What is Sleep Medicine?
Sleep medicine is a medical subspecialty devoted to the diagnosis and therapy of sleep disturbances and disorders. Sleep medicine is practiced by physicians and others who possess a post doctoral degree (e.g., Ph.D.). Board certification exists in sleep medicine and behavioral sleep medicine. Sleep studies (polysomnography) are performed by technologists. The sleep technologist has mastered polysomnographic tasks and successfully passed the certification process through the Board of Registered Polysomnographic Technologists.
Sleep Disorders
Common sleep disorders seen at sleep disorders centers include:
Snoring. Snoring is a sign of obstruction to the airflow at the back of the mouth. When benign, it can cause annoyance to family members, or even marital discord. When more severe, snoring may be a sign of obstructive sleep apnea, a condition in which the individual stops breathing between snores. Sleep apnea is also associated with life- threatening heart rhythm disturbances during the night, elevated blood pressure and sleepiness during the daytime.
Daytime Sleepiness and Fatigue: The inability to remain alert, reduced concentration or impaired daytime performance may be due to any number of sleep disorders such as: obstructive sleep apnea, nocturnal myoclonus, sleep-wake rhythm disturbances, narcolepsy or underlying medical disorders. Insomnia: Insomnia is a sleep disorder in which people experience poor sleep or have trouble sleeping. Some people have trouble falling asleep at night; many others wake up during the night or awaken much too early in the morning. Insomnia can have many different causes. For example, it may be related to breathing difficulties at night, or to abnormal movements of the legs or other parts of the body of which the person is unaware. Insomnia can also be caused by, or worsened by, sleeping pills if taken frequently or over a long period of time. Often, it is related to emotional depression or anxiety.
Abnormal Sleep-Wake Rhythm: The biological rhythm of sleep and wakefulness may be disrupted by shift work, frequent travel or certain psychiatric conditions. Other kinds of rhythm disturbances are found in people with long standing difficulty in falling asleep at night and getting up in the morning, as well as in people who suffer from insomnia of other origins.
Other Sleep-Related Disorders: sleep-walking, sleep-talking, bedwetting, frequent nightmares and nocturnal convulsions are sleep-related disorders that affect children as well as adults. These symptoms can be disturbing not only to individuals but also to other members of the household. Some are potentially dangerous, and some may indicate the presence of an underlying psychiatric disturbance.
Treatments:
Most sleep-wake disorders can be treated effectively once the condition has been fully and accurately diagnosed. In order to make an accurate diagnosis it is usually necessary for both the physical and emotional aspects of the problem to be examined. Some conditions require treatment with medications, while others may require careful planned change in the hours that sleep is scheduled. For still others, psychiatric treatment including medication, psychotherapy or both may be the best solution. Occasionally, surgery may be advised to relieve severe breathing problems during sleep.
Cognitive Behavioral Therapy (CBT) and Behavioral Sleep Medicine
CBT for sleep disorders is a non-drug approach that combines a number of strategies specifically designed to address the factors that contribute to sleep problems. A highly effective treatment, CBT is considered to be a first-line treatment for insomnia (CBT-I). Treatment generally includes: education on the many factors that can interfere with sleep, developing healthy and effective sleep behaviors, learning skills for calming the mind and managing stress, individualized sleep-wake scheduling programs, eliminating sleep-incompatible behaviors, and the use of properly timed light exposure to reset the sleep-wake body clock. These procedures are often complemented with relaxation training and cognitive therapy, based upon the treatment plan. CBT has also been effectively applied to the treatment circadian rhythm disorders, nightmares and CPAP compliance.
CBT for sleep disorders requires a high degree of training and specialization in behavioral and cognitive techniques. To find a specialist in Behavioral Sleep Medicine, please go to this link:
Certified Behavioral Sleep Medicine Specialists
Polysomnography and other Sleep Studies
- Polysomnogram
A polysomnogram monitors a person’s sleep habits overnight in a sleep lab. A technologist will position tiny painless sensors to different points of an individual’s body to record brain waves, muscle activity, leg and arm movements, heart rhythm, and other body functions during sleep.
- Multiple Sleep Latency Test (MSLT)
An MSLT is done during the day to study an individual’s degree of daytime sleepiness. It consists of a series of daytime naps in which a person’s sleep is monitored.
- Maintenance of Wakefulness Test (MWT)
An MWT is a daytime test to evaluate the extent of daytime somnolence. A technologist will monitor an individual’s ability to resist the urge to fall asleep during the daytime.