“SLEEPERS”

John Hey MD

DABSM. FAASM

Medical Director--Sleep Disorders Center--Greenwood Leflore Hospital

What we’re gonna do

• Over view of sleep medicine

• Medical/Surgical conditions from sleep disorders

• Office screening for sleep disorders

Sleeper Diagnoses

• Pulmonary Embolus

• Alcoholism/Drugs

• Depression

• Abuse

• Polypharmacy

• Munchausin

• Tubal pregnancy

• Sarcoid

SLEEP DISORDERS

New field in medicine

Confluence of Specialties Psychiatry Neurology ENT Pulmonary Medical Pediatrics

And most of all FP

Significant Dates in Sleep • 1953 REM Sleep discovered

• 1975 First sleep lab at Stanford U

• 1978 First PSG exam

•.1981 CPAP first used for OSA

Levels of Sleep Labs

• Accredited Sleep Center--AASM

• Accredited Sleep Lab--AASM

• Accredited Sleep Clinic--JCAOH

• Non accredited Hospital based lab

• Non accredited Freestanding Lab

• PRN testing site

Sleep Lab vs Sleep Center

• Lab: only study sleep related breathing disorders--85% of sleep disorders for PSG

• Center: study and treat all disorders (89 at last count)--50% are simple insomnia and not needing PSG

• Labs now being phased out

TOOLS OF SLEEP

• Detailed H&P

• ESS and other questionnaires

• Sleep logs

• PSG

• MSLT

• CPAP Titration

• Patient and family education

SLEEP STAGES

• Awake

• Stage I--NREM

• Stage II--NREM

• Stage III-SWS or Delta

• Stage IV-SWS or Delta

• REM

REM CHARACTERISTICS

• Rapid eye movements

• Muscle paralysis

• Irregular breathing

• Difficult to awake

• Subtle EEG changes

• Dreaming

ADULT MEDICAL CONDITIONS

• Cognitive difficulty• Night sweats• Nocturia• Daytime fatigue• Impotency• Enuresis• Headaches• MVA

• OBSTRUCTIVE SLEEP APNEA

• OSA

STROKES

4 times the stroke rate in pts with OSA

3 times MI

2 times HBP

56% of resistant HBP = OSA

15% sudden death in OSA--mostly in daytime

38,000 cardiac deaths due to OSA

30% CHF pt’s have sleep apnea33% epileptics have OSA

SCHOOL PROBLEMS

• Hyperactivity

• Inattention

• Discipline problems

• Irritability

• Poor grades

• THINK OSA in 5-16 year olds

• THINK NARCOLEPSY in 12 yr.. or older

INSOMNIA

• DEPRESSION

• OSA

• ANXIETY

• BIPOLAR

• ALCOHOL/SUBSTANCE ABUSE

• SLEEP MISPRECEPTION

• Medical conditions

“SYNCOPY”

• DROP ATTACKS

• “SEIZURE”

• SUDDEN WEAKNESS

• DROPPING OBJECTS

• SUDDEN CLUMSINES

• THINK ---NARCOLEPSY with Cataplexy

NARCOLEPSY

• SLEEP ATTACKS

• INSOMNIA

• VISUAL HALLUCINATIONS

• PARALYSIS ON AWAKENING

• FATIGUE

• “DEPRESSION”

• CATAPLEXY

MVA

• Pts with OSA --24% fell asleep--74% had accident

• 24,000 auto deaths due to SD

• 12.4 billion dollars lost in auto accidents secondary to SD

• #1 cause of fatal accidents in 18-25 y/o

EVALUATING SLEEP IN THE BUSY OFFICE

• B---bed time problems

• E---excessive day time sleepiness-EDS

• A---awakening in the night

• R---regularity and duration of sleep

• S---sleep disordered breathing-snoring

Workup not complete

until

you think about

SLEEP

DOOR PRIZE QUIZ

• 1--Sleep related laryngospasm

• 2--Sleepwalking

• 3--Sleep state misperception

• 4--Sleep related epilepsy

• 5-Narcolepsy

CONTINUED

• 6--REM behavior disorder

• 7--Limit-setting sleep disorder

• 8--Sleep paralysis

• 9--Terrifying hypnagogic hallucinations

• 10--Sleepwalking-sleep eating

Accreditation RequirementsSleep H & PPatient QuestionnaireCertification by Sleep Doc of necessityQA for tech scoring of PSGInterpretation by DABSM or overeadFollow up by sleep doc

That concludes my talkand I will now try to fend offquestions.