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

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

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

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

6. 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

7. 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

8. 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

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

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

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

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

13. 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

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

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

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

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

18. 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

19. 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

20. Workup not complete until you think about SLEEP

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

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

23. 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

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