Offering a practical approach to the introduction of sleep medicine, this easy-to-use, concise volume uses actual patient cases from the Cleveland Clinic Sleep Disorders Center. A wide spectrum of diagnoses are included to expose the reader to the extensive range of sleep-wake disorders that a patient can experience. Written in a concise format designed to illustrate the signs and symptoms, diagnostic criteria, workup and routine treatment of patients presenting to the sleep clinic, this volume serves as a practical text perfect for the busy primary-care practitioner seeking to improve her knowledge of sleep-wake disorders. Whenever possible, tracings from diagnostic tests, photography, and video clips are provided to enhance clinical presentations and to aid in recognition of abnormities identified in the sleep laboratory.

Table of Contents

Introduction to the Sleep Clinic N. Foldvary-Schaefer, K Budur, J. Krishna (lead K. Budur)
(emphasis on provider and patient diversity; behavioral
and group therapy clinics; special exam rooms:
ENT/on-site blood draws, Utox screening, etc)
Video of sleep clinics

Introduction to the Sleep Laboratory N. Foldvary-Schaefer, K Budur, J. Krishna (lead J. Krishna)
(emphasis on instrumentation, variety of hook-ups
and studies and hotel labs)
Video of sleep lab


Insomnia (Section Head : K. Budur)

1. Psychophysiological Insomnia V. Luppa
(emphasis on diagnosis and pharmacological management) K. Budur


2. Psychophysiological Insomnia M. Drerup
(emphasis on non-pharmacological management)
Consider video quiz for poor sleep hygiene,
"what's wrong with this bed room"


3. Insomnia Due to Mental Disorder K. Ashton
(emphasis on Depression/ Anxiety and Insomnia) K. Budur


4. Behavioral Insomnia of Childhood M. Richards
(emphasis on limit setting/sleep onset association and
behavioral interventions)


5. Paradoxical Insomnia M. Zaharna
K. Budur


6. Insomnia Due to Medical Condition K. Adury
(emphasis on fibromyalgia/pain and K. Budur
common medical conditions associated with Insomnia)




Sleep-Related Breathing Disorders (Section Head: N. Foldvary-Schaefer)

Central Sleep Apnea Syndromes


7. Primary Central Sleep Apnea H. Mermingis
(emphasis on diagnosis and different treatment options) Z. Alsheikhtaha

8. Central Sleep Apnea Due to Cheyne Stokes Breathing Pattern I. Sriubiene
Consider video of a patient S. Baccaray
N. Foldvary-Schaefer

9. Central Sleep Apnea Due to Medical Condition not CSR B. Cohen
J. Krishna

10. Complex Sleep Apnea H. Mermingis
(emphasis on diagnosis and ASV) Z. Alsheikhtaha


Obstructive Sleep Apnea Syndromes


11. OSA, Adult- Use of portable monitoring and screening tools for OSA S. Baccaray
(emphasis on standard signs and symptoms of OSA in adults N. Andrews
and indications/contra-indications for PM) N. Foldvary-Schaefer
Consider video of a patient: hook-up


12. OSA, Adult Challenging PAP - Behavioral strategies W. Novak
(emphasis on PAP treatments and need for behavioral J. Sliwinski
interventions: desensitization in challenging cases, etc)
Consider video of a patient with CPAP desensitization


13. OSA, Adult - Obesity/Metabolic Syndrome/Bariatric surg
/Perioperative Issues R. Kaw
Consider a photograph and hypnogram pre and post C. Bae
bariatric surgery

14. OSA, Adult - Craniofacial anomaly/ Mandibular Advancement S. Ibrahim
Consider video of a patient with craniofacial anomaly and R. Armstrong
components of a good ENT exam


15. Adult OSA -Upper airway surgery A. Kominsky
(emphasis on patient selections, interventions, success rates)
Consider video

16. Pediatric OSA - Supraglottoplasty R. Seth
(emphasis on surgery for pediatric OSA) J. Krishna
P. Krakovitz
Consider video of a laryngoscopy/surgery

17 Pediatric OSA - Severe OSA -Urgent assessment J. Krishna
(emphasis on pediatric OSA and identifying high risk patients) J. Sciuva

18. OSA - PAP interfaces L. Aboussuan
(emphasis on mechanical problems) Z. Zahand
Consider video of mask fitting P. Podmore

19. Pediatric OSA - Obesity J. Krishna
(emphasis on metabolic syndrome in peds) J. Sciuva

20. OSA- oral appliances F. Sreshta
Consider video of different oral appliances, fitting, etc


Sleep-Related Hypoventilation/Hypoxemic Syndromes


21. Sleep-Related Hypoventilation/Hypoxemia Due to Pulmonary
Parenchymal or Vascular Pathology N. Jaimchariyatam
O. Minai

22. Sleep-Related Hypoventilation/Hypoxemia Due to Lower Airways
Obstruction - Overlap Syndrome N. Jaimchariyatam
O. Minai

23. Sleep-Related Hypoventilation/Hypoxemia Due to Neuromuscular and
Chest Wall Disorders (Pompe's disease)
(emphasis on timing of sleep study and management) L. Aboussuan
Consider video N. Jaimchariyatam
J. Krishna


Hypersomnias of Central Origin Not Due to a Circadian Rhythm Sleep Disorder, Sleep-Related Breathing Disorder, or Other Cause of Disturbed Nocturnal Sleep (Section Head: J. Krishna)


24. Narcolepsy with cataplexy C. Griffin
(emphasis on diagnosis of narcolepsy, MSLT S. Neme
interpretation, and treatment of narcolepsy) N. Foldvary-Schaefer
Consider video

25. Narcolepsy Due to Medical Condition R. Valentino
(emphasis on differential diagnosis of hypersomnia and F. Talih
medical conditions that cause narcolepsy)

26. Klein-Levin Syndrome C. Brooker
(emphasis on KLS and other recurrent hypersomnias) P. Kotagal

27. Idiopathic Hypersomnia With/Without Long Sleep Time K. Budur
(emphasis on management of hypersomnia; discuss MWT) N. Jaimchariyatam

28. Behaviorally Induced Insufficient Sleep Syndrome K. Budur
(emphasis on consequences of sleep deprivation) N. Jaimchariyatam

29. Hypersomnia due to Drugs J. Sciuva
(emphasis on preparation for MSLT: stop meds; Utox) K. Budur
J. Krishna



Circadian Rhythm Sleep Disorders (Section Head: K. Budur)


30. Circadian Rhythm Sleep Disorder, DSPS C. Rodriguez
(emphasis on differential diagnosis of hypersomnia)

31. Circadian Rhythm Sleep Disorder, DSPS W. Novak
(emphasis on actigraphy, treatment)
Consider video of actigraphy and light therapy

32. Circadian Rhythm Sleep Disorder, Shift Work Disorder K. Budur
(emphasis on SCN, core body temperature)


33. Circadian Rhythm Sleep Disorder, Jet Lag Type W. Novak
(emphasis on circadian misalignment, FAA recommendations)



Parasomnias (Section Head: N. Foldvary-Schaefer)


Disorders of Arousal (From NREM Sleep)


34. Confusional Arousals - Sleepwalking A. Roy
(emphasis on prevalence of arousal disorders, overlap in S. Neme
presentation, provoking factors, and treatment) N. Foldvary-Schaefer
Consider video

35. Sleep Terrors A. Irwin
(emphasis on differential diagnosis and treatment) J. Krishna
Consider video

Parasomnias Usually Associated with REM Sleep


36. REM Sleep Behavior Disorder S. Neme
(emphasis on diagnosis and treatment/safety measures) A. Avidan
Consider video

37. RBD (pseudo RBD) C. Rodriguez
(emphasis on differential diagnosis, impact of treating other sleep
disorders)
Consider video


Other Parasomnias

38. Sleep Enuresis J. Krishna
(emphasis on differential diagnosis, work up, role of sleep expert) J. Sciuva


39. Sexsomnia C. Brooker
N. Foldvary-Schaefer


40 Sleep-Related Eating Disorder S. Baccaray
N. Foldvary-Schaefer

41. Sleep-Related Groaning (Catathrenia) M. Grigg-Damberger
Consider video N. Foldvary-Schaefer


Sleep-Related Movement Disorders


42. Restless Legs Syndrome J. Lee
(emphasis on diagnosis and treatment including augmentation) C. Bae
Consider video

43. Restless Legs Syndrome L. L. Lim
(emphasis on workup; secondary RLS) Ai Ping Chua
N. Foldvary-Schaefer

44. Periodic Limb Movement Disorder F. Zarrouf
(emphasis on scoring leg movements; etiology of PLMS) K. Budur
Consider video

45. Hypnogenic Foot Tremor S. Ibrahim
(emphasis on differential diagnosis) R. Valentino
Consider video


Sleep Disorders Associated with Other Conditions


46. Sleep-related epilepsy S. Neme
(emphasis on frontal lobe epilepsy mimicking parasomnia) N. Foldvary-Schaefer
Consider video

47. VNS, epilepsy and apnea J. Fong
(emphasis on PSG findings) C. Bae
Consider video K. Yang
N. Foldvary-Schaefer

48. Continuous Spike Wave in Sleep (CSWS) T. Loddenkemper
Consider video P. Kotagal

49. Parkinson's disease J. Vensel
(emphasis on sleep in PD: hypersomnia, RBD, RLS) C. Rodriguez
Consider video showing multiple sleep manifestations a in PD patient

50. Dementia with CRD W. Novak
(emphasis on sleep in the aged; ASPS, Irregular SW cycle)

51. Headache D. Rothner
(emphasis on multidisciplinary approach, specifically role of sleep specialist)

52. Stroke M. Alattar
(emphasis on sleep in stroke patients: central apneas, hypersomnolence, etc) J. Lee-Iannotti