Introduction to Sleep Medicine (original) (raw)
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Revista de investigación clínica; organo del Hospital de Enfermedades de la Nutrición
Sleep is a basic biological process that has an impact on all the functions of the body, and interacts bidirectionally with virtually all of the body systems, so that the sleep disorders are associated with disturbances in other systems, either respiratory, neurological, cardiovascular, endocrine, immune, etc., and vice versa. The complexity of the regulatory mechanisms of sleep and the variety of their disorders, together with the clinical evidence accumulated in recent decades, have led to the birth of a new branch in medicine: the Sleep Medicine, with well defined intrinsic disorders. The consequences of sleep deprivation or fragmentation induced by changes in social and work dynamics, as well as sleep disorders have harmful effects on individuals in the short and long-term, the most important are an elevated risk for vehicular and occupational accidents, cardiovascular damage, cognitive impairment, obesity, diabetes mellitus, among others, impacting individuals of all ages. The ...
Sleep medicine: Practice, challenges and new frontiers
Frontiers in Neurology
Sleep medicine is an ambitious cross-disciplinary challenge, requiring the mutual integration between complementary specialists in order to build a solid framework. Although knowledge in the sleep field is growing impressively thanks to technical and brain imaging support and through detailed clinic-epidemiologic observations, several topics are still dominated by outdated paradigms. In this review we explore the main novelties and gaps in the field of sleep medicine, assess the commonest sleep disturbances, provide advices for routine clinical practice and offer alternative insights and perspectives on the future of sleep research.
The Contribution of Sleep Medicine to the Assessment of the Tired Patient
The Canadian Journal of Psychiatry, 2000
Tiredness is one of the most common complaints that confront the clinician. Yet the nature of the symptom and its implications for sleep-related disorders is poorly understood. This review provides the clinician with an understanding of the difficulties inherent in assessing the tired patient. The complaint of tiredness is commonly an expression of sleepiness and fatigue that arises as the result of sleep-wake–related disorders. Behavioural and physiological procedures are described in the assessment and management of sleepiness and fatigue in primary sleep disorders and sleep-related medical and psychiatric disorders. Improvement in the diagnosis and management of the fatigued or sleepy patient requires that residents in psychiatry and neurology be exposed to the behavioural and physiological techniques of sleep medicine as part of their post-graduate training programs.
Schulz Salzaruo 2016 The Development of Sleep Medicine A Historical Sketch
For centuries the scope of sleep disorders in medical writings was limited to those disturbances which were either perceived by the sleeper him-or herself as troublesome, such as insomnia, or which were recognized by an observer as strange behavioral acts during sleep, such as sleepwalking or sleep terrors. Awareness of other sleep disorders, which are caused by malfunction of a physiological system during sleep, such as sleep-related respiratory disorders, were widely unknown or ignored before sleep monitoring techniques became available, mainly in the second half of the 20 th century. Finally, circadian sleep-wake disorders were recognized as a group of disturbances by its own only when chronobiology and sleep research began to interact extensively in the last two decades of the 20 th century. Sleep medicine as a medical specialty with its own diagnostic procedures and therapeutic strategies could be established only when key findings in neurophysiology and basic sleep research allowed a breakthrough in the understanding of the sleeping brain, mainly since the second half of the last century.
Sleep Medicine–Time for a Change
Journal of Clinical Sleep Medicine, 2006
Sleep Medicine-Unprecedented Growth Since the 1980s Sleep medicine has seen an unprecedented growth in the last 2 decades. It is estimated that, throughout the United States in 1292 sleep clinics, at least 1.17 million people were examined during 2001. 1 These numbers have likely doubled since then, and other countries have seen a similar growth in the field of sleep medicine. 2 This dramatic increase in sleep clinics and the number of polysomnographic recordings is undoubtedly explained by the growing awareness of obstructive sleep apnea syndrome and its profound impact on patients' quality of life and health. At least 85% of patients are referred to a sleep examination in a laboratory because of suspected sleep apnea, which affects, in at least moderate form, 1 in 10 men and 1 in 25 women. 3 For people over 60 years of age and in certain high-risk populations, such as obese people or habitual snorers, there are more people with breathing disorders during sleep than without. 4 The fact that the field of sleep medicine is overwhelmingly centered on a single disorder, sleep apnea, explains why sleep medicine has become almost a subspecialty of pulmonary medicine in the last few years and why more than 50% of diagnostic sleep laboratory directors are pulmonologists. 1 This is a complete turnabout from the 1970s and 1980s when the vast majority of sleep specialists were neurologists, psychiatrists, and psychologists. This may be changed, however, as a result of the decision of the Accreditation Council for Graduate Medical Education to approve the sleep medicine fellowship training programs that may open sleep medicine to other medical specialties. Sleep Medicine-Practiced Now as 20 Years Ago The focus of sleep medicine on a single disorder and the dominance of pulmonologists in this field have not affected the practice of sleep medicine in any major way. Examinations to diagnose breathing disorders in sleep are carried out in more or less the same way as they were done 20 or 30 years ago by sleep specialists who mostly examined patients complaining of insomnia or suspected sufferers of narcolepsy. 5 There has been, however, impressive progress in data-acquisition and data-storage technologies. Electrophysiologic recordings have moved from analog to digital, and data are no longer stored on miles and miles of recording paper but on compact, miniature, digital, storage media. Also, more detailed and focused guidelines have been developed to quantify respiratory events during sleep that were not given much clinical importance just 20 years ago. Thus, a person suspected of having sleep apnea is referred to a sleep clinic and spends the night there connected to electrophysiologic recordings that monitor electroencephalography, electrooculography, electromyography, respiratory effort, airflow, body position, and arterial oxygen saturation level, all of which provide the necessary information for a diagnosis. Presenting symptoms and medical history are also taken into consideration in the diagnostic process and treatment recommendation. To save the patients' time and the insurance companies' money, many of the diagnostic sleep recordings performed nowadays are based on only half of the night (the so-called split-night procedure). 6 If the pa
2000
The International Journal of Sleep and Wakefulness -Primary Care is designed to bring a critical analysis of the world literature on sleep disorders, written by clinicians, for clinicians, to an international, multidisciplinary audience. Our mission is to promote better understanding of the treatment of sleep disorders across the global healthcare system by providing an active forum for the discussion of clinical and healthcare issues. Leading Articles -These major review articles are chosen to reflect topical clinical and healthcare issues in sleep disorders. All contributions undergo a strict editorial review process. Foundations in Sleep/In Focus -These articles are designed to educate primary care physicians in the basic principles shaping modern sleep medicine. Clinical Reviews -The most important papers from the best of the international literature on sleep disorders are systematically selected by an internationally recognized panel of experts. The Editors then prepare concise and critical analyses of each paper, and, most importantly, place the findings into clinical context. Meeting Reports -The International Journal of Sleep and Wakefulness -Primary Care also provides incisive reportage from the most important international congresses.
Sleep is a complex neurological state, with its primary function of providing rest and restoring the body's energy levels. The importance of sleep could be seen from the fact that people spend about one-third of their lifespan in sleep. Normal human sleep is divided into non-rapid eye movement (NREM) and rapid eye movement (REM) sleep, and the alteration between NREM and REM occurs about 4-5 times during a night of normal sleep. Human NREM sleep could be classified into four stages, namely, stage I, II, III and IV, representing successively deeper stages of sleep. Sleep is an active rhythmic neural process produced by several brain areas, of which the preoptic and other basal forebrain areas play a major role in the generation of NREM sleep. Interaction of the pedenculo-pontine and lateral dorsal tegmental areas with the dorsal raphae nucleus and locus coeruleus, is important for REM sleep generation. Suprachiasmatic nucleus of the hypothalamus and the pineal gland ensure that sleep and wakefulness follow a circadian periodicity of nearly 24 hours. Alterations in the quality, quantity and pattern of sleep result in sleep disorders. Persistent and repeated interruption of sleep affects the health of an individual. Undiagnosed and untreated wake/sleep complaints cause not only misery to the sufferer, but it also has socioeconomic consequences. Sleep disorders cover a wide spectrum of diseases. Though there are more than 100 identified sleep/wake disorders, most sleep complaints can be categorised into five, namely, hypersomnia, insomnia, circadian rhythm disorders, parasomnias, and sleep disorders associated with mental, neurological, and other medical disorders. Researches during the last 50 years, and the advances made in clinical sleep medicine, have lead to more effective treatments for the myriad human sleep disorders. It is not possible to assign a specific reason for many of the sleep disorders, but some aspects of sleep and wakefulness are genetically influenced. But, most commonly, sleepiness during waking hours, results from volitional or forced sleep deprivation during previous nights, due to social, economic and environmental reasons. So, public awareness about sleep disorders should be an essential part of any programme aimed at global management of sleep disorders.
Clinical Cornerstone, 2004
Although sleep disorders medicine is a relatively young discipline, understanding of the diagnosis, pathophysiology, and treatment of sleep disorders is evolving at a rapid pace. This overview discusses the history of the development of sleep disorders medicine, tracing changes in the diagnostic classification of sleep disorders as well as the role of polysomnography in diagnosis. This evolution is most evident for insomnia, one of the major sleep disturbances. The accumulation of epidemiologic data on the prevalence and temporal course of insomnia and emerging information regarding its pathophysiology derived from laboratory assessments have led to the development of new therapeutic approaches for primary insomnia and insomnia associated with medical and psychiatric disorders.