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