

Indications for Polysomnography

Indications for Ambulatory PSG

Polysomnographic Findings in Sleep Disorders [62]

Pitfalls of PSG

Video-Polysomnographic Study

Multiple Sleep Latency Test

Maintenance of Wakefulness Test

Standard Electroencephalographic Study

Ambulatory Electroencephalography or Polysomnography

Actigraphy

Neuroimaging Studies

Pulmonary Function Tests

Electrodiagnosis of the Respiratory Muscles

Other Laboratory Tests

Principles of Management of Sleep Disorders

References

27 International Classification of Sleep Disorders

DSM-V

International Classification of Sleep Disorders 3rd Revision

Insomnia Disorders

Sleep-related Breathing Disorders

Central Disorders of Hypersomnolence

Circadian Rhythm Sleep–Wake Disorders

Parasomnias

Conclusion

References

28 Epidemiology: Principles and Application in Sleep Medicine

Epidemiological Methods in Sleep Medicine

Analytical Studies

Observational Population Surveys

Data Collection

The P Value

Validity

Precision and Comparability of Information; Randomized Controlled Trials

Standardization, Matching

Population-Based Rates

Epidemiology of Sleep Disorders

Insomnia

Psychiatric Disorders and Insomnia

Insomnia Among Patients with Neurological and Other Somatic Diseases

Is Anticipation of Coming Health-Related Events Possible with Follow-up of Sleeping Pattern and Slee

Sleep Length; Natural Short and Long Sleepers

Daytime Sleepiness

Narcolepsy

Snoring and Sleep Apnea

Habitual Snoring

Sleep Apnea

Risk Factors for Snoring and Sleep Apnea

Central Obesity, Thick Neck, and Obstructed Upper Airways

Other Risk Factors for Snoring and Sleep Apnea

Ethnic Differences in Occurrence of Snoring and Sleep Apnea

Snoring and Sleep Apnea in Children

Sleep Apnea Among Elderly People

Arterial Hypertension

Heart Disease

Snoring and Stroke

Sleep Apnea and Stroke

Circadian Variation of Strokes and Snoring

Snoring, Sleep Apnea, and Dementia

Snoring, Sleep Apnea, and Sudden Death

Evolution of Obstructive Sleep Apnea Syndrome

Parasomnias

REM Sleep Behavioral Disorder

Restless Legs Syndrome

References

29 Genetics of Sleep and Sleep Disorders

Introduction

Genetics of Normal Sleep and the Electroencephalogram

Mutagenesis

QTL Analysis

QTLs for Sleep Amount

QTLs for Sleep EEG

QTLs for Sleep Homeostasis

Genetics of Sleep Disorders

Disorders Caused by a Single Gene

Fatal Familial Insomnia

Familial Advanced Sleep-phase Syndrome

Short Sleep

Primary Insomnia

Narcolepsy

Disorders with Human Leukocyte Antigen Association

REM Sleep Behavior Disorder

Sleepwalking

Kleine–Levin Syndrome

Delayed Sleep-phase Syndrome

Narcolepsy

Disorders with Other Gene Associations

Obstructive Sleep Apnea Syndrome

Restless Legs Syndrome

Primary Nocturnal Enuresis

Conclusions

References

30 Nutrition and Sleep

Introduction

Enteric Nervous System and Sleep

Role of Neuromediators

Peptides and Hormones

Serotonin

Irritable Bowel Syndrome and Role of the Intestinal Microbiota

Case Example

Role of Neurosteroids

Role of Neurohormetic Phytochemicals

Caffeine, Adenosine, and Sleep

Glucose, Lactate, and Glial Cells

Meals, Dietary Nutrients, and Sleep

Rapidly Absorbing Carbohydrates, Large Meals, and Tryptophan

Wheat, Starch, Amylopectins, and Postprandial Sleepiness

Eating in the Evening and Night Sleep

Postlunch Fatigue

Obesity and Sleep

Dietary Patterns and Sleep

Effect of Fasting on Sleep

Ketogenic Diet and Sleep

Power Naps

Alcohol and Sleep

Essential Fatty Acids and Sleep

Narcolepsy and Meals

Dietary Minerals and Sleep

Iron

Copper, Zinc, and Other Minerals

Nutrition and Development of the Central Nervous System

References

31 Sleep Duration, Morbidity, and Mortality

Introduction

Epidemiologic Principles and Designs

Cross-Sectional Studies

Case–Control Studies

Prospective Cohort Studies

Epidemiologic Evidence Linking Short and Long Sleep with Mortality

Arguments Advanced Against the Idea that Long Sleep Is Harmful

An “Epidemic” of Insufficient Sleep?

Association of Long Sleep with Risks Could Be Explained by Other Factors

Long Total Sleep Time or Long Time in Bed?

Plausible Mechanisms of Risks of Long Sleep

Experimental Sleep Deprivation and “Short Sleep”

Genetic Causality

The Need for Controlled Trials

Summary

References

32 Obstructive Sleep Apnea Syndrome

Introduction

Epidemiology

Morbidity: Cardiovascular System

Hypertension

Heart Failure

Pulmonary Hypertension

Cardiac Arrhythmias

Coronary Artery Disease, Myocardial Infarction, Stroke, and Early Death

Pathophysiology

Summary

Snoring

Upper Airway Resistance Syndrome

Secondary Apnea

Evaluation

History: Nighttime Symptoms

History: Daytime Symptoms

Physical Examination

Laboratory Evaluation

Polysomnography

Multiple Sleep Latency Test

Imaging Studies

Other Studies

Treatment

Behavioral Recommendations

Pharmacologic Treatment

Continuous and Bilevel Positive Airway Pressure (See also Chap. 34)

Surgical Approaches (See also Chap. 36)

Oral Appliances (See also Chap. 36)

Obstructive Sleep Apnea in Children

Clinical Features

Polysomnographic Testing

Asthma and Upper Airway Obstruction During Sleep

Orthodontic Complications and Upper Airway Obstruction During Sleep

Treatment

Tonsillectomy and Adenoidectomy

Orthodontic and Maxillomandibular Surgery

Tracheostomy

Nasal Continuous Positive Airway Pressure

Summary

References

33 Central Sleep Apnea, Hypoventilation Syndrome, and Sleep in High Altitude

Introduction

General Considerations in CSA and Alveolar Hypoventilation Pathophysiology

Specific Considerations by Disease Entity

Central Sleep Apneas Syndromes

Primary Central Sleep Apnea

Central Sleep Apnea Due to Cheyne–Stokes Breathing Pattern in Congestive Heart Failure (CSB-CHF)

Central Sleep Apnea Due to a Medication or Substance, Opioids

Central Sleep Apnea Due to High-Altitude Periodic Breathing

Sleep-Related Hypoventilation Disorder, Central in Origin Versus Due to Medical Disorder

Alveolar Hypoventilation Syndrome with Decrease in Ventilatory Drive (Normal Pulmonary Function)

Alveolar Hypoventilation Syndrome with Abnormal Respiratory Mechanics/Gas Exchange

Neuromuscular Disorders and Chest Wall Syndromes

Lower Airways Obstruction, Pulmonary Parenchymal Disease, and/or Vascular Pathology

Alveolar Hypoventilation Due to Obesity Hypoventilation Syndrome

Treatment-Emergent Central Sleep Apnea

Summary

References

34 Positive Airway Pressure in the Treatment of Sleep Apnea–Hypopnea

Introduction

Positive Pressure Modalities Used to Treat Obstructive Sleep Apnea/Hypopnea

Continuous Positive Airway Pressure

Bilevel Positive Pressure

Autotitrating CPAP and Bilevel PAP

“Pressure-Relief” CPAP and Bilevel PAP

Adaptive Servo-Ventilation

Effectiveness of PAP in Treating Patients with OSA

Side Effects of Pap Therapy

Claustrophobia

Problems Related to Nasal Route of Breathing

Nasal Dryness and Congestion

Rhinorrhea

Barotrauma and Chest Discomfort

Effects on Arterial Blood Gases and Oxyhemoglobin Saturation

Acceptance of and Adherence to Pap Therapy

Patient–PAP Device Interface Options

Variations and Modalities of PAP Therapy for OSA: Implications for Acceptance and Adherence

Pressure Ramping

Bilevel PAP Therapy

APAP and Auto-titrating Bilevel PAP

Pressure-Relief CPAP and Bilevel PAP

Follow-up of CPAP Patients and Its Role in Enhancing Adherence

Summary

Traditional and Evolving Methods of Initiating Pap Therapy

Split-Night Diagnostic and CPAP Titrations

Home CPAP Titration

Use of Predictive Formulas to Estimate or Establish the CPAP Pressure Prescription

Use of APAP Devices

Effect of Positive Airway Pressure Therapy of OSA on Systemic Disorders

Effect of PAP Therapy on Cardiovascular Mortality in OSA Patients

Effect of PAP Therapy on Cardiac Rhythm Disturbances in OSA Patients

Effect of PAP Therapy in OSA Patients with Heart Failure

Effect of PAP Therapy in OSA Patients with Hypertension

PAP Therapy and Stroke

PAP Therapy of Abnormal Glycemic Control and Type 2 Diabetes Mellitus

Summary

References

35 Preoperative, Perioperative, and Postoperative Evaluation and Management of Sleep-Disordered Brea

Introduction

OSA Prevalence, Associated Comorbidities, and Perioperative Complications

Classical Diagnostic Criteria of OSA

Principles of Perioperative Evaluation and Management of OSA Patients

Preoperative Evaluation of the Patient with Diagnosed OSA

Preoperative Screening Tools for Evaluation of Suspected OSA

Preoperative Evaluation of the Patient with Suspected OSA

Home Sleep Testing and Nocturnal Oximetry

Perioperative Management Strategies for OSA Patients

Postoperative Management Strategies for OSA Patients

Ambulatory Surgery and the OSA Patient

Central Sleep Apnea

Obesity Hypoventilation Syndrome

Cheyne–Stokes Breathing Syndrome

Conclusion

References

36 Oral Appliances and Surgical Techniques for Treatment of Obstructive Sleep Apnea Syndrome

Introduction

Oral Appliances

Appliance Type

Mechanism of Action

Efficacy

Predictors of Success

Treatment Adherence

Side Effects and Complications

Cost

Treament Recommendations

Upper Airway Surgery

Tonsillectomy

Uvulopalatopharyngoplasty

Laser-Assisted Uvulopalatoplasty

Other Palatal Procedures

Nasal Surgery

Maxillary and Mandibular Surgery

Tongue-Base Surgery

Tracheostomy

References

37 Nature, Evaluation, and Treatment of Insomnia

Introduction

Significance of Insomnia

Nature of Insomnia

Clinical Presentation and Objective Findings

Polysomnographic (PSG) Findings

Daytime Complaints and Neurobehavioral Findings

Course and Prognosis

Etiology and Pathophysiology

Evaluation of Insomnia

Clinical and Laboratory Evaluations

Treatment

Psychological and Behavioral Therapies

Outcome Evidence

Combined Behavioral and Pharmacological Approaches

Pharmacotherapy (See also Chap. 55 [Monti])

Benzodiazepine Receptor Agonists

Benzodiazepines

Nonbenzodiazepines

Outcome Evidence

Indications and Limitations

Melatonin and Melatonin Receptor Agonist

Melatonin

Ramelteon

Warnings for Hypnotics

Sedating Antidepressants

Tricyclic Antidepressants

Trazodone

Mirtazapine

Summary and Conclusions

Acknowledgments

References

38 Narcolepsy and Idiopathic Hypersomnia

Introduction

Symptoms of Narcolepsy

Excessive Daytime Sleepiness (EDS)

Cataplexy

Sleep Paralysis

Hypnagogic and Hypnopompic Hallucinations

Other Important Symptoms

Neurobiology of Wakefulness

Sleep Physiology and Symptoms of Narcolepsy

Discovery of Hypocretin Deficiency in Human Narcolepsy

What Causes Loss of Hypocretin Neurons?

How Does Hypocretin Ligand Deficiency Cause the Narcolepsy Phenotype?

Hypocretin/Orexin System and Sleep Regulation

Hypocretin/Orexin Deficiency and Narcoleptic Phenotype

Narcolepsy with Normal CSF Hypocretin Levels

Idiopathic Hypersomnia, a Hypocretin Non-deficient Primary Hypersomnia

Nosological and Diagnostic Considerations of Major Primary Hypersomnias

CSF Histamine and GABAA Receptor Modulators in Narcolepsy and Idiopathic Hypersomnia

Conclusion

References

39 Motor Control and Dyscontrol in Sleep

Introduction

Motor Control in Wakefulness and Sleep

Muscle Tone, Posture, and Reflexes

Motor Control in Wakefulness

Changes in Motor Control in Sleep

Modulation of Neuronal Firing

Motor Neuronal Modulation

Reflex Modulation

Effect of NREM Sleep on Motor Control

Effect of REM Sleep on Motor Control

Circadian Activity Cycles

Development and Aging

Drowsiness and the Sleep–Wake Transition Period

Effects of Sleep Stage on Motor Control

Cyclical Alternating Pattern and Movements in Sleep

Classification of Motor Disorders in Sleep

Description of Individual Motor Disorders of Sleep

Scoring Criteria for Sleep-Related Movements

Methods for Studying Sleep-Related Movements

Principles of Treatment of Sleep Disorders Related to Abnormal Movements

Summary and Conclusion

References

40 Evaluation and Management of RLS and PLMD

Periodic Leg Movements of Sleep (PLMS)

Periodic Limb Movement Disorder (PLMD)

Restless Legs Syndrome

Clinical Features and Diagnosis of RLS

Epidemiology, Biology, and Genetics of RLS

Prevalence of RLS in Different Ethnic Groups

Incidence and Natural History of RLS

Secondary (Causally Related) and Comorbid Conditions for RLS

RLS Biology

Familial Aggregation and Genetics in RLS

Evaluating the Severity and Impact of RLS

Treatment of RLS and PLMD

Pharmacologic Treatment of RLS (see Boxes 40.8, 40.9, 40.12, and Table 40.1)

Historic Note and RLS Augmentation

α2δ Ligands

Levodopa

Dopamine Agonists

RLS Augmentation on Dopaminergic Treatment: Rates and Management

Anticonvulsants (Other than α2δ Agents)

Opioids

Sedative Hypnotics

Iron Treatment

Treatment of Refractory and Intractable RLS

Pharmacologic Treatment of PLMD and PLMS

Summary

References

41 Sleep, Breathing, and Neurologic Disorders

Introduction

Functional Anatomy of Sleep and Wakefulness

Neuroanatomic Substrates of Wakefulness

Neuroanatomic Substrates of REM Sleep

Neuroanatomic Substrates of NREM Sleep

Functional Anatomy of Respiration in Sleep and Wakefulness

Sleep-Related Respiratory Dysrhythmia in Neurologic Disorders

Sleep Apnea

Sleep-Related Hypopnea

Paradoxical Breathing

Cheyne–Stokes and Cheyne–Stokes Variant Patterns of Breathing

Dysrhythmic Breathing

Apneustic Breathing

Inspiratory Gasp

Ataxic Breathing

Biot’s Breathing

Other Abnormal Breathing Patterns

Sleep-Related Hypoventilation

Mechanism of Respiratory Dysrhythmias in Neurologic Disease

Sleep and Breathing Disorders Secondary to Somatic Neurologic Illness

Clinical Manifestations

Mechanisms of Sleep Disturbances

Sleep and Breathing Disturbances in Central Nervous System Disorders

Alzheimer’s Disease and Related Dementias

Types of Sleep Disturbances in Dementia

Sleep Dysfunction in Alzheimer’s Disease

Dementia with Diffuse Lewy Body Disease

Sleep Disturbances in Frontotemporal Dementia

Sleep Dysfunction in Corticobasal Degeneration (CBD)

Stroke and Sleep-Wake Disorders

Hemispheric Stroke

Brain Stem Vascular Lesions

Diencephalic Stroke

Other Sleep-Wake Disorders in Stroke

Basal Ganglia Disorders

Disorders of the Cerebellum

Brain Stem Tumor

Other Brain Stem and Diencephalic Lesions

Traumatic Brain Injury and Sleep Dysfunction

Demyelinating Lesion in the Brain Stem

Mechanisms of Sleep Dysfunction in MS

Bulbar Poliomyelitis and Post-polio Syndrome

Syringobulbia-Syringomyelia

Sleep Dysfunction and Encephalitis

Arnold–Chiari Malformation

Spinal Surgery

Spinal Trauma

Sleep and Breathing Disturbances in Neuromuscular Disorders

Mechanism of SDB and Respiratory Failure in Neuromuscular Diseases

Clinical Approach

Amyotrophic Lateral Sclerosis

Other Types of Motor Neuron Diseases

Charcot–Marie–Tooth Disease

RLS/WED, Polyneuropathies, and Sleep Dysfunction

Other Neuropathies and Sleep Dysfunction

Muscular Dystrophy

Myotonic Dystrophy

Acid Maltase Deficiency and Other Glycogen Storage Disorders

Other Varieties of Congenital Myopathies

Miscellaneous Myopathies

Sleep and Breathing Disorders in Autonomic Failure

Multiple System Atrophy with Progressive Autonomic Failure (Shy–Drager Syndrome)

Postural Tachycardia Syndrome

Familial Dysautonomia (Riley–Day Syndrome)

Secondary Autonomic Failure

Neurodegenerative Disease with Autonomic Failure and Sleep Dysfunction

Cardiac Arrhythmias and Autonomic Deficits in Obstructive Sleep Apnea Syndrome

Other Primary Sleep Disorders with Autonomic Dysfunction

Miscellaneous Neurologic Disorders

Sleep Apnea in Narcolepsy Syndrome

Kleine–Levin Syndrome

Idiopathic Recurrent Stupor

Idiopathic Hypersomnia

Central Sleep Apnea and Sleep Hypoventilation Syndromes

Sleep and Increased Intracranial Pressure

Headache Syndromes

Familial and Sporadic Fatal Insomnia

Laboratory Investigations

Laboratory Tests for the Primary Neurologic Disorders

Laboratory Tests to Investigate Sleep and Sleep-Related Breathing Disorders

Other Laboratory Tests

Treatment of Sleep and Respiratory Dysfunction Secondary to Neurologic Disorders

Treatment of Primary Neurologic Illness

Treatment of Sleep Disturbances Including Sleep-Related Breathing Disorders

General Measures

Pharmacologic Treatment

Mechanical Devices

Oxygen Supplementation

Surgical Treatment

Treatment of Sleep Disturbances in Alzheimer’s Disease and Related Dementias

Treatment of Sleep Disturbances in Patients with Parkinson’s Disease

Conclusion

References

42 Fatigue in Clinical Practice

Introduction

Identifying the Sites of Fatigue

Fatigue in Specific Conditions

Chronic Fatigue Syndrome (see also Chapter 47)

Fatigue in Primary Sleep Disorders

Fatigue in Neurological Disorders

Fatigue in Peripheral Nervous System (PNS) Disorders

Fatigue in Neuromuscular Junction Disorders

Fatigue in Neuropathies and Myopathies

Fatigue in CNS Disorders

Fatigue in Anterior Horn Cell Disorders

Fatigue in Multiple Sclerosis

Fatigue in Parkinson’s Disease

Post-stroke Fatigue

Fatigue in Traumatic Brain Injury

Fatigue in General Medical Conditions

Fatigue in Cardiopulmonary Disease

Fatigue in COPD

Fatigue in Heart Failure

Fatigue in Chronic Renal Failure

Fatigue in Other Medical Conditions

Cancer-Related Fatigue

Fatigue and Psychiatric Disorders

References

43 Sleep, Coma, Vegetative and Minimally Conscious States

Introduction

Disorders of Consciousness

Neural Correlates of Awareness

Functional Neuroimaging and Detection of Awareness in Disorders of Consciousness

Electroencephalography (EEG) and transcranial magnetic stimulation (TMS)

Sleep and Disorders of Consciousness: Differences and Crossing Points

Conclusions

References

44 Sleep and Epilepsy

Introduction

Interrelationship Between Sleep and Epilepsy: Physiologic Mechanisms

Basic Mechanism of Epilepsy

Mechanism of Sleep

Interrelationship Between Epilepsy and Sleep

Effect of Sleep on Epilepsy

Effect of Sleep on Specific Seizure Types

Clinical Seizures

Generalized Epilepsies

Primary Generalized Grand Mal Seizure

Petit Mal (Absence) Epilepsy

Juvenile Myoclonic Epilepsy

Lennox–Gastaut Syndrome

West’s Syndrome (Infantile Spasms)

Partial Epilepsies

Interictal Epileptiform Discharges

Primary Generalized Grand Mal Tonic-Clonic Seizures

Petit Mal (Absence Epilepsy)

Juvenile Myoclonic Epilepsy

Lennox–Gastaut Syndrome

West’s Syndrome (Infantile Spasm)

Partial Epilepsies

Status Epilepticus

Special Seizure Types Related to Sleep-Wake Cycle

Benign Epilepsy of Childhood with Centrotemporal Spikes

Juvenile Myoclonic Epilepsy of Janz

Epileptic Syndrome with Generalized Tonic-Clonic Seizure on Awakening

Continuous Spike-and-Wave Discharges During Slow-Wave Sleep

Landau–Kleffner Syndrome

Nocturnal Temporal Lobe Epilepsy

Nocturnal Frontal Lobe Epilepsy

Autosomal Dominant Nocturnal Frontal Lobe Epilepsy

Effect of Sleep Deprivation on Epilepsy

Phenomena During Sleep that Can Be Mistaken for Epilepsy (Nonepileptiform Disorders)

Effect of Epilepsy on Sleep

Sleep Complaints in Patients with Epilepsy

Relationship Between Seizure Type, Severity of Seizure, and Extent of Sleep Deficits

Can Epilepsy Lead to a Sleep Disorder?

Can a Sleep Disorder Lead to Epilepsy?

Effect of Anticonvulsants on Sleep and Sleep Architecture in Epileptics

Older Antiepileptic Drugs

Newer Antiepileptic Drugs (AEDs)

Nonpharmacologic Treatment

Summary

Sleep, Epilepsy, and Autonomic Dysfunction

Epilepsy and Sleep Apnea

SUDEP and Sleep

Utility of Sleep in the Diagnosis of Epilepsy

Sleep EEG Recording and Sleep Deprivation Study

All-Night Polysomnographic Recording

Video-Polysomnographic Study

Multiple Sleep Latency Test

Ambulatory 24-h EEG Recording and Sleep Scoring

Long-Term Video-EEG Monitoring

Intracranial Recordings

Neuroimaging

Practical Relevance to Understanding the Relationship Between Sleep and Epilepsy

References

45 Dreaming in Neurological Disorders

Background

Deficits of Dreaming

Charcot–Wilbrand Syndrome

Charcot’s Variant: Isolated Loss of Visual Dream Imagery

Negative Findings

Wilbrand’s Variant: Global Loss or Suppression of Dreaming

Cessation or Suppression of Dreaming Following Prefrontal Leucotomy

Effects of Pontine Brainstem Lesions

Neuroimaging and Transcranial Magnetic Stimulation Studies Related to Dreaming

Excesses of Dreaming

Dream/Reality Confusion

Nightmares

REM Behaviour Disorder (RBD)

Pharmacological Findings

Reward and Motivational Processes During Sleep and Dreaming

Conclusion

References

46 Sleep in Psychiatric Disorders

Introduction

Sleep Disturbances, Sleep Loss, and Psychiatric Disorders

Associations Between Sleep Disorders and Psychiatric Symptoms/Disorders

Insomnia

Circadian Rhythm Disorders

Sleep Apnea

Restless Legs Syndrome/Periodic Limb Movements

Narcolepsy

Sleep in Psychiatric Disorders

Mood Disorders

Major Depression

Bipolar Disorder

Anxiety Disorders

Generalized Anxiety Disorder

Panic Disorder

Post-traumatic Stress Disorder

Obsessive–Compulsive and Social Phobia Disorders

Eating Disorders

Schizophrenia

Borderline Personality Disorder

Childhood Psychiatric Disorders

Alcohol and Substance Abuse Disorders

Medication Effects and Substance Abuse

Treatment of Sleep Problems in Patients with Psychiatric Illness

Conclusion

References

47 Sleep Disturbances in General Medical Disorders

Introduction

Medical Disorders that Cause Sleep Disturbances

Mechanism of Sleep Disturbances in Medical Disorders

General Features of Sleep Disturbances in Medical Illness

Specific Medical Disorders and Related Sleep Disturbances

Cardiovascular Disease

Ischemic Heart Disease

Heart Failure

Miscellaneous Other Measures

Hypertension

Cardiac Arrhythmias and Sleep

Sudden Cardiac Death

Intrinsic Respiratory Disorders

Chronic Obstructive Pulmonary Disease

Bronchial Asthma, Including Nocturnal Asthma

Restrictive Lung Disease

Gastrointestinal Diseases

Peptic Ulcer Disease

Gastroesophageal Reflux Disease

Sleep in Functional Bowel Disorders

Miscellaneous Gastrointestinal Disorders and Sleep

Endocrine Diseases

Thyroid Disorders

Diabetes Mellitus

Growth Hormone Disorders

Miscellaneous Endocrine Diseases and Sleep

Renal Disorders

Sleep Disturbances and Chronic Renal Failure

Sleep Apnea in Patients Receiving Dialysis

Restless Legs Syndrome in Chronic Renal Failure Patients

Fibromyalgia Syndrome, Rheumatoid Arthritis, and Other Rheumatologic Disorders

Fibromyalgia Syndrome

Rheumatoid Arthritis and Other Rheumatologic Disorders

Hematologic Disorders

Dermatologic Disorders

Miscellaneous Disorders

Acquired Immunodeficiency Syndrome

Lyme Disease

Chronic Fatigue Syndrome

Sleep of Intensive Care Unit Patients (Medical and Surgical)

African Sleeping Sickness (Trypanosomiasis)

Sleep and Cancer

Medication-Related Sleep–Wake Disturbances

Drugs for General Medical Disorders

Drugs Used to Treat Psychiatric Disorders

Drugs Used to Treat Neurologic Disorders

Miscellaneous Agents

Over-the-Counter Medications

Summary and Conclusions

References

48 Evaluation and Management of Circadian Rhythm Sleep Disorders

Introduction

Circadian Rhythm Sleep Disorders

Delayed Sleep Phase Disorder

Advanced Sleep Phase Disorder

Irregular Sleep–Wake Rhythm

Non-24-h Sleep–Wake Disorder

Shift Work Disorder

Jet Lag Disorder

Evaluation of Circadian Rhythm Sleep Disorders

Sleep Logs

Actigraphy

Circadian Phase Markers

Questionnaires

Polysomnography

Treatment of Circadian Rhythm Sleep Disorders

Delayed Sleep Phase Disorder

Advanced Sleep Phase Disorder

Irregular Sleep–Wake Rhythm

Non-24-h Sleep–Wake Disorder

Shift Work Disorder

Jet Lag Disorder

Conclusion

References

49 Rapid Eye Movement Sleep Behavior Disorder

Introduction

Diagnosis and Classification of RBD

Diagnosis of RSWA

Quantitative Methods of RSWA Analysis

Epidemiology

The Association of RBD with Neurodegenerative Synucleinopathy Disorders

Imaging in RBD

RBD and RSWA Association with Specific Synucleinopathy Disorders: Parkinson Disease, Lewy Body Demen

RBD and Parkinson Disease

RBD and Lewy Body Dementia

RBD and Multiple System Atrophy

RBD and Tauopathies

Narcolepsy and RBD

RBD Associated with Brainstem Lesions and Autoimmunity

RBD Associated with Psychiatric Disorders and Antidepressants

Pathophysiology of RBD

The Braak Staging Hypothesis and RBD

Treatment of RBD

Clonazepam and Other GABA Agonists

Melatonin

Other Potential Treatments of RBD

Conclusions

Acknowledgments

References

50 Parasomnias

Introduction

Disorders of Arousal (From NREM Sleep)

Somnambulism

Clinical Presentation

Associated Factors and Pathophysiology

Prevalence

Treatment

Sleep Terrors

Clinical Presentation

Associated Factors and Pathophysiology

Prevalence

Treatment

Parasomnias Associated with REM Sleep

Nightmare Disorder

Clinical Presentation

Associated Factors and Pathophysiology

Prevalence

Treatment

Recurrent Isolated Sleep Paralysis

Clinical Presentation

Associated Factors

Prevalence

Treatment

REM Sleep Behavior Disorder

Clinical Presentation

Associated Factors (Idiopathic and Secondary RBD) and Pathophysiology

Prevalence

Treatment

Other Parasomnias

Sleep Enuresis

Clinical Presentation

Associated Factors and Pathophysiology

Prevalence

Treatment

Sleep-related Bruxism

Clinical Presentation

Associated Factors and Pathophysiology

Prevalence

Treatment

Sleep-related Rhythmic Movement Disorder

Clinical Presentation

Associated Factors and Pathophysiology

Prevalence

Treatment

Somniloquy

Clinical Presentation

Associated Factors and Pathophysiology

Prevalence

Treatment

Sleep-related Groaning

Clinical Presentation

Associated Factors and Pathophysiology

Prevalence

Treatment

Conclusion

References

51 Sleep Disorders in the Elderly

Introduction

Neurology of Aging

Clinical Aspects of Central Nervous System Changes

Physiologic Changes in Old Age

Electroencephalographic Changes

Awake Electroencephalography

Sleep EEG Changes, Including Changes in Sleep Architecture and Organization

Changes in the Circadian Rhythm

Autonomic Nervous System Changes with Age

Sympathetic Nerve Activity

Thermoregulation

Cardiovascular Changes

Respiration

Nocturnal Penile Tumescence

Gastrointestinal Function

Endocrine Changes with Age

Plasma Cortisol

Growth Hormone

Prolactin Secretion

Gonadotropins (Follicle-Stimulating Hormone and Luteinizing Hormone)

Plasma Insulin and Glucose

Thyroid-Stimulating Hormone

Melatonin Secretion

Changes in Cerebral Blood Flow and Cerebral Metabolism

Pathologic Central Nervous System Changes of Normal Aging

Sleep Complaints in Old Age

Clinical Assessment of Sleep Disorders

Sleep History

Medical History

Drug History

Psychiatric History

Sleep Disorders in Old Age

Diagnosis of Sleep Disorders in Old Age

Sleep Apnea Syndrome

Periodic Limb Movements in Sleep

Sleep Disturbances and Medical Illnesses

Sleep Disturbances and Comorbid Psychiatric Illness

Sleep Disturbances and Comorbid Neurodegenerative and Other Neurologic Disorders

Sleep Disturbances Associated with Drugs and Alcohol

Nocturia and Sleep Problems

Narcolepsy

Restless Legs Syndrome

Parasomnias

Disorders of Circadian Function

Laboratory Assessment

Treatment

Indications for Treatment of Obstructive Sleep Apnea

Indications for Treatment of Insomnia

Special Pharmacologic Considerations

Situational and Lifestyle Considerations

Treatment of Sleep Cycle Changes Related to Age

Treatment of Situational Stress

Treatment of Nocturnal Confusional Episodes

Treatment of Medication-Induced Sleep–Wakefulness Disturbances

Special Environmental Considerations in Treatment

Exercise Program

Nonpharmacologic Treatment

References

52 Evolution of Sleep from Birth to Adolescence and Sleep Disorders in Children

Introduction

The Evolution of Sleep from Birth Through Adolescence

Infant Sleep

Sleep in Toddlers and Preschoolers

Sleep in Preadolescent Children

Adolescent Sleep

Sleep-Disordered Breathing in Children

History and Classification of Sleep-Disordered Breathing in Children

Epidemiology of Childhood SDB

Clinical Features of Childhood SDB

Physical Features Associated with Childhood SDB

Secondary Sequelae of Childhood SDB

Clinical and Laboratory Assessment of Children with SDB

Polysomnography in Childhood SDB

Treatment of SDB in Children

Alternative Surgical Treatments for Childhood SDB

Alternative Medical Treatments for Childhood SDB

References

53 Sleep and Sleep Disorders in Women

The Menstrual Cycle and the Effects on Sleep

Hormonal and Sleep-Related Changes Across the Menstrual Cycle

Subjective Reports of Sleep Across the Menstrual Cycle

Polysomnographic Studies Across the Menstrual Cycle

Oral Contraceptives and Their Effect on Sleep

Premenstrual-Related Effects on Sleep: Premenstrual Syndrome and Premenstrual Dysphoric Disorder

Painful Menstrual Conditions: Dysmenorrhea and Endometriosis

Fibromyalgia (FM) and Functional Somatic Syndromes

Polycystic Ovarian Syndrome

Sleep-Disordered Breathing in Women

Sleep Disorders Associated with the Menstrual Cycle

Sleep During Pregnancy

Subjective Changes in Sleep

Objective Changes in Sleep

Primary Sleep Disorders Associated with Pregnancy

Risks Associated with Sleep Disruption During Pregnancy

Management of Pregnancy-Related Sleep Disruption

Menopause and the Climacteric

Sleep Disturbance and Climacteric Symptoms

Hormone and Estrogen Replacement Therapy: A Role for Improving Sleep?

Alternatives to Hormone Replacement Therapy for Sleep Disruption

Sleep-Disordered Breathing in the Menopause

Other Factors Influencing Sleep During Menopause

Conclusion

References

54 Sleep, Violence, and Forensic Implications

Introduction

Case Examples

Neurophysiology of Sleep-Related Violence

The State-Dependent Nature of Violence

Sleep-Related Disorders Associated with Violence

Neurologic Conditions Associated with Violent Behaviors

Disorders of Arousal (Confusional Arousals, Sleepwalking, Sleep Terrors)

REM Sleep Behavior Disorder

Nocturnal Seizures

Psychiatric Conditions

Psychogenic Dissociative States

Malingering

Munchausen Syndrome by Proxy

Medicolegal Evaluation

Clinical and Laboratory Evaluation of Waking and Sleep Violence

Legal and Forensic Medicine Evaluation

Forensic Sleep Medicine Experts as Impartial Friends of the Court (Amicus Curae)

Summary and Directions for the Future

References

Add Reference Addendum

55 General Principle of Treatment of Sleep Dysfunction and Pharmacology of Drugs Used in Sleep Disor

Introduction

Neurotransmitters and Circulating Factors Involved in the Regulation of Sleep and Wakefulness

Wake-Promoting Structures and Neurotransmitters

NREM Sleep-Promoting Structures and Neurotransmitters

REM Sleep-Promoting Structures and Neurotransmitters

Role of Neurotransmitter Systems in the Regulation of the Behavioral State: Experimental Approaches

Insomnia: Diagnostic Criteria

Treatment of Primary and Comorbid Insomnia

Preclinical Pharmacology of BZD and Non-BZD Hypnotics

Mechanism of Action of BZD and Non-BZD Hypnotics

Pharmacokinetics of BZD and Non-BZD Hypnotics in Healthy Adults and Populations at Risk

The Effects of BZD and Non-BZD Hypnotics in Patients with Primary Insomnia and Comorbid Insomnia

Benzodiazepine Hypnotics

Non-benzodiazepine Hypnotics

Zolpidem

Zolpidem Immediate-Release in Patients with Chronic Primary Insomnia

Sublingual Low-Dose Zolpidem

Non-nightly Administration of Zolpidem Immediate-Release

Zolpidem Extended-Release in Patients with Chronic Primary Insomnia

Zolpidem Immediate-Release and Extended-Release in Patients with Comorbid Insomnia

Safety and Adverse Effects of Zolpidem

Zopiclone and Eszopiclone

Zopiclone and Eszopiclone in Patients with Chronic Primary Insomnia

Eszopiclone in Patients with Comorbid Insomnia

Adverse Events of Eszopiclone

Zaleplon

Zaleplon in Patients with Chronic Primary Insomnia

Adverse Events of Zaleplon

Ramelteon

Ramelteon in Patients with Chronic Primary Insomnia

Ramelteon in Patients with Comorbid Insomnia

Safety and Adverse Effects of Ramelteon

Doxepin

Doxepin in Patients with Chronic Primary Insomnia

Safety and Adverse Effects of Doxepin

References

56 Sleep and Alternative Medicine: I

Introduction

Problems

Placebo and Nocebo Effects

Herbs

Other CAM Approaches

CAM and Other Sleep Disorders

Nutrition and Supplements [56]

Homeopathy

Acupuncture

Restless Legs Syndrome (RLS) and CAM

Points to Consider for Selecting Complementary Health Approaches for Sleep Problems [69]

Acknowledgments

References

The Author Would Also Want to Acknowledge the Following Sources

57 Approach to Sleep Disorders in the Traditional School of Indian Medicine: Alternative Medicine II

Introduction

Ayurvedic Concept of Dhatus (Doshas) and Sleep

Ayurvedic Concepts About Sleep Types and Factors Modifying It

Ayurvedic Concept of Dreams and Dhatus

Treatments for Sleep Disorders in Ayurveda

Physical Procedures

Exercise

Letting Oil Drip on Head

Making Medicated Oil Stand Over the Scalp for a Prescribed Period of Time

Application of Medicinal Paste on the Head

Herbal Face Pack

Anointing, Massage, and Bath

Tying Herbs on the Head (Hair Lock)

Herbal Medication

Valerian (Tagara)

Root of Piper longum (Pippalimoola)

Citrus medica Linn (Bijapooraka)

Withania somnifera (Ashwagandha)

Acorus calamus Linn. (Araceae)

Acorus gramineus (Bhutanashini)

Polyherbal Preparations

Sleeping Environment and Psychological Factors

Diet Regulations

Yoga and Meditation

Prayer

Summary

Acknowledgments

References

58 Sleep in Extreme Environment

General Introduction

Sleep in Extreme Environment

Sleep in Space Travel

Summary of Sleep Dysfuction in Space

Literature Review

Pathophysiology and Factors Responsible for Sleep Dysfunction in Spaceflight

Countermeasures and Therapy

Sleep at High Attitude

Sleep in the Polar Regions

Sleep in Hot Tropical Climate

Sleep and Deep-Sea Diving

Conclusion

References

59 Erratum to: Sleep Disorders Medicine

Erratum to:S. Chokroverty (ed.), Sleep Disorders Medicine, https://doi.org/10.1007/978-1-4939-65

Epilogue

Index

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An aparitie	3 May 2017
Autor	Sudhansu Chokroverty
Dimensiuni	9781493965762
Editura	Springer
Format	Hardcover
ISBN	9781493965762
Limba	Engleza
Nr pag	2334