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“SLEEPERS” : 

“SLEEPERS” John Hey MD DABSM. FAASM Medical Director--Sleep Disorders Center--Greenwood Leflore Hospital

What we’re gonna do : 

What we’re gonna do Over view of sleep medicine Medical/Surgical conditions from sleep disorders Office screening for sleep disorders

Slide 4: 

Sleeper Diagnoses Pulmonary Embolus Alcoholism/Drugs Depression Abuse Polypharmacy Munchausin Tubal pregnancy Sarcoid

Slide 5: 

SLEEP DISORDERS New field in medicine Confluence of Specialties Psychiatry Neurology ENT Pulmonary Medical Pediatrics And most of all FP

Significant Dates in Sleep : 

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 : 

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 : 

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 : 

TOOLS OF SLEEP Detailed H&P ESS and other questionnaires Sleep logs PSG MSLT CPAP Titration Patient and family education

SLEEP STAGES : 

SLEEP STAGES Awake Stage I--NREM Stage II--NREM Stage III-SWS or Delta Stage IV-SWS or Delta REM

REM CHARACTERISTICS : 

REM CHARACTERISTICS Rapid eye movements Muscle paralysis Irregular breathing Difficult to awake Subtle EEG changes Dreaming

ADULT MEDICAL CONDITIONS : 

ADULT MEDICAL CONDITIONS Cognitive difficulty Night sweats Nocturia Daytime fatigue Impotency Enuresis Headaches MVA OBSTRUCTIVE SLEEP APNEA OSA

STROKES : 

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 apnea 33% epileptics have OSA

SCHOOL PROBLEMS : 

SCHOOL PROBLEMS Hyperactivity Inattention Discipline problems Irritability Poor grades THINK OSA in 5-16 year olds THINK NARCOLEPSY in 12 yr.. or older

INSOMNIA : 

INSOMNIA DEPRESSION OSA ANXIETY BIPOLAR ALCOHOL/SUBSTANCE ABUSE SLEEP MISPRECEPTION Medical conditions

“SYNCOPY” : 

“SYNCOPY” DROP ATTACKS “SEIZURE” SUDDEN WEAKNESS DROPPING OBJECTS SUDDEN CLUMSINES THINK ---NARCOLEPSY with Cataplexy

NARCOLEPSY : 

NARCOLEPSY SLEEP ATTACKS INSOMNIA VISUAL HALLUCINATIONS PARALYSIS ON AWAKENING FATIGUE “DEPRESSION” CATAPLEXY

MVA : 

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 : 

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

Slide 20: 

Workup not complete until you think about SLEEP

DOOR PRIZE QUIZ : 

DOOR PRIZE QUIZ 1--Sleep related laryngospasm 2--Sleepwalking 3--Sleep state misperception 4--Sleep related epilepsy 5-Narcolepsy

CONTINUED : 

CONTINUED 6--REM behavior disorder 7--Limit-setting sleep disorder 8--Sleep paralysis 9--Terrifying hypnagogic hallucinations 10--Sleepwalking-sleep eating

Accreditation Requirements : 

Accreditation Requirements Sleep H & P Patient Questionnaire Certification by Sleep Doc of necessity QA for tech scoring of PSG Interpretation by DABSM or overead Follow up by sleep doc

Slide 25: 

That concludes my talk and I will now try to fend off questions.

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