Oxford Handbook of Sleep Medicine (Oxford Medical Handbooks)

The Oxford Handbook of Sleep Medicine provides a comprehensive, practical guide to clinicians of all backgrounds for the diagnosis and treatment of sleep disorders across clinical specialties. Sleep medicine is encountered in almost every field of medicine yet clinical training and practical guidance is often difficult to find. This handbook is essential for all clinicians seeking a clear and concise quick-reference guide to sleep disorders in their day-to-day practice, from the GP to specialists in respiratory medicine, psychiatry, neurology and surgery. It will also provide an excellent resource for those pursuing specialist training in clinical sleep medicine. This handbook is written from a practical perspective, to guide clinical practice, rather than providing simply theoretical knowledge. It provides guidance from experienced clinicians across a range of specialties to provide a truly comprehensive multidisciplinary approach to sleep medicine. This handbook covers the full range of sleep disorders, from insomnia to very rare movement disorders, to ensure the reader has quick access to the right information whenever they need it. Cover Half Title Series Title Copyright Foreword Contents Detailed contents Symbols and abbreviations Contributors Introduction 1 The neurobiological basis of sleep Definition Neuroanatomical and neurotransmitter basis of sleep Sleep, synaptic homeostasis, and memory Sleep and the glymphatic system Conclusion 2 General approach to sleep disorders Introduction Sleep assessment summary Taking a sleep history Useful clinical tools Clinical decision- making in sleep medicine Conclusion 3 Diagnostic tests in sleep medicine Introduction Pulse oximetry Respiratory polygraphy studies Video polysomnography Multiple sleep latency test (MSLT) Maintenance of wakefulness test (MWT) Oxford Sleep Resistance Test (OSLER) Actigraphy Conclusion 4 Clinical aspects of insomnia Introduction What is insomnia? Epidemiology Consequences of insomnia Diagnosis Treatment 5 Psychological therapies for insomnia Introduction Recommended psychological and behavioural therapies Summary of treatment components Outline of psychological and behavioural interventions Effectiveness of psychological and behavioural interventions Emerging treatment approaches Special populations Insomnia and hypnotics Contraindications Risks Treatment resistance Relapse prevention 6 Medical management of insomnia Introduction Neurotransmitters in insomnia treatment Mode of action of licensed hypnotics Drugs that act on GABAA receptors Melatonin and melatonin agonists Antihistamines Antidepressants Practical considerations when prescribing for insomnia Stopping hypnotics 7 Sleep- disordered breathing Introduction Classification Epidemiology Definition Clinical features Obstructive sleep apnoea Upper airway resistance syndrome Central sleep apnoea Hypoventilation Comorbidities of sleep- disordered breathing 8 Sleep- disordered breathing and its associations Introduction Obstructive sleep apnoea and cardiovascular disease Conclusion 9 Medical management of sleep- disordered breathing Introduction Continuous positive airway pressure for obstructive sleep apnoea Further options for the management of obstructive sleep apnoea Management of central sleep apnoea and obesity hypoventilation syndrome 10 Dental approaches to the management of sleep- disordered breathing Introduction History of oral appliances Oral appliance therapy Conclusion 11 Surgical approaches to the management of sleep- disordered breathing Introduction Clinical evaluation of the upper airway Surgical procedures for sleep- disordered breathing Recent advances in surgery for sleep- disordered breathing 12 Novel approaches for the treatment of obstructive sleep apnoea Introduction Electrical stimulation Transcutaneous electrical stimulation: a randomized controlled trial Hypoglossal nerve stimulation: a randomized controlled trial Ongoing studies and clinical trials Future research Patient and public involvement NICE guidance Further alternatives 13 Restless legs syndrome and periodic limb movement disorder Introduction Definition Epidemiology Clinical features Pathophysiology Management 14 Narcolepsy Introduction Narcolepsy type 1 Narcolepsy type 2 15 Other hypersomnias Idiopathic hypersomnia Kleine– Levin syndrome (recurrent hypersomnia) 16 Circadian rhythm sleep– wake disorders Introduction Delayed sleep– wake phase disorder Advanced sleep– wake phase disorder Non- 24- hour sleep– wake rhythm disorder Irregular sleep– wake rhythm disorder Shift work disorder Jet lag disorder 17 Sleep walking and other NREM parasomnias Definition Diagnostic criteria Pathophysiology Epidemiology Clinical features Diagnostic testing Management Conclusion 18 REM sleep behaviour disorder Introduction Clinical features Diagnostic criteria The significance of RBD Pathophysiology Differential diagnosis Management Conclusion 19 Other parasomnias Introduction Sleep paralysis Sleep- related hallucinations Sleep- related rhythmic movement disorder Sleep- related bruxism Hypnic jerks (sleep starts) Alternating leg muscle activation and hypnagogic foot tremor Exploding head syndrome Propriospinal myoclonus at sleep onset Excessive fragmentary myoclonus Sleep- related painful erections 20 Insomnia in childhood Introduction Behavioural principles Sleep associations and night wakings Assessment Intervention Sleep- training methods Adolescent insomnia 21 Primary sleep problems in the typically developing child Introduction Sleep- related breathing disorders Partial arousal (NREM) parasomnias Movements in sleep Hypersomnias Circadian rhythm disorders 22 Paediatric neurodisability and sleep Introduction Goals of treatment General treatment approaches Specific neurodisabilities 23 Sleep and cognition Introduction Clinical features Sleep in older age Sleep disorders and cognition Sleep and dementia 24 Sleep and headache disorders Introduction Migraine Cluster headache Hypnic headache Sleep apnoea headache Exploding head syndrome Bruxism Secondary headaches 25 Sleep and epilepsy Introduction Circadian influence on cortical excitability and distribution of seizures Sleep- related epilepsy Sleep disorders exacerbating epilepsy Epilepsy and antiseizure treatment exacerbating sleep disorders Management Conclusion 26 Sleep and pain Introduction Drugs influencing sleep Coexisting symptoms complicating sleep Sleep complicating pain Possible management options 27 Sleep and psychiatric disorders Introduction Clinical considerations 28 Medications influencing sleep Introduction Drugs causing sleepiness Drugs causing insomnia Drugs used in sleep disorders 29 Sleep, the workplace, and driving Introduction Long- term consequences of shift work Mitigation strategies Sleepiness and driving Conclusion Index Sleep medicine is encountered in almost every field of medicine, from general practice to psychiatry, neurology, general medicine and surgical specialties. Despite this, clinical training in sleep medicine is almost entirely non-existent. This book provides a comprehensive, practical guide to clinicians of all backgrounds for the diagnosis of treatment of sleep disorders, and their relevance to their own clinical field. It will be useful for those seeking guidance in their day-to-day practice, but will also be helpful for those seeking a starting point for specialist training in clinical sleep medicine. This handbook provides a comprehensive, practical guide to clinicians of all backgrounds for the diagnosis of treatment of sleep disorders, and their relevance to their own clinical field. It is useful for day-to-day practice and as an introduction to specialist training in clinical sleep medicine.