Sleeping medicine is a medical or subspecialty specialization devoted to the diagnosis and treatment of sleep disturbances and disorders. From the mid-20th century, research has provided a great deal of knowledge and answered many questions about sleep-wake function. The rapidly growing field has become a recognized medical subspecialist in several countries. Dentists are also eligible for board certification in some countries. The 12 month postgraduate training program, properly organized, is still determined in the United States. In some countries, sleep researchers and physicians treating patients may be the same person.
The first sleeping clinic in the United States was founded in 1970 by interested physicians and technicians; study, diagnosis and treatment of obstructive sleep apnea is their first task. By the end of 1999, almost all American doctors, without special training in sleep medication, could open a sleep laboratory.
Sleep disturbances and disorders are widespread and can have significant consequences for affected individuals as well as economic and other consequences for society. The US National Transportation Safety Agency has, according to Dr. Charles Czeisler, a member of the Institute of Medicine and Director of the Harvard School of Medicine Division at the University of Sleep Medicine at Brigham and Women's Hospital, found that the main cause (31%) of death-for-drivers of severe accidents was associated fatigue, (though rarely directly related with sleep disturbances, such as sleep apnea), with drugs and alcohol as the number two cause (29%). Lack of sleep is also a significant factor in dramatic accidents, such as the Exxon Valdez oil spill, the nuclear incident at Chernobyl and Three Mile Island and the explosion of the Challenger space shuttle.
Video Sleep medicine
Coverage and classification
Competence in sleeping pills requires an understanding of a large number of highly variable disorders, many of which are present with the same symptoms as excessive daytime sleepiness, which, in the absence of sleep deprivation, is "almost certainly caused by identifiable and treatable sleep disorders , such as sleep apnea, narcolepsy, idiopathic hypersomnia, Kleine-Levin syndrome, menstrual hyperomnia associated, recurrent idiopathic fainting, or circadian rhythm disorder. Another common complaint is insomnia, a series of symptoms that can have many causes, physical and mental. Management in different situations is very different and can not be done without the correct diagnosis.
ICSD, International Sleep Disorder Classification , was restructured in 1990, in relation to its predecessors, to include only one code for each diagnostic entry and to classify interference with pathophysiology mechanisms, as far as possible, rather than with major complaints. Multidisciplinary sleep medication training, and structures are now selected to encourage a multidisciplinary approach to diagnosis. Sleep disturbances often do not fit the traditional classification; differential diagnosis across the medical system. Small revisions and updates for ICSD were made in 1997 and in subsequent years. The current classification system in fact follows the groupings suggested by Nathaniel Kleitman, "the father of sleep research," in his 1939 book Sleep and Wakefulness.
The revised ICSD, ICSD-R, puts major sleep disorders in subgroups (1) dyssomnias, which include those resulting in insomnia or excessive sleepiness, and (2) parasomnia, which do not produce major complaints but interfere with or occur during sleep. A further division of dyssomnias maintains the integrity of sleep disorders of circadian rhythm, as mandated by about 200 physicians and researchers from around the world who participated in the process between 1985-1990. The last two subgroups are (3) the sleeping or psychiatric sleep disorders section and (4) the proposed new impairment section. The authors find the title "medical or psychiatric" less than ideal but better than "organic or non-organic" alternatives, which seem more likely to change in the future. Detailed reporting scheme aims to provide data for further research. The second edition, called ICSD-2, was published in 2005.
MeSH, Title of Medical Subjects , services from the National Library of Medicine and National Institutes of Health, use the same broad categories: (1) dyssomnia, including narcolepsy, apnea, and sleep disorders circadian rhythms, (2) parasomnia, which includes, inter alia, bruxism, sleepwalking and wetting, and (3) sleep disturbances caused by medical or psychiatric conditions. The system used produces a "tree," approaching each diagnosis from up to several angles so that any interference can be detected by some code.
The DSM-IV-TR, The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision , uses the same diagnostic code as the International Statistical Classification of Diseases and Related Health Problems , dividing sleep disorders into three groups: (1) primary sleep disorders, both dyssomnias and parasomnias, suspected result of endogenous disorders in sleep-building or time mechanisms; (2) secondary to mental disorders and (3) associated with general medical conditions or substance abuse.
Recent thinking is open to a common cause of mood and sleep disorders that occur in the same patient; the 2010 review states that, in humans, "single nucleotide polymorphisms within Clock and other clock genes have been linked to depression" and that "evidence that mood disorders are associated with impaired or at least inaccurate rhythmic circadians suggests that strategy treatment or medication aimed at restoring 'normal' circadian rhythms may be clinically useful. "
Maps Sleep medicine
History
A 16th-century doctor wrote that many laborers fell asleep exhausted at the beginning of each night; sexual intercourse with their wives usually occurs during the watch period, after the first cure of sleep. Anthropologists have found that societies are isolated without sleeping electric lights in various patterns; they rarely resemble our modern habits of sleep in an hour and eight hours. Much has been written about the interpretation of dreams, from biblical times to Freud, but sleep itself is historically viewed as an unconscious passive state.
The concept of sleeping pills belongs to the second half of the 20th century. Due to increased knowledge of sleep, including the growing field of chronobiology research from around 1960 and the invention of REM sleep (1952-53) and sleep apnea (first described in medical literature in 1965), the importance of medically admitted sleep. The medical community is beginning to pay more attention to previous primary sleep disorders, such as sleep apnea, as well as the role and quality of sleep in other conditions. In the 1970s in the US, and in many western countries in the next two decades, clinics and laboratories devoted to studying sleep and the treatment of disorders have been found. Most sleep doctors are primarily concerned with apnea; some experts in narcolepsy. Nothing restricts the use of a "sleeping doctor" degree, and the need for standards to arise.
Basic medical training does not pay much attention to sleep problems; according to Benca in its review Diagnosis and Treatment of Chronic Insomnia (2005), most physicians "are not well trained with respect to sleep and sleep disorders," and a 1990-91 survey of 37 American medical schools showed that sleep disorders and sleep "closed" in less than two (2) hours of teaching time, on average. The Benca review cites a 2002 survey by Papp et al. over 500 primary care physicians who self-reported their knowledge of sleep disorders as follows: Excellent - 0%; Good - 10%, Enough - 60%; and Poor - 30%. A review of more than 50 studies indicates that both physicians and patients appear reluctant to discuss sleep complaints, in part because of the perception that treatment for insomnia is ineffective or risk-related, and:
Also, the editorial in the journal of the American College of Chest Physicians (pulmonologists) CHEST in 1999 was quite concerned about Conundrums in Sleep Medicine . The author, then chairman of the Sleeping Section of his organization, asked, "What does it take to set up a sleep laboratory? Money and buildings! Anyone can open a sleeping laboratory, and it seems almost everyone." In the accreditation process for sleep labs, he continued: "This accreditation, however, is currently not required by most countries, or more importantly, by most insurance carriers for reimbursement... There is also the American Board of Sleep Medicine (ABSM) which certifies individuals as sleep specialists.This certification may make these individuals more qualified to run a sleep laboratory, however, certification is not required to run a laboratory or to read sleep studies. "His attention at the turn of the century was:
In the UK, knowledge of sleeping pills and the possibility for diagnosis and treatment seem to lag. Guardian.co.uk cites director of the Imperial College College Health Center: "One problem is that there is relatively little training in sleep medications in the country - certainly no structured training for sleeping pediatricians." The Imperial College Healthcare website shows concern for obstructive sleep apnea syndrome (OSA) and very few other disorders, especially excluding insomnia.
Training and certification
Worldwide
The World Federation of Sleep & amp; Sleep Drug Society (WFSRSMS) was established in 1987. As the name suggests, members are concerned with basic and clinical research as well as medicines. Society members in America are the American Academy of Sleep Medicine (AASM), the Sleep Research Society of the United States (SRS), the Canadian Sleep Society (CSS) and the Latin American Federation of Sleep Societies (FLASS). WFSRSMS publishes the Journal of Sleep Research, Journal of Clinical Sleep Medicine, Sleep and Biological Rhythms and promotes both the "Sleep and Biological Rhythms" and/or sleep studies as well as doctor and education training.
Africa
The South African Medical College (CMSA) provides a well-defined Diploma in Sleep Medicine from the College of Neurologists of South Africa: DSM (SA), first announced by the Council of Health Professionals in 2007. The newly formed South African Society of Sleep Medicine (SASSM) was launched at its first congress in February 2010. Community membership varied; including general practitioners, ENT surgeons, lung experts, cardiologists, endocrinologists and psychiatrists.
Asia
WFSRSMS members in Asia include the Australasian and Australian Australasian (ASA) Sleep Associations and the Asian Sleep Study Society (ASRS), an umbrella organization for communities from several Asian countries.
Europe
The European Sleep Research Society (ESRS) is a member of the WFSRSMS. The Assembly of the National Sleep Societies (ANSS), which includes medical and scientific organizations from 26 countries in 2007, is the official body of the ESRS. ESRS has published the European Accreditation Guidelines for SMCs (Sleeping Medicine Center), the first of several guidelines proposed to coordinate and promote sleep science and medicine in Europe.
United States
The American Academy of Sleep Medicine (AASM), established in 1978, manages the process of certifying and sleeping pills for doctors until 1990. The independent daughter of the American Board of Sleep Medicine (ABSM) was established in 1991 and took over the stated responsibilities above.. In 2007, ABSM ceased managing its examinations, recognizing that the examination process recognized by the American Medical Specialist Board (ABMS) was profitable to the field. Candidates who passed the ABSM exam in 1978-2006 maintained a lifetime certification as a Diplomat of the organization.
The American Board of Psychiatry and Neurology (ABPN), and administrators of Internal Medicine, Pediatrics, and Otolaryngology (ear, nose and throat, ENT) are now collectively managing the Sleeping Card Certification test for their members. Each board oversees the 12 month formal training required for its candidate, while the exam is given to all of them at the same time at the same place. During the first five years, 2007-2011, during "grandfathering," there is a "practice path" for certified ABSM specialists while additional, coordinated requirements should be added after 2011. ABPN provides information on paths, requirements, and exams. on its website. In addition, there are currently four councils from the American Osteopathic Association Bureau of Osteopathic Specialists who administer the Sleeping Card Certification exam. The American Osteopathic Boards of Family Medicine, Internal Medicine, Neurology & amp; Psychiatry, and Ophthalmology & amp; Otolaryngology provides additional qualification certificates to qualified candidate doctors.
Sleeping pills are now a recognized subspecialty in anesthesiology, internal medicine, family medicine, pediatrics, otolaryngology, psychiatry and neurology in the United States. Certification in Sleep Treatment by some "Board Members" of the ABMS shows that specialists:
Pulmonologists, already subspecialists in internal medicine, are welcome to sit for the board and are certified in Sleep Medicine after just six months of fellowship, building up their knowledge of sleep-related breathing issues, rather than the usual twelve months required by other specialists.
Sleep dentistry (bruxism, snoring and sleep apnea), while not recognized as one of nine dental specialists, qualifies for board-certification by the American Board of Dental Sleep Medicine (ABDSM). The resulting diplomacy status is recognized by AASM, and the dentist is regulated in the Academy of Dental Sleep Medicine (USA). Qualified dentists collaborate with a sleeping doctor at an accredited sleep center and may provide some type of oral equipment or upper airway surgery to treat or manage sleep-related respiratory distress as well as gnashing and clenching.
Laboratories for sleep-related respiratory disorders are accredited by AASM, and are required to follow the Medical Code of Ethics of the American Medical Association. The new and very detailed Standard for Accreditation is available online. The sleep disturbance center, or clinic, is accredited by the same body, whether hospital-based, university-based or "free-standing"; they are required to provide tests and treatments for all sleep disorders and to have a sleep professional specialist who has been certified by the American Board of Sleep Medicine and if it does not meet the same standards.
Diagnostic methods
Taking a comprehensive medical history while remembering an alternative diagnosis and the possibility of more than one disease in the same patient is the first step. Symptoms for very different sleep disorders may be similar and should be determined whether there is a primary or secondary psychiatric problem.
The patient's history includes previous treatment and treatment efforts and careful medical review. Transient differentiation of chronic and primary disturbances from secondary disorders influences the evaluation direction and treatment plan.
The Epworth Sleepiness Scale (ESS), designed to provide sleep indication and correlate with sleep apnea, or other questionnaires designed to measure excessive daytime sleepiness, is a diagnostic tool that can be used repeatedly to measure treatment outcomes.
A sleep diary, also called a sleep log or sleep journal, is kept by the patient at home for at least two weeks, while subjectively, can help determine the level and nature of sleep disturbances and the level of alertness in a normal environment. A parallel journal kept by a parent or spouse, if any, can also help. Sleep logs can also be used for self-monitoring and in connection with other behaviors and treatments. The image at the top of this page, with midnight and weekend nights in the middle, shows a layout that can help in watching the trend
The aktigraf unit is a motion sensing device worn on the wrist, generally for a week or two. This gives a rough idea of ​​the sleep-wake cycle and is often used to verify the sleep diary. This is cost-efficient when full polysomnography is not required.
Polysomnography is performed in a sleep laboratory while the patient is asleep, preferably at regular bedtime. The polysomnogram (PSG) objectively records the stages of sleep and respiratory events. It shows several channels of electroencephalogram (EEG), electrooculogram (EOG), electrocardiogram (EKG), air flow of the nose and mouth, abdomen, chest and legs and blood oxygen levels. One part of the polysomnogram is sometimes measured at home with portable equipment, such as oxymetry, which records blood oxygen levels throughout the night. Polysomnography is not routinely used in the evaluation of patients with insomnia or circadian rhythm disorders, unless it is necessary to rule out other disorders. This will usually be the definitive test for sleep apnea.
Multiple Sleep Latency (MSLT) tests are often performed throughout the day after polysomnography while electrodes and other equipment are still present. Patient is given a chance to take a nap every second hour; the test measures the number of minutes required from the beginning of the period of daytime sleep until the first signs of sleep. It is the size of daytime sleepiness; it also shows whether REM sleep is achieved in short naps, a typical indication of narcolepsy.
Imaging studies may be performed if the patient should be evaluated for neurodegenerative disease or to determine obstruction in obstructive sleep apnea.
Treatment
When a sleep complaint is secondary to pain, other medical or psychiatric diagnoses, or substance abuse, it may be necessary to treat underlying causes and sleep problems.
When the underlying cause of sleep problems is not immediately apparent, behavioral care is usually the first to suggest. These range from patient education on sleep hygiene to cognitive behavioral therapy (CBT). Studies from both parents and older adults have compared CBT for treatment and found that CBT should be considered as a first-line and cost-effective intervention for chronic insomnia, not least because benefits can be maintained in long-term follow-up. Doctors and sleep psychologists, at least in the US, disagree about who should do CBT or whether sleep centers should be required to have a psychologist on staff. In the UK the number of therapists trained in CBT is limited so that CBT is not widely available in the NHS.
Behavioral therapy includes progressive relaxation, stimulus control (to reconnect bed with sleep), limit time-in-bed to improve sleep efficiency and uncover misunderstandings about sleep.
Pharmacotherapy is necessary for some conditions. The drug may be useful for acute insomnia and for some parasomnia. This is almost always necessary, along with a short nap scheduled and a rigorous follow-up, in the treatment of narcolepsy and idiopathic hypersomnia.
Chronic circadian rhythm disturbances, most commonly delayed delayed sleep phase phases, can be managed with special bright light therapy, usually in the morning, darkness therapy in the hours before bed, and oral administration of the hormone melatonin. Chronotherapy has also been prescribed for circadian rhythm disorders, although results are generally short-lived. Stimulants can also be prescribed. When this therapy is unsuccessful, counseling may be indicated to help a person adapt and live with the condition. People with this disorder who have chosen a lifestyle that suits their sleep schedule do not require treatment, although they may require a diagnosis to avoid having to meet for an appointment or meeting during their sleep.
Continuous Positive Airway Pressure (CPAP) machines and oral equipment are used nightly at home to manage sleep-related breathing disorders such as apnea. In mild cases in obese people, weight reduction may be enough, but it is usually recommended as an adjunct to CPAP treatment as it maintains difficult weight loss. In some cases, upper airway surgery, generally performed by otolaryngologist/head & amp; a neck surgeon or sometimes an oral and maxillofacial surgeon, is indicated. Treatment prevents the airways from collapsing, which interferes with breathing during sleep. A 2001 study published by Hans-Werner Gessmann in the Journal of Sleep Medicine and Sleep Psychology found that patients who practiced a series of suprahyoidal uterine muscle supplements for 20 minutes a day showed decreased sleep apnea symptoms after two months. Patients experienced an average of 36% fewer apnea episodes after successful completion of treatment.
See also
- National Sleep Foundation
- Environmental noise health effects
- Polysomnographic Technician
- The vegetative symptoms are reversed
- Sleep lessons
- Sundowning (dementia)
- White noise machine
References
Further reading
- American Academy of Sleep Medicine. International Classification of Sleep Disorders: Diagnostic and Coding Manual. 2nd ed. American Academy of Sleep Medicine, 2005.
- National Academy of Sciences: Committee of the Institute of Medicine (USA) on Sleep Treatment and Research; Colten HR, Altevogt BM, editor. Sleep Disorders and Sleep Deprivation: Unfulfilled Public Health Problems. Washington (DC): National Academies Press (US); 2006. Chapter 5 (full text): Raising Awareness, Diagnosis, and Treatment of Sleep Disorders,
External links
- Sleep Center, Imperial College Healthcare NHS Video five minutes after patient with obstructive sleep apnea through diagnosis and treatment
- An AASM accredited sleep center directory in the United States
Source of the article : Wikipedia
0 Comments