Sleep Medicine Pearls

Sleep Medicine is a rapidly growing and changing field. Experienced sleep medicine clinicians and educators Richard B. Berry, MD and Mary H. Wagner, MD present the completely revised, third edition of Sleep Medicine Pearls featuring 150 cases that review key elements in the evaluation and management of a wide variety of sleep disorders. The cases are preceded by short fundamentals chapters that present enough basic information so that a physician new to sleep medicine can start reading page 1 and quickly learn the essential information needed to care for patients with sleep disorders. A concise, practical format makes this an ideal resource for sleep medicine physicians in active practice, sleep fellows learning sleep medicine, and physicians studying for the sleep boards. New to this edition Stay current with knowledge about the latest developments in sleep medicine by reading updated chapters using the new diagnostic criteria of the recently published International Classification of Sleep Disorder, 3rd Edition and sleep staging and respiratory event scoring using updated versions of the scoring manual of the American Academy of Sleep Medicine Manual for the Scoring of Sleep and Associated Events. Benefit from Drs. Berry and Wagner’s 25+ years of clinical experience providing care for patients with sleep disorders and educational expertise from presenting lectures at local, regional and national sleep medicine courses. Dr Berry was awarded the AASM Excellence in Education Award in 2010. Access the full contents online at ExpertConsult. By Richard B. Berry, MD, Professor of Medicine, Director of the Sleep Disorders Center, Malcom Randall VAMC/University of Florida, Gainesville, FL and Mary H Wagner, MD, Associate Professor, Department of Pediatrics, University of Florida, Gainesville, Florida Table of Contents: Fundamentals of Sleep Medicine 1: Sleep Stages and Electroencephalographic Patterns 1. A 30-year-old man taking a hypnotic nightly 2. A 30-year-old man with insomnia Fundamentals of Sleep Medicine 2: Electroencephalographic Lead Placement 3. A 50-year-old man with insomnia Fundamentals of Sleep Medicine 3: Eye Movement Monitoring Fundamentals of Sleep Medicine 4: Eye Movement Patterns 4. A 20-year-old man with excessive daytime sleepiness Fundamentals of Sleep Medicine 5: Chin (Submental) Electromyography 5. A 40-year-old man experiencing difficulty falling asleep 6. A 30-year-old woman having trouble falling asleep 7. A 30-year-old man having difficulty staying awake during the day 8. A 35-year-old woman with insomnia 9. A 25-year-old man with a history of sleep-walking 10. A 20-year-old man with daytime sleepiness 11. A 40-year-old man with a history of snoring and daytime sleepiness 12. A 34-year-old man with sleep disturbance 13. A 22-year-old woman with frequent awakenings during sleep secondary to chronic pain 14. A 40-year-old man being treated for depression Fundamentals of Sleep Medicine 6: Additional Sleep Staging Rules 15. A 30-year-old man with severe snoring and occasional breathing lapses 16. A 35-year-old woman experiencing uncontrollable episodes of sleep Fundamentals of Sleep Medicine 7: Sleep Architecture Definitions 17. A 23-year-old man with difficulty sleeping 18. A 25-year-old man with daytime sleepiness and fatigue Fundamentals of Sleep Medicine 8: Polysomnography 19. A 30-year-old man having difficulty staying awake during the day 20. A 25-year-old man complaining of excessive daytime sleepiness 21. A 30-year-old man with loud snoring 22. A 40-year-old man with complaints of snoring 23. Two patients with recording artifacts 24. A 29-year-old man struggling with daytime sleepiness Fundamentals of Sleep Medicine 9: Multiple Sleep Latency Test and Maintenance of Wakefulness Test 25. A 25-year-old man with daytime sleepiness Fundamentals of Sleep Medicine 10: Monitoring Respiration During Sleep 26. A 45-year-old man with possible sleep apnea 27. A 50-year-old man with possible central apnea 28. A 30-year-old man with heavy snoring 29. A 33-year-old man complaining of daytime sleepiness Fundamentals of Sleep Medicine 11: Excessive Daytime Sleepiness 30. A 45-year-old man with a snoring problem 31. A 40-year-old woman with “mild” sleep apnea Fundamentals of Sleep Medicine 12: Respiratory Arousals 32. A 30-year-old woman with severe fatigue 33. A 30-year-old man with heavy snoring and daytime sleepiness 34. A 45-year-old man with a distinct pattern of desaturation Fundamentals of Sleep Medicine 13: Treatment of Obstructive Sleep Apnea 35. A 30-year-old man with weight loss and sleep apnea Fundamentals of Sleep Medicine 14: Positive Airway Pressure Titration 36. A 55-year-old man with heavy nighttime snoring and daytime sleepiness 37. A 50-year-old man with problems during a CPAP titration 38. A patient refusing to accept treatment for obstructive sleep apnea Fundamentals of Sleep Medicine 15: Positive Pressure Airway Treatment: Improving Acceptance & Adherence 40. A 55-year-old man with obstructive sleep apnea still sleepy on nasal CPAP 41. A 50-year-old man unable to sleep on CPAP due to mask leak and claustrophobia 42. A 55-year-old man having difficulty with CPAP because of nasal congestion 43. A 30-year-old man unable to tolerate nasal CPAP because of “too much pressure” 44. A 55-year-old man unable to use nasal CPAP due to intractable nasal congestion 45. A 45-year-old man with intolerance to nasal CPAP because of difficulty exhaling 46. A 60-year-old man with a suboptimal CPAP titration 47. A 55-year-old obese man with desaturation during a nasal CPAP trial 48. A 30-year-old woman with fatigue and mild daytime sleepiness 49. A 50-year-old man with a return of snoring 6 months after uvulopalatopharyngo-plasty 50. A 55-year-old man with severe daytime sleepiness and limited treatment options 51. A 40-year-old man with sleep apnea unable to tolerate nasal CPAP 52. A 45-year-old man still experiencing daytime sleepiness after uvulopalatopharyngo-plasty 53. A 50-year-old man needing objective confirmation of his ability to stay awake 54. A 45-year-old man falling asleep at the wheel while driving 55. A 30-year-old man with severe snoring 56. A 30-year-old choir singer with heavy snoring 57. A 50-year-old man with severe hypertension 58. A 55-year-old man with premature ventricular contractions during sleep 59. A 30-year-old pregnant woman with onset of snoring 60. A 45-year-old man with snoring and hypercapnia 61. A 55-year-old man with hypercapnic respiratory failure 62. A 57-year-old man with severe obstructive sleep apnea treated with oxygen 63. A 5-year-old child with behavior problems 64. A 6-year-old boy with large tonsils 65. A 20-year-old woman with daytime sleepiness since childhood 66. A 55-year-old man with chronic obstructive pulmonary disease and nocturnal desaturation 67. A 60-year-old man with leg swelling 68. A 55-year-old man with chronic obstructive pulmonary disease and severe pedal edema 69. A 60-year-old “pink puffer” with insomnia 70. A 52-year-old man with chronic obstructive pulmonary disease and pedal edema 71. A 35-year-old woman with asthma and poor sleep at night Fundamentals of Sleep Medicine 16: Central Sleep Apnea 72. A 58-year-old man with daytime sleepiness 73. A 55-year-old man with central sleep apnea 74. A 70-year-old man with daytime sleepiness and pedal edema 75. A 60-year-old man with severe congestive heart failure and daytime sleepiness 76. A 60-year-old man with obstructive sleep apnea and numerous central apneas on CPAP 77. A 12-year-old boy with daytime CO2 retention 78. A 75-year-old man with a history of polio Fundamentals of Sleep Medicine 17: The Restless Leg Syndrome and Periodic Leg Movements in Sleep 79. A 50-year-old man with snoring and leg kicks 80. A 56-year-old man with crawling sensations in his legs at bedtime 81. A 40-year-old man who kicks in his sleep 82. A 50-year-old man who kicks during sleep 83. A 72-year-old man with worsening symptoms during treatment for restless legs 84. A 58-year-old man with sleep apnea and leg jerks during sleep Fundamentals of Sleep Medicine 18: Narcolepsy 85. A 30-year-old man with daytime sleepiness and episodes of weakness 86. A 23-year-old man with daytime sleepiness, but no symptoms of cataplexy 87. A 25-year-old man with narcolepsy who is still sleepy on medication 88. A 25-year-old man with frequent episodes of cataplexy 89. A 24-year-old man with narcolepsy who was irritable and lost weight on methylphenidate 90. A 35-year-old man with sleep apnea and a short REM latency 91. A 40-year-old man with sleep apnea and persistent daytime sleepiness 92. A 35-year-old man requesting stimulant medication 93. A 64-year-old man with daytime sleepiness since age 21 Fundamentals of Sleep Medicine 19: Parasomnias 94. A 20-year-old man with severe “nightmares” 95. A 25-year-old woman walking in her sleep 96. A 55-year-old man with violent dreams 97. A 50-year-old man with an interesting chin EMG Fundamentals of Sleep Medicine 20: Monitoring for Nocturnal Seizures 98. A 55-year-old man with unusual movements during sleep 99. A 60-year-old man with a rhythmic EEG pattern during a CPAP titration 100. A 30-year-old man who got out of bed during sleep Fundamentals of Sleep Medicine 21: Evaluation of Insomnia 101. A 30-year-old woman having difficulty falling asleep 102. A 30-year-old woman with insomnia 103. A 40-year-old man with difficulty falling asleep after the death of his brother Fundamentals of Sleep Medicine 22: Circadian Sleep Disorders 104. A 40-year-old woman complaining of difficulty falling asleep 105. A 70-year-old man with early morning awakening 106. A 44-year-old man with jet lag 107. A 40-year-old woman with fibromyalgia 108. A 40-year-old woman with fatigue and disturbed sleep 109. A 45-year-old man with persistent insomnia while on treatment for depression 110. A 45-year-old man with hyperphagia and hypersomnia 111. A 50-year-old veteran of the Vietnam War with upsetting dreams 112. A 40-year-old woman with terrifying awakenings