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“SLEEPERS”
John Hey MD
DABSM. FAASM
Medical Director--Sleep Disorders Center--Greenwood Leflore Hospital
What we’re gonna do
• Over view of sleep medicine
• Medical/Surgical conditions from sleep disorders
• Office screening for sleep disorders
Sleeper Diagnoses
• Pulmonary Embolus
• Alcoholism/Drugs
• Depression
• Abuse
• Polypharmacy
• Munchausin
• Tubal pregnancy
• Sarcoid
SLEEP DISORDERS
New field in medicine
Confluence of Specialties Psychiatry Neurology ENT Pulmonary Medical Pediatrics
And most of all FP
Significant Dates in Sleep • 1953 REM Sleep discovered
• 1975 First sleep lab at Stanford U
• 1978 First PSG exam
•.1981 CPAP first used for OSA
Levels of Sleep Labs
• Accredited Sleep Center--AASM
• Accredited Sleep Lab--AASM
• Accredited Sleep Clinic--JCAOH
• Non accredited Hospital based lab
• Non accredited Freestanding Lab
• PRN testing site
Sleep Lab vs Sleep Center
• Lab: only study sleep related breathing disorders--85% of sleep disorders for PSG
• Center: study and treat all disorders (89 at last count)--50% are simple insomnia and not needing PSG
• Labs now being phased out
TOOLS OF SLEEP
• Detailed H&P
• ESS and other questionnaires
• Sleep logs
• PSG
• MSLT
• CPAP Titration
• Patient and family education
SLEEP STAGES
• Awake
• Stage I--NREM
• Stage II--NREM
• Stage III-SWS or Delta
• Stage IV-SWS or Delta
• REM
REM CHARACTERISTICS
• Rapid eye movements
• Muscle paralysis
• Irregular breathing
• Difficult to awake
• Subtle EEG changes
• Dreaming
ADULT MEDICAL CONDITIONS
• Cognitive difficulty• Night sweats• Nocturia• Daytime fatigue• Impotency• Enuresis• Headaches• MVA
• OBSTRUCTIVE SLEEP APNEA
• OSA
STROKES
4 times the stroke rate in pts with OSA
3 times MI
2 times HBP
56% of resistant HBP = OSA
15% sudden death in OSA--mostly in daytime
38,000 cardiac deaths due to OSA
30% CHF pt’s have sleep apnea33% epileptics have OSA
SCHOOL PROBLEMS
• Hyperactivity
• Inattention
• Discipline problems
• Irritability
• Poor grades
• THINK OSA in 5-16 year olds
• THINK NARCOLEPSY in 12 yr.. or older
INSOMNIA
• DEPRESSION
• OSA
• ANXIETY
• BIPOLAR
• ALCOHOL/SUBSTANCE ABUSE
• SLEEP MISPRECEPTION
• Medical conditions
“SYNCOPY”
• DROP ATTACKS
• “SEIZURE”
• SUDDEN WEAKNESS
• DROPPING OBJECTS
• SUDDEN CLUMSINES
• THINK ---NARCOLEPSY with Cataplexy
NARCOLEPSY
• SLEEP ATTACKS
• INSOMNIA
• VISUAL HALLUCINATIONS
• PARALYSIS ON AWAKENING
• FATIGUE
• “DEPRESSION”
• CATAPLEXY
MVA
• Pts with OSA --24% fell asleep--74% had accident
• 24,000 auto deaths due to SD
• 12.4 billion dollars lost in auto accidents secondary to SD
• #1 cause of fatal accidents in 18-25 y/o
EVALUATING SLEEP IN THE BUSY OFFICE
• B---bed time problems
• E---excessive day time sleepiness-EDS
• A---awakening in the night
• R---regularity and duration of sleep
• S---sleep disordered breathing-snoring
Workup not complete
until
you think about
SLEEP
DOOR PRIZE QUIZ
• 1--Sleep related laryngospasm
• 2--Sleepwalking
• 3--Sleep state misperception
• 4--Sleep related epilepsy
• 5-Narcolepsy
CONTINUED
• 6--REM behavior disorder
• 7--Limit-setting sleep disorder
• 8--Sleep paralysis
• 9--Terrifying hypnagogic hallucinations
• 10--Sleepwalking-sleep eating
Accreditation RequirementsSleep H & PPatient QuestionnaireCertification by Sleep Doc of necessityQA for tech scoring of PSGInterpretation by DABSM or overeadFollow up by sleep doc
That concludes my talkand I will now try to fend offquestions.