Disorders of Sleep and Wakefulness
Approach to the Patient: Sleep Disorders
Patients may seek help from a physician because of one of several symptoms: (1) an acute or chronic inability to initiate or maintain sleep adequately at night (insomnia); (2) chronic fatigue, sleepiness, or tiredness during the day; or (3) a behavioral manifestation associated with sleep itself. Complaints of insomnia or excessive daytime sleepiness should be approached as symptoms (much like fever or pain) of underlying disorders.
Persistent psychophysiologic insomnia is a behavioral disorder in which patients are preoccupied with a perceived inability to sleep adequately at night. This sleep disorder begins like any other acute insomnia; however, the poor sleep habits and sleep-related anxiety ("insomnia phobia") persist long after the initial incident. Such patients become hyperaroused by their own efforts to sleep or by the sleep environment, and the insomnia becomes a conditioned or learned response.
Insomnia Associated with Neurologic Disorders
A variety of neurologic diseases result in sleep disruption through both indirect, nonspecific mechanisms (e.g., pain in cervical spondylosis or low back pain) or by impairment of central neural structures involved in the generation and control of sleep itself. For example, dementia from any cause has long been associated with disturbances in the timing of the sleep-wake cycle, often characterized by nocturnal wandering and an exacerbation of symptomatology at night (so-called sundowning).
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Harrison's Internal Medicine Chapter 28. Sleep Disorders
Sleep Disorders: Introduction Disturbed sleep is among the most frequent health complaints physicians encounter. More than one-half of adults in the United States experience at least intermittent sleep disturbances.
For most, it is an occasional night of poor sleep or daytime sleepiness. However, the Institute of Medicine estimates that 50–70 million Americans suffer from a chronic disorder of sleep and wakefulness, which can lead to serious impairment of daytime functioning.
Worry had completely defeated me. My mind was so confused and troubled that I could see no joy in living. My nerves were so strained that I could neither sleep at night nor relax by day. My three young children were widely separated, living with relatives. My husband, having recently returned from the armed service, was in another city trying to establish a law practice. I felt all the insecurities and uncertainties of the postwar readjustment period. I was threatening my husband's career, my children's natural endowment of a happy, normal home life, and I was also threatening my...
The answer depends on when you will need the money,
your goals, and if you will be able to sleep at night if you pur-
chase a risky investment where you could lose your principal.
For instance, if you are saving for retirement, and you have
35 years before you retire, you may want to consider riskier
investment products, knowing that if you stick to only the “sav-
ings” products or to less risky investment products, your money
will grow too slowly—or, given inflation and taxes, you may
lose the purchasing power of your money. A frequent mistake
people make is putting...
.THE GREATEST DISTANCE BETWEEN TWO POINTS IS AT 6:45 A.M. a. The Direction of the Undershirt It happened with greater frequency as he grew older, and today was one of the days. Brank found himself by the side of the bed, his undershirt half on, half off, and for the life of him he couldn’t think whether he was going to sleep at night or getting up in the morning.
Listen to part of Ms Linda Cupple’s talk again and write the missing words. (2ms) A serious calling (1) ________is calling very late at night, or very early in the morning. This (2) ________mistake is made mostly by young people who consider 10 or 11 p.m , when a lot of tired (3) ________are happily sleeping , the shank of the evening .So please tell your friends not to call after 10 o’clock. The shock of (4) ________ out of a sound sleep and the fright of that instant thought – “There is an accident”-are enough to give your...
Directions: Fill in the blanks in the following sentences with the
correct form of the verb given. (30 points)
Example: She (sleep, not) didn’t sleep last night.
1. I (call, not) __________ Clara yet. I’ll call her later.
2. We (finish, not) __________ this exam yet.
3. Mr. Perez travels to Washington, D.C. frequently. He (fly)
___________ there many times.
4. Lucas is not going to eat lunch with us today. He (eat, already)
____________. He (eat) __________ an hour ago.
5. I (meet) __________ Ann’s husband. I (meet) __________ him
at a conference last month....
Imagine for a moment that you are a woman who weighs 350
pounds. Only two months ago, you weighed 342 pounds and, in
spite of diets and promises and tablets bought over the Internet,
you gained another eight pounds. You have given up on exercise
because it left you breathless; at night, your face is covered by an
oxygen mask that, at least, lets you get some sleep. Three years
ago you learned that you have diabetes; a year ago you were told
that you needed to have your knee replaced. Your husband left
right after the last pregnancy, one of three children who are now
all ashamed to...
Physiology of Sleep and Wakefulness Most adults sleep 7–8 h per night, although the timing, duration, and internal structure of sleep vary among healthy individuals and as a function of age. At the extremes, infants and the elderly have frequent interruptions of sleep. In the United States, adults of intermediate age tend to have one consolidated sleep episode per day, although in some cultures sleep may be divided into a midafternoon nap and a shortened night sleep.
slated for (something)
- to be scheduled for something The building is slated for demolition at the end of the year.
a slave to (someone or something)
- someone who is under the control of someone or something My mother is a slave to her desire to watch soap operas on television.
not sleep a wink
- to not get any sleep (used in the negative) I did not sleep a wink last night.
- to oversleep, to sleep late in the morning I was very tired so I decided to sleep in this morning.
sleep like a log/baby
- to sleep very soundly I slept like...
Multiple Sleep Latency Test (MSLT) can objectively evaluate daytime sleepiness. When used
as diagnostic prosedure of central hypersomnia it should be done during the day after
polysomnographically documented adequate night sleep, which lasts at least six hours and
after two weeks of regular sleep. (Carscadon & Dement, 1982, American sleep disorders
association, 1992) (ICSD-2, 2005). Evaluation of MSLT starts 1,5-3 hours after morning
awakening and consists of 5, or at least 4 records of polysomnography, each lasting
20minutes (Littner et al., 2005).
From where Dick Barrow sat, hundreds of men were visible, occupying benches in every manner of position. Some stretched at full length, sleeping in the morning sun after a night in the park. Others sat with heads hanging; thinking thoughts of their own. Depression or recession, it meant the same to all of them. Some didn't care, but others tried to find any kind of work that would fill their stomachs with food. For three days Dick hadn't eaten a good meal, and felt almost as low as the derelicts whom he had for companions. He would have enjoyed a...
Ronnie couldn't remember the exact month he started having his nightmares only that it was after the killing began and before his Dad had gone to war. Nights blurred into days, days into nights and sleep deprivation had muddled his find. Fuddled his mind. Damn, he couldn't think straight anymore. He lay down in his bed, staring at the ceiling, like a corpse with its eyes wide open. He wondered if this was how Clifford Montgomery had looked underneath the lid at his funeral service. His mother had told him not to go but he had snuck in anyway,...