1. Understanding Sleep Disorders for the Clinician Part 1
Lisa Cottrell, Ph.D., CBSM, DBSM

3. Sleep in America, 2018
According to the National Sleep Foundation 2018 “Sleep in America” poll:
65% of American adults believe that sleep contributes to next day effectiveness
10% prioritize it over other aspects of daily living
35% prioritize fitness and nutrition
27% prioritize work
17% prioritize hobbies and interests
9% prioritize social life

4. According to previous National Sleep foundation studies, sleep health is strongly connected in self report to overall health, stress levels and life satisfaction. Those studies further indicate that sleep health is a strong independent predictor that a person will feel effective in daily functions. So, why don’t more people make it a priority?

5. More Sleep in America poll results
90% of Americans say their day starts when they get up, rather than with their sleep the night before
60% generally don’t take into account how much sleep they’ll need the night before when planning their day
Just so we know where we stand when we are addressing sleep concerns…

6. Joint Consensus Statement of the American Academy of Sleep Medicine and Sleep Research Society
“Sleeping less than 7 hours per night on a regular basis is associated with adverse health outcomes, including weight gain and obesity, diabetes, hypertension, heart disease and stroke, depression and increased risk of death. Sleeping less than 7 hours per night is also associated with impaired immune function, increased pain, impaired performance, increased errors and greater risk of accidents.” (Watson, N.F. et. al., 2015)

8. Purpose of Sleep
There is no unified theory about the function of sleep. It probably has more than one function: energy conservation, nervous system recuperation, memory consolidation, brain plasticity, emotion regulation, survival benefits by reducing risks associated with wakeful activity

10. Measurement of Sleep Objective measurement using polysomnography
Sleep staging
Electroencephalography
Electro-oculography
Electromyography
Central nervous system arousals
Sleep-related breathing
Thermal sensor at nose and mouth
Nasal pressure transducer
Esophageal manometer/chest-abdominal inductance plethysmograph/intercostal electromyography to detect respiratory effort
Pulse oximetry
Cardiac rhythm
Electrocardiogram
This procedure is necessary for appropriate diagnosis of some of the sleep disorders we’ll discuss

14. Measurement of Sleep Subjective assessment
Standardized sleep questionnaires
E.g., Pittsburgh Sleep Quality Index
E.g., Insomnia Severity Index
E.g., Epworth Sleepiness Scale
Sleep diary
Interview
Includes sleep history, assessment of symptoms of sleep disorders, medication and substance use patterns, medical history and exam, psychiatric assessment

15. Sleep and Psychological Health
“Psychiatric disorders and sleep are related in important ways. In contrast to the longstanding view of this relationship which viewed sleep problems as symptoms of psychiatric disorders, there is growing experimental evidence that the relationship between psychiatric disorders and sleep is complex and includes bi-directional causation.” Krystal, A. D. (2012)

16. Sleep and Psychological Health
“Healthy sleep is required for restoring functioning and vitality, promoting memory consolidation, and maintaining immune function. However, many individuals are affected with sleep disorders. There are about 60 million Americans who have problems with sleep, with associated costs of about $16 billion each year in medical care. Insomnia affects about 10% to 15% of the population, sleep apnea affects about 10%, followed by other sleep disorders, such as restless legs syndrome and circadian rhythm disorders. Untreated sleep disorders can increase the risk of heart disease, motor vehicle accidents, memory problems, depression, and impaired functioning” Khurshid, K. (2015)

17. This is the end of Part 1. Please continue to Part 2 in the next segment.