Preface

This course covers the main issues a healthcare provider must know about when it comes to sleep and sleep-related disorders. The prevalence of sleep disorders is high in clinical practices, both inpatient and outpatient, and many practitioners do not really know how to handle them. Through studying this course, you will come to understand what constitutes normal sleep and what the different sleep disorders are all about. The diagnosis, manifestations, and management of sleep disorders and sleep-related disorders are covered so you will come to feel competent about how to help individuals suffering from these types of problems.

The purpose of chapter one in the course is to understand what constitutes normal sleep, including why people need to sleep in the first place. The circadian rhythm is an important part of the sleep-wake cycle and regulates many aspects of sleep. When a person sleeps, they go through many different sleep stages, which together constitutes the sleep cycle. While the rest of the course is about sleep disorders, this chapter introduces the different sleep disorders and what they mean when it comes to getting quality sleep.

Chapter two looks more deeply into the physiology and neuroanatomy of sleep. There are specific brain areas associated with sleep and wakefulness, and there are certain neurotransmitters that are involved with falling asleep and maintaining sleep. There are different EEG patterns associated with the different sleep stages as well. Sleep has a remarkable effect on the respiratory system, the cardiovascular system, and the thermoregulatory system, which are covered as part of this chapter.

Chapter three in the course discusses the different ways of evaluating human sleep. The main thing that is used to evaluate sleep is the polysomnography evaluation, which is also called a sleep study. Several parameters are evaluated as part of polysomnography that look at different aspects of sleep. Sleep stage scoring is a way to evaluate the different aspects of the sleep cycle; this is also discussed as part of the chapter.

Chapter four in the course introduces the topic of sleep deprivation by first defining what it is and what the different types of sleep deprivation there are. There are certain manifestations of sleep deprivation that define a person who is probably sleep deprived. Besides catching up on lost sleep and getting sleep, there are different ways to treat sleep deprivation, which are covered in the chapter. The adverse effects or sequelae of sleep deprivation are also discussed at the end of the chapter; these can occur if sleep deprivation is prolonged and untreated.

The focus of chapter five is insomnia, which is the difficulty in attaining or maintaining sleep. Most people will have episodes of insomnia in their lifetime, but some individuals are chronic insomniacs. There are several different types of insomnia, which have unique symptoms and manifestations. There are different ways to diagnose insomnia and multiple treatment strategies that vary from behavioral to the use of sleeppromoting medications. There are also preventative measures to avoid insomnia, which are covered in this chapter.

Chapter six in the course covers hypersomnias or situations where the individual sleeps more than the normal amount of time or sleeps at inappropriate times. The two main hypersomnias discussed as part of this chapter are primary hypersomnia and narcolepsy. Both of these are considered neurological disorders that adversely affect the amount of sleep the person gets. These can have severe implications on daily functioning for the sufferer. The way in which these disorders are identified and treated are covered as part of this chapter.

The topics of chapter seven are obstructive sleep apnea and central sleep apnea. With obstructive sleep apnea, the patient has breathing efforts but these efforts are impeded, usually by a temporary occlusion of the upper airway. For patients who have central sleep apnea, there are apneic spells in breathing; however, the problem is related to a diminished respiratory drive. There are similarities and differences in the pathophysiology, presentation, workup, and treatment of these sleep-related breathing disorders.

Chapter eight in the course talks about those sleep disorders that are related to the normal 24-hour circadian rhythm in the human body that regulates bodily functions

according to the time of day. The most common of these disorders is jet lag, although there are several other related disorders, including shift work sleep problems, delayed phase sleep disorder, advanced phase sleep disorder, and non-24 sleep disorder, which can happen in people who are blind. These disorders are related to one another in that each involves a problem in the timing of sleep and wakefulness.

Chapter nine takes on the topic of parasomnias. These represent specific disruptions in the normal sleep cycle that are associated with arousal from REM or non-REM sleep. Much of the time, these disorders lead to undesirable behaviors such as sleepwalking or talking in one’s sleep. Others can be extremely distressful, such as can be seen in things like night terrors, sleep paralysis, and nightmare disorder. While these sleep problems can occur at any age, they often start early in life and persist until adulthood or until the problem is treated. There are psychological and medical treatments for these disorders that vary with the problem.

The focus of chapter ten in the course is movement disorders in sleep. These can include sleep bruxism, which is the grinding of one’s teeth during sleep, which is very common in adults and children. There are two related limb movement disorders in sleep, which are restless legs syndrome and periodic limb movement disorder—both of which can greatly disrupt sleep. REM sleep movement disorder is also called REM sleep behavior disorder can be classified as a movement disorder or parasomnia and involves acting out one’s dreams during REM sleep.

Chapter eleven discusses the different sleep disorders and sleeping problems that can exist with certain neurologic disorders and psychiatric disorders as well as the sleep difficulties that happen in individuals with acute and chronic pain. There is a strong relationship between these disorders and the development of sleep problems. Interestingly, while people with these problems often have sleep deficits, the sleep deficits cycle back and contribute to the worsening of the medical and psychiatric disorders the patient has to begin with.

Chapter twelve in the course looks more deeply into the drugs used to treat sleep problems. There is a variety of drugs used to treat insomnia, such as benzodiazepines, sedative-hypnotic drugs, and herbal preparations that help in attaining and maintaining

sleep. Certain antidepressants and antipsychotics are sedating and represent nonaddicting alternatives to improve sleep. For people who have narcolepsy or other causes of hypersomnia, stimulant drugs can be helpful in maintaining wakefulness.

The focus of chapter thirteen is pediatric sleep disorders. An overview of these types of disorders indicates that children have many of the same sleep disorders as adults but at a different frequency than is seen in adults. Nocturnal enuresis is almost always a disorder of children due to a relative immaturity of the nervous system and bladder mechanics. Infants can suffer from benign neonatal sleep myoclonus, which requires an adequate diagnosis but not necessarily any treatment. Also seen in infants is sudden infant death syndrome or SIDS, which is perhaps the most dangerous outcome of sleeping in neonates and young infants.