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Evaluation of Sleep Complaints, An Issue of Sleep Medicine Clinics, E-Book

Evaluation of Sleep Complaints, An Issue of Sleep Medicine Clinics, E-Book

Clete Kushida

(2014)

Additional Information

Abstract

Dr. Clete Kushida has assembled an expert panel of authors focused on Sleep Complaints. Articles in this issue include: Difficulty Falling or Staying Asleep; Irregular Bedtimes and Awakenings; Snoring, Irregular Respiration, Hypoventilation, and Apneas; Periodic or Rhythmic Movements During Sleep; Nightmares and Dream-Enactment Behaviors; Poor Sleep with Age; Difficulty Falling or Staying Asleep and more!

Table of Contents

Section Title Page Action Price
Front Cover Cover
Program Objective iii
Target Audience iii
Learning Objectives iii
Accreditation iii
Disclosure of Conflicts of Interest iii
Unapproved/Off-Label Use Disclosure iii
To Enroll iii
Method of Participation iii
CME Inquiries/Special Needs iii
Contributors v
Consulting Editor v
Editor v
Authors v
Contents vii
Preface: Evaluation of Sleep Complaintsxi vii
Difficulty Falling or Staying Asleep463 vii
Irregular Bedtimes and Awakenings481 vii
Daytime Sleepiness491 vii
Snoring, Irregular Respiration, Hypoventilation, and Apneas499 vii
Restless Legs513 viii
Periodic or Rhythmic Movements During Sleep523 viii
Confusional Arousals, Sleep Terrors, and Sleepwalking537 viii
Nightmares and Dream-Enactment Behaviors553 viii
Jet Lag and Shift Work561 viii
Poor Sleep with Age571 ix
Evaluation of Sleep Complaints xi
Difficulty Falling or Staying Asleep 463
Key points 463
Introduction 463
Barriers/access to care 464
Access to sleep specialists 465
Initial assessment 465
The interview 466
Difficulties with initial sleep onset 467
Models and causes of insomnia 467
Arousal system overactivity 467
Circadian rhythm disorders 470
Clinical vignette 471
Nighttime and early morning awakenings 472
The 2-Process Model and Homeostatic Load Issues 472
Sleep-fragmenting conditions 473
Medical conditions 473
Psychiatric conditions 474
Diagnostic and assessment tools 474
Sleep diaries 474
Actigraphy 475
Sleep testing 475
Laboratory testing and other assessments 475
Psychological and neurobehavioral testing 475
Summary 476
References 476
Irregular Bedtimes and Awakenings 481
Key points 481
Introduction: nature of the problem 481
Basics of Sleep and Circadian Rhythms 481
Overview of the Circadian Rhythm Sleep Disorders 482
Delayed sleep phase disorder 482
Advanced sleep phase disorder 482
Free-running disorder or non–24-hour sleep-wake syndrome 483
Irregular sleep-wake disorder 483
Other considerations for irregular sleep 483
Patient history 483
Questions About Sleep Timing 483
Questions to Assess Circadian Preference 483
Questions to Assess Insomnia 483
Questions to Assess Daytime Sleepiness 484
Questions to Differentiate Mood or Psychiatric Disorders 484
Questions to Identify Potential Consequences 484
Physical examination 484
Sleep tests and additional testing 485
Epworth Sleepiness Scale 485
Sleep Log 485
Actigraphy 485
Polysomnography 485
Multiple Sleep Latency Testing and Maintenance of Wakefulness Testing 485
Other Laboratory Studies and Imaging 485
Treatment options 486
Regular Sleep Schedule 486
Phototherapy 486
Cognitive Behavioral Therapy for Insomnia 486
Chronotherapy 487
Melatonin 487
Further Treatments 487
Summary 487
References 488
Daytime Sleepiness 491
Key points 491
Introduction 491
Patient history 491
Insufficient Sleep Time 493
Insomnia 493
Circadian Rhythm Disorders 494
Restless Leg Syndrome and Periodic Limb Movement Disorder 494
Sleep-Related Breathing Disorders 495
Narcolepsy and Other Hypersomnias of Central Origin 495
Parasomnias 495
Physical examination 495
Additional testing 496
Surveys 496
Actigraphy 496
Laboratory Testing 496
Polysomnography, Multiple Sleep Latency Test, and Maintenance of Wakefulness Test 496
References 498
Snoring, Irregular Respiration, Hypoventilation, and Apneas 499
Key points 499
Introduction 499
Snoring 499
Clinical Evaluation 500
Diagnostic Evaluation 500
Treatment 500
Apnea 501
Obstructive Sleep Apnea 502
Central Sleep Apnea 502
Clinical Evaluation 503
Diagnostic Evaluation 504
Treatment 504
Positive airway pressure 504
Oral appliance 505
Surgical procedures 505
Behavioral therapy 505
Adjunctive therapies 506
Irregular respiration 506
Clinical Evaluation 506
Diagnostic Evaluation 507
Treatment 507
Hypoventilation 507
Clinical Evaluation 507
Diagnostic Evaluation 508
Treatment 508
Summary 508
References 509
Restless Legs 513
Key points 513
Clinical features 513
Epidemiology 514
Cause 514
Clinical evaluation 515
Differential Diagnosis for Restless Legs Syndrome 515
Treatment 516
Nonpharmacological Therapy 516
Iron therapy 516
Pharmacologic Therapy 516
Dopamine agonists 516
Anticonvulsants 517
α-2-δ ligand 517
Opiates 517
Sedative hypnotics 518
Clonidine 518
Amantadine 518
Magnesium 518
Treatment algorithms 518
Treatment of restless legs syndrome in special populations 519
Restless Legs Syndrome Treatment in Pregnancy 519
Restless Legs Syndrome in Hemodiaylsis Patients 519
Refractory restless legs syndrome 519
Summary 519
References 519
Periodic or Rhythmic Movements During Sleep 523
Key points 523
Clinical case 523
Sleep-related rhythmic movement disorder 523
Epidemiology 524
Clinical Evaluation 524
Diagnosis 524
Differential Diagnosis 525
Treatment 525
Clinical case (continued) 526
Periodic limb movements 526
Epidemiology 526
Objective Evaluation 526
Concept of Periodic Limb Movement Disorder 526
Diagnosis 527
Periodic Limb Movement Disorder as an Exclusion Diagnosis 527
Treatment of Periodic Limb Movement Disorder 528
Clinical case (continued) 529
Bruxism 529
Epidemiology 529
Clinical Diagnosis 529
Primary and Secondary Bruxism 529
Diagnostic Evaluation 530
Differential Diagnosis 531
Treatment 531
Clinical case (end) 531
Miscellaneous conditions 531
Hypnagogic Foot Tremor 531
Alternating Leg Muscle Activation 531
Propriospinal Myoclonus 532
References 532
Confusional Arousals, Sleep Terrors, and Sleepwalking 537
Key points 537
Introduction 537
Epidemiology and prevalence 538
Role of Familial Traits and Genetics in Disorders of Arousal 538
Pathophysiology 538
Factors precipitating disorders of arousal 539
Clinical presentation 540
Confusional Arousals 540
Sleepwalking 540
Sleep Terrors 541
Specialized Forms of Disorders of Arousal 541
Sleep-related eating disorder 541
Sleep-related abnormal sexual behaviors 542
Diagnosis 543
Investigations 544
Role of Polysomnography in the Diagnosis of Disorders of Arousal 544
Electroencephalography Findings in Disorders of Arousal 544
Differential diagnosis 544
Management 546
Confusional Arousals 547
Sleepwalking 547
Sleep Terrors 547
Summary 547
Acknowledgments 547
References 548
Jet Lag and Shift Work 561
Key points 561
Introduction 561
Jet lag 562
Diagnosis of Jet Lag Disorder 562
Case Example of Jet Lag Without Jet Lag Disorder 563
Shift work disorder 563
Diagnosis of Shift Work Disorder 563
Case Example of Shift Work Disorder 564
Treatment strategies for jet lag and shift work disorder 566
Phototherapy 566
Jet lag 566
Bright light for jet lag 566
Use of light for shift work 567
Melatonin Supplements 568
Melatonin for shift work 568
Overlap Schedule Versus Full Entrainment for Shift Work 569
Pharmacologic Approaches to Sleepiness 569
Modafinil 569
References 570
Poor Sleep with Age 571
Key points 571
Introduction 571
Sleep changes with aging 571
Sleep Architecture 571
Napping 572
Clinical Evaluation of Sleep Complaints 572
Sleep History 572
Physical Examination 574
Questionnaires and Diagnostic Testing 574
Sleep disorders across the lifespan 575
Children (0–12 Years of Age) 575
Prevalence and characteristics of sleep disorders 575
Management 576
Adolescent (12–18 Years of Age) 576
Prevalence and characteristics of sleep disorders 576
Management 577
Middle-Aged Adults (18–60 Years of Age) 578
Prevalence and characteristics of sleep disorders 578
Management 579
Elderly (﹥60 Years of Age) 580
Prevalence and characteristics of sleep disorders 580
Management 581
Summary 582
References 582
Index 585
A 585
B 585
C 585
D 585
E 586
F 586
H 586
I 586
J 586
L 587
M 587
N 587
O 587
P 587
R 587
S 588