Sleeping Disorders

Learning Objectives
After completing the course, you’ll be able to:

Chapter 1. Test Your Sleep I.Q.

  1. Answer questions of your patient and dispel misconceptions about sleep.

Chapter 2. Brain Basics: Understanding Sleep

  1. Describe various phases of sleep and our body's reaction during each phase.
  2. Explain the role played by circadian rhythms in our sleep.
  3. Make the connection between sleep and many diseases.

Chapter 3. Insomnia: Assessment and Management in Primary Care

  1. Define insomnia and classify insomnia associated with various causes.
  2. Provide a differential diagnosis of primary insomnia.
  3. Frame and ask questions to assess insomnia.
  4. List 8 general sleep hygiene measures.
  5. Describe the behavioral and pharmaceutical interventions in the treatment of insomnia.
  6. Explain various therapeutic approaches in the treatment of insomnia, specifically relaxation therapy, sleep restriction therapy, stimuli control therapy and cognitive therapy.
  7. Compare the efficacy and side effects of various medications in the treatment of insomnia.
  8. Describe the effects of light, level of melatonin in the body and sleep problems.
  9. Explain the correlation between the nighttime drop in temperature and sleep.
  10. Explain how your bedroom environment can affect your sleep.

Chapter 4. Integration of Behavioral and Relaxation Approaches Into the Treatment of Chronic Pain and Insomnia

  1. State four relaxation and behavioral techniques for the management of insomnia.
  2. Identify barriers to the appropriate integration of behavioral and relaxation approaches into the treatment of pain and insomnia.
  3. Explain how the behavioral and relaxation approaches in the treatment of pain and insomnia work.

Chapter 5. Problem Sleepiness

  1. Define sleepiness, distinguish it from fatigue and describe the magnitude of problem sleepiness.
  2. Describe the magnitude and causes of problem sleepiness among shift workers, adolescents and young adults.
  3. Identify strategies that may help counter problem sleepiness in adolescents and young adults.

Chapter 6. Problem Sleepiness in Your Patient

  1. Describe the prevalence, symptoms and diagnoses of four primary sleep disorders.
  2. Describe the effects of various drugs and stimulants on sleep and sleepiness.
  3. Make an assessment of whether a patient is getting an adequate quantity of sleep and identify the patient with problem sleepiness
  4. Ask specific questions of a patient in the history-taking process to obtain a sleep/wake profile.

Chapter 7. Drowsy Driving and Automobile Crashes

  1. List the risk factors for drowsy-driving crashes, identify population groups at highest risk and suggest countermeasures to prevent drowsy driving and its consequences.
  2. Identify elements of human performance that are impaired by sleepiness.
  3. Describe some tools for the assessment of chronic and situational (acute) sleepiness.
  4. Assess the risk for drowsy-driving crashes based on factors that include sleep loss, driving patterns, the use of sedating medications, untreated sleep disorders and consumption of alcohol.
  5. Identify three broad population groups at high risk for drowsy-driving crashes.
  6. Describe four categories of countermeasures and compare their effectiveness in reducing drowsy-driving crashes.
  7. Suggest behavioral interventions that reduce drowsy-driving crashes.
  8. Make three recommendations to reduce drowsy-driving crashes focusing on young males, promoting shoulder rumble strips and educating shift workers.
  9. Educate young males and shift workers about drowsy driving and how to reduce lifestyle-related risks.

Chapter 8. Narcolepsy

  1. Define narcolepsy and list four classic symptoms of the disorder.
  2. Provide a diagnosis of narcolepsy and suggest effective courses of treatment.

Chapter 9. Restless Legs Syndrome

  1. Describe restless legs syndrome and list some common symptoms.
  2. Identify five causes of restless legs syndrome.
  3. List three categories of drugs that are most commonly used to treat RLS.

Chapter Sleep Apnea

  1. Define sleep apnea, list several common symptoms, differentiate among the three types of sleep apnea and explain basic facts about sleep apnea to a patient.
  2. Instruct clients concerning their children's obstructive sleep apnea, evaluation and possible treatment.
  3. Advise a patient about choosing a continuous positive airway pressure (CPAP) device with the desired features and applications.
  4. Help the patient with sleep apnea choose an appropriate mask and headgear.

Chapter Sleep Apnea: Is Your Patient at Risk?

  1. Brief a patient who is considering surgery for OSA about various options, efficacies of the treatments and possible outcomes.
  2. Caution a patient with sleep apnea about the dangers of general anesthesia in any surgery.

Chapter Infantile Apnea and Home Monitoring

  1. Define terms related to infantile apnea, such as apnea of prematurity (AOP), asymptomatic premature infants, symptomatic premature infants, apparent life-threatening event (ALTE), apnea of infancy (AOI), and sudden infant death syndrome (SIDS).
  2. Describe the relation of neonatal and infant apnea to each other and to mortality (especially SIDS) and morbidity in infancy.
  3. Evaluate the circumstances and make recommendations to parents regarding the use of home apnea monitoring of infants.

Chapter Jet Lag

  1. Describe the jet lag phenomenon, list the factors that cause jet lag, identify people who get jet lag and prescribe some of the techniques for reducing jet lag.

Chapter The Treatment of Sleep Disorders of Older People

  1. Explain the changes in sleep and wakefulness as functions of aging and of diseases of older people and name the diagnostic criteria that establish clinical abnormalities.
  2. Provide indications for the treatment of sleep disorders, specifically obstructive sleep apnea and insomnia, in older individuals.
  3. Describe the common medical practices and lay treatment practices and their health implications for patients with insomnia and hypersomnia.
  4. Outline the issues that the medical profession and general public should know about good sleep hygiene and treatment of sleep disorders.
  5. Describe behavioral, mechanical and surgical approaches to the treatment of sleep apnea.
Contents Outline

Chapter 1.Test Your Sleep I.Q.

  • Sleep I.Q.
  • Answers to the Sleep I.Q.

Chapter 2. Brain Basics: Understanding Sleep

  • Sleep: A Dynamic Activity
  • How Much Sleep Do We Need?
  • What Does Sleep Do For Us?
  • Dreaming and REM Sleep
  • Sleep and Circadian Rhythms
  • Sleep and Disease
  • Sleep Disorders
  • Insomnia
  • Sleep Apnea
  • Restless Legs Syndrome
  • Narcolepsy
  • Night Owls & Morning Larks
  • Dementia-Related Sleep Disorders
  • The Future
  • Tips for a Good Night's Sleep

Chapter 3. Insomnia: Assessment and Management in Primary Care

  • Introduction
  • Definition and Prevalence
  • Types of Insomnia
  • Acute Insomnia
  • Chronic Insomnia
  • Selected Circadian Rhythm Sleep Disorders
  • Consequences
  • Recognition and Assessment
  • Sleep/Wake Profile
  • Suggested Questions Following a Complaint of Insomnia
  • Signs of Sleepiness
  • Management
  • Introduction
  • General Sleep Hygiene Measures
  • Behavioral Treatment
  • Pharmacological Treatment
  • Conclusion
  • References
  • Members of the National Heart, Lung, and Blood Institute Working Group on Insomnia
  • National Institutes of Health Staff
  • Support Staff
  • How Do I Cure Insomnia?
  • Trouble Sleeping? Chill Out
  • A Drop in Temperature May Help You Fall Asleep
  • Using Light Therapy to Treat Insomnia
  • Natural Treatments For Insomnia
  • Bedroom Inventory
  • Creating a Peaceful Place
  • What's Worrying You?
  • Melatonin
  • What is Melatonin?
  • Why Isn't Melatonin Considered a Drug?
  • What Does This Mean to You?
  • Why Do People Take Melatonin?
  • Understanding Insomnia
  • For More Information
  • Stanford Group Therapy Program Aims to Put Insomniacs to Sleep

Chapter 4.Integration of Behavioral and Relaxation Approaches Into the Treatment of Chronic Pain and Insomnia

  • Introduction
  • What Behavioral and Relaxation Approaches Are Used for Conditions Such as Chronic Pain and Insomnia?
  • Pain
  • Insomnia
  • Selection Criteria
  • Relaxation Techniques
  • Deep Methods
  • Brief Methods
  • Hypnotic Techniques
  • Biofeedback Techniques
  • Cognitive-Behavioral Therapy
  • Relaxation and Behavioral Techniques for Insomnia
  • How Successful Are These Approaches?
  • Pain
  • Insomnia
  • Critique
  • How Do These Approaches Work?
  • Pain
  • Insomnia
  • Are There Barriers to the Appropriate Integration of These Approaches Into Health Care
  • What Are the Significant Issues for Future Research and Applications
  • Conclusions
  • Technology Assessment Panel
  • Bibliography

Chapter 5.Problem Sleepiness

  • Introduction
  • Daytime Sleepiness Test
  • The Epworth Sleepiness Scale Results
  • Overview of Sleepiness
  • Defining Sleepiness
  • Magnitude of Problem Sleepiness
  • Sleepiness Caused by Sleep Need
  • Sleepiness Caused by the Biological Clock
  • Effects of Problem Sleepiness
  • Reversing Sleepiness
  • Medications for Sleep and Sleepiness
  • Shift Workers
  • Introduction
  • Magnitude of Problem Sleepiness Among Shift Workers
  • Causes of Problem Sleepiness in Shift Workers
  • Consequences of Problem Sleepiness for Shift Workers
  • Countermeasures for Shift Worker Sleepiness
  • Adolescents and Young Adults
  • Introduction
  • Magnitude of Problem Sleepiness Among Adolescents and Young Adults
  • Causes of Problem Sleepiness in Adolescents and Young Adults
  • Consequences of Problem Sleepiness for Adolescents and Young Adults
  • Countermeasures for Problem Sleepiness in Adolescents and Young Adults
  • Conclusion
  • References
  • Acknowledgments

Chapter 6.Problem Sleepiness in Your Patient

  • Introduction
  • Consequences of Problem Sleepiness
  • Automobile Crashes
  • Adolescent Development and School Performance
  • Work-Related Accidents
  • Causes of Problem Sleepiness
  • Primary Sleep Disorders
  • Other Medical Conditions That Disrupt Sleep
  • Effects of Drugs That Disrupt Sleep
  • Inadequate Sleep Due to Lifestyle
  • Identification of the Patient With Problem Sleepiness
  • Table 1. Sleep/Wake Profile–Sample Questions
  • Management of Problem Sleepiness
  • Primary Sleep Disorders
  • Where to Get More Information
  • References
  • Acknowledgments

Chapter 7.Drowsy Driving and Automobile Crashes

  • Executive Summary
  • Biology of Human Sleep and Sleepiness
  • Crash Characteristics
  • Risks for Drowsy-Driving Crashes
  • Population Groups at Highest Risk
  • Countermeasures
  • Focusing an Educational Campaign: Panel Recommendations
  • Introduction
  • Methods and Knowledge Base of This Report
  • Research Needs
  • Biology of Human Sleep and Sleepiness
  • The Sleep-Wake Cycle
  • Sleepiness Impairs Performance
  • The Causes of Sleepiness/Drowsy Driving
  • Evaluating Sleepiness
  • Characteristics of Drowsy-Driving Crashes
  • Risk for Drowsy-Driving Crashes
  • Sleep Loss
  • Driving Patterns
  • The Use of Sedating Medications
  • Untreated Sleep Disorders: Sleep Apnea Syndrome and Narcolepsy
  • Consumption of Alcohol Interacts With Sleepiness to Increase Drowsiness and Impairment
  • Interactions Among Factors Increase Overall Risk
  • Population Groups at Highest Risk
  • Young People, Especially Young Men
  • Shift Workers
  • People With Untreated Sleep Apnea Syndrome and Narcolepsy
  • Countermeasures
  • Behavioral Interventions
  • Medical Interventions to Treat Narcolepsy and Sleep Apnea Syndrome
  • Alerting Devices
  • Shift Work Measures
  • Employer Management of Work Schedules
  • Employee Behavioral Steps
  • Using Bright Light Treatments
  • Focusing an Educational Campaign: Panel Recommendations
  • Educate Young Males About Drowsy Driving and How to Reduce Lifestyle-Related Risks
  • Promote Shoulder Rumble Strips as an Effective Countermeasure for Drowsy Driving; in this Context, Raise Public Awareness About Drowsy-Driving Risks and How to Reduce Them
  • Educate Shift Workers About the Risks of Drowsy Driving and How to Reduce Them
  • Other Organizations Can Provide Drowsy Driving Education
  • References

Chapter 8.Narcolepsy

  • What Is Narcolepsy?
  • When Should You Suspect Narcolepsy?
  • How Common Is Narcolepsy?
  • Who Gets Narcolepsy?
  • What Happens in Narcolepsy?
  • How Is Narcolepsy Diagnosed?
  • How Is Narcolepsy Treated?
  • What Is Being Done To Better Understand Narcolepsy?
  • How Can Individuals and Their Families and Friends Cope With Narcolepsy?
  • References
  • Resources
  • Organizations

Chapter 9.Restless Legs Syndrome

  • What Is Restless Legs Syndrome?
  • Common Characteristics of Restless Legs Syndrome
  • What Causes It?
  • Who Gets RLS?
  • How Is It Diagnosed?
  • How Is It Treated?
  • Where Can I Get More Information?

Chapter 10.Sleep Apnea

  • Sleep Apnea Defined
  • Sleep Apnea Fact Sheet
  • Symptoms of Sleep Apnea
  • Risk Factors for Sleep Apnea
  • Treatments for Sleep Apnea
  • Personal Experiences
  • Sleep Apnea and Driving
  • Having Your Child Evaluated for Obstructive Sleep Apnea
  • Choosing a CPAP
  • Choosing a Mask and Headgear
  • Considering Surgery for OSA?
  • Sleep Apnea and Same-Day Surgery
  • Considering Surgery for Snoring?

Chapter 11. Sleep Apnea: Is Your Patient at Risk?

  • Definition and Prevalence
  • Consequences and Comorbidity
  • Identification of Patients at Risk for Sleep Apnea
  • Table 1. Patients at Risk for Sleep Apnea Diagnosis Treatment Options
  • Table 2. Treatment of Sleep Apnea Behavioral Approaches
  • Nasal Continuous Positive Airway Pressure
  • Oral/Dental Appliances
  • Surgical Procedures Pharmacological Treatment
  • Oxygen
  • Management Considerations
  • Where to Get More Information
  • References

Chapter 12.Infantile Apnea and Home Monitoring

  • Introduction
  • Definitions
  • What Is Known About the Relation of Neonatal and Infant Apnea to Each Other and to Mortality (Especially SIDS) and Morbidity in Infancy?
  • What Are the Efficacy and Safety of Currently Available Home Devices for Detecting Infant Apnea?
  • Essential Features
  • Desirable Features
  • Other Considerations
  • What Evidence Exists Regarding the Effectiveness of Home Monitoring in Reducing Infant Mortality (Especially SIDS) and Morbidity?
  • Effectiveness of Home Monitoring
  • Home Monitoring for ALTE
  • Home Monitoring for Subsequent Siblings of SIDS Victims
  • Home Monitoring for Premature Infants
  • Home Monitoring for Other Pathologic Conditions
  • SIDS Mortality Trends and Home Monitoring
  • Home Monitoring and Morbidity
  • Problems in Dealing With Studies of Effectiveness
  • Based on the Above, What Recommendations Can Be Made at Present Regarding the Circumstances for Use of Home Apnea Monitoring in Infancy?
  • What Further Research Is Needed on Home Apnea Monitoring for Infants?
  • Apnea
  • Monitoring: Technical
  • Monitoring: Psychosocial
  • Apnea Program: Health Services
  • Sudden Death, Including SIDS
  • Conclusion
  • Consensus Development Panel
  • Speakers
  • Conference Sponsors

Chapter 13.Jet Lag

  • What Is Jet Lag?
  • What Causes Jet Lag?
  • Who Gets Jet Lag?
  • Techniques for Reducing Jet Lag
  • Escaping Jet Lag
  • Set Your Body Clock

Chapter 14.The Treatment of Sleep Disorders of Older People

  • Abstract
  • Introduction
  • What Are the Changes in Sleep and Wakefulness as Functions of Aging and of Diseases of Older People?
  • What Are the Diagnostic Criteria That Establish Clinical Abnormalities?
  • Which Are Clinically and Epidemiologically Important?
  • What Are the Indications for a Diagnostic Evaluation?
  • What Sequence of Assessment Methods Should Be Used To Determine if the Diagnostic Criteria Are Met?
  • What Are the Indications for the Treatment of Sleep Disorders?
  • Indications for Treatment of Obstructive Sleep Apnea
  • Indications for Treatment of Insomnia Complaints
  • What Are the Common Medical Practices and Lay Treatment Practices and Their Health Implications?
  • Insomnia
  • Hypersomnia
  • What Should the Medical Profession and General Public Know About Good Sleep Hygiene and Treatment of Sleep Disorders, and What Should Be Done To Increase Awareness?
  • What Are the Directions for Future Research?
  • Conclusions and Recommendations
  • Consensus Development Panel
  • Speakers
  • Self-Study Examination
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