Sleep medicine
[11] Sleep deprivation has also been a significant factor in dramatic accidents, such as the Exxon Valdez oil spill, the nuclear incidents at Chernobyl and Three Mile Island and the explosion of the space shuttle Challenger.
Sleep disorders often do not fit neatly into traditional classification; differential diagnoses cross medical systems.
A further subdivision of the dyssomnias preserves the integrity of circadian rhythm sleep disorders, as was mandated by about 200 doctors and researchers from all over the world who participated in the process between 1985 and 1990.
The authors found the heading "medical or psychiatric" less than ideal but better than the alternative "organic or non-organic", which seemed more likely to change in the future.
[16] MeSH, Medical Subject Headings,[17] a service of the US National Library of Medicine and the National Institutes of Health, uses similar broad categories: (1) dyssomnias, including narcolepsy, apnea, and the circadian rhythm sleep disorders, (2) parasomnias, which include, among others, bruxism (tooth-grinding), sleepwalking and bedwetting, and (3) sleep disorders caused by medical or psychiatric conditions.
Recent thinking opens for a common cause for mood and sleep disorders occurring in the same patient; a 2010 review states that, in humans, "single nucleotide polymorphisms in Clock and other clock genes have been associated with depression" and that the "evidence that mood disorders are associated with disrupted or at least inappropriately timed circadian rhythms suggests that treatment strategies or drugs aimed at restoring 'normal' circadian rhythmicity may be clinically useful.
"[19] A 16th-century physician wrote that many laborers dozed off exhausted at the start of each night; sexual intercourse with their wives typically occurring in the watching period, after a recuperative first sleep.
[21] Much has been written about dream interpretation, from biblical times to Freud, but sleep itself was historically seen as a passive state of not-awake.
By the 1970s in the US, and in many western nations within the two following decades, clinics and laboratories devoted to the study of sleep and the treatment of its disorders had been founded.
[24] Benca's review cites a 2002 survey by Papp et al. of more than 500 primary care physicians who self-reported their knowledge of sleep disorders as follows: Excellent – 0%; Good – 10%, Fair – 60%; and Poor – 30%.
The review of more than 50 studies indicates that both doctors and patients appear reluctant to discuss sleep complaints, in part because of perceptions that treatments for insomnia are ineffective or associated with risks, and: Physicians may avoid exploring problems such as sleep difficulties in order to avoid having to deal with issues that could take up more than the normal allotted time for a patient.
"[25] The Imperial College Healthcare site[26] shows attention to obstructive sleep apnea syndrome (OSA) and very few other disorders, specifically not including insomnia.
[28] The newly formed South African Society of Sleep Medicine (SASSM) was launched at its inaugural congress in February 2010.
[29][30] The society's membership is diverse; it includes general practitioners, ENT surgeons, pulmonologists, cardiologists, endocrinologists and psychiatrists.
The Assembly of National Sleep Societies (ANSS), which includes both medical and scientific organizations from 26 countries as of 2007, is a formal body of the ESRS.
Its independent daughter entity the American Board of Sleep Medicine (ABSM) was incorporated in 1991 and took over the aforementioned responsibilities.
Each board supervises the required 12 months of formal training for its candidates, while the exam is administered to all of them at the same time in the same place.
For the first five years, 2007–2011, during "grandfathering", there was a "practice pathway" for ABSM certified specialists while additional, coordinated requirements were to be added after 2011.
This specialist is skilled in the analysis and interpretation of comprehensive polysomnography, and well-versed in emerging research and management of a sleep laboratory.
The resulting Diplomate status is recognized by the AASM, and these dentists are organized in the Academy of Dental Sleep Medicine (USA).
The taking of a thorough medical history while keeping in mind alternative diagnoses and the possibility of more than one ailment in the same patient is the first step.
Differentiation of transient from chronic disorders and primary from secondary ones influences the direction of evaluation and treatment plans.
It shows multiple channels of electroencephalogram (EEG), electrooculogram (EOG), electrocardiogram (ECG), nasal and oral airflow, abdominal, chest and leg movements and blood oxygen levels.
A single part of a polysomnogram is sometimes measured at home with portable equipment, for example oximetry, which records blood oxygen levels throughout the night.
HSTs are performed at home in the patient’s usual sleep environment and thus are more representative of their natural sleep than staying overnight at a lab, where patients often experience “first night syndrome” [1] These devices are increasing in utilization due to their convenience and cost effectiveness and the fact that many insurance companies now require them instead on a polysomnography.
A Multiple Sleep Latency Test (MSLT) is often performed during the entire day after polysomnography while the electrodes and other equipment are still in place.
It is a measure of daytime sleepiness; it also shows whether REM sleep is achieved in a short nap, a typical indication of narcolepsy.
Chronic circadian rhythm disorders, the most common of which is delayed sleep phase disorder, may be managed by specifically timed bright light therapy, usually in the morning, darkness therapy in the hours before bedtime, and timed oral administration of the hormone melatonin.
