BOOK
Principles and Practice of Sleep Medicine E-Book
Meir H. Kryger | Thomas Roth | William C. Dement
(2010)
Additional Information
Book Details
Abstract
Principles and Practice of Sleep Medicine, 5th Edition, by Meir H. Kryger, MD, FRCPC, Thomas Roth, PhD, and William C. Dement, MD, PhD, delivers the comprehensive, dependable guidance you need to effectively diagnose and manage even the most challenging sleep disorders. Updates to genetics and circadian rhythms, occupational health, sleep in older people, memory and sleep, physical examination of the patient, comorbid insomnias, and much more keep you current on the newest areas of the field. A greater emphasis on evidence-based approaches helps you make the most well-informed clinical decisions. And, a new more user-friendly, full-color format, both in print and online, lets you find the answers you need more quickly and easily. Whether you are preparing for the new sleep medicine fellowship examination, or simply want to offer your patients today's best care, this is the one resource to use!
- Make optimal use of the newest scientific discoveries and clinical approaches that are advancing the diagnosis and management of sleep disorders.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front cover | cover | ||
| Principles and Practice of Sleep Medicine | i | ||
| Copyright page | iv | ||
| Dedication | v | ||
| Poetry | vii | ||
| Contributors | ix | ||
| Foreword | xxiii | ||
| Preface | xxvii | ||
| Acknowledgments | xxix | ||
| Abbreviations | xxxi | ||
| Table of Contents | xxxv | ||
| Video Contents | xli | ||
| I Principles of Sleep Medicine | 1 | ||
| 1 Normal Sleep and its Variations | 3 | ||
| 1 History of Sleep Physiology and Medicine | 3 | ||
| Abstract | 14 | ||
| SLEEP AS A PASSIVE STATE | 3 | ||
| THE ELECTRICAL ACTIVITY OF THE BRAIN | 4 | ||
| THE ASCENDING RETICULAR SYSTEM | 5 | ||
| EARLY OBSERVATIONS OF SLEEP PATHOLOGY | 5 | ||
| SIGMUND FREUD AND THE INTERPRETATION OF DREAMS | 6 | ||
| CHRONOBIOLOGY | 6 | ||
| THE DISCOVERY OF REM SLEEP | 6 | ||
| ALL-NIGHT SLEEP RECORDINGS AND THE BASIC SLEEP CYCLE | 7 | ||
| REM SLEEP IN ANIMALS | 8 | ||
| THE DUALITY OF SLEEP | 9 | ||
| PREMONITIONS OF SLEEP MEDICINE | 9 | ||
| SLEEP-ONSET REM PERIODS AND CATAPLEXY | 9 | ||
| THE NARCOLEPSY CLINIC: A FALSE START | 9 | ||
| EUROPEAN INTEREST | 9 | ||
| BENZODIAZEPINES AND HYPNOTIC EFFICACY STUDIES | 10 | ||
| THE DISCOVERY OF SLEEP APNEA | 10 | ||
| ITALIAN SYMPOSIA | 10 | ||
| BIRTH PANGS | 10 | ||
| THE EARLY DEVELOPMENT OF SLEEP MEDICINE CLINICAL PRACTICE | 11 | ||
| CLINICAL SIGNIFICANCE OF EXCESSIVE DAYTIME SLEEPINESS | 12 | ||
| FURTHER DEVELOPMENT OF SLEEP MEDICINE | 12 | ||
| THE TURN OF THE CENTURY AND BEYOND | 13 | ||
| REFERENCES | 14 | ||
| 2 Normal Human Sleep: | 16 | ||
| Abstract | 25 | ||
| SLEEP DEFINITIONS | 16 | ||
| SLEEP ONSET | 17 | ||
| Definition of Sleep Onset | 17 | ||
| Electromyogram | 17 | ||
| Electrooculogram | 18 | ||
| Electroencephalogram | 18 | ||
| Behavioral Concomitants of Sleep Onset | 18 | ||
| Simple Behavioral Task | 18 | ||
| Visual Response | 19 | ||
| Auditory Response | 19 | ||
| Olfactory Response | 19 | ||
| Response to Meaningful Stimuli | 19 | ||
| Hypnic Myoclonia | 19 | ||
| Memory Near Sleep Onset | 19 | ||
| Learning and Sleep | 20 | ||
| PROGRESSION OF SLEEP ACROSS THE NIGHT | 20 | ||
| Pattern of Sleep in a Normal Young Adult | 20 | ||
| First Sleep Cycle | 20 | ||
| NREM-REM Cycle | 21 | ||
| Distribution of Sleep Stages across the Night | 21 | ||
| Length of Sleep | 21 | ||
| Generalizations about Sleep in the Normal Young Adult | 21 | ||
| Factors Modifying Sleep Stage Distribution | 22 | ||
| Age | 22 | ||
| Prior Sleep History | 22 | ||
| Circadian Rhythms | 23 | ||
| Temperature | 23 | ||
| Drug Ingestion | 23 | ||
| Pathology | 24 | ||
| Narcolepsy | 24 | ||
| Sleep Apnea Syndromes | 24 | ||
| Sleep Fragmentation | 24 | ||
| Acknowledgments | 25 | ||
| REFERENCES | 25 | ||
| 3 Normal Aging | 27 | ||
| Abstract | 37 | ||
| SLEEP ARCHITECTURE | 27 | ||
| Percentage of Time Spent in Each Sleep Stage | 28 | ||
| Arousals during Sleep | 29 | ||
| Comorbidities | 29 | ||
| Slow-Wave Sleep | 29 | ||
| CIRCADIAN RHYTHMS IN AGING | 30 | ||
| CAUSES AND CONSEQUENCES OF POOR SLEEP IN OLD AGE | 32 | ||
| Causes | 32 | ||
| Potential Consequences | 33 | ||
| RESTLESS LEGS SYNDROME AND PERIODIC LIMB MOVEMENTS IN SLEEP | 33 | ||
| SLEEP-DISORDERED BREATHING | 34 | ||
| Risk Factors | 34 | ||
| Outcomes | 35 | ||
| WHY DO OLDER PEOPLE NAP? | 36 | ||
| BASIC SCIENCE CONSIDERATIONS | 36 | ||
| SUMMARY | 37 | ||
| Acknowledgment | 37 | ||
| REFERENCES | 37 | ||
| 4 Daytime Sleepiness and Alertness | 42 | ||
| Abstract | 51 | ||
| INTRODUCTION | 42 | ||
| EPIDEMIOLOGY OF SLEEPINESS | 42 | ||
| Sleepiness in Limited Populations or Populations of Convenience | 42 | ||
| Sleepiness in Representative Populations | 42 | ||
| Risk Factors for Sleepiness | 43 | ||
| NATURE OF SLEEPINESS | 43 | ||
| Physiological Need State | 43 | ||
| Neural Substrates of Sleepiness | 44 | ||
| ASSESSMENT OF SLEEPINESS | 45 | ||
| Quantifying Sleepiness | 45 | ||
| Relation of Sleepiness to Behavioral Functioning | 46 | ||
| Clinical Assessment of Sleepiness | 47 | ||
| DETERMINANTS OF SLEEPINESS | 47 | ||
| Quantity of Sleep | 47 | ||
| Quality of Sleep | 48 | ||
| Circadian Rhythms | 48 | ||
| CNS Drugs | 49 | ||
| Sedating Drug Effects | 49 | ||
| Alerting Drug Effects | 50 | ||
| Influence of Basal Sleepiness | 50 | ||
| CNS Pathologies | 50 | ||
| CLINICAL AND PUBLIC HEALTH SIGNIFICANCE OF SLEEPINESS | 50 | ||
| REFERENCES | 51 | ||
| 5 Acute Sleep Deprivation | 54 | ||
| Abstract | 54 | ||
| TOTAL SLEEP DEPRIVATION | 54 | ||
| Behavioral Effects | 54 | ||
| Sleep/Circadian Influences | 54 | ||
| Arousal Influences | 55 | ||
| Activity | 55 | ||
| Bright light | 55 | ||
| Noise | 55 | ||
| Temperature | 55 | ||
| Posture | 56 | ||
| Drugs | 56 | ||
| Motivation or Interest | 56 | ||
| Group Effects | 57 | ||
| Repeated Periods of Sleep Loss | 57 | ||
| Individual Characteristics | 57 | ||
| Age | 57 | ||
| Sensitivity to Sleep Loss | 57 | ||
| Personality and Psychopathology | 57 | ||
| Test Characteristics and Types | 58 | ||
| Length of Test | 58 | ||
| Knowledge of Results | 58 | ||
| Test Pacing | 58 | ||
| Proficiency Level | 58 | ||
| Difficulty or Complexity | 58 | ||
| Memory Requirement | 58 | ||
| Executive Function | 58 | ||
| Subjective (versus Objective) Measures | 58 | ||
| EEG Measures | 58 | ||
| Summary | 59 | ||
| PHYSIOLOGIC EFFECTS OF SLEEP DEPRIVATION | 59 | ||
| Neurologic Changes | 59 | ||
| Imaging Studies | 59 | ||
| Clinical EEG | 59 | ||
| Autonomic Changes | 59 | ||
| Biochemical Changes | 60 | ||
| Gene Studies | 60 | ||
| Clinical Changes | 60 | ||
| Immune Function | 60 | ||
| Pain | 60 | ||
| Weight Control and Insulin | 61 | ||
| Exercise | 61 | ||
| Summary | 61 | ||
| SLEEP FRAGMENTATION | 61 | ||
| Experimental Sleep Fragmentation | 61 | ||
| Sleep Disorders and Fragmentation | 62 | ||
| RECOVERY SLEEP | 62 | ||
| Performance Effects | 62 | ||
| EEG Effects | 63 | ||
| Relationship between EEG and Psychomotor Performance Recovery Effects | 64 | ||
| CONCLUSIONS | 64 | ||
| Acknowledgements | 64 | ||
| REFERENCES | 64 | ||
| 6 Chronic Sleep Deprivation | 67 | ||
| Abstract | 67 | ||
| INCIDENCE OF CHRONIC SLEEP RESTRICTION | 67 | ||
| THEORETICAL PERSPECTIVES ON SLEEP NEED AND SLEEP DEBT | 67 | ||
| Basal Sleep Need | 67 | ||
| Core Sleep versus Optional Sleep | 68 | ||
| Adaptation to Sleep Restriction | 68 | ||
| Two-Process Model Predictions of Sleep Restriction | 68 | ||
| EFFECTS OF CHRONIC SLEEP RESTRICTION | 69 | ||
| Sleep Architecture | 69 | ||
| Sleep Propensity | 69 | ||
| Waking Electroencephalogram | 70 | ||
| Cognitive Effects | 70 | ||
| Driving Performance | 72 | ||
| Subjective Sleepiness and Mood | 72 | ||
| Individual Differences in Responses to Chronic Sleep Restriction | 72 | ||
| PHYSIOLOGIC EFFECTS | 73 | ||
| Endocrine and Metabolic Effects | 73 | ||
| Immune and Inflammatory Effects | 73 | ||
| Cardiovascular Effects | 73 | ||
| Acknowledgments | 73 | ||
| REFERENCES | 73 | ||
| 2 Sleep Mechanisms and Phylogeny | 76 | ||
| 7 Neural Control of Sleep in Mammals | 76 | ||
| Abstract | 89 | ||
| DIVERSE BRAIN REGIONS MODULATE WAKING AND NREM SLEEP | 76 | ||
| Isolated Forebrain | 76 | ||
| Diencephalon | 77 | ||
| Thalamus | 77 | ||
| Lower Brainstem | 77 | ||
| RETICULAR ACTIVATING SYSTEM AND DELINEATION OF AROUSAL SYSTEMS | 77 | ||
| WAKE-ON, REM-OFF AROUSAL SYSTEMS | 78 | ||
| Serotonin | 78 | ||
| Norepinephrine | 79 | ||
| Histamine | 79 | ||
| Orexin | 79 | ||
| WAKE-ON, REM-ON AROUSAL SYSTEMS | 79 | ||
| Acetylcholine | 79 | ||
| Dopamine | 79 | ||
| Glutamate | 79 | ||
| SLEEP-PROMOTING MECHANISMS | 79 | ||
| A POA Sleep-Promoting System | 80 | ||
| c-Fos Mapping | 80 | ||
| THE ORCHESTRATION OF SLEEP BY THE POA HYPNOGENIC SYSTEM | 81 | ||
| THALAMIC–CORTICAL INTERACTIONS AND THE GENERATION OF THE SLEEP EEG | 82 | ||
| Sleep Spindles | 84 | ||
| Delta Waves | 84 | ||
| Slow Oscillations | 84 | ||
| INTEGRATION OF CIRCADIAN RHYTHMS AND SLEEP | 86 | ||
| THE POA, THERMOREGULATION, AND CONTROL OF SLEEP | 86 | ||
| HIERARCHICAL CONTROL MODEL | 86 | ||
| SLEEP-PROMOTING NEUROCHEMICAL AGENTS | 87 | ||
| Adenosine | 87 | ||
| Proinflammatory Cytokines | 88 | ||
| Prostaglandin D2 | 88 | ||
| Growth Hormone–Releasing Hormone | 88 | ||
| Sleep as Detoxification or Protection from Oxidative Stress | 88 | ||
| SUMMARY | 89 | ||
| Acknowledgments | 89 | ||
| REFERENCES | 89 | ||
| 8 REM Sleep* | 92 | ||
| Abstract | 108 | ||
| CHARACTERISTICS OF REM SLEEP | 92 | ||
| REM GENERATION MECHANISMS | 93 | ||
| Technical Considerations | 93 | ||
| Inactivation of Neurons by Lesions, Inhibition, Antisense Administration, or Genetic Manipulation | 93 | ||
| Activation of Neurons by Electrical or Chemical Stimulation, Gene Activation, or Ion Channel Manipulation | 94 | ||
| Observation of Neuronal Activity | 95 | ||
| Summary | 96 | ||
| Transection Studies | 96 | ||
| Localized Lesion Studies | 98 | ||
| Stimulation Studies | 99 | ||
| Neuronal Activity, Transmitter Release | 99 | ||
| Medial Brainstem Reticular Formation | 99 | ||
| Cholinergic Cell Groups | 100 | ||
| Cells with Activity Selective for REM Sleep | 100 | ||
| Monoamine-Containing Cells | 100 | ||
| Other Cholinergic Cells in Lateral Pontine Regions | 100 | ||
| Fos Labeling | 100 | ||
| CONTROL OF MUSCLE TONE | 101 | ||
| NARCOLEPSY AND HYPOCRETIN | 103 | ||
| THE FUNCTIONS OF REM SLEEP | 105 | ||
| REFERENCES | 108 | ||
| 9 Phylogeny of Sleep Regulation | 112 | ||
| Abstract | 112 | ||
| SLEEP REGULATION IN MAMMALS | 112 | ||
| The Origins and Definition of Sleep Homeostasis | 112 | ||
| Sleep Duration and Sleep Intensity | 113 | ||
| Daily Time Course of Slow-Wave Activity and Its Sleep-Wake Dependence | 115 | ||
| Is REM Sleep Homeostatically Regulated? | 116 | ||
| The Waking EEG Reflects Homeostatic Mechanisms | 116 | ||
| Circadian versus Homeostatic Aspects of Sleep Regulation | 116 | ||
| Special Features | 118 | ||
| Herbivores: Cows and Horses, Ruminants and Nonruminants | 118 | ||
| Sleep Regulation: Unihemispheric Sleep and Regional Aspects of Sleep | 118 | ||
| Sleep and Hibernation | 118 | ||
| Other Measures for Sleep Regulation: Sleep or Rest Consolidation | 119 | ||
| SLEEP REGULATION IN NONMAMMALIAN VERTEBRATES | 119 | ||
| Birds | 119 | ||
| Reptiles | 120 | ||
| Amphibians and Fish | 120 | ||
| SLEEP REGULATION IN INVERTEBRATES | 120 | ||
| OUTLOOK | 122 | ||
| REFERENCES | 123 | ||
| 10 Sleep in Animals: | 126 | ||
| Abstract | 126 | ||
| ADAPTIVE INACTIVITY | 126 | ||
| QUANTITATIVE ANALYSES OF THE CORRELATES OF SLEEP DURATION | 127 | ||
| THE DIVERSITY OF SLEEP | 129 | ||
| SLEEP IN MONOTREMES | 130 | ||
| REINDEER | 132 | ||
| BIRDS | 132 | ||
| WALRUS | 133 | ||
| SLEEP IN CETACEANS (DOLPHINS AND WHALES) | 133 | ||
| SLEEP IN OTARIIDS (EARED SEALS) | 135 | ||
| SLEEP REBOUND | 135 | ||
| CONCLUSION | 136 | ||
| Acknowledgment | 136 | ||
| REFERENCES | 136 | ||
| 3 Genetics of Sleep | 139 | ||
| 11 Introduction | 139 | ||
| REFERENCES | 140 | ||
| 12 Circadian Clock Genes | 141 | ||
| Abstract | 141 | ||
| THE MAMMALIAN CELLULAR CIRCADIAN CLOCK | 141 | ||
| CIRCADIAN CLOCK PROPERTIES AND CLOCK GENES | 141 | ||
| POSITIVE ELEMENTS | 142 | ||
| Clock | 142 | ||
| Bmal1 | 143 | ||
| NEGATIVE ELEMENTS | 143 | ||
| Period Genes | 143 | ||
| Cryptochromes | 144 | ||
| MODULATORS OF Period | 144 | ||
| Timeless | 144 | ||
| Casein Kinase 1 | 145 | ||
| MODULATORS OF Bmal1 | 145 | ||
| Rev-erbα and ROR | 145 | ||
| MODULATORS OF Cry | 145 | ||
| Fbxl3 | 145 | ||
| Other bHLH-PAS Family Members | 146 | ||
| Dec1 and Dec2 | 146 | ||
| OUTPUT REGULATION | 146 | ||
| Clock | 146 | ||
| Prokineticin 2 | 146 | ||
| Transforming Growth Factor α | 146 | ||
| VPAC2 | 146 | ||
| Cardiomyotrophin-like Cytokine | 146 | ||
| INPUT REGULATION | 146 | ||
| Melanopsin | 146 | ||
| Rab3a | 147 | ||
| CONCLUSIONS | 147 | ||
| REMAINING QUESTION: CLOCK GENES AS SLEEP GENES? | 147 | ||
| Acknowledgements | 148 | ||
| REFERENCES | 148 | ||
| 13 Genetics of Sleep in a Simple Model Organism: | 151 | ||
| Abstract | 151 | ||
| DROSOPHILA AS A MODEL SYSTEM FOR GENETICS | 151 | ||
| DROSOPHILA AS A MODEL FOR STUDIES OF SLEEP | 152 | ||
| DROSOPHILA CIRCADIAN BEHAVIOR REVEALS CONSERVED MECHANISMS BETWEEN FLIES AND HUMANS | 153 | ||
| CELLULAR AND MOLECULAR BASIS OF DROSOPHILA SLEEP | 154 | ||
| SPECIFIC NEURAL CIRCUITS ARE IMPORTANT FOR SLEEP–WAKE REGULATION | 154 | ||
| GENETICS AND PHARMACOLOGY OF SLEEP: WHICH MOLECULES REGULATE SLEEP? | 155 | ||
| Circadian Clock Pathway | 155 | ||
| Stress and Immune Pathways | 156 | ||
| Membrane Excitability | 156 | ||
| Growth Factors and Signal Transduction | 156 | ||
| Arousal Neurotransmitters: Monoaminergic Arousal Pathways | 157 | ||
| Sleep Neurotransmitters: GABA and Adenosine Sleep Pathways | 157 | ||
| WHICH GENES ARE REGULATED BY SLEEP–WAKE? | 158 | ||
| SUMMARY | 158 | ||
| REFERENCES | 158 | ||
| 14 Genetic Basis of Sleep in Rodents | 161 | ||
| Abstract | 171 | ||
| GENE EXPRESSION, mRNAs, AND MICROARRAY STUDIES | 161 | ||
| IDENTIFICATION OF ALLELES THAT INFLUENCE SLEEP OR SLEEP-RELATED TRAITS | 164 | ||
| MUTAGENESIS AND KNOCKOUTS | 168 | ||
| High-Throughput Screening | 169 | ||
| Targeted Gene Deletion | 169 | ||
| Genetic Regulation of Homeostasis | 170 | ||
| Genetic Regulation of Circadian Rhythm | 170 | ||
| REFERENCES | 171 | ||
| 15 Genetic Basis of Sleep in Healthy Humans | 175 | ||
| Abstract | 182 | ||
| EVIDENCE FOR GENOTYPE-DEPENDENT DIFFERENCES IN DIURNAL PREFERENCE, SLEEP TIMING, SLEEP DURATION, SLEEP ARCHITECTURE, AND SLEEP EEG | 175 | ||
| GENES CONTRIBUTING TO HUMAN MORNINGNESS–EVENINGNESS AND TIMING OF SLEEP | 175 | ||
| Candidate Genes | 175 | ||
| Genome-Wide Association Study | 178 | ||
| GENES CONTRIBUTING TO HABITUAL SLEEP DURATION | 178 | ||
| GENES CONTRIBUTING TO SLEEP ARCHITECTURE | 178 | ||
| Slow-Wave Sleep and REM Sleep | 178 | ||
| The Sleep EEG: Among the Most Heritable Traits in Humans | 179 | ||
| GENES CONTRIBUTING TO THE SLEEP EEG | 180 | ||
| GENETIC BASIS OF SLEEP–WAKE REGULATION: INTERACTION BETWEEN HOMEOSTATIC AND CIRCADIAN SYSTEMS | 181 | ||
| CONCLUDING REMARKS | 181 | ||
| Acknowledgements | 181 | ||
| REFERENCES | 182 | ||
| 16 Genetics of Sleep and Sleep Disorders in Humans | 184 | ||
| Abstract | 184 | ||
| GENETIC STUDIES OF HUMAN SLEEP: METHODOLOGICAL LIMITATIONS | 185 | ||
| GENETIC FACTORS UNDERLYING THE CIRCADIAN CLOCK AND CIRCADIAN RHYTHM DISORDERS | 187 | ||
| GENETIC FACTORS REGULATING EEG AND THE SLEEP HOMEOSTAT | 188 | ||
| GENETICS OF NARCOLEPSY | 188 | ||
| Heritability | 188 | ||
| Human Leukocyte Antigen in Narcolepsy | 189 | ||
| Hypocretin Deficiency in Narcolepsy | 189 | ||
| Non-HLA, Non-Hypocretin Genes in Narcolepsy | 189 | ||
| GENETICS OF RESTLESS LEGS SYNDROME | 190 | ||
| Heritability | 190 | ||
| RLS Linkage Studies | 190 | ||
| Genome-Wide Associations | 190 | ||
| MEIS1 as a Candidate and Its Symptomatology | 191 | ||
| BTBD9 as a Candidate and Its Symptomatology | 191 | ||
| LBXCOR as a Candidate and Symptomatology | 191 | ||
| PTPRD and Nitric Oxide Synthase as Candidates in RLS | 191 | ||
| GENETICS OF OTHER HYPERSOMNIAS, INSOMNIA, AND PARASOMNIAS | 192 | ||
| AUTOSOMAL DOMINANT FRONTAL LOBE EPILEPSY | 192 | ||
| GENETICS OF OBSTRUCTIVE SLEEP APNEA | 193 | ||
| CONGENITAL CENTRAL HYPOVENTILATION SYNDROME | 193 | ||
| SLEEP DISORDERS IN ASSOCIATION WITH OTHER GENETIC DISORDERS | 194 | ||
| CONCLUSION | 194 | ||
| REFERENCES | 195 | ||
| 4 Physiology in Sleep | 199 | ||
| 17 Relevance of Sleep Physiology for Sleep Medicine Clinicians | 199 | ||
| Abstract | 199 | ||
| REFERENCES | 200 | ||
| 18 What Brain Imaging Reveals about Sleep Generation and Maintenance | 201 | ||
| Abstract | 201 | ||
| FUNCTIONAL SEGREGATION AND INTEGRATION DURING NORMAL HUMAN SLEEP | 201 | ||
| NON–RAPID EYE MOVEMENT SLEEP | 201 | ||
| PROCESSING OF EXTERNAL STIMULI DURING NREM SLEEP | 204 | ||
| RAPID EYE MOVEMENT SLEEP | 205 | ||
| Reorganization of Regional Brain Function during REM Sleep: Relation with Dream Characteristics | 205 | ||
| Brain Imaging and Other Characteristic Features of REM Sleep | 206 | ||
| Experience-Dependent Modifications of Regional Brain Function during NREM and REM Sleep | 206 | ||
| BRAIN IMAGING AND NEURAL CORRELATES OF SLEEP–WAKE CYCLE REGULATION | 206 | ||
| BRAIN IMAGING AND NEURAL CORRELATES OF HUMAN SLEEP DEPRIVATION | 208 | ||
| FUNCTIONAL NEUROIMAGING IN SLEEP DISORDERS | 209 | ||
| Insomnia and Brainstem and Hypothalamic Arousal Networks | 209 | ||
| Insomnia, Disorders of Emotion, and Limbic and Paralimbic Arousal Networks | 210 | ||
| Insomnia, Disorders of Emotion, and Neocortical Arousal Networks | 211 | ||
| REM Sleep in Depression | 212 | ||
| Fatal Familial Insomnia | 212 | ||
| SUMMARY | 212 | ||
| Acknowledgements | 212 | ||
| REFERENCES | 212 | ||
| 19 Cardiovascular Physiology: | 215 | ||
| Abstract | 223 | ||
| SLEEP-STATE CONTROL OF CARDIOVASCULAR FUNCTION | 215 | ||
| CARDIORESPIRATORY INTERACTIONS | 216 | ||
| Central Mechanisms | 216 | ||
| Cardiorespiratory Homeostasis | 217 | ||
| SLEEP STATE–DEPENDENT CHANGES IN HEART RHYTHM | 218 | ||
| Heart Rate Surges | 218 | ||
| Heart Rhythm Pauses | 219 | ||
| CORONARY ARTERY BLOOD FLOW REGULATION DURING SLEEP | 220 | ||
| IMPACT OF SLEEP ON ARRHYTHMOGENESIS | 220 | ||
| Central Nervous System Sites Influencing Cardiac Electrical Stability | 220 | ||
| Autonomic Factors in Arrhythmogenesis during Sleep | 222 | ||
| SUMMARY | 223 | ||
| Acknowledgments | 223 | ||
| REFERENCES | 223 | ||
| 20 Cardiovascular Physiology: | 226 | ||
| Abstract | 226 | ||
| INTRODUCTION | 226 | ||
| THE CARDIOVASCULAR AUTONOMIC NERVOUS SYSTEM: DEFINITION AND FUNCTIONS | 226 | ||
| Arterial Baroreflex | 227 | ||
| Cardiopulmonary Reflexes | 227 | ||
| The Chemoreflexes | 227 | ||
| MEASURES TO EXPLORE AUTONOMIC CHANGES DURING SLEEP AND THEIR PHYSIOLOGICAL SIGNIFICANCE | 227 | ||
| Heart Rate, Arterial Blood Pressure, and Their Variability | 227 | ||
| Baroreflex Sensitivity | 229 | ||
| Preejection Period | 229 | ||
| Microneurographic Recording of Sympathetic Nerve Activity | 229 | ||
| Peripheral Arterial Tone and Pulse Transit Time | 230 | ||
| Systemic Catecholamines | 230 | ||
| SLEEP RELATED CARDIOVASCULAR AUTONOMIC CHANGES | 230 | ||
| Day–Night Changes in Neural Circulatory Control | 230 | ||
| Physiologic Responses to NREM and REM Sleep | 230 | ||
| RR Variability and EEG Coupling | 231 | ||
| Autonomic Responses Associated with Arousal from Sleep and from Periodic Leg Movements | 231 | ||
| Arousals | 231 | ||
| Periodic Leg Movements during Sleep | 231 | ||
| IMPACT OF AGING ON NEURAL CIRCULATORY RESPONSE TO NORMAL SLEEP | 232 | ||
| EFFECTS OF DISORDERED SLEEP AND PRIMARY AUTONOMIC DYSFUNCTION ON DAY–NIGHT AUTONOMIC CHANGES | 233 | ||
| Effects of Sleep Loss and Sleep Disorders on Nighttime BP | 233 | ||
| Loss of Diurnal Variation in Autonomic Function in Diabetes Mellitus: What Comes First? | 233 | ||
| SYMPATHETIC ACTIVATION IN OBSTRUCTIVE SLEEP APNEA | 234 | ||
| SUMMARY | 235 | ||
| REFERENCES | 235 | ||
| 21 Respiratory Physiology: | 237 | ||
| Abstract | 237 | ||
| RESPIRATORY NEUROBIOLOGY: BASIC OVERVIEW | 237 | ||
| Medullary Respiratory Neurons and Motoneurons | 237 | ||
| Pre-Bötzinger Complex | 237 | ||
| Neuronal Connections | 238 | ||
| SLEEP NEUROBIOLOGY: BASIC OVERVIEW | 239 | ||
| Wakefulness | 239 | ||
| NREM Sleep | 240 | ||
| REM Sleep | 240 | ||
| CONTROL OF RESPIRATORY MOTONEURONS | 240 | ||
| DETERMINANTS OF RESPIRATORY MOTONEURON ACTIVITY | 241 | ||
| Tonic and Respiratory-Related Inputs to Respiratory Motoneurons | 241 | ||
| Electrical Properties of Motoneurons | 242 | ||
| Presynaptic Modulation | 242 | ||
| Tonic and Respiratory-Related Activity in Respiratory Muscle | 243 | ||
| NEUROMODULATION OF RESPIRATORY MOTONEURONS ACROSS SLEEP–WAKE STATES | 243 | ||
| Excitatory Influences across Sleep–Wake States | 244 | ||
| Inhibitory Influences across Sleep–Wake States | 245 | ||
| CONTROL OF RESPIRATORY NEURONS | 246 | ||
| Respiratory Neurons Vary in the Strength of Their Relationship to Breathing | 246 | ||
| Respiratory Neuron Activity in NREM Sleep | 246 | ||
| Respiratory Neuron Activity in REM Sleep | 246 | ||
| Neuromodulation of Respiratory Neurons across Sleep–Wake States | 247 | ||
| Acknowledgments | 248 | ||
| REFERENCES | 248 | ||
| 22 Respiratory Physiology: | 250 | ||
| Abstract | 250 | ||
| INTRODUCTION | 250 | ||
| Chemical Information | 250 | ||
| Mechanical Information | 250 | ||
| Information from Higher Central Nervous System Centers | 250 | ||
| PHYSIOLOGY OF VENTILATORY CONTROL DURING SLEEP | 250 | ||
| Hypoxic Ventilatory Response during Sleep | 251 | ||
| II Practice of Sleep Medicine | 639 | ||
| 8 Impact, Presentation, and Diagnosis | 641 | ||
| 56 Approach to the Patient with Disordered Sleep | 641 | ||
| Abstract | 641 | ||
| CHIEF COMPLAINT AND HISTORY | 641 | ||
| Insomnia | 643 | ||
| Excessive Sleepiness | 643 | ||
| Nocturnal Movements, Behaviors, and Sensations | 644 | ||
| MEDICATION USE AND PAST MEDICAL HISTORY | 644 | ||
| FAMILY HISTORY | 644 | ||
| SOCIAL HISTORY | 644 | ||
| REVIEW OF SYSTEMS | 645 | ||
| PHYSICAL EXAMINATION | 645 | ||
| FORMULATION AND DIAGNOSTIC STUDIES | 645 | ||
| CONCLUSION | 646 | ||
| REFERENCES | 646 | ||
| 57 Cardinal Manifestations of Sleep Disorders | 647 | ||
| Abstract | 647 | ||
| INSOMNIA | 647 | ||
| EXCESSIVE DAYTIME SLEEPINESS | 650 | ||
| FATIGUE | 650 | ||
| SNORING | 650 | ||
| SLEEP APNEA | 651 | ||
| MORNING HEADACHE | 653 | ||
| CATAPLEXY | 653 | ||
| SLEEP PARALYSIS | 653 | ||
| HYPNAGOGIC AND HYPNOPOMPIC HALLUCINATIONS | 653 | ||
| AUTOMATIC BEHAVIOR | 654 | ||
| EXCESSIVE MOVEMENT IN SLEEP OR PARASOMNIA | 654 | ||
| Sleeptalking | 654 | ||
| Sleepwalking | 654 | ||
| Sleep Terrors | 654 | ||
| Confusional Arousals and Sleep Drunkenness | 655 | ||
| Sleep-Related Groaning (Catathrenia) | 655 | ||
| Dream-Related Movement | 655 | ||
| Nightmares | 655 | ||
| Rhythmic Movement Disorder | 655 | ||
| Bruxism | 655 | ||
| RESTLESS LEGS SYNDROME AND PERIODIC MOVEMENTS OF SLEEP | 656 | ||
| SYSTEMIC FEATURES | 656 | ||
| PEDIATRIC CARDINAL MANIFESTATIONS | 656 | ||
| SUMMARY | 657 | ||
| REFERENCES | 657 | ||
| 58 Physical Examination in Sleep Medicine | 658 | ||
| Abstract | 658 | ||
| SLEEP APNEA | 658 | ||
| Overall Inspection | 658 | ||
| Craniofacial Factors | 658 | ||
| Nasal Factors | 658 | ||
| Neck Circumference | 658 | ||
| Examination of the Pharynx | 660 | ||
| Examination of the Tonsils | 660 | ||
| Neurologic Examination | 661 | ||
| Cardiopulmonary Examination | 662 | ||
| NARCOLEPSY | 662 | ||
| RESTLESS LEGS SYNDROME | 663 | ||
| PARASOMNIAS | 663 | ||
| Nocturnal Eating Disorder and Sleep-Related Eating Disorder | 663 | ||
| REM Sleep Behavior Disorder | 663 | ||
| Sleep-Related Movement Disorders | 663 | ||
| Bruxism | 663 | ||
| Acknowledgment | 664 | ||
| REFERENCES | 664 | ||
| 59 Use of Clinical Tools and Tests in Sleep Medicine | 666 | ||
| Abstract | 666 | ||
| EVALUATION FOR SLEEP-RELATED BREATHING DISORDERS | 666 | ||
| History and Questionnaires | 666 | ||
| Physical Examination | 668 | ||
| Nocturnal Polysomnography | 671 | ||
| Modified Forms of the Polysomnogram | 672 | ||
| Portable Recording | 672 | ||
| Studies of Airway Morphology | 673 | ||
| EVALUATION OF HYPERSOMNOLENCE | 674 | ||
| History and Questionnaires | 674 | ||
| Physical Examination | 674 | ||
| Nocturnal Polysomnography | 674 | ||
| Multiple Sleep Latency Test | 674 | ||
| Use of the MSLT in the Diagnosis of Narcolepsy | 675 | ||
| Variations of the Multiple Sleep Latency Test and Other Physiologic Tests | 675 | ||
| EVALUATION OF INSOMNIA | 675 | ||
| EVALUATION FOR SUSPECTED PARASOMNIAS | 676 | ||
| BEYOND SENSITIVITY, SPECIFICITY, AND PREDICTIVE VALUE: DECISION AND COST-EFFECTIVENESS ANALYSES | 676 | ||
| REFERENCES | 677 | ||
| 60 Classification of Sleep Disorders | 680 | ||
| Abstract | 680 | ||
| INSOMNIAS | 680 | ||
| Primary Insomnia | 680 | ||
| Secondary Insomnia | 683 | ||
| SLEEP-RELATED BREATHING DISORDERS | 683 | ||
| Primary Sleep Apneas | 684 | ||
| Obstructive Sleep Apneas | 684 | ||
| Hypoventilation and Hypoxemia | 684 | ||
| HYPERSOMNIA OF CENTRAL ORIGIN | 684 | ||
| CIRCADIAN RHYTHM SLEEP DISORDERS | 685 | ||
| PARASOMNIAS | 685 | ||
| SLEEP-RELATED MOVEMENT DISORDERS | 686 | ||
| OTHER SLEEP DISORDERS | 687 | ||
| Isolated Symptoms, Apparently Normal Variants, and Unresolved Issues | 687 | ||
| Other Organic Disorders Commonly Encountered in the Differential Diagnosis of Sleep Disorders | 687 | ||
| Other Psychiatric or Behavioral Disorders Commonly Encountered in the Differential Diagnosis of Sleep Disorders | 687 | ||
| CURRENT AND FUTURE CLASSIFICATION CONSIDERATIONS | 687 | ||
| Comorbid Insomnia and Insomnia Research Criteria | 687 | ||
| Hypersomnia | 689 | ||
| Parasomnia | 689 | ||
| REFERENCES | 690 | ||
| 61 Epidemiology of Sleep Disorders | 694 | ||
| Abstract | 694 | ||
| SLEEP DURATION | 694 | ||
| INSOMNIA AND USE OF HYPNOTIC AGENTS | 695 | ||
| Use of Hypnotics | 698 | ||
| CIRCADIAN RHYTHMS AND THEIR DISORDERS | 698 | ||
| EXCESSIVE SLEEPINESS AND HYPERSOMNIA | 698 | ||
| NARCOLEPSY AND NARCOLEPSY-LIKE SYMPTOMS | 701 | ||
| SNORING, SLEEP-DISORDERED BREATHING, AND SLEEP APNEA SYNDROME | 702 | ||
| A Syndrome or a Disease? | 702 | ||
| Prevalence of Sleep Apnea | 702 | ||
| Role of Obesity as a Risk Factor for Snoring and Sleep Apnea | 705 | ||
| Other Risk Factors for Snoring and Sleep Apnea | 705 | ||
| Snoring and Sleep Apnea in Children | 705 | ||
| Sleep Apnea among Elderly People | 705 | ||
| Arterial Hypertension and Snoring | 705 | ||
| Snoring, Sleep Apnea, and Heart Disease | 705 | ||
| Snoring, Sleep Apnea, and Brain Infarction | 706 | ||
| Snoring and Sudden Death | 706 | ||
| Snoring and Dementia | 706 | ||
| Evolution of Obstructive Sleep Apnea Syndrome | 706 | ||
| RESTLESS LEGS SYNDROME | 708 | ||
| REM SLEEP BEHAVIOR DISORDER | 708 | ||
| PARASOMNIAS | 708 | ||
| REFERENCES | 709 | ||
| 62 Sleep Medicine, Public Policy, and Public Health | 716 | ||
| Abstract | 716 | ||
| SLEEP IN MODERN SOCIETY | 716 | ||
| THE CHALLENGE | 717 | ||
| KEY AREAS FOR EDUCATION AND AWARENESS | 717 | ||
| Cardiovascular Disease | 717 | ||
| Metabolism, Obesity, and Diabetes | 718 | ||
| Transportation Safety | 718 | ||
| Relieving Sleepiness with Naps: Aviation as a Case Study | 720 | ||
| Health Care Workers | 720 | ||
| Hazardous Workplaces | 721 | ||
| Adolescents and Young Adults | 721 | ||
| MAKING SLEEP A MATTER OF PUBLIC HEALTH AND PUBLIC POLICY | 721 | ||
| CONCLUSION | 722 | ||
| REFERENCES | 723 | ||
| 63 Sleep Forensics | 725 | ||
| EVOLUTION OF LEGAL THOUGHT | 725 | ||
| General | 725 | ||
| Sleep | 725 | ||
| EVOLUTION OF CONSCIOUSNESS THOUGHT | 726 | ||
| Waking Consciousness | 726 | ||
| Dreaming Consciousness | 727 | ||
| COMPLEX BEHAVIOR ARISING FROM SLEEP | 728 | ||
| Consciousness as a Continuum | 728 | ||
| Fixed Action Patterns and Central Pattern Generators: A Neuroethologic Approach to Behavior | 729 | ||
| THE DEVELOPMENT OF SLEEP FORENSICS | 730 | ||
| CLINICAL GUIDELINES TO ASSIST IN DETERMINING PURPORTED VIOLENCE ARISING FROM SLEEP | 730 | ||
| THE ROLE OF THE SLEEP MEDICINE SPECIALIST | 731 | ||
| Expert Witness Qualifications | 731 | ||
| Guidelines for Expert Testimony | 731 | ||
| CONCLUSION | 731 | ||
| REFERENCES | 732 | ||
| 9 Occupational Sleep Medicine | 734 | ||
| 64 Introduction | 734 | ||
| Abstract | 734 | ||
| FATIGUE AS A FUNCTION OF SLEEP–WAKE HISTORY, CIRCADIAN RHYTHM, AND WORK LOAD | 734 | ||
| MANAGING SLEEP AND CIRCADIAN RHYTHM–RELATED FATIGUE RISK | 735 | ||
| DROWSY DRIVING | 735 | ||
| MONITORING SLEEP AND WORKPLACE PERFORMANCE | 736 | ||
| SHIFT WORK, SHIFT-WORK SLEEP DISORDER, AND JET LAG | 736 | ||
| POLICE, FIRST RESPONDERS, AND THE MILITARY | 736 | ||
| PHARMACOLOGIC MANAGEMENT OF SLEEP AND FATIGUE | 736 | ||
| SLEEP, STRESS, AND BURNOUT | 736 | ||
| THE SCIENCE AND ART OF OCCUPATIONAL SLEEP MEDICINE | 737 | ||
| REFERENCES | 737 | ||
| 65 Performance Deficits during Sleep Loss: | 738 | ||
| Abstract | 738 | ||
| THE NATURE OF SLEEPINESS-INDUCED PERFORMANCE DEFICITS | 738 | ||
| FUNCTIONAL BRAIN IMAGING STUDIES OF SLEEPINESS AND PERFORMANCE | 739 | ||
| INFLUENCE OF THE CIRCADIAN RHYTHM OF ALERTNESS ON PERFORMANCE | 740 | ||
| TIME ON TASK (FATIGUE) EFFECTS | 740 | ||
| THE NONSPECIFICITY OF SLEEP LOSS–INDUCED PERFORMANCE DEFICITS | 742 | ||
| PERFORMANCE PREDICTION MODELING | 742 | ||
| CONCLUSION | 743 | ||
| Disclaimer | 743 | ||
| REFERENCES | 743 | ||
| 66 Fatigue and Performance Modeling | 745 | ||
| Abstract | 745 | ||
| COMPONENTS OF A FATIGUE MODEL | 745 | ||
| Circadian Oscillators | 745 | ||
| Sleep–Wake Homeostatic Regulation | 746 | ||
| Sleep Inertia | 746 | ||
| MODULATION OF PERFORMANCE | 746 | ||
| RECUPERATION DURING SLEEP | 746 | ||
| SLEEP ESTIMATION | 748 | ||
| ADAPTATION OF CIRCADIAN PHASE | 748 | ||
| PREDICTING PERFORMANCE | 748 | ||
| FATIGUE MODELING APPLIED TO OPERATIONAL SETTINGS | 749 | ||
| LIMITATIONS AND ENHANCEMENTS OF FATIGUE MODELS | 750 | ||
| REFERENCES | 751 | ||
| 67 Fatigue, Performance, Errors, and Accidents | 753 | ||
| Abstract | 753 | ||
| SLEEP, CIRCADIAN, AND TIME-ON-TASK FACTORS MODULATING RISK OF ERRORS AND ACCIDENTS | 753 | ||
| FATIGUE, PERFORMANCE IMPAIRMENT, AND WAKE- STATE INSTABILITY | 754 | ||
| PREDICTING ACCIDENTS | 755 | ||
| MODELING SLEEP–WAKE–WORK AND ACCIDENT RISK | 756 | ||
| CONCLUSION | 758 | ||
| REFERENCES | 758 | ||
| 68 Fatigue Risk Management | 760 | ||
| Abstract | 760 | ||
| A THEORETICAL FRAMEWORK | 760 | ||
| DYNAMICS OF SLEEP LOSS AND RECOVERY | 761 | ||
| Effects of Total Sleep Deprivation and Sleep Restriction | 761 | ||
| Influence of Task Type | 762 | ||
| Individual Differences in Sensitivity to Sleep Loss | 762 | ||
| Restorative Value of Sleep | 762 | ||
| Role of the Circadian Pacemaker | 763 | ||
| MANAGING FATIGUE RISK | 763 | ||
| Safety Management Systems | 764 | ||
| The Role of Regulation | 764 | ||
| CHALLENGES | 765 | ||
| Scientific Knowledge Gaps | 765 | ||
| Knowledge Transfer | 765 | ||
| Changing Roles and Competing Interests | 765 | ||
| Cost | 766 | ||
| Evaluation | 766 | ||
| CONCLUSIONS | 766 | ||
| Acknowledgement | 766 | ||
| REFERENCES | 766 | ||
| 69 Drowsy Driving | 769 | ||
| Abstract | 769 | ||
| PREVALENCE AND ASSOCIATED RISKS | 769 | ||
| Rest/Activity Patterns | 769 | ||
| Sleep Disorders | 770 | ||
| Drugs | 771 | ||
| EVALUATION OF RISK IN PATIENTS WITH SLEEPINESS WHILE DRIVING | 771 | ||
| IMPACT OF TREATMENT AND COUNTERMEASURES ON ACCIDENT RISK | 771 | ||
| DRIVING LICENSE REGULATIONS | 771 | ||
| FUTURE CONSIDERATIONS | 772 | ||
| REFERENCES | 773 | ||
| 70 Sleep and Performance Monitoring in the Workplace: | 775 | ||
| Abstract | 775 | ||
| SLEEP, CIRCADIAN RHYTHM, WORKLOAD, AND OPERATIONAL PERFORMANCE | 775 | ||
| Sleep and Sleep Loss | 775 | ||
| Circadian Rhythm | 776 | ||
| Workload and Operational Environment | 776 | ||
| TECHNIQUES FOR MEASURING SLEEP AND PERFORMANCE IN THE OPERATIONAL ENVIRONMENT | 777 | ||
| Historical Perspective | 777 | ||
| Measuring Sleep | 777 | ||
| Performance and Total Sleep Time in 24 Hours | 777 | ||
| Performance and Napping | 777 | ||
| Added, Simulator-Derived, and Embedded Performance Metrics | 777 | ||
| A REVIEW OF FIELD SLEEP AND PERFORMANCE STUDIES | 778 | ||
| METHODOLOGICAL FACTORS IN FIELD STUDIES OF SLEEP AND PERFORMANCE | 778 | ||
| Studies in Military Field Training Exercises | 778 | ||
| Studies of Physicians in Training | 778 | ||
| Effect of Sleep on Task Performance | 779 | ||
| Effect of Sleep on Cognitive Performance | 779 | ||
| A Series of Field Studies in Other Industries | 779 | ||
| Driving Home after the Night Shift | 780 | ||
| More Studies in Train Drivers | 780 | ||
| USEFULNESS OF FIELD STUDIES OF SLEEP AND PERFORMANCE | 781 | ||
| SLEEP AND PERFORMANCE STUDIES AND THE MANAGEMENT OF FATIGUE-ASSOCIATED RISK OF ERROR, INCIDENT, AND ACCIDENT | 781 | ||
| THE FUTURE OF SLEEP AND PERFORMANCE MONITORING IN THE WORKPLACE | 781 | ||
| REFERENCES | 781 | ||
| 71 Shift Work, Shift-Work Disorder, and Jet Lag | 784 | ||
| Abstract | 784 | ||
| SHIFT WORK | 784 | ||
| Prevalence | 784 | ||
| Types | 784 | ||
| Night-Shift Workers | 784 | ||
| Early Morning-Shift Workers | 785 | ||
| Evening/Afternoon-Shift Workers | 785 | ||
| Rotating-Shift Workers | 785 | ||
| Circadian Misalignment and Effects of Light Exposure | 785 | ||
| Morbidity Associated with Shift Work | 786 | ||
| Sleepiness and Insomnia | 786 | ||
| Reduced Alertness and Accidents | 786 | ||
| Work Productivity and Quality of Life | 786 | ||
| Health Effects of Shift Work | 787 | ||
| SHIFT-WORK DISORDER | 787 | ||
| Prevalence | 787 | ||
| Morbidity | 788 | ||
| Clinical Evaluation | 788 | ||
| Treatment | 789 | ||
| Circadian Interventions | 789 | ||
| Improving Diurnal (and Nocturnal) Sleep | 790 | ||
| Pharmacologically Enhancing Alertness | 791 | ||
| Enhancing Alertness with Combined Treatments | 791 | ||
| Management Guidelines for Shift-Work Sleep Disorder | 791 | ||
| JET LAG | 791 | ||
| Treatment | 792 | ||
| Promoting Sleep during Flight and in the New Time Zone | 793 | ||
| Promoting Wakefulness during Flight in the New Time Zone | 793 | ||
| Circadian Adaptation | 793 | ||
| Partial Preflight Circadian Adaptation | 793 | ||
| CONCLUSIONS | 794 | ||
| Acknowledgments | 795 | ||
| REFERENCES | 795 | ||
| 72 Sleep Problems in First Responders and the Military | 799 | ||
| Abstract | 799 | ||
| PREVALENCE OF SLEEP LOSS, MORTALITY, AND MORBIDITY | 799 | ||
| IMPLICATIONS FOR OTHER FIRST RESPONDERS AND THE MILITARY | 800 | ||
| Performance Challenges and Sleep Loss | 800 | ||
| Decision-Making | 802 | ||
| SYSTEMATICALLY MANAGING, PREVENTING, AND TREATING SLEEP-DEPRIVED POLICE | 802 | ||
| Shift Work: Interaction between the Organization and the Individual | 802 | ||
| Shift Work: The Individual | 804 | ||
| Shift Work: The Organization | 804 | ||
| Exemplary Unified Approach | 806 | ||
| REFERENCES | 807 | ||
| 73 Pharmacologic Management of Performance Deficits Resulting from Sleep Loss and Circadian Desynchrony | 809 | ||
| Abstract | 809 | ||
| PHARMACOLOGIC STRATEGIES FOR IMPROVING COGNITIVE PERFORMANCE | 810 | ||
| Caffeine | 810 | ||
| Modafinil | 810 | ||
| Dextroamphetamine | 811 | ||
| Summary and Future Directions | 811 | ||
| PHARMACOLOGIC STRATEGIES FOR IMPROVING SLEEP | 811 | ||
| Prescription Sleep-Inducing Agents | 811 | ||
| Melatonin | 812 | ||
| Summary and Future Directions | 812 | ||
| CONCLUSION | 812 | ||
| Disclaimer | 812 | ||
| REFERENCES | 812 | ||
| 74 Sleep, Stress, and Burnout | 814 | ||
| Abstract | 814 | ||
| THE CROSS-SECTIONAL CONNECTION BETWEEN STRESS AND SLEEP | 814 | ||
| THE PROSPECTIVE CONNECTION BETWEEN STRESS AND SLEEP | 815 | ||
| RUMINATION AND ANTICIPATION | 816 | ||
| POSTTRAUMATIC STRESS | 816 | ||
| SLEEP PHYSIOLOGY THAT SEEMS TO LINK SLEEP WITH STRESS | 816 | ||
| SIMILARITY OF MORBIDITY DUE TO STRESS AND SLEEP LOSS | 817 | ||
| BURNOUT AND SLEEP | 817 | ||
| MEASURING STRESS | 818 | ||
| CONCLUSION | 818 | ||
| REFERENCES | 818 | ||
| 10 Insomnia | 822 | ||
| 75 Insomnia: | 822 | ||
| EPIDEMIOLOGY | 822 | ||
| DIAGNOSIS AND ASSESSMENT | 822 | ||
| PATHOPHYSIOLOGY AND BIOLOGICAL FINDINGS | 823 | ||
| TREATMENT | 824 | ||
| Behavioral Treatment | 824 | ||
| Pharmacologic Treatment | 824 | ||
| DEVELOPMENT OF TREATMENT GUIDELINES | 825 | ||
| FUTURE DIRECTIONS | 825 | ||
| Acknowledgments | 825 | ||
| REFERENCES | 825 | ||
| 76 Insomnia: | 827 | ||
| Abstract | 827 | ||
| EPIDEMIOLOGY | 827 | ||
| Definition of Insomnia | 827 | ||
| Evaluation | 828 | ||
| Prevalence | 828 | ||
| Comorbidities | 829 | ||
| Demographics | 830 | ||
| Aging | 830 | ||
| Gender | 831 | ||
| Ethnicity | 832 | ||
| Education and Socioeconomic Status | 832 | ||
| RISK FACTORS | 833 | ||
| Static Risk Factors for Insomnia | 833 | ||
| Gender | 833 | ||
| Age | 833 | ||
| Ethnicity | 833 | ||
| Genetics | 833 | ||
| Modifiable Risk Factors for Insomnia | 833 | ||
| Hyperarousal | 833 | ||
| Stress and Life Events | 834 | ||
| Transient Insomnia | 834 | ||
| Medical Comorbidities | 834 | ||
| Psychological Comorbidities | 834 | ||
| Hypotheses for How Risk Factors Result in Chronic Insomnia | 834 | ||
| Insomnia as a Risk Factor | 834 | ||
| Evidence | 834 | ||
| Hypotheses for Why Insomnia Is a Risk for Other Disorders | 835 | ||
| CONCLUSIONS | 835 | ||
| REFERENCES | 835 | ||
| 77 Insomnia: | 838 | ||
| Abstract | 838 | ||
| DIAGNOSING INSOMNIA | 838 | ||
| CLINICAL ASSESSMENT | 838 | ||
| Theoretical Guide | 841 | ||
| Developmental, Social, and Cultural Context | 842 | ||
| Clinical Interview | 842 | ||
| Focusing on the Night | 842 | ||
| Sleep History | 842 | ||
| Current Sleep | 842 | ||
| Questionnaire Measures | 843 | ||
| Sleep Diary | 843 | ||
| Focusing on the Day | 844 | ||
| Comorbid Disorders | 844 | ||
| Comorbid Psychiatric Disorders | 844 | ||
| Comorbid Sleep Disorders | 845 | ||
| Comorbid Medical Disorders | 845 | ||
| Perpetuating Factors | 846 | ||
| Testing | 846 | ||
| Polysomnography | 846 | ||
| Actigraphy | 846 | ||
| TREATMENT OUTCOME | 847 | ||
| SUMMARY | 847 | ||
| REFERENCES | 847 | ||
| 78 Models of Insomnia | 850 | ||
| THE DEFINITION OF INSOMNIA | 850 | ||
| THE STIMULUS CONTROL MODEL | 850 | ||
| Basic Description | 850 | ||
| Strengths and Weaknesses | 850 | ||
| Implications for Current and Future Research and Therapeutics | 851 | ||
| THE 3P MODEL | 851 | ||
| Basic Description | 851 | ||
| Strengths and Weaknesses | 852 | ||
| Implications for Current and Future Research and Therapeutics | 852 | ||
| THE NEUROCOGNITIVE MODEL | 853 | ||
| Basic Description | 853 | ||
| Strengths and Weaknesses | 854 | ||
| Strengths | 854 | ||
| Weaknesses | 855 | ||
| Implications for Current and Future Research and Therapeutics | 855 | ||
| THE PSYCHOBIOLOGICAL INHIBITION MODEL | 855 | ||
| Basic Description | 855 | ||
| Psychobiological Framework for Normal Sleep | 856 | ||
| Insomnia as the Failure to Inhibit Wakefulness | 856 | ||
| Cognitive Factors Trigger the Failure to Inhibit Wakefulness | 856 | ||
| Strengths and Weaknesses | 856 | ||
| Strengths | 856 | ||
| Limitations | 857 | ||
| Implications for Current and Future Research and Therapeutics | 857 | ||
| THE DROSOPHILA MODEL | 858 | ||
| Basic Description | 858 | ||
| Strengths and Weaknesses | 859 | ||
| Implications for Current and Future Research and Therapeutics | 860 | ||
| THE CAGE EXCHANGE MODEL OF ACUTE INSOMNIA | 860 | ||
| Basic Description | 860 | ||
| Strengths and Weaknesses | 861 | ||
| Implications for Current and Future Research and Therapeutics | 862 | ||
| CONCLUSION | 862 | ||
| Acknowledgement | 863 | ||
| REFERENCES | 863 | ||
| 79 Psychological and Behavioral Treatments for Insomnia I: | 866 | ||
| Abstract | 866 | ||
| CURRENT TREATMENT PRACTICES | 866 | ||
| TREATMENTS | 866 | ||
| Rationale and Indications | 866 | ||
| Sleep Restriction | 867 | ||
| Stimulus Control Therapy | 867 | ||
| Relaxation-Based Interventions | 868 | ||
| Cognitive Therapy | 868 | ||
| Sleep Hygiene Education | 869 | ||
| Multifaceted Cognitive Behavior Therapy | 869 | ||
| Complementary and Alternative Therapies | 869 | ||
| TREATMENT OUTCOME EVIDENCE | 869 | ||
| Evidence for Efficacy | 869 | ||
| Generalizability of Treatment Effects to Comorbid Insomnia | 870 | ||
| Treatment of Insomnia in Older Adults | 879 | ||
| Initial Treatment Response versus Long-Term Outcome | 879 | ||
| Clinical Significance | 880 | ||
| Comparative Efficacy of Single Therapies | 880 | ||
| Treatment Specificity and Mechanisms of Changes | 880 | ||
| Combined Cognitive Behavior Therapy and Medication | 880 | ||
| Efficacy versus Effectiveness | 881 | ||
| Clinical and Practical Considerations | 881 | ||
| SUMMARY AND CONCLUSION | 881 | ||
| Acknowledgment | 882 | ||
| REFERENCES | 882 | ||
| 80 Psychological and Behavioral Treatments for Insomnia II: | 884 | ||
| Abstract | 884 | ||
| INTERVENTION TOOLS | 884 | ||
| Sleep Diaries | 884 | ||
| Actigraphy | 884 | ||
| Written Behavioral Prescriptions and Instruments for Home Use | 885 | ||
| Sleep Restriction | 886 | ||
| Stimulus Control | 888 | ||
| Sleep Hygiene | 888 | ||
| Sleep Education | 889 | ||
| Additional Educational Resources | 889 | ||
| Cognitive Therapy Tools | 889 | ||
| Structured Problem-Solving | 889 | ||
| Thought Records | 889 | ||
| METHODS OF DELIVERING TREATMENT | 890 | ||
| Individualized Treatment | 890 | ||
| Group Treatment Protocols | 890 | ||
| Delivery by Nontraditional Providers | 892 | ||
| Delivering Treatment Outside of the Office | 892 | ||
| Summary | 893 | ||
| TREATMENT DOSING | 893 | ||
| TREATMENT ACCEPTABILITY AND ADHERENCE ISSUES | 894 | ||
| Treatment Acceptability | 895 | ||
| Treatment Adherence | 895 | ||
| APPLICATIONS TO PATIENTS WITH COMORBID PSYCHIATRIC CONDITIONS | 896 | ||
| APPLICATIONS TO PATIENTS WITH COMORBID MEDICAL CONDITIONS | 897 | ||
| The Impact of Disease-Specific Symptoms on Insomnia | 897 | ||
| Addressing Pain and Fatigue with Psychological and Behavioral Strategies | 898 | ||
| Increasing Activities | 898 | ||
| Scheduling Short Naps | 898 | ||
| Other Considerations for Patients with Chronic Pain | 898 | ||
| Cognitive Issues in Insomnia Related to Medical Treatment | 898 | ||
| Excessive Concern about Sleep | 898 | ||
| Unhelpful Sleep-Related Beliefs | 898 | ||
| Alterations in Standard Behavioral Instructions | 899 | ||
| Addressing Psychological Reactions to the Comorbid Medical Disease | 899 | ||
| USE WITH YOUNGER AND OLDER ADULTS | 899 | ||
| Young Children | 899 | ||
| Adolescents | 899 | ||
| Older Adults | 900 | ||
| SUMMARY AND CONCLUSIONS | 900 | ||
| REFERENCES | 900 | ||
| 81 Pharmacologic Treatment of Insomnia: | 905 | ||
| Abstract | 905 | ||
| EFFICACY AND EFFECTIVENESS | 905 | ||
| Primary Insomnia | 906 | ||
| Comorbid Insomnia | 907 | ||
| Effectiveness Studies | 908 | ||
| Impact on Daytime Symptoms of Insomnia and Comorbid Conditions | 909 | ||
| SAFETY | 910 | ||
| Residual Effects | 910 | ||
| Amnestic Effects | 910 | ||
| Discontinuation Effects | 910 | ||
| Abuse Potential | 911 | ||
| Falls, Cognitive Effects, and Other Considerations for Older Adults | 911 | ||
| Complex Behavior in Sleep | 912 | ||
| Mortality | 912 | ||
| CONSIDERATIONS FOR PHARMACOTHERAPY | 912 | ||
| CONCLUSION | 913 | ||
| REFERENCES | 913 | ||
| 82 Pharmacologic Treatment: | 916 | ||
| Abstract | 916 | ||
| MELATONIN AND MELATONIN RECEPTOR AGONISTS | 916 | ||
| Melatonin | 916 | ||
| Overview | 916 | ||
| Index | 1697 | ||
| A | 1697 | ||
| B | 1700 | ||
| C | 1700 | ||
| D | 1703 | ||
| E | 1705 | ||
| F | 1706 | ||
| G | 1707 | ||
| H | 1708 | ||
| I | 1709 | ||
| J | 1711 | ||
| K | 1711 | ||
| L | 1711 | ||
| M | 1711 | ||
| N | 1713 | ||
| O | 1714 | ||
| P | 1715 | ||
| Q | 1717 | ||
| R | 1717 | ||
| S | 1719 | ||
| T | 1721 | ||
| U | 1722 | ||
| V | 1722 | ||
| W | 1723 | ||
| Y | 1723 | ||
| Z | 1723 | ||
| Kryger’s Atlas of Clinical Sleep Medicine: | e1 | ||
| Cardiac Rhythm Abnormalities | e1 | ||
| Neurologic Diseases | e1 | ||
| Movement Disorders | e4 | ||
| Seizure | e4 | ||
| Artifacts in Sleep Recordings | e7 | ||
| New Web-Only Sections | e8 | ||
| Sleep Staging | e9 | ||
| Rapid Review of Polysomnographs | e9 |