(BQ) Part 1 book "Sleep medicine - A comprehensive guide to its development, clinical milestones and advances in treatment" presents the following contents: Evolution of sleep medicine by historical periods, sleep medicine from the medieval period to the 19th century, the early evolution of modern sleep medicine,...
(BQ) Part 2 book "Sleep medicine - A comprehensive guide to its development, clinical milestones and advances in treatment" presents the following contents: Neurological sleep disorders, psychiatric and psychological sleep disorders, respiratory diseases, medical disorders and sleep, miscellaneous important aspects,...
The history of sleep medicine and sleep research can be
summarized as a history of remarkable progress and, at
the same time, a history of remarkable ignorance. Since
the publication of the second edition in 1999 enormous
progress has been made in all aspects of sleep science
and sleep medicine. I am pleased to see these rapid
advances in sleep medicine and growing awareness about
the importance of sleep and its dysfunction amongst the
public and the profession.
From the emergence of clinical sleep medicine marked by the establishment of the
harbinger Stanford Sleep Disorders Clinic in the mid 1970s, offspring sleep disorders
clinics and centers have grown exponentially with the recognition of the unmet
diagnostic and treatment needs of the reservoir of patients suffering from symptoms
of what are now recognized and classified as the nosology of human sleep
Stages of REM sleep (solid bars), the four stages of NREM sleep, and wakefulness over the course of the entire night for representative young and older adult men. Characteristic features of sleep in older people include reduction of slow-wave sleep, frequent spontaneous awakenings, early sleep onset, and early morning awakening. (From the Division of Sleep Medicine, Brigham and Women's Hospital.)
Sleep is a function of the brain. However, the ultimate physiological function
of sleep remains enigmatic and unknown despite recent extensive research of this
ubiquitous and important brain activity. Sleep intervenes in functions of somatic
growth, regeneration, and memory. Sleep is important in medicine because it
modulates quality of life, while its disorders provoke family pathology, disturb
work routines, alter social activities, and, in general, affect the health of the
I often thought of this mantra during my on-call nights when, as a Stanford sleep
medicine fellow, I was awakened from sleep by a technologist informing me that
one of the clinic patients had repetitive obstructive apneas with significant oxygen
desaturations. The technologist would typically ask, “can I start the patient on CPAP?”
Invariably, I would mutter a drowsy “yes,” often chiding myself that on the previous
day I should have clearly written the respiratory thresholds for starting continuous
positive airway pressure on the patient’s sleep-study order sheet....
For progress to be maintained in a clinical field like sleep medicine, unimpeded,
unrestricted access to data and the advances in clinical practice should be available.
The reason this book is exciting is that it breaks down the barriers to dissemination of
information. Researchers at the forefront of areas that have limited funding can find it
difficult to get data from randomised, double-blind, (placebo-controlled), crossover or
parallel group studies, etc., and so may be limited to the lowest level of scientific
research, i.e. single case, or restricted observational series....
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.
There are a number of excellent books on the market addressing the role of complementary
and alternative medicine (CAM) in nursing, midwifery and physiotherapy
(Rankin-Box 2001, Tiran 2000, Charman, 2000) which review, in
general, a range of themes relevant to the discipline. As far as possible I have
tried to avoid going over the same ground in this· book, however, there will be
inevitably some overlap. In addition I have assumed that the reader has a prior
level of knowledge covering paediatric, professional and legal issues in nursing.
This report summarizes the presentations and discussion at a work-
shop entitled Sleep Needs, Patterns, and Difficulties of Adolescents, held
on September 22, 1999. The workshop was organized by the Board on
Children, Youth, and Families and the Forum on Adolescence of the Na-
tional Research Council and Institute of Medicine, with funding from the
Carnegie Corporation of New York and the National Institute on Child
Health and Human Development, U.S. Department of Health and Hu-
Physiology of Circadian Rhythmicity
The sleep-wake cycle is the most evident of the many 24-h rhythms in humans. Prominent daily variations also occur in endocrine, thermoregulatory, cardiac, pulmonary, renal, gastrointestinal, and neurobehavioral functions. At the molecular level, endogenous circadian rhythmicity is driven by self-sustaining transcriptional/translational feedback loops (Fig. 28-2). In evaluating a daily variation in humans, it is important to distinguish between those rhythmic components passively evoked by periodic environmental or behavioral changes (e.g.
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.
Evaluation of Insomnia
Insomnia is the complaint of inadequate sleep; it can be classified according to the nature of sleep disruption and the duration of the complaint. Insomnia is subdivided into difficulty falling asleep (sleep onset insomnia), frequent or sustained awakenings (sleep maintenance insomnia), early morning awakenings (sleep offset insomnia), or persistent sleepiness/fatigue despite sleep of adequate duration (nonrestorative sleep). Similarly, the duration of the symptom influences diagnostic and therapeutic considerations.
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.
Specific questioning about the occurrence of sleep episodes during normal waking hours, both intentional and unintentional, is necessary to determine the extent of the adverse effects of sleepiness on a patient's daytime function. Specific areas to be addressed include the occurrence of inadvertent sleep episodes while driving or in other safety-related settings, sleepiness while at work or school (and the relationship of sleepiness to work and school performance), and the effect of sleepiness on social and family life.
The term parasomnia refers to abnormal behaviors or experiences that arise from or occur during sleep. A continuum of parasomnias arise from NREM sleep, from brief confusional arousals to sleepwalking and night terrors. The presenting complaint is usually related to the behavior itself, but the parasomnias can disturb sleep continuity or lead to mild impairments in daytime alertness. Two main parasomnias occur in REM sleep: REM sleep behavior disorder (RBD), which will be described below, and nightmare disorder.
Circadian Rhythm Sleep Disorders
A subset of patients presenting with either insomnia or hypersomnia may have a disorder of sleep timing rather than sleep generation. Disorders of sleep timing can be either organic (i.e., due to an intrinsic defect in the circadian pacemaker or its input from entraining stimuli) or environmental (i.e., due to a disruption of exposure to entraining stimuli from the environment). Regardless of etiology, the symptoms reflect the influence of the underlying circadian pacemaker on sleep-wake function.
Shift-Work Disorder: Treatment
Caffeine is frequently used to promote wakefulness. However, it cannot forestall sleep indefinitely, and it does not shield users from sleep-related performance lapses. Postural changes, exercise, and strategic placement of nap opportunities can sometimes temporarily reduce the risk of fatigue-related performance lapses. Properly timed exposure to bright light can facilitate rapid adaptation to night-shift work.
While many techniques (e.g.