Culebras: Case Studies in Sleep Neurology: Common & Uncommon Presentations

Sleep is the only free voluptuosity given to humans by Nature. Sleep is as necessary as food or drink. When sleep fails, many other biological functions suffer. Sleep is a function of the brain and the neurology of sleep its corollary. And yet, so numerous are the ramifications and so extensive the reach of sleep and its disorders, that sleep medicine remains a multidisciplinary body at the center of which lies sleep apnea, a pervasive disease that has emerged as a public health problem, as have sleep deprivation, excessive daytime sleepiness and fatigue. In the end, however, the neurology of sleep will prevail as the core discipline underlying sleep functions and dysfunctions, the study of which in the hotbed of the brain will lead to a better understanding of their nature.

With great excitement and enthusiasm, we present this book featuring case studies in sleep neurology. The book presents a series of clinical situations representative of problems that challenge the clinical-solving abilities of practitioners in the neurology of sleep, also known as neurosomnology. The book focuses attention on the major categories of sleep medicine including insomnia, hypersomnias, sleep-breathing disorders, parasomnias and circadian dysrhythmias with emphasis on the neurology of sleep. Both usual and unusual cases are presented with the aim of creating a teaching tool that stimulates the thinking process in sleep neurology along established lines of practice. Each case is introduced with an allusive title, followed by a clinical history, an examination and special studies. This sets the stage for the question asking the diagnosis, treatment or management of the case. The follow-up section states the clinical diagnosis and describes the proper clinical actions to be taken based on the results of tests, with a discussion of the differential diagnosis where appropriate. Each presentation ends with general remarks based on current knowledge and standards of practice. A section entitled “Pearls and gold” summarizes the teaching, take-home points. The bibliography introduces the reader to one or two historical references, where available, followed by a recommended review article, and in all cases to five to ten specific citations. Illustrations have been added where appropriate.

The result is a book containing 40 case histories that provoke and educate clinicians at all stages in their careers. The book is intended to be a didactic tool that dares clinical skills, stimulates memory and provides orientation for additional reading. The target audience is sleep medicine specialists and neurologists. Physicians in training in the discipline of sleep and physicians interested in the knowledge of clinical sleep medicine, with particular curiosity for neurological situations, will find the book singularly readable and useful. The authors are skilled clinicians and seasoned writers with academic titles and vast experience in sleep medicine. As constituents of an international elite in sleep neurology, many are part of that first generation of sleep specialists that has enjoyed the privilege and been granted the unique opportunity of describing new disorders and novel clinical conditions of sleep, contained here in.

Contents

• Foreword page
• List of contributors
• List of abbreviations
• Introduction

Part I Sleep-related breathing disorders

• Case 1 Opioid-induced central sleep apnea
• Case 2 Fourteen-year-old with sleep-disordered breathing and excessive daytime sleepiness
• Case 3 A harsh noise in the night
• Case 4 An infant with obstructed breathing

Part II Hypersomnias of central origin

• Case 5 My child falls at school
• Case 6 A sleepy-head
• Case 7 A roller-coaster of neurological diagnoses

Part III Circadian rhythm disorders

• Case 8 A shift worker falls repeatedly

Part IV Parasomnias

A. REM-sleep-associated parasomnias

• Case 9 Extreme dreams
• Case 10 Odd sleep-related behaviors
• Case 11 Paralyzed and unable to breathe
• Case 12 Nightmares and numbness in the right arm
• Case 13 Screaming at night
• Case 14 Violent sleep behavior resulting in subdural hemorrhage

B. Arousal disorders

• Case 15 Amnestic nocturnal behavior
• Case 16 A terrified and terrifying scream
• Case 17 Frequent night-time wanderings
• Case 18 An adult sleepwalker who was sleep deprived

C. Other parasomnias

• Case 19 Seeking food in the night
• Case 20 The case of the missing loaf of bread
• Case 21 Gaining weight while asleep
• Case 22 Vivid images in the bedroom
• Case 23 Noisy breathing during sleep
• Case 24 Sexsomnia and obstructive sleep apnea

Part V Sleep-related epilepsy

• Case 25 The anxious hitting sleeper
• Case 26 Bad dreams
• Case 27 Sleepwalking or seizing?
• Case 28 Seizure, parasomnia or behavioral disorder?
• Case 29 Sounds of choking at night
• Case 30 Fighting in sleep

Part VI Sleep and stroke

• Case 31 Sleep and stroke

Part VII Sleep-related movement disorders

• Case 32 Violent tongue biting recurring during sleep
• Case 33 A child with behavioral problems and violent sleep behavior leading to trauma
• Case 34 Clicking all night
• Case 35 Repetitive arm movements
• Case 36 Restlessness and jerking upon recumbency when trying to fall asleep
• Case 37 Jumping and yelling while asleep
• Case 38 A case of attention deficit

Part VIII Neuromuscular disorders and sleep

• Case 39 Snoring and leg cramps
• Case 40 “So tired I take naps in the morning”

Appendix: Epworth Sleepiness Scale

Index

Product Details

• Paperback: 318 pages
• Publisher: Cambridge University Press; 1 edition (November 15, 2010)
• Language: English
• ISBN-10: 0521146488
• ISBN-13: 978-0521146487
• Product Dimensions: 9.7 x 6.8 x 0.7 inches

List Price: $75.00 

Berry: Fundamentals of Sleep Medicine (Expert Consult Series)

The goal of this book is to provide the reader with a core of fundamental knowledge about sleep medicine and polysomnography. I have tried to write the book so that a person without training in sleep medicine can start reading chapter one and progress until the end of the book. With the publication of the International Classification of Sleep Disorders, Second Edition, and the American Academy of Sleep Medicine scoring manual, there is a need for an up-to-date text using current terminology and diagnostic criteria. A single text cannot hope to cover all aspects of sleep medicine and sleep physiology. Therefore, I have tried to focus on information that I feel is the most clinically useful. The field of sleep medicine is changing so rapidly that any text is “out-of-date” before it is even published. To this end, there will be an associated website to allow for updates, corrections, review questions, illustrative case studies, and some video clips of parasomnias.

My inspiration for writing this book has come in part from the satisfaction and appreciation that I received from writing the text Sleep Medicine Pearls. Sleep Medicine Pearls had short fundamentals chapters mixed with cases and was heavy on graphics and illustrative sleep tracings. I have tried to amplify the fundamentals sections to provide what I hope is a concise and useful introduction to the entire spectrum of sleep disorders. In particular, I have tried to cover aspects of the technology of sleep monitoring and interpreting sleep studies that many new to the sleep field find difficult. The challenging but enjoyable experience of teaching sleep fellows and residents about sleep medicine has also prompted me to write a book covering the fundamentals both to serve as an introductory text and to assist those physicians actively taking care of sleep patients.

-- Richard B. Berry, MD
 

Key Features

• Spend less time searching thanks to a more clinically focused, user-friendly format that concentrates on the "fundamentals" of sleep medicine.
• Zero in on the practical, "hands-on" information you need, including how to interpret sleep scans.
• Access the full contents online at expertconsult.com plus additional illustrations, numerous video clips (parasomnias, leg kicks, and more), case studies, and enhanced sleep tracings (showing detailed sleep pattern alterations).
• Benefit from the author's 25 years of clinical experience taking care of patients with sleep disorders. Dr. Berry was awarded the 2010 AASM Excellence in Education award and is an experienced educator in the field of sleep medicine.
• Get clear, visual guidance on the new AASM scoring criteria, for which Dr. Berry served on the committee and provided all illustrations used.

Website Features

• Consult the book from any computer at home, in your office, or at any practice location.
• Instantly locate the answers to your clinical questions via a simple search query.
• Quickly find out more about any bibliographical citation by linking to its MEDLINE abstract.
• Images: Browse a Library of all book images. Easily select, organize, and download your images into a presentation.

Contents 

• Chapter 1 - Sleep Stages and Basic Sleep Monitoring
• Chapter 2 - The Technology of Sleep Monitoring
• Chapter 3 - Sleep Staging in Adults
• Chapter 4 - Biocalibration, Artifacts, and Common Variants of Sleep
• Chapter 5 - Sleep Staging in Infants and Children
• Chapter 6 - Sleep Architecture Parameters, Normal Sleep, and Sleep Loss
• Chapter 7 - Neurobiology of Sleep
• Chapter 8 - Monitoring Respiration—Technology and Techniques
• Chapter 9 - Monitoring Respiration—Event Definitions and Examples
• Chapter 10 - Sleep and Respiratory Physiology
• Chapter 11 - Cardiac Monitoring during Polysomnography
• Chapter 12 - Monitoring of Limb Movements and Other Movements during Sleep
• Chapter 13 - Polysomnography, Portable Monitoring, and Actigraphy
• Chapter 14 - Subjective and Objective Measures of Daytime Sleepiness
• Chapter 15 - Obstructive Sleep Apnea Syndromes
• Chapter 16 - Pathophysiology of Obstructive Sleep Apnea
• Chapter 17 - Consequences of Obstructive Sleep Apnea and the Benefits of Treatment
• Chapter 18 - Obstructive Sleep Apnea Treatment Overview and Medical Treatments
• Chapter 19 - Positive Airway Pressure Treatment
• Chapter 20 - Oral Appliance and Surgical Treatment for Obstructive Sleep Apnea
• Chapter 21 - Central Sleep Apnea and Hypoventilation Syndromes
• Chapter 22 - Sleep and Obstructive Lung Disease
• Chapter 23 - The Restless Leg Syndrome, Periodic Limb Movements in Sleep, and the Periodic Limb Movement Disorder
• Chapter 24 - Hypersomnias of Central Origin
• Chapter 25 - Insomnia
• Chapter 26 - Circadian Rhythm Sleep Disorders
• Chapter 27 - Clinical Electroencephalography and Nocturnal Epilepsy
• Chapter 28 - Parasomnias
• Chapter 29 - Psychiatry and Sleep
• Chapter 30 - Sleep and Nonrespiratory Physiology—Impact on Selected Medical Disorders
• Chapter 31 - Sleep and Neurologic Disorders
• Glossary

  

About the Author

• Richard B. Berry, MD, Professor of Medicine, University of Florida, Gainesville, Medical Director, University of Florida and Shands Sleep Disorder Center, Gainesville, Florida.

Product Details

• Hardcover: 704 pages
• Publisher: Saunders; Har/Dol edition (August 22, 2011)
• Language: English
• ISBN-10: 1437703267
• ISBN-13: 978-1437703269

List Price: $99.00 

 

Kryger: Principles and Practice of Sleep Medicine 5th edition (Expert Consult Series)

It has been a quarter century since we started work on the first edition of Principles and Practice of Sleep Medicine. At that time there was a great deal of concern from colleagues that there simply wasn't enough information available for a book, and there simply wasn't enough of a market to justify all that effort. In fact, several colleagues whom we respect a great deal tried to talk us out of a textbook because they felt it would have been a waste of time. At that time there were roughly 2000 members of the American Sleep Disorders Association (now the American Academy of Sleep Medicine). Information about sleep medicine was transmitted and shared via telephone (almost everybody knew everybody practicing sleep medicine), articles, scientific meetings and one or two journals that regularly published articles about sleep.How things have changed. In the United States of America, within about 25 miles of anybody's home there are about 5 to 10 accredited sleep disorders centers, and also some unaccredited centers. There are about 1900 accredited sleep disorders centers. The American Academy of Sleep medicine has approximately 9000 members and counting. The number of doctors who practice sleep medicine is unknown, but there are 3,445 who have specialty certification in sleep awarded by the American Board of Sleep Medicine. This has been supplanted by a new certification exam administered by the American Board of Medical Specialties. The first time the exam was given, 724 physicians passed the examination. In addition, doctors from other specialties who may not have had any training in sleep medicine (for example those trained in pulmonary, neurology, otolaryngology) frequently evaluate and manage patients with sleep disorders.There are now eleven journals that publish articles exclusively about sleep. Whereas in 1985 there were about 400 articles published using the keywords “sleep apnea” or “sleep apnoea,” by 2010 about 4000 articles are being published per year. Entirely new fields now have important sleep components including geriatrics, occupational health, women's health, and there has been an explosion of knowledge just in the past few years in the genetics, molecular biology, and neuroanatomy and neurochemistry of sleep.To ensure that the information is up-to-date, this edition has five entirely new sections (“Sleep Medicine in the Elderly,” “Occupational Sleep Medicine,” “Physiology in Sleep,” “Genetics of Sleep,” and “Sleep Mechanisms and Phylogeny”). There are more than 50 brand new chapters and the remaining chapters have all been updated. There are new sleep stage and respiratory event scoring rules and this is perhaps the first major sleep textbook that incorporates these rules. A companion volume, Atlas of Clinical Sleep Medicine, contains hundreds of examples of polysomnographic data, and videos of interviews with patients with sleep disorders.Besides the dramatic increase in content, we had to deal with the changes in the delivery of information. Books were the way to go in the 1980s, content on CDs were the rage in the 1990s, but web-enabled books appear to be what people want beyond 2010. The third edition almost came out solely on a CD. It turned out that CDs were a passing trend and people hated reading large amounts of text on a computer screen. What doctors want now is a book that they can access in their library, via the internet and even on their handheld device and tablet. We have been listening to caregivers who use this content to help them better care for their patients and hope that you will continue to provide feedback.

Book Review
Medicine has only recently discovered the importance of sleep, and how sleep symptoms can be the canary in the mine of serious medical and psychiatric problems that can affect all people. I can attest firsthand about the importance of sleep, and how symptoms affecting sleep can impact a person's life. I was the Canadian Force Commander of the United Nations Assistance Mission for Rwanda between October 1993 and August 1994. During that time, a genocide resulted in the deaths of 800,000 people and I was an eyewitness having heard, smelled, seen, and touched thousands and thousands of mutilated bloated bodies of innocent civilians while trying to arrange a peace during a civil war while much of the world stood idly by. My sleep suffered, my health suffered, and I developed the symptoms of posttraumatic stress disorder. As the mission was winding down …“After prayers, I climbed into my vehicle and took off without telling anyone. It wasn't the first time. I had begun to suffocate in the headquarters, with its endless stream of problems and demands. I had been inventing trips to get me away from it, deciding that I had to see the troops in the field or just tour the country. In every village, along every road, in every church, in every school were unburied corpses. My dreams at night became my reality of the day, and increasingly I could not distinguish between the two.By this point, I wasn't bothering to make excuses anymore to disguise my quest for solitude. I would just sneak away and then drive around thinking all manner of black thoughts that I couldn't permit myself to say to anyone for fear of the effect on the morale of my troops. Without my marking the moment, death became a desired option. I hoped I would hit a mine or run into an ambush and just end it all. I think some part of me wanted to join the legions of the dead, whom I felt I had failed. I could not face the thought of leaving Rwanda alive after so many people had died. On my travels around the country, whole roads and villages were empty, as if they'd been hit by a nuclear bomb or the bubonic plague. You could drive for miles without seeing a single human being or a single living creature. Everything seemed so dead.”

 —From, Roméo A. Dallaire, Shake Hands with the Devil: The Failure of Humanity in Rwanda. Carroll & Graf Publishers, New York. 2003. pp 499-500.

This is the first medical textbook that focuses on the sleep disorders that affect everyone, and that also includes the problems of first responders and the military and teaches doctors about how post traumatic stress disorder impacts sleep. I congratulate the editors. 

—Lt. Gen the Hon. Roméo Dallaire, OC, CMM, GOQ, MSC, CD, (Ret'd), Senator, Canada
 

It is an honor for us, representing the Sleep Research Society, to help introduce the 5^th edition of Principles and Practice of Sleep Medicine. This volume appears nearly fifty years after the first professional sleep research meeting in the United States on March 25 and 26, 1961, a meeting which directly led to the formation of the Sleep Research Society. According to records of Al Rechtschaffen, maintained in the University of Chicago Library, the first meeting was titled the “Conference on Research in EEG, Sleep and Dreams.” Two days of scientific sessions included topics such as: “Methods and Merits of Various Systems of Scoring,” “Equipment and Technical Problems” and “The Relation of EEG to Verbal Report.” As the session titles suggest, in 1961 sleep scientists were necessarily focused upon some of the most basic tenants of research: observation, measurement, standardization, and technology. It seems very unlikely that any of the thirty-six scientists in attendance, including Bill Dement, would have envisioned the exponential growth of knowledge about sleep and its disorders represented in the many pages of the current volume.Sleep research has evolved to include the breadth of modern scientific approaches, and sleep medicine is germane to most medical specialties and public health concerns. In the 149 chapters of this text (including more than 50 new chapters and new sections on Genetics, Occupational Sleep Medicine, Sleep Medicine in Older People) experts describe the intricate mechanisms of biological timing, the genetic polymorphisms conferring risk for sleep disorders, sleep-immune interactions, the morbidity and mortality risks of sleep apnea, and the impact of sleep disturbance on workplace and transportation safety, just to highlight as few areas. We commend the authors on their excellent contributions which will serve to educate and inspire practitioners, researchers and students for years to come.The Sleep Research Society congratulates Drs. Kryger, Roth, and Dement on the publication of this very impressive 5^th edition of Principles and Practice of Sleep Medicine and thanks them for undertaking the important service of identifying the latest advances in the field and compiling the body of knowledge represented herein.

—James K. Walsh, PhD
President, Sleep Research Society, Executive Director and Senior Scientist, Sleep Medicine and Research Center, St. Luke's Hospital, Chesterfield, Missouri

—Clifford B. Saper, MD, PhD
Past-president, Sleep Research Society, James Jackson Putnam Professor of Neurology and Neuroscience, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, Massachusetts

The success of any field of medicine is often directly proportional to the scope and comprehensiveness of the knowledge base available to physicians, scientists, trainees, and the general public. For the field of sleep medicine, we are fortunate in that there continues to be dramatic growth in this knowledge, derived from both patient care and clinical/basic research. It is revealing when we step back and reflect on how this knowledge base has developed in so short a time: It has been less than 60 years since the discovery of rapid eye movement (REM) sleep, which initiated the organized, scientific study of sleep, and barely 25 years since the invention of continuous positive airway pressure (CPAP), which comprised the first effective treatment for obstructive sleep apnea. In this short time, the sleep field has expanded to the point where we have almost 1,900 accredited sleep centers and laboratories in the United States and over 9,000 members of the American Academy of Sleep Medicine. Our field has blossomed to the point where it is truly interdisciplinary, comprising specialists from the areas of pulmonary medicine, neurology, psychiatry, internal and family medicine, pediatrics, psychology, otolaryngology, and others. Exciting breakthroughs in sleep research have impacted other disciplines of science and research as well, and it is not unusual for sleep medicine specialists to collaborate with other diverse fields of medicine such as cardiology, endocrinology, and immunology.Despite our amazing growth, there are still many questions yet to be answered, including the holy grail of our field: the function of sleep. To explore these questions, the field requires a continued supply of dedicated and talented researchers in both the clinical and basic sciences. In addition, funding from the government, industry, and foundations; support from institutions; and strong mentorship by experienced investigators are important cornerstones to a successful independent research career. As members of the field, we must collectively strive to ensure that funding, support, and mentorship continues in order to ensure success of our field, even in times of economic downturns and increased competition from other fields. For without breakthroughs in research, there won't be new diagnostic tools, medications, or treatments to help us manage the nearly 90 different sleep disorders that we have identified thus far.The growth of our field and the exploration of critical research areas cannot exist without adequate education and training of our young clinicians and investigators. We are indeed privileged that we have excellent resources available that enable trainees to learn more about sleep and sleep medicine. For countless numbers of students, Principles and Practice of Sleep Medicine has served as the primary textbook, study material for the sleep medicine board certification examination, and/or the basic resource for any sleep-related condition or question about sleep. Often fondly referred to simply as “P&P”, it continues to rise in prominence and demand. I've had the great pleasure to learn from and collaborate with Drs. Kryger, Roth, and Dement, and not only are they among the top clinicians and scientists within our field, but they have continued to produce a sleep medicine reference that has remained the gold standard over the span of 20 years. Our field is deeply indebted to their dedication, hard work, and diligence.

—Clete A. Kushida, MD, PhD, RPSGT
President, American Academy of Sleep Medicine, Director, Stanford Center for Human Sleep Research, Stanford University, California

The American Sleep Apnea Association (ASAA) congratulates the editors of the Principles and Practice of Sleep Medicine on the publication of the fifth edition of this invaluable guide for those practicing sleep medicine. As the field evolves, it has become a key resource for those responsible for diagnosing and treating those with sleep disorders like sleep apnea. The long-term management of patients requires a partnership between the doctor who will learn from this volume the scientific basis of the field and the patient with a chronic illness who must also learn about their condition.For the patient and their families seeking to understand sleep apnea prior to diagnosis, and often once they are treated, they frequently turn to the ASAA, since 1990 the only patient interest organization in the USA dedicated to sleep apnea education, support and advocacy. The ASAA produces educational materials and includes support groups for sleep apnea patients and their families operating under the name A.W.A.K.E. that stands for Alert, Well, And Keep Energetic. The network of the more than 300 A.W.A.K.E. groups has locations around the United States, Canada and overseas.As elucidated in this book sleep apnea is associated with several important comorbidities and thus the ASAA will expand contacts with other patient groups concerned such as heart disease and type 2 diabetes.The fifth edition of Practice and Principles of Sleep Medicine is for the education and support of the caregiver and the American Sleep Apnea Association for the education and support of the apnea patient and their family.

—Edward Grandi
Executive Director, American Sleep Apnea Association

On behalf of the National Sleep Foundation, it is my pleasure and honor to help introduce the fifth edition of Principles and Practice of Sleep Medicine, the latest update to what has over the past 21 years properly come to be regarded as the preeminent reference text on sleep medicine. I congratulate the editors, Drs. Kryger, Roth, and Dement, for this new edition – representing as it does their long-standing and continuing commitment to the expansion of the field of sleep medicine and science, and their collective talent for presentation and dissemination of sleep-related knowledge.When the first edition was published, the discipline of sleep medicine was in its infancy. Today, perusing previous editions of PPSM is akin to marveling over the growth of a child by leafing through old family photo albums: Although it is understood on an intellectual level that growth and maturation have been occurring continuously, the intermittent nature of the photographic record serves to crystallize those changes in startlingly sharp relief. So it is with PPSM and the history of our field. Each successive edition of PPSM has faithfully reflected the progress made in the intervening years, in a narrative manner that makes clear the process by which high-quality scientific research on sleep and its disorders accrues and is translated into the practice of sleep medicine.Perusal of the current edition will, I think, make it apparent that our field has now grown past infancy, spurted through childhood, and entered its adolescence: to be sure, a phase of high energy and escalating complexity with a few early hints of maturity, but a phase primarily characterized by the exhilaration of a future that still seems horizonless. For those wishing an understanding of the roots of sleep science, desiring a comprehensive overview of the current ‘state of the art’ of sleep medicine, or yearning for a glimpse of what the future of sleep science holds, just start turning the pages. …

—Thomas J. Balkin, Ph.D.

Chairman of the Board of Directors, National Sleep Foundation, Washington, DC

Contents 
Part I - Principles of Sleep Medicine
Section 1 - Normal Sleep and Its Variations

• Chapter 1 - History of Sleep Physiology and Medicine
• Chapter 2 - Normal Human Sleep: An Overview
• Chapter 3 - Normal Aging
• Chapter 4 - Daytime Sleepiness and Alertness
• Chapter 5 - Acute Sleep Deprivation
• Chapter 6 - Chronic Sleep Deprivation

Section 2 - Sleep Mechanisms and Phylogeny

• Chapter 7 - Neural Control of Sleep in Mammals
• Chapter 8 - REM Sleep
• Chapter 9 - Phylogeny of Sleep Regulation
• Chapter 10 - Sleep in Animals: A State of Adaptive Inactivity

Section 3 - Genetics of Sleep

• Chapter 11 - Introduction
• Chapter 12 - Circadian Clock Genes
• Chapter 13 - Genetics of Sleep in a Simple Model Organism: Drosophila
• Chapter 14 - Genetic Basis of Sleep in Rodents
• Chapter 15 - Genetic Basis of Sleep in Healthy Humans
• Chapter 16 - Genetics of Sleep and Sleep Disorders in Humans

Section 4 - Physiology in Sleep

• Chapter 17 - Relevance of Sleep Physiology for Sleep Medicine Clinicians
• Chapter 18 - What Brain Imaging Reveals about Sleep Generation and Maintenance
• Chapter 19 - Cardiovascular Physiology: Central and Autonomic Regulation
• Chapter 20 - Cardiovascular Physiology: Autonomic Control in Health and in Sleep Disorders
• Chapter 21 - Respiratory Physiology: Central Neural Control of Respiratory Neurons and Motoneurons during Sleep
• Chapter 22 - Respiratory Physiology: Understanding the Control of Ventilation
• Chapter 23 - Normal Physiology of the Upper and Lower Airways
• Chapter 24 - Respiratory Physiology: Sleep at High Altitudes
• Chapter 25 - Sleep and Host Defense
• Chapter 26 - Endocrine Physiology in Relation to Sleep and Sleep Disturbances
• Chapter 27 - Gastrointestinal Physiology in Relation to Sleep
• Chapter 28 - Body Temperature, Sleep, and Hibernation
• Chapter 29 - Memory Processing in Relation to Sleep
• Chapter 30 - Sensory and Motor Processing during Sleep and Wakefulness

Section 5 - Chronobiology

• Chapter 31 - Introduction: Master Circadian Clock and Master Circadian Rhythm
• Chapter 32 - Circadian Rhythms in Mammals: Formal Properties and Environmental Influences
• Chapter 33 - Anatomy of the Mammalian Circadian System
• Chapter 34 - Physiology of the Mammalian Circadian System
• Chapter 35 - The Human Circadian Timing System and Sleep–Wake Regulation
• Chapter 36 - Melatonin and the Regulation of Sleep and Circadian Rhythms
• Chapter 37 - Sleep Homeostasis and Models of Sleep Regulation
• Chapter 38 - Circadian Rhythms in Sleepiness, Alertness, and Performance
• Chapter 39 - Animal Models for Disorders of Circadian Functions: Whole Organism
• Chapter 40 - Animal Models for Disorders of Chronobiology: Cell and Tissue
• Chapter 41 - Circadian Disorders of the Sleep–Wake Cycle

Section 6 - Pharmacology

• Chapter 42 - Hypnotic Medications: Mechanisms of Action and Pharmacologic Effects
• Chapter 43 - Clinical Pharmacology of Other Drugs Used as Hypnotics
• Chapter 44 - Wake-Promoting Medications: Basic Mechanisms and Pharmacology
• Chapter 45 - Wake-Promoting Medications: Efficacy and Adverse Effects
• Chapter 46 - Drugs That Disturb Sleep and Wakefulness

Section 7 - Psychobiology and Dreaming

• Chapter 47 - Introduction: The Changing Historical Context of Dream Research
• Chapter 48 - The Neurobiology of Dreaming
• Chapter 49 - Ultradian, Circadian, and Sleep-Dependent Features of Dreaming
• Chapter 50 - Dream Content: Quantitative Findings
• Chapter 51 - Dream Analysis and Classification: The Reality Simulation Perspective
• Chapter 52 - Dreams in Patients with Sleep Disorders
• Chapter 53 - Dreams and Nightmares in Posttraumatic Stress Disorder
• Chapter 54 - Dreaming as a Mood-Regulation System
• Chapter 55 - Why We Dream

Part II - Practice of Sleep Medicine
Section 8 - Impact, Presentation, and Diagnosis

• Chapter 56 - Approach to the Patient with Disordered Sleep
• Chapter 57 - Cardinal Manifestations of Sleep Disorders
• Chapter 58 - Physical Examination in Sleep Medicine
• Chapter 59 - Use of Clinical Tools and Tests in Sleep Medicine
• Chapter 60 - Classification of Sleep Disorders
• Chapter 61 - Epidemiology of Sleep Disorders
• Chapter 62 - Sleep Medicine, Public Policy, and Public Health
• Chapter 63 - Sleep Forensics

Section 9 - Occupational Sleep Medicine

• Chapter 64 - Introduction
• Chapter 65 - Performance Deficits during Sleep Loss: Effects of Time Awake, Time of Day, and Time on Task
• Chapter 66 - Fatigue and Performance Modeling
• Chapter 67 - Fatigue, Performance, Errors, and Accidents
• Chapter 68 - Fatigue Risk Management
• Chapter 69 - Drowsy Driving
• Chapter 70 - Sleep and Performance Monitoring in the Workplace: The Basis for Fatigue Risk Management
• Chapter 71 - Shift Work, Shift-Work Disorder, and Jet Lag
• Chapter 72 - Sleep Problems in First Responders and the Military
• Chapter 73 - Pharmacologic Management of Performance Deficits Resulting from Sleep Loss and Circadian Desynchrony
• Chapter 74 - Sleep, Stress, and Burnout

Section 10 - Insomnia

• Chapter 75 - Insomnia: Recent Developments and Future Directions
• Chapter 76 - Insomnia: Epidemiology and Risk Factors
• Chapter 77 - Insomnia: Diagnosis, Assessment, and Outcomes
• Chapter 78 - Models of Insomnia
• Chapter 79 - Psychological and Behavioral Treatments for Insomnia I: Approaches and Efficacy
• Chapter 80 - Psychological and Behavioral Treatments for Insomnia II: Implementation and Specific Populations
• Chapter 81 - Pharmacologic Treatment of Insomnia: Benzodiazepine Receptor Agonists
• Chapter 82 - Pharmacologic Treatment: Other Medications
• Chapter 83 - Treatment Guidelines for Insomnia

Section 11 - Neurologic Disorders

• Chapter 84 - Narcolepsy: Pathophysiology and Genetic Predisposition
• Chapter 85 - Narcolepsy: Diagnosis and Management
• Chapter 86 - Idiopathic Hypersomnia
• Chapter 87 - Parkinsonism
• Chapter 88 - Sleep and Stroke
• Chapter 89 - Sleep and Neuromuscular Diseases
• Chapter 90 - Restless Legs Syndrome and Periodic Limb Movements during Sleep
• Chapter 91 - Alzheimer's Disease and Other Dementias
• Chapter 92 - Epilepsy, Sleep, and Sleep Disorders
• Chapter 93 - Other Neurologic Disorders

Section 12 - Parasomnias

• Chapter 94 - Non-REM Arousal Parasomnias
• Chapter 95 - REM Sleep Parasomnias
• Chapter 96 - Other Parasomnias
• Chapter 97 - Idiopathic Nightmares and Dream Disturbances Associated with Sleep–Wake Transitions
• Chapter 98 - Disturbed Dreaming as a Factor in Medical Conditions
• Chapter 99 - Sleep Bruxism

Section 13 - Sleep Breathing Disorders

• Chapter 100 - Central Sleep Apnea and Periodic Breathing
• Chapter 101 - Anatomy and Physiology of Upper Airway Obstruction
• Chapter 102 - Snoring
• Chapter 103 - Genetics of Obstructive Sleep Apnea
• Chapter 104 - Cognition and Performance in Patients with Obstructive Sleep Apnea
• Chapter 105 - Clinical Features and Evaluation of Obstructive Sleep Apnea and Upper Airway Resistance Syndrome
• Chapter 106 - Medical Therapy for Obstructive Sleep Apnea
• Chapter 107 - Positive Airway Pressure Treatment for Obstructive Sleep Apnea–Hypopnea Syndrome
• Chapter 108 - Surgical Management for Obstructive Sleep-Disordered Breathing
• Chapter 109 - Oral Appliances for Sleep-Disordered Breathing
• Chapter 110 - Management of Obstructive Sleep Apnea–Hypopnea Syndrome
• Chapter 111 - Sleep in Patients with Asthma and Chronic Obstructive Pulmonary Disease
• Chapter 112 - Restrictive Lung Disorders
• Chapter 113 - Noninvasive Ventilation to Treat Chronic Ventilatory Failure
• Chapter 114 - Obstructive Sleep Apnea and Metabolic Dysfunction
• Chapter 115 - Obstructive Sleep Apnea, Obesity, and Bariatric Surgery

Section 14 - Cardiovascular Disorders

• Chapter 116 - Sleep and Cardiovascular Disease: Present and Future
• Chapter 117 - Sleep-Related Cardiac Risk
• Chapter 118 - Cardiac Arrhythmogenesis during Sleep: Mechanisms, Diagnosis, and Therapy
• Chapter 119 - Cardiovascular Effects of Sleep-Related Breathing Disorders
• Chapter 120 - Systemic and Pulmonary Hypertension in Obstructive Sleep Apnea
• Chapter 121 - Coronary Artery Disease and Obstructive Sleep Apnea
• Chapter 122 - Heart Failure

Section 15 - Other Medical Disorders

• Chapter 123 - Sleep and Fatigue in Cancer Patients
• Chapter 124 - Fibromyalgia and Chronic Fatigue Syndromes
• Chapter 125 - Endocrine Disorders
• Chapter 126 - Pain and Sleep
• Chapter 127 - Gastrointestinal Disorders
• Chapter 128 - Sleep in Chronic Kidney Disease

Section 16 - Psychiatric Disorders

• Chapter 129 - Anxiety Disorders
• Chapter 130 - Mood Disorders
• Chapter 131 - Schizophrenia
• Chapter 132 - Medication and Substance Abuse

Section 17 - Sleep Medicine in the Elderly

• Chapter 133 - Medical and Psychiatric Disorders and the Medications Used to Treat Them
• Chapter 134 - Obstructive Sleep Apnea in the Elderly
• Chapter 135 - Insomnia in Older Adults
• Chapter 136 - Sleep in Independently Living and Institutionalized Elderly

Section 18 - Women's Health

• Chapter 137 - Sex Differences and Menstrual-Related Changes in Sleep and Circadian Rhythms
• Chapter 138 - Sleep Disturbances and Sleep-Related Disorders in Pregnancy
• Chapter 139 - The Postpartum Period
• Chapter 140 - Menopause

Section 19 - Methodology

• Chapter 141 - Monitoring and Staging Human Sleep
• Chapter 142 - Monitoring Techniques for Evaluating Suspected Sleep-Disordered Breathing
• Chapter 143 - Evaluating Sleepiness
• Chapter 144 - Assessment Techniques for Insomnia
• Chapter 145 - Neurologic Monitoring Techniques
• Chapter 146 - Chronobiologic Monitoring Techniques
• Chapter 147 - Actigraphy
• Chapter 148 - Gastrointestinal Monitoring Techniques
• Chapter 149 - Light Therapy

Product Details

• Hardcover: 1766 pages
• Publisher: Saunders; 5 edition (November 1, 2010)
• Language: English
• ISBN-10: 1416066454
• ISBN-13: 978-1416066453

List Price: $199.00 

 

Chokroverty: Sleep Disorders Medicine 3rd Edition: Basic Science, Technical Considerations, and Clinical Aspects (Expert Consult Series)

The history of sleep medicine and sleep research can be summarized as a history of remarkable progress and, at the same time, a history of remarkable ignorance. Since the publication of the second edition in 1999 enormous progress has been made in all aspects of sleep science and sleep medicine. I am pleased to see these rapid advances in sleep medicine and growing awareness about the importance of sleep and its dysfunction amongst the public and the profession. A sleep disorder is a serious health hazard and a “sleep attack” or a lack of sleep should be taken as seriously as a heart attack or “brain attack” (stroke); undiagnosed and untreated, a sleep disorder will have catastrophic consequences as severe as heart attack and stroke. Many dedicated and committed sleep scientists and clinicians, regional, national and international sleep organizations and foundations are responsible for pushing the topic forward. I can name a few such organizations (not an exhaustive list), e.g., American Academy of Sleep Medicine (AASM), National Sleep Foundation (NSF), European Sleep Research Society (ESRS), Asian Sleep Research Society (ASRS), Federation of Latin American Sleep Society (FLASS), World Association of Sleep Medicine (WASM), World Federation of Sleep Research and Medicine Societies (WFSRMS), Restless Legs Syndrome (RLS) Foundation and International Restless Legs Syndrome Study Group (IRLSSG). Thanks to these dedicated individuals and organizations sleep medicine is no longer in its infancy stage but is now a mature, but rapidly evolving branch within the broad field of medicine, standing on its own laurels.

Rapid advances in basic science, technical aspects, laboratory tests, clinical and therapeutic fields of sleep medicine have captivated sleep scientists and clinicians. In the sphere of basic science, a discovery in 1998 of two hypothalamic neuropeptides, hypocretin 1 (orexin A) and hypocretin 2 (orexin B), independently by two groups of neuroscientists, followed by the observations of narcoleptic phenotype in hypocretin receptor 2 mutated dogs and pre-prohypocretin knock-out mice in 1999, electrified the scientific community of sleep medicine. This was rapidly followed by advances in other basic science aspects of sleep, e.g., new understanding about neurobiology of sleep-wakefulness, sleep and memory consolidation, genes and circadian clock and neuroimaging of sleep-wakefulness showing a spectacular picture of the living brain non-invasively. Some examples of advances in clinical science include new insight into neurobiology of narcolepsy-cataplexy syndrome, obstructive sleep apnea and metabolic syndrome associated with serious cardiovascular risks and heart failure, advances in pathophysiology and clinical criteria of restless legs syndrome and rapid eye movement sleep behavior disorder, genetics of sleep disorders including RLS genes, new understanding of nocturnal frontal lobe epilepsy (nocturnal paroxysmal dystonia), fatal familial insomnia and the role of the thalamus in sleep-wake mechanisms, descriptions of new disorders (e.g., propriospinal myoclonus at sleep onset, expiratory groaning or catathrenia, rhythmic foot tremor and alternating leg muscle activation [ALMA]), and the revised international classification of sleep disorders (ICSD-2). In laboratory techniques the following can be cited as recent advances: new AASM scoring guidelines, improved in-laboratory and ambulatory polysomnographic (PSG) techniques, role of peripheral arterial tonometry, pulse transit time, actigraphy in sleep medicine, identification of autonomic activation by heart rate spectral analysis and realization of the importance of cyclic alternating pattern (CAP) in the EEG as an indication of sleep stability and arousal. Rapid advances have also been made in the therapeutic field which include new medications for narcolepsy-cataplexy, insomnia, restless legs syndrome, refinements of CPAP-BIPAP, introduction of auto-CPAP, assisted servo ventilation (ASV) in Cheyne-Stokes and other complex breathing disorders and intermittent positive pressure ventilation (IPPV) in neuromuscular disorders, and phototherapy for circadian rhythm disorders. The third edition tried to incorporate most of these advances, but in a field as vast as sleep medicine—rapidly evolving and encompassing every system and organ of the body—something will always be missing and outdated.

The third edition contains seven new chapters. Chapter 3 addresses an important topic of sleep deprivation and sleepiness reflecting the controversy of sleep duration and diseases and the causes and consequences of excessive daytime sleepiness. In Chapter 9 Walker and Stickgold discuss the question of sleep and memory consolidation, focusing not only on their own original contributions but also other important research in this field. In Chapter 15 the group lead by Maquet discusses how modern neuroimaging techniques can explore the living brain in a non-invasive manner, opening a new field in our understanding of sleep and sleep disorders. Partinen summarizes the importance of understanding the role of nutrition for sleep health in Chapter 23. In Chapter 31 Solms, based on his longstanding interest and research in neurological aspects of dreaming, brings into focus dream disorders in neurological diseases, a very timely topic which remains ill understood and unexplained. Hoban, in Chapter 38, masterfully and succinctly tells us how our sleep pattern and requirement change from birth to adolescence. Finally, a very important and often neglected topic of sleep medicine in women is discussed by Driver in Chapter 39. In this edition I have invited new contributors for these seven chapters which appeared in the second edition. Hirshkowitz, Rose, and Sharafkhaneh (Chapter 6) replaced Zoltoski and co-authors for neurochemistry and biochemical pharmacology of sleep. Robert Y. Moore, one of the pioneers in circadian neurobiology, wrote Chapter 8, replacing Kilduff and Kushida. Mehra and Strohl replaced Parisi for writing the chapter (14) dealing with an essential topic of evaluation and monitoring respiratory function. Hirshkowitz and Sharafkhaneh replaced Mitler and co-workers for updating the sleep scoring technique chapter (18). Tafti and co-workers (Chapter 22) replaced Mignot, bringing together all the recent advances in human and animal genetics of sleep and sleep disorders. Morin and Benca replaced Spielman and Anderson for the insomnia chapter (26), shedding light on recent understanding about the role of non-pharmacologic and pharmacologic treatments of insomnia based on their vast experience and original contributions to the field. Montplaisir and co-workers replaced Broughton for the chapter (35) on behavioral parasomnias, incorporating many of their original contributions in the topic. I have invited Professor Montagna to join me in revising Chapters 29 and 30Chapter 29 Chapter 30. The remaining chapters have been revised and updated with new materials, references, illustrations and tables.

The purpose of the third edition remains the same as those of the previous editions, namely to provide a comprehensive text covering basic science, technical and laboratory aspects and clinical and therapeutic advances in sleep medicine so that both the beginners and seasoned practitioners of sleep medicine will find the text useful. Hence the book should be useful to internists (especially those specializing in pulmonary, cardiovascular, gastrointestinal, renal and endocrine medicine), neurologists, family physicians, psychiatrists, psychologists, otolaryngologists, pediatricians, dentists, neurosurgeons and neuroscientists, as well as those technologists, nurses and other paraprofessionals with an interest in understanding the value of a good night's sleep.

I conclude the preface for this edition with a sad note. Two of our great scientists and giants in the field (Wayne Hening and Mircea Steriade) passed away after writing their chapters but before publication. We will miss their robust scientific contributions and writings, but they remain forever in our memory and in their last and lasting contributions to this text. I am particularly devastated by the unexpected and premature death of Wayne Hening, who had been not only a longstanding colleague but also a most dear friend of my wife and me for over two decades. Our vivid memory of Wayne traveling with us, visiting cultural centers in the North and South of India, participating in vigorous discussions of many interesting and intellectually stimulating topics will never fade away.

-- Sudhansu Chokroverty

Key Features

• Covers all aspects of sleep medicine in a practical, logical format divided into three sections: the basic science of sleep physiology, neuroanatomy, and biochemistry; the technical methods of recording; and a clinical approach to patients with sleep complaints.
• Represents the breadth of knowledge across disciplines through the contributions of 50 prominent names in the field of sleep medicine.
• Provides a multidisciplinary approach to the diagnosis and management of sleep disorders with coverage of related fields such as pulmonology, otolaryngology, and psychiatry.
• Includes a Glossary of Terms adapted from the American Sleep Disorders Association for quick reference to the sleep terminology used throughout the text.
• Offers online access to the full text through Expert Consult functionality for convenient reference.
• Demonstrates how recent basic science advances affect clinical medicine through new chapters on Sleep Deprivation and Sleepiness; Sleep and Memory Consolidation; Neuroimaging in Sleep and Sleep Disorders; Nutrition and Sleep; Nature and Treatment of Insomnia; Evolution of Sleep from Birth through Adolescence; Sleep-Disordered Breathing in Children and Women's Sleep.
• Improves on the clarity and consistency of the text with a new, completely redrawn art program, including full-color illustrations in the clinical section that enhances diagnostic material.
• Presents the material in an even more readable and user-friendly two-color design and page layout.

Website Features

• Consult the book from any computer at home, in your office, or at any practice location.
• Instantly locate the answers to your clinical questions via a simple search query.
• Quickly find out more about any bibliographical citation by linking to its MEDLINE abstract.

Contents

Part I - Basic Aspects of Sleep

• Chapter 1 - Introduction
• Chapter 2 - An Overview of Normal Sleep
• Chapter 3 - Sleep Deprivation and Sleepiness
• Chapter 4 - Neurobiology of Rapid Eye Movement and Non–Rapid Eye Movement Sleep
• Chapter 5 - Neurophysiologic Mechanisms of Slow-Wave (Non–Rapid Eye Movement) Sleep
• Chapter 6 - Neurotransmitters, Neurochemistry, and the Clinical Pharmacology of Sleep
• Chapter 7 - Physiologic Changes in Sleep
• Chapter 8 - Circadian Timing and Sleep-Wake Regulation
• Chapter 9 - Sleep and Memory Consolidation
• Chapter 10 - Dreaming in Sleep-Disordered Patients

Part II - Technical Considerations

• Chapter 11 - Polysomnographic Technique: An Overview
• Chapter 12 - Electroencephalography, Electromyography, and Electro-Oculography: General Principles and Basic Technology
• Chapter 13 - Electrocardiographic Technology of Cardiac Arrhythmias
• Chapter 14 - Evaluation and Monitoring of Respiratory Function
• Chapter 15 - Neuroimaging in Sleep and Sleep Disorders
• Chapter 16 - Measurement of Sleepiness and Alertness: Multiple Sleep Latency Test
• Chapter 17 - The Maintenance of Wakefulness Test
• Chapter 18 - Clinical Polysomnography and the Evolution of Recording and Scoring Technique

Part III - Clinical Aspects

• Chapter 19 - Approach to the Patient with Sleep Complaints
• Chapter 20 - Classification of Sleep Disorders
• Chapter 21 - Epidemiology of Sleep Disorders
• Chapter 22 - Human and Animal Genetics of Sleep and Sleep Disorders
• Chapter 23 - Nutrition and Sleep
• Chapter 24 - Obstructive Sleep Apnea Syndrome
• Chapter 25 - Positive Airway Pressure in the Treatment of Sleep Apnea-Hypopnea
• Chapter 26 - Nature and Treatment of Insomnia
• Chapter 27 - Narcolepsy
• Chapter 28 - Motor Functions and Dysfunctions of Sleep
• Chapter 29 - Sleep, Breathing, and Neurologic Disorders
• Chapter 30 - Sleep and Epilepsy
• Chapter 31 - Dreaming in Neurologic Disorders
• Chapter 32 - Sleep in Psychiatric Disorders
• Chapter 33 - Sleep Disturbances in General Medical Disorders
• Chapter 34 - Circadian Rhythm Disorders
• Chapter 35 - Parasomnias
• Chapter 36 - Sleep Disorders in the Elderly
• Chapter 37 - Sleep Disorders of Childhood
• Chapter 38 - Evolution of Sleep from Birth through Adolescence, and Sleep-Disordered Breathing in Children
• Chapter 39 - Women's Sleep
• Chapter 40 - Sleep-Related Violence: Forensic Medicine Issues

About the Author

• Sudhansu Chokroverty, MD, FRCP, FACP, Professor and Co-Chair of Neurology, Clinical Neurophysiology and Sleep Medicine, New Jersey Neuroscience Institute at JFK Medical Center, Edison, New Jersey; Professor of Neuroscience, Seton Hall University School of Graduate Medical Education, South Orange, New Jersey.

Book Review

"The third edition of this classic work maintains its core strengths, while at the same time is dramatically updated and modernized, reflecting the enormous contributions in the field provided by neuroimaging, genetics and technical advances. One can use the book in two ways: as a reference work to look up a particular phenomenon or as a textbook, which can be read by students, residents or practicing clinicians in virtually any setting. The clinical chapters have the flavor or authenticity that can only be achieved by the fact that they are written by experienced and seasoned clinicians who understand the challenges of diagnosing and managing sleep disorders in the real world.

Dr. Chokroverty picked his authors carefully from a world cast of characters in the field. He wrote several of the chapters himself and fastidiously edited the others so that the text holds together as a single work that adheres to his vision of a book that is authoritative, while simultaneously a valuable manual for the practice of sleep medicine. The third edition of what is now the classic work in the field will undoubtedly find its way to the book shelves of everyone who sees patients.

I once asked Dr. Chokroverty what he thought the function of sleep might be. He responded that without it, we would probably become quite drowsy. His tongue in cheek answer reflects the fact that we do not yet know the full answer to this age old question. The current theories are clearly explicated in the third edition. Whether the function of sleep is to consolidate memories, to metabolize soporific compounds that are the products of brain metabolism or some other as yet unknown purpose, we can be sure that we will see the answer in authoritative form in the next edition of Chokroverty's Sleep Disorders Medicine."

-- Martin A. Samuels, MD, FAAN, MACP, Chairman, Department of Neurology, Brigham and Women's Hospital, Professor of Neurology, Harvard Medical School, Boston, Massachusetts

Product Details

• Hardcover: 750 pages
• Publisher: Saunders; 3 edition (July 24, 2009)
• Language: English
• ISBN-10: 0750675845
• ISBN-13: 978-0750675840
• Product Dimensions: 11 x 8.8 x 1.1 inches

List Price: $218.00