By Nancy Foldvary-Schaefer, Jyoti Krishna, Kumaraswamy Budur
Supplying a realistic method of the creation of sleep drugs, this easy-to-use, concise quantity makes use of genuine sufferer circumstances from the Cleveland health facility Sleep problems middle. a large spectrum of diagnoses are integrated to reveal the reader to the wide diversity of sleep-wake issues sufferer can event. Written in a concise layout designed to demonstrate the signs, diagnostic standards, workup and regimen remedy of sufferers providing to the sleep health facility, this quantity serves as a realistic textual content excellent for the busy primary-care practitioner trying to increase her wisdom of sleep-wake problems. at any time when attainable, tracings from diagnostic checks, images, and videos are supplied to reinforce medical shows and to assist in popularity of abnormities pointed out within the sleep laboratory.
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Additional info for A Case a Week: Sleep Disorders from the Cleveland Clinic
Since some disorders of sleepiness are cyclical or secondary to central nervous system disorders including trauma, it is important to elicit these details. Frequently, sleepiness emerges with the development of snoring or weight gain, and this may heighten suspicion of sleep related breathing disorders. Medical and Surgical History A general history, with special focus on disorders that are relevant to sleep, is required. This includes an assessment of cardiovascular disease (hypertension, INTRODUCTION TO THE SLEEP CLINIC 5 angina, heart failure), pulmonary disorders (asthma, emphysema, chronic bronchitis), otolaryngological problems (sinus diseases, nasal fracture, deviated nasal septum, tonsillomegaly, nasal allergies), metabolic disorders (obesity, diabetes, hypercholesterolemia, hypothyroidism) and gastrointestinal disorders (heartburn, gastroesophageal reﬂux).
Drugs often confound results of testing. The MSLT for example, should be planned after adequate period of withdrawal from REM-suppressing drugs and adequate attention to ensure any sleep debt from insufﬁcient sleep in the near past is addressed. Selective serotonin re-uptake inhibitors (SSRIs) may increase limb movements in sleep and bias the scoring of REM sleep in a critical MSLT due to their effect in enhancing eye movements. These so-called “Prozac eyes” are well known in the sleep laboratory.
Epworth Sleepiness Scale (ESS) The ESS is an 8-item, self-administered questionnaire that rates the chances of dozing off in 8 common situations of daily life. The patient is asked to estimate his/her chance of dozing on 8 items on a scale of 0 to 3; the higher the score, the sleepier the subject (Appendix I). While the ESS is widely used and wellvalidated, it is still a subjective assessment and some patients overestimate or underestimate the severity of daytime sleepiness. The ESS and the Multiple Sleep Latency Test (MSLT), the gold standard test to objectively assess daytime sleepiness in patients with narcolepsy, correlate though inconsistently.
A Case a Week: Sleep Disorders from the Cleveland Clinic by Nancy Foldvary-Schaefer, Jyoti Krishna, Kumaraswamy Budur