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Sleep Academic Award 1

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Circadian. Homeostatic. Drug / alcohol. Cardiorespiratory. Neurology ... Circadian Rhythm Disorders. Insufficient Sleep. Excessive Sleepiness (narcolepsy) ... – PowerPoint PPT presentation

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Title: Sleep Academic Award 1


1
Sleep Processes
  • Bedtime
  • Circadian
  • Homeostatic
  • Drug / alcohol
  • Cardiorespiratory
  • Neurology
  • Behavioral / psychiatric
  • Developmental

2
WAKE, REM, NREM
Oscillate in a predictable, repetitive, sequence
3
Two year old with frequent awakenings
  • Noah has never slept well. As an infant he had
    colic and cried for hours in the evening before
    falling asleep in the parents arms. By four
    months of age the colic was better, but he
    continued to be difficult to put to sleep and he
    has never consistently slept through the night.
    At two he is a bright happy toddler who is
    developmentally age appropriate, without any
    medical problems, but his parents are exhausted.
    Physical examination, growth and development are
    all normal.

4
  • Noah has always fallen asleep while being rocked
    and fed. Bedtime is at 8 pm and goes smoothly.
    The parents will hold Noah until he has fallen
    asleep, but they cant put him in his crib for
    another 20 minutes. If they do ,he will wake up
    and begin crying immediately. If he is picked up
    he will quiet down again. He generally sleeps
    well for 3-4 hours, but after that he is
    awakening 2-4 times every night . There is no
    obvious cause for the awakenings, and if he is
    picked up and fed he will quiet immediately and
    return to sleep. If not he will cry for hours. In
    the morning he awakens spontaneously at 8 am in a
    good mood. Noah naps at daycare for 1-3 hours
    without a problem, but on the weekends he needs a
    bottle and to be held to fall asleep at naptime

Sleep Academic Award 4
5
Sleep Processes
  • Excessive daytime sleepiness
  • Circadian
  • Homeostatic
  • Drug / alcohol
  • Cardiorespiratory
  • Neurology
  • Behavioral / psychiatric
  • Developmental

6
Sleep Processes
  • Awakenings
  • Circadian
  • Ultradian
  • Homeostatic
  • Drug/alcohol
  • Cardiorespiratory
  • Neurology
  • Behavioral / psychiatric
  • Developmental

7
Sleep Processes
  • Regularity
  • Circadian
  • Homeostatic
  • Drugs / alcohol
  • Neurology
  • Behavioral / psychiatric
  • Developmental

8
Sleep Processes
  • Snoring
  • Ultradian
  • Drugs / alcohol
  • Cardiorespiratory

9
Physiologic Process - Sleep
  • Circadian
  • Homeostatic
  • Ultradian
  • Drugs / alcohol
  • Cardiorespiratory / upper airway
  • Neurologic
  • Psychiatric / behavioral
  • Developmental

10
Sleep History
  • 20-40 of people of all ages have sleep problems
  • Begin with How is your sleep?
  • Then ask about
  • B - bedtime
  • E - excessive sleepiness
  • A - awakenings from sleep
  • R - regularity of sleep schedule
  • S - snoring

11
Differential Diagnosis of Sleep Problems
  • Obstructive Sleep Apnea (snoring / observed apnea
    / daytime sleepiness)
  • Insomnia
  • Circadian Rhythm Disorders
  • Insufficient Sleep
  • Excessive Sleepiness (narcolepsy)
  • Parasomnias (nocturnal behaviors)

12
Differential Diagnosis of Sleep Problems (cont.)
  • Think sleep when
  • cardiovascular - ?BP, COPD, asthma, CHF
  • neurologic - seizures, neuromuscular disease
  • obesity - sleep apnea, hypoventilation
  • blindness
  • psychiatric - depression, anxiety
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