SleepWhen a cup of warm milk is not enough : Sleep When a cup of warm milk is not enough K. Van Gundy, M.D. Associate Clinical Professor UCSF


Normal Sleep: Normal Sleep Normal Sleep patterns (cycles) Non REM REM Circadian rhythm Drugs influence on sleep Genetics of sleep


Status Americans: Status Americans 62% say the experience sleep problems a week or more 40% report sleepy enough during the day to interfer with activities 62% drive while drowsy 27% have fallen asleep while driving 60% children feel parients are tired during the day 15% children admit falling asleep at school


Status Men: Status Men On week days one third of men get less than 6 hours sleep 47% truck drivers report falling asleep at the wheel 25% of truck drivers fall asleep yearly OSA cost $2720.00 / year undiagnosed but costs $1384.00 / year if diagnosed and treated. Over all additional cost of OSA in the US is 3.4 Billion dollars. African American Men have a a higher risk of OSA?


Status Women: Status Women 79% report sleep disturbance during pregnancy 36% women peri- menopausal women report disturbed sleep 25% suffer from significant daytime sleepiness 30% disturbed sleep interferes with daily activity, 27% job performance is impaired, 24% say sleep gets in the way of caring for family


Normal Sleep: Normal Sleep Normal Sleep patterns (cycles) Non REM REM Circadian rhythm Drugs influence on sleep Genetics of sleep


Insomnia: Insomnia Difficulty initiating sleep Frequent awakenings ( including early morning awakening) Subjective feeling of insufficient sleep Preoccupation with sleep complants


Insomnia: Insomnia Causes of Insomnia (short term insomnia) Change in sleep environments Jet lag Changes in work shift Excessive noise Unpleasant room temperature Stressful life events Medical condition Medications


Insomnia: Insomnia Chronic insomnia Anxiety Schizophrenia Depression Learned insomnia Sleep state misperception Poor sleep hygiene Insufficient sleep High altitude insomnia Restless legs / Periodic limb movments Circadian rhythm disorders Delayed , Advanced , non 24 hour sleep – wake disorder Sleep apneas


Treatment: Treatment Nonpharmacologic treatment Hygiene Relaxation Stimulus control Sleep restriction Pharmacologic therapy Benzodiazepines / related hypnotics Antidepressants Antihistamines Melatonin Light


Other sleep disorders: Other sleep disorders Narcolepsy Genetic Aspects of narcolepsy DR2, DR2 DQw1 Dw2 = DR2 Diagnosis Cataplexy (pathognomonic) Treatment of narcolepsy Stimulants, REM suppressants, Behavioral adjustments child.MOV


Sleep Apnea: Sleep Apnea Disorders of breathing and sleep Obstructive sleep apnea Clinical manifestations Treatment Central sleep apnea Restrictive lung disease Neuromuscular disease Cardiac Neurological


Parasomnias of Sleep: Parasomnias of Sleep Non REM Sleep terrors and sleep walking Bruxism CNS disease, Drugs, Cardiac disease can trigger


Disrupted Sleep: Disrupted Sleep Parkinsonism Neuromuscular disease Respiratory disease Dementia Epileptic seizures Cardiovascular disease


Sleep hygiene: Sleep hygiene