Transcript Sleep Mini Lecture Dr Verma

Nitun Verma MD MBA
Medical Director
Washington Center for Sleep Disorders
http://www.washingtonsleep.com
Presenter Background
 Tufts University MD MBA
 Georgetown University Residency
 Stanford University Fellowship
 Board Certified in adult / pediatric sleep medicine
Washington Center for Sleep Disorders
 There are only 2 accredited sleep centers in the East Bay
 Established relationships with surgeons, dentists, equipment
providers for a multidisciplinary treatment approach
Washington Center for Sleep Disorders
Conditions Treated
 Changes in sleep associated with adolescence, menopause,
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retirement
Obstructive Sleep Apnea (OSA)
Insomnia
Restless Legs Syndrome (RLS)
Delayed/Advanced Sleep Phase Syndrome
Narcolepsy
Drowsy Driving
QUIZ:
How many US drivers fall asleep at
the wheel every day?
80,000
Drowsy Driving
Who is at risk?
 Young people, particularly males
 Work requires long or odd hours
 Commercial drivers
 Persons with undiagnosed or untreated sleep disorders Those
who have consumed alcohol
 People taking prescription medication that contain sedatives
http://www.aasmnet.org/Resources/FactSheets/DrowsyDriving.pdf
QUIZ:
How many sleep-related motor
vehicle accidents are there each
year ?
250,000
Drowsy Driving
Who is at risk?
 Get enough sleep
 Take breaks while driving
 Short nap, preferably 15 to 20 minutes in length.
 Do not drink alcohol
 Do not drive late at night
http://www.aasmnet.org/Resources/FactSheets/DrowsyDriving.pdf
QUIZ:
How many people in the US have a
sleep disorder?
30,000,000
Obstructive Sleep Apnea
Only 1 out of 10 people with OSA
are diagnosed by their doctor.
Is obstructive sleep apnea and
snoring the same thing?
Obstructive Sleep Apnea
What is it?
 Airway narrowing
 Crisis and shocks
 Shallow sleep
 Can’t remember it
Obstructive Sleep Apnea
What is it?
Obstructive Sleep Apnea
What is it?
Obstructive Sleep Apnea
What is it?
 Airway narrowing
 Crisis and shocks
 Shallow sleep
 Can’t remember it
Is obstructive sleep apnea and
snoring the same thing?
Obstructive Sleep Apnea
What happens if you have it?
 Heart and blood vessels
Obstructive Sleep Apnea
What happens if you have it?
 Heart and blood vessels
Neurocognitive Effects of OSA
 Hyperactivity, rebelliousness, aggression more common
in SDB children
 Inattention
 Difficulty regulating emotions
 Lower grades than unaffected children
 Decreased performance on IQ tests
Insomnia
Insomnia
30% of adults have symptoms of insomnia
10% of adults have insomnia that is severe enough to cause
daytime consequences
Almost 10% of adults are likely to have chronic insomnia
http://www.aasmnet.org/Resources/FactSheets/Insomnia.pdf
Insomnia
Effects
Fatigue
Moodiness
Irritability or anger
Anxiety about sleep
Lack of concentration
Poor Memory
Poor quality performance at school or work
Lack of motivation or energy
Headaches or tension
Upset stomach
Mistakes/accidents at work or while driving
http://www.aasmnet.org/Resources/FactSheets/Insomnia.pdf
Insomnia
Types
 Adjustment Sleep Disorder
 Psychophysiologic Insomnia
 Paradoxical Insomnia
 Insomnia due to a mental disorder
 Idiopathic Insomnia
 Inadequate Sleep Hygiene
 Behavioral Insomnia of Childhood
 Insomnia due to a drug or substance
 Insomnia due to a medical condition
Sleep Hygiene
 Good sleep habits = good sleep without meds
 Regular sleep schedule
 Prevent heart burn at night
 Avoid stimulants in afternoon / evening
 Avoid naps after 3pm
Cognitive Behavioral Therapy
Stimulus Control Therapy
 Stimulus Control Therapy
 Go to bed only when sleepy-not just fatigued, but sleepy.
 Get out of bed when unable to sleep (e.g., after 20 min), go to
another room, and return to bed only when sleep is imminent.
 Curtailing all sleep-incompatible activities (overt and covert);
no eating, TV watching, radio listening, planning or problem
solving in bed.
 Arise at a regular time every morning regardless of the amount
of sleep the night before.
 Avoid daytime napping.
Restless Legs Syndrome
Restless Legs Syndrome
“Creepy crawling” sensations in legs at night (rarely arms
and rarely pain)
Sensations decrease with movement or massage
Delay sleep time
10% of people have symptoms of RLS
Women have 1.5 – 2x increased risk
Most people are treated after many years of symptoms
Restless Legs Syndrome
Factors that make it worse
Medical conditions: iron deficiency, kidney disease
Medications: antihistamine, antidepressant, tranquilizer
Also: obesity, sleepiness, pregnancy, smoking
Risk increased if other sleep disorders also present
Restless Legs Syndrome
Treatments
Massage, compresses, movement
Medications: some for intermittent use, others for daily use
Specific to iron deficiency: Iron replacement
Narcolepsy
Common Vignette:
19 year old male presents with symptoms of sleepiness for over 3 months.
When telling a joke or surprised, his jaw becomes slack, but consciousness
is maintained. A few times he has had to hold on to the wall or railing for
support. These episodes last between 30 seconds to 2 minutes. Also when
waking up from sleep, he occasionally feels paralyzed, unable to move.
This is very frightening to him, but resolves spontaneously. Because of
sleepiness, his school performance has deteriorated.
Narcolepsy Summary
EDS / Cataplexy / Sleep Hallucinations
Etiology unclear but genetics / environment / autoimmune possible
Treat both EDS and Cataplexy
Prevalence
 0.05% general population (1 out of 2,000)
 55% of narcoleptics are ever diagnosed (some sources 1 out of
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10 years is the time to diagnosis
2nd decade of life is peak onset
Symptoms are rare before 5 years of age
EDS before cataplexy
Japan 0.16%
Israel <0.01%
Signs and Symptoms
 EDS (excessive day time sleepiness)
 Cataplexy
 Sleep Paralysis
 Sleep Hallucinations
Signs and Symptoms
 EDS
 Can also occur while active
 Can occur as a sleep attack
 Can occur several times a day
 Naps are refreshing (important to distinguish from idiopathic
hypersomnia)
 Can result in poor work / school performance
 Need to monitor driving safety
Signs and Symptoms
 Cataplexy (60% of patients with narcolepsy have it)
 Abrupt / reversible loss of voluntary muscle tone
 Tendon reflexes inhibited
 30 seconds – 2 minutes
 Usually bilateral
 Consciousness usually maintained
 Severity and frequency vary
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Common= muscle tone decreases, slurred speech
Severe= total body collapse
 Important to identify triggers
Signs and Symptoms
 Sleep Paralysis
 Upon awakening or falling asleep
 Frightening to patient
 (affects 3-5% of non-narcoleptic population as well)
Signs and Symptoms
 Hallucinations
 Sleep onset (hypnagogic)
 Upon waking (hypnopompic)
Mignot E. Narcolepsy: A Guide for Understanding , Diagnosing, and Treating Narcolepsy.
Obstructive Sleep Apnea
Quizzes
 Sleep Apnea Quiz
 Sleepiness Quiz
 Insomnia Quiz
Online quizzes at
www. washingtonsleep. com
that do the scoring for you
Nitun Verma MD MBA
Medical Director