1 Sleep Disorders among Veterans with PTSD Sadeka Tamanna, MD, MPH. Medical Director, Sleep Disorders Laboratory, G.V.(Sonny) Montgomery VA Medical Center, Jackson, MS.
2 Learning objectives Sleep problems among veterans with post traumatic stress disorder (PTSD). Insomnia: clinical presentation, diagnosis and treatment among veterans with PTSD. Obstructive sleep apnea: presentation, diagnosis and treatment options among veterans with PTSD.
3 Poll questions What is your role in treating veterans with PTSD? A. Clinician B. TBI Physician C. Psychologist D. Social worker E. Case manager
4 Poll Question In your experience, is sleep a challenge for PTSD sufferers? 1. Yes 2. No In your regular practice, do you routinely ask the patients how well they sleep at night? 1. Yes 2. No
5 Poll Question A 55 year old veteran with chronic PTSD came in complaining his sleep is getting worse with repeated awakening with nightmares and panic attacks, waking up with headache, feeling very tired and sleepy during the day. His wife complains that he is awake most of the night and when he falls asleep, he snores loud, stops breathing during sleep. He is compliant with all his medications. What is your next step in management?
6 Poll question- answers 1. Adjust his anti-depressant medications 2. Send for psychotherapy 3. Ask to follow with primary care provider 4. Request sleep consult for sleep study
7 Post traumatic stress disorder PTSD is an anxiety disorder that develops in response to severe traumatic life stress. Studies have shown that certain type of trauma like combat, rape and other form of assaultive violence are more likely than others to result in PTSD. Lifetime prevalence of PTSD in the community is around 5-6% compared to 15-31% among veterans. The syndrome of PTSD puts a heavy toll on the quality of life of the individual and society.
8 Sleep among PTSD sufferers 70% to 90% patients with PTSD suffer from sleep disturbances. PTSD sufferers have much higher prevalence of insomnia, nightmares, restless sleep and also sleep related breathing disorders like obstructive sleep apnea when compared to healthy cohorts. Specific sleep treatments for sleep disturbances in this population lead to significant improvement in sleep and global PTSD symptoms.
9 Sleep difficulties after combat
10 Sleep Cycle
11 Insomnia Difficulty in initiating and maintaining sleep resulting in daytime functioning impairment is termed as insomnia. In a recent study of 110 military personnel who returned from combat, 88.2% were diagnosed with sleep disorders. Among the sleep disorders, 63.6% met the criteria for insomnia and 62.7% met diagnostic criteria for obstructive sleep apnea Vincent Mysliwiec et al. Sleep Disorders in US Military personnel: a high rate of comorbid insomnia and obstructive sleep apnea. CHEST 2013
12 How to diagnose insomnia 1. Subjective assessment: By clinical interview with self report questionnaires like Insomnia severity index (ISI) Pittsburgh sleep quality index, or Epworth sleepiness scale.
13 Diagnosis and treatment of insomnia Objective assessment: Sleep diary Actigraphy Polysomnography No objective tools are recommended for diagnosis of insomnia.
14 Treatment of Insomnia Sleep Hygiene Cognitive behavioral therapy Pharmacological treatment Treat other causes triggering insomnia like anxiety, depression or sleep disordered breathing like obstructive sleep apnea.
15 Sleep Hygiene Keep regular bedtime and waking time, avoid spending excessive time in bed. Avoid use of sleep disrupting products Avoid caffeine, alcohol, nicotine before bedtime Avoid exercise 2 hours prior to bedtime Avoid stimulating activities close to bedtime Avoid watching television, reading, snacking in bed Avoid use of bed for activities other than sleep Maintain a comfortable sleeping environment Keep the bedroom quiet and cool.
16 Hypnotic indicated insomnia BzRA/Melatonin receptor agonist Ramelton Zaleplon/Zolpidem/Eszopiclon/ Temazepam Not improved Improved Increase dosages of BzRA or change alternative BzRA BzRA+Sedative anti-depressant Continue
17 Hypnotics used in insomnia Ramelteon: Melatonin receptor agonist (MT1 and MT2), 8 mg 30 min before sleep. Benzodiazepine receptor agonist: Eszopiclone, zaleplon, zolpidem, flurazepam, temazepam, triazolam Bertisch SM, Herzig SJ, Winkleman JW et al. National use of prescription medications for insomnia, SLEEP 2014 Trazodone: serotonin receptor antagonist and reuptake inhibitor( SARIs), most commonly used antidepressant and hypnotic agent. National use of prescription medication showed that Zolpidem and Trazodone were the two most commonly used med for insomnia from NHANES data.
18 Hypnotics used for insomnia in PTSD Anti-depressants: Selective serotonin reuptake inhibitors (SSRI) like Sertraline, Fluoxetine, Paroxetine. Some antidepressants improve sleep disruption in PTSD where as others are less beneficial and can cause adverse sleep events. Some anti-depressants can cause REM suppression and sleep fragmentation. SSRI and Venlafaxine have been found to exacerbate periodic leg movements during sleep.
19 Non-pharmacologic treatment Cognitive behavioral therapy specifically designed for PTSD related insomnia: Primary insomnia strategy: Sleep hygiene Sleep restriction Stimulus control Imagery rehearsal therapy (IRT) These sleep treatments may benefit patients with trauma related nightmares and insomnia.
20 Obstructive sleep apnea Prevalence of OSA is higher among veterans with PTSD than those without PTSD. 47.6% of combat veterans with PTSD was found to have OSA compared to 12.5% of healthy controls. 3 There is a complex relationship between hyper-arousal from PTSD, insomnia and respiratory disturbance generated by special neuro-endocrine connections which are being explored in different basic and clinical studies. 3. Mellman TA, Kulick-Bell R, Ashlock LE et al. Sleep events among veterans with combat-realetd post traumatic stress disorder. Am J Psychiatry 1995
21 Symptoms of OSA Loud snoring Observed apneas-stopping breathing during sleep observed by someone Gasping/choking during sleep Day time sleepiness Excessive fatigue/tiredness not explained by other diseases Morning headaches Uncontrolled hypertension
24 Mallampati Score Scoring is as follows: Class 1: Full visibility of tonsils, uvula and soft palate Class 2: Visibility of hard and soft palate, upper portion of tonsils and uvula Class 3: Soft and hard palate and base of the uvula are visible Class 4: Only Hard Palate visible
25 Oropharyngeal examination
26 Sagittal section of a normal vs. OSA patient
27 What is polysomnography?
28 What is apnea? Complete cessation of airflow for 10 seconds or more during sleep is called apnea.
29 What is Hypopnea? Reduction of airflow by 50% with 4% reduction of oxygen saturation is termed as hypopnea. Total number of apnea and hypopnea per hour of sleep is calculated to generate apnea hypopnea index (AHI).
30 Diagnosis of OSA Three categories of OSA: 1. Mild : AHI 5-15 with symptoms 2. Moderate: AHI Severe: AHI >30
31 Treatment of OSA Continuous positive airway pressure therapy (CPAP) or Bi-level positive airway pressure therapy (BiPAP) is the gold standard of treatment for OSA. Surgical correction for increasing the oropharyngeal space is also used for therapy. Dental appliances and maxillofacial advancement are available therapy to use for OSA.
32 CPAP/BiPAP Sleeping with CPAP/BiPAP How does it work?
33 How does CPAP/BiPAP help? How does it help? Keeps airway open during sleep. Snoring and apneas should not happen or improve. Oxygen saturation during sleep will be normalized. Improves daytime sleepiness/tiredness Improves HTN Reduces risk of diseases Improves neurocognitive functioning. Improves alertness. Reduces risk of cardiovascular diseases. Reduces motor vehicle accident Reduces headaches
34 Improves HTN control A randomized trial on 118 men with severe OSA treated with optimal CPAP and subtherapeutic CPAP showed significant reduction in both SBP and DBP after 1 month in optimally treated group.
35 Improves Heart failure 88 patients with heart failure was grouped into CPAP treated and untreated group and their cumulative event-free survival was calculated over 25 months. The cumulative event-free survival was significantly lower in untreated patients than in CPAP-treated patients (p = [logrank test]).
36 Effect of CPAP on PTSD Improves nightmares Improves neurocognitive functioning and memory Improves insomnia and maintenance of sleep through the night. Treatment of co-morbid OSA alleviates PTSD symptoms Reduces night terrors, periodic leg movements and panic attacks during sleep.
37 Nightmares improve with CPAP Treatment of sleep apnea with CPAP has shown improvement on nightmares and PTSD symptoms in a retrospective study by Krakow and his colleagues in We retrospectively reviewed 69 veterans with PTSD at Jackson VAMC at MS and found a significant improvement in number of nightmares among PTSD sufferers who have used CPAP for their co-morbid OSA. Krakow et al. A retrospective study in improvement in nightmares and PTSD following treatment of co-morbid sleep disordered breathing. Journal of Psychosomatic research, 2000 Tamanna et al. CPAP therapy reduces nightmares in veterans with PTSD and sleep apnea, AASM meeting, 2013.
38 CPAP compliance among PTSD CPAP compliance is very poor among veterans with PTSD CPAP adherence was compared between PTSD and non-ptsd group among veterans by El-Solh et al. in VAMC at New York. Veterans with PTSD were only 41% compared to veterans without PTSD who were 70% compliant for CPAP use. Claustrophobia is a major barrier for compliance among this group. (El-Solh AA, Ayyar L, Akinnusi M et al. Positive airway pressure adherence in veterans with PTSD. SlEEP,2010)
39 CPAP compliance Documentation of PAP therapy ( >4 hours per night for 70% of the night in 30 consecutive days ) is considered compliant by CMS. CPAP compliance has shown to improve to 86% by using a designated team of personnel for trouble shooting and fixing the issues. First 2 weeks compliance can predict the overall compliance of the patient.
40 Improving Compliance among PTSD veterans CPAP mask fitting and follow up with sleep provider are important. Offering different masks for trial will give them more options to try. Nasal masks and nasal pillows seem to work better for this group. Cognitive behavior therapy (CBT) for CPAP use has been found to be effective among noncompliant patients. Richards S, Bartlett D, et al. Increased adherence to CPAP with a group cognitive behavioral treatment intervention: A randomized trial. SLEEP, 2007
41 References: 1. Zahava Solomon, Mario Mikulincer, Trajectories of PTSD: a 20 year longitudinal study, Journal of American Psychiatry, Vincent Mysliwiec et al. Sleep Disorders in US Military personnel: a high rate of comorbid insomnia and obstructive sleep apnea. CHEST Schutte-Rodin S, Broch L, Buysse D, Dorsey C, Sateia M. Clinical guideline for the evaluation and management of chronic insomnia in adults. J Clin Sleep Med. 2008;4(5): Bertisch SM, Herzig SJ, Winkleman JW et al. National use of prescription medications for insomnia, SLEEP Mellman TA, Kulick-Bell R, Ashlock LE et al. Sleep events among veterans with combat-realetd post traumatic stress disorder. Am J Psychiatry El-Solh AA, Ayyar L, Akinnusi M et al. Positive airway pressure adherence in veterans with PTSD. SlEEP, Richards S, Bartlett D, et al. Increased adherence to CPAP with a group cognitive behavioral treatment intervention: A randomized trial. SLEEP, Inman D, Silver S, et al. Sleep disturbances in PTSD: a comparison with non-ptsd insomnia. J Trauma Stress Maher M, Rego S, et al. Sleep disturbances in patients with PTSD: epidemiology, impact and approaches to management. CNS drugs 2006
42 References and sources Krakow et al. A retrospective study in improvement in nightmares and PTSD following treatment of comorbid sleep disordered breathing. Journal of Psychosomatic research, 2000 Tamanna et al. CPAP therapy reduces nightmares in veterans with PTSD and sleep apnea, AASM meeting, Pepperell J.C., Ramdassingh-Dow S., Crosthwaite N., Mullins R., Jenkinson C., Stradling J.R., Davies R.J.; Ambulatory blood pressure after therapeutic and subtherapeutic nasal continuous positive airway pressure for obstructive sleep apnoea: a randomised parallel trial. Lancet :
E-Resource December, 2013 SLEEP DISTURBANCE AND PSYCHIATRIC DISORDERS Between 10-18% of adults in the general population and up to 50% of adults in the primary care setting have difficulty sleeping. Sleep
Underwriting Sleep Apnea Joel Weiner, MD, FLMI April 29, 2014 WAHLU The Northwestern Mutual Life Insurance Company Milwaukee, WI A Brief Survey Before We Get Started The Weiner Sleepiness Scale How likely
A Practical Guide on SLEEP AND PARKINSON S DISEASE MICHAELJFOX.ORG Introduction Many people with Parkinson s disease (PD) have trouble falling asleep or staying asleep at night. Some sleep problems are
Sleep Difficulties By Thomas Freedom, MD and Johan Samanta, MD For most people, night is a time of rest and renewal; however, for many people with Parkinson s disease nighttime is a struggle to get the
History of the present illness: 70 year old patient went to the sleep lab at his wife s request in 2007 with the results shown below. He denied sleepiness at the time and denies that CPAP led him to feel
Obstructive Sleep Apnea Case Study Shirin Shafazand, MD, MS Neomi Shah, MD for the Sleep Education for Pulmonary Fellows and Practitioners, SRN ATS Committee August 2014 Part 1: Case Presentation Mr. Simon
Nursing Interventions for Sleep Disorders Following TBI Kadesha Clark, RN BSN When you sleep, your body rests and restores its energy levels. A good night's sleep is often the best way to help you cope
Understanding Sleep Apnea www.sleepmangementsolutions.com What is Obstructive Sleep Apnea (OSA)? OSA afflicts 20 million adult men and women in the U.S. People who have OSA stop breathing repeatedly during
October 21, 2014 Diseases and Health Conditions that can Lead to Daytime Sleepiness Indira Gurubhagavatula, MD, MPH Associate Professor Director, Occupational Sleep Medicine University of Pennsylvania,
Sleep Apnea: Treatment I. Policy University Health Alliance (UHA) will reimburse for positive airway pressure devices for the treatment of obstructive sleep apnea (OSA) when it is determined to be medically
MODULE POSITIVE AIRWAY PRESSURE (PAP) Titrations POSITIVE AIRWAY PRESSURE (PAP) TITRATIONS OBJECTIVES At the end of this module the student must be able to: Identify the standards of practice for administering
MP9239 Covered Service: Prior Authorization Required: Additional Information: Yes when meets criteria below Yes as shown below None Prevea360 Health Plan Medical Policy: 1.0 A continuous positive airway
Old Republic Insurance Company of Canada *January 2014 Sleep Apnea Obstructive sleep apnea (OSA) is a condition that causes a blockage of air while a person sleeps. This blockage is caused by soft tissues
Is Obstructive Sleep Apnea Affecting Your Daily Life? Is Obstructive Sleep Apnea Affecting Your Daily Life? Do you feel sleepy during the day no matter how much sleep you get? Can you fall asleep easily
BIPAP Coverage Guidelines BIPAP/E0470 DX: Thoracic Disorder There is documentation in the patient's medical record of a neuromuscular disease (for example, amyotrophic lateral sclerosis) or a severe thoracic
Sleep Disorders Introduction Sleep disorders are very common conditions that can be overcome. It is important to understand what affects sleep and the importance of sleep. This reference summary will help
Understanding sleep apnea What is Obstructive Sleep Apnea (OSA)? OSA is a common, yet often undiagnosed sleep disorder. It afflicts 20 million adult men and women in the U.S. People who have OSA stop breathing
S Snoring & Sleep Apnea elf-awareness Toolkit Snoring: Your Dentist Can Test So You Can Rest 2009 Snoring Isn t Sexy, LLC S Snoring & Sleep Apnea elf-awareness Toolkit Snoring: Your Dentist Can Test So
Changes in the Evaluation and Treatment of Sleep Apnea Joseph DellaValla, MD FACP Medical Director Center for Sleep Medicine At Androscoggin Valley Hospital Sleep Related Breathing Problems Obstructive
Raising Sleep Apnea Awareness: Among People with Diabetes in North Carolina, 2012 People with diabetes have more sleep problems than people without diabetes in the same age, sex, and race/ethnicity group.
BREATHE EASY WHY AM I USING CPAP? Your doctor has prescribed Continuous Positive Airway Pressure or CPAP (pronounced See -pap) therapy for you. When used appropriately, CPAP therapy is nearly 100% effective
Sleep Medicine and Psychiatry Roobal Sekhon, D.O. Common Diagnoses Mood Disorders: Depression Bipolar Disorder Anxiety Disorders PTSD and other traumatic disorders Schizophrenia Depression and Sleep: Overview
Snoring and Obstructive Sleep Apnea (updated 09/06) 1. Define: apnea, hypopnea, RDI, obstructive sleep apnea, central sleep apnea and upper airway resistance syndrome. BG 2. What are the criteria for mild,
Scope Primary Care Management of Sleep Complaints in Adults (Revised 2004) This guideline is for the primary care management of non-respiratory sleep disorders in adults and follows the DSM-IV-TR classification
Obstructive Sleep Apnea: Test and you will diagnose But what does that mean? A PCP s attempt to understand John Koeppe, MD General Internal Medicine Grand Rounds March 18 th, 2014 Disclosures No financial
Diabetes and Sleep Problems Sleep Study Diabetes and Sleep Problems Sanjay R. Patel, MD, MS Suzanne M. Bertisch MD, MPH Amy P. Campbell, MS, RD, CDE David Erani, MD This booklet was developed by Joslin
David W. Kidder, Ph.D. Counseling Psychologist 893 Brownswitch Road, Suite 207 985-649-2011 Slidell, LA 70458 DrKidder.com CAN'T SLEEP? YOU MAY HAVE INSOMNIA WHAT IS INSOMNIA? Difficulty falling asleep
Insomnia What is insomnia? Having insomnia means you often have trouble falling or staying asleep or going back to sleep if you awaken. Insomnia can be either a short-term or a long-term problem. Insomnia
Introduction Excessive daytime sleepiness (EDS) is a common complaint. Causes of EDS are numerous and include: o Intrinsic sleep disorders (e.g. narcolepsy, obstructive sleep apnoea/hypopnea syndrome (OSAHS)
1 ROLE OF ORAL APPLIANCES TO TREAT OBSTRUCTIVE SLEEP APNEA There are three documented ways to treat obstructive sleep apnea: 1. CPAP device 2. Oral Appliances 3. Surgical correction of nasal and oral obstructions
Category [Case Report] Rapid Resolution of Intense Suicidal Ideation after Treatment of Severe Obstructive Sleep Apnea Lois E. Krahn, MD Bernard W. Miller, RPSGT Larry R. Bergstrom, MD From the Department
Restoring a good night s sleep Products for diagnosing, treating, and monitoring sleep apnea Sleep apnea solutions A good night s sleep is an essential part of healthy living, but for patients diagnosed
What to Expect During Your Stay at a Sleep Disorders Lab Information for patients and families Read this information to learn: what a sleep study is what a CPAP titration study is how to prepare what to
General Information about Sleep Studies and What to Expect Why do I need a sleep study? Your doctor has ordered a sleep study because your doctor is concerned you may have a sleep disorder that is impacting
Understanding Sleep Disorders Bob, diagnosed in 2005. What Are Sleep Disorders? Many sleep disorders are brain disorders that cause interruptions in sleep patterns. They prevent people from getting enough
ABOUT SLEEP APNEA About Sleep Apnea What is Sleep Apnea? Sleep Apnea (from Greek, meaning "without breath") is one of the most common sleep disorders in which breathing stops and then restarts again recurrently
Challenges to Detection and Management of PTSD in Primary Care Karen H. Seal, MD, MPH University of California, San Francisco San Francisco VA Medical Center General Internal Medicine Section PTSD is Prevalent
Aging with Physical Disability FACT SHEET Sleep and Aging with a Disability Many people with physical disabilities suffer from sleep disturbances, and sleep tends to become more disrupted as we get older.
Get Rid of Your CPAP and Get a Better Night s Rest RFASleep Apnea Treatment Guide Non-Surgical Treatment Proven Effective in Treating Mild to Moderate Obstructive Sleep Apnea (OSA) RFA Sleep Apnea Treatment
Treatment for Snoring and Obstructive Sleep Apnea Ri 林 鴻 錡 /AsP 譚 慶 鼎 Nonsurgical treatment Weight loss Avoidance of alcohol,sedatives,tobacco Positional devices Oral or nasal appliances Nasal continuous
PPD Protecting Professional Drivers SM Driver edition Summer 2011 Volume 4, Issue 3 News on sleep apnea for the commercial trucking industry Visit PPD s new driver blog for OSA support Support system leads
Tara Leigh Taylor, MD, FCCP Intensivist, Wyoming Medical Center Objectives Define the magnitude of the problem Define diagnostic criteria of insomnia Understand the risk factors and consequences of insomnia
Dear Patient: You have been referred for a Sleep Study, because your physician is concerned you may have a serious medical condition called Sleep Apnea. Sleep apnea is a common disorder in which you have
for health professionals Insomnia Insomnia Healthy sleep Most people think that healthy sleep is one long 7-8 hour period of unconsciousness. However, sleep consists of different states of sleep that cycle
Obstructive Sleep Apnea: Review of Screening and Management JOHN REID MD, FRCP(C), D.ABSM CSIM CONFERENCE CALGARY OCTOBER 2014 Disclosure Slide No financial or intellectual conflicts of interest to declare
Don t just dream of higher-quality sleep. How health care should be Many of our patients with sleep disorders don t realize there s another way of life, a better way, until they are treated. Robert Israel,
Management of Sleep Disturbances Following Concussion/Mild Traumatic Brain Injury: Guidance for Primary Care Management in Deployed and Non-Deployed Settings Learning Objectives Understand the occurrence
Snoring Introduction Snoring is the harsh sound that is made when the flow of air through your mouth and nose is blocked while you are sleeping. Snoring can be an annoyance for your partner or other people
Home Sleep Test Liability Form Study Equipment Due: @ I, accept responsibility for the sleep monitoring device while it is in rny possession. I understand that if I fail to return the device or I return
Patient Information Leaflet: Obstructive Sleep Apnoea Greenlane Respiratory Services, Auckland City Hospital & Greenlane Clinical Centre Auckland District Health Board What is Obstructive Sleep Apnoea?
HEALTH EVIDENCE REVIEW COMMISSION (HERC) COVERAGE GUIDANCE: DIAGNOSIS OF SLEEP APNEA IN ADULTS DATE: 5/9/2013 HERC COVERAGE GUIDANCE The following diagnostic tests for Obstructive Sleep Apnea (OSA) should
Obstructive Sleep Apnea Syndrome Prof. A K Janmeja Head, department of Pulmonary Medicine & Medical Superintendent, Govt. Medical College & Hospital, Chandigarh Objectives What is sleep? Common sleep disorders
Hypnotic Drugs Insomnia is a disturbance of normal sleep patterns commonly characterised by difficulty in initiating sleep (sleep onset latency) and / or difficulty in maintaining sleep (sleep maintenance).
GUIDELINES FOR THE INPATIENT TREATMENT OF INSOMNIA IN ADULTS version 4 GUIDELINE REPLACED Version 4 RATIFYING COMMITTEE Drugs and Therapeutics Group DATE RATIFIED 26 October 2015 NEXT REVIEW DATE October
Obstructive Sleep Apnoea What is obstructive sleep apnoea? People who suffer from Obstructive Sleep Apnoea (OSA) reduce or stop their breathing for short periods while sleeping. This can happen many times
Sleepless After TBI Why is it important to treat sleep disorders in TBI? Over 5 million people in the United States are currently living with a disability associated with brain injury. Although the major
Sleep Apnea Dr. Douglas Tapper Dr. Hendler: Hello and welcome to KP Healthcast. I m your host today, Dr. Peter Hendler, and our guest is Dr. Douglas Tapper who is the chief of Pulmonary Medicine at Kaiser
Cognitive Behavioural Therapy for Insomnia: What It Is & What it Does Colin A Espie Director: University of Glasgow Sleep Centre Sackler Institute of Psychobiological Research University of Glasgow Scotland
CPAP titration: PSG technologist or at Home Carolyn D Ambrosio, MD, MS Associate Professor of Medicine Director, The Center for Sleep Medicine Tufts Medical Center Conflict of Interest No financial interest
OHTAC Recommendation Polysomnography in Patients with Obstructive Sleep Apnea June 16, 2006 1 The Ontario Health Technology Advisory Committee (OHTAC) met on June 16, 2006 and reviewed a health technology
Welcome! Please read the following document carefully as it contains pertinent information regarding your sleep study, interpretation of your study, and billing information. On behalf of our staff here
E-Resource March, 2015 DEPRESSION Depression Assessment PHQ-9 Screening tool Depression treatment Treatment flow chart Medications Patient Resource Depression affects approximately 20% of the general population
Sleep studies, outpatient facility or clinic-based setting Blue Care Network provides coverage for attended sleep studies in the outpatient treatment setting for pediatric members and for adult members
for health professionals Obstructive Sleep Apnoea Obstructive Sleep Apnoea Definition Sleep apnoea is a disorder in which breathing is repeatedly interrupted during sleep. The word apnoea literally means
THE CENTER FOR SLEEP DISORDERS GW- MEDICAL FACULTY ASSOCIATES SLEEP DISORDERS INVENTORY Vivek Jain, M.D. Director, The Center for Sleep Disorders GW-Medical Faculty Associates Samuel J. Potolicchio, M.
Post Traumatic Stress Disorder (PTSD) Karen Elmore MD Robert K. Schneider MD Revised 5-11-2001 by Robert K. Schneider MD Definition and Criteria PTSD is unlike any other anxiety disorder. It requires that
SLEEP DISORDER ADULT QUESTIONNAIRE Name: Date: Date of Birth (month/day/year): / / Gender: ο Male ο Female Marital Status: ο Never Married ο Married ο Divorced ο Widowed Home Address: City: Zip: Daytime
Summary and Conclusions Summary and Conclusions Conclusions Cardiovascular complications, diabetes mellitus and death q Obstructive sleep apnoea syndrome covaries with cardiovascular disease, including
Parkland College A with Honors Projects Honors Program 2012 Post-traumatic Stress Disorder Nicole Smith Parkland College Recommended Citation Smith, Nicole, "Post-traumatic Stress Disorder" (2012). A with
TITLE: Cannabinoids for the Treatment of Post-Traumatic Stress Disorder: A Review of the Clinical Effectiveness and Guidelines DATE: 01 December 2009 CONTEXT AND POLICY ISSUES: Post-traumatic stress disorder
SUMMA HEALTH SYSTEM Sleep Medicine Services Contents Why should I be concerned about a sleep disorder? 2 Evaluate Your Daytime Sleepiness 3 Common sleep disorders 5 About sleep studies 6 What to expect
Sleep Disorders Center 505-820-5363 455 St. Michael s Dr. 505-989-6409 fax Santa Fe, New Mexico 87505 QUESTIONNAIRE NAME: DOB: REFERRING PHYSICIAN: PRIMARY CARE PHYSICIAN: Do you now have or have you had:
Diagnosis of Sleep Apnea John E. Stevenson, MD, FACP ABSTRACT Rapidly accumulating evidence shows that sleep apnea is a major factor influencing personal health and public safety. Diagnosis and treatment
THE ROLE OF SLEEP IN THE LIFE OF A TEEN Did You Know? 85% of teens get less than the minimum requirement of 8 ½ hours of sleep Less Sleep More Time Shortened sleep impairs learning, performance, health
Treating Sleep Apnea A Review of the Research for Adults Is This Information Right for Me? Yes, if: A doctor said you have mild, moderate, or severe obstructive sleep apnea, or OSA. People with OSA may
8425 South 84th Street Suite B Omaha, NE 68127 Phone: 402.339.7378 Fax: 402.339.9455 SLEEP QUESTIONNAIRE NAME: ADDRESS: Last First MI Street Address DATE City State Zip PHONE: ( ) BIRTHDATE: HEIGHT: WEIGHT:
The heart of the matter Sleep apnea and cardiovascular disease The cardiologist s role Obstructive Sleep Apnea (OSA) is a common breathing disorder that has been associated with an increased risk of hypertension,
Compliance Issues in Home CPAP Therapy Joseph Lewarski, BS, RRT, FAARC Obstructive Sleep Apnea Syndrome OSA 1 st recognized over 30 years ago 1981 Sullivan publishes small study in Lancet¹ Late 80s, early
Coping with Shift Work & Fatigue A good practice guide for drivers Working shifts can lead to fatigue. This may make you more likely to be involved in incidents and accidents. Managing your sleep at home
Out of Center Sleep Testing and Auto-titrating CPAP: Gizmos and Gadgets Kathleen Sarmiento, MD NAMDRC 2014 DISCLOSURE Dr. Sarmiento has received research grants from Philips Respironics and ResMed, these
SLEEP DISORDERS CENTER St. Joseph Mercy Ann Arbor 5305 Elliott Drive, Ypsilanti, MI 48197 734-712-2276 / Fax 734-712-2967 Sleep Study Information Home Sleep Apnea Testing Dear,, Your are Sleep scheduled
Page 1 of 8 SLEEP DISORDERS CENTER QUESTIONNAIRE Swedish Medical Center Name: Date: Date of Birth: Age: Sex: M F Height: Weight: Neck Size: Handedness: Right/Left Which physician evaluated you for your
IMPORTANCE OF SLEEP Essential to your physical health and emotional wellbeing Helps improve concentration and memory formation Allows your body to repair any cell damage that occurred during the day Refreshes
Cardio Respiratory Department Obstructive Sleep Apnoea (OSA) Obstructive sleep apnoea (OSA) is a condition where the walls of the throat relax and narrow during sleep, interrupting normal breathing. If
The Interface Between Sleep Apnea and Seizures Hrayr Attarian M.D. Northwestern University Feinberg School of Medicine. What is Sleep Apnea? Obstructive sleep apnea syndrome (OSA) is characterized by repeated
Positive Airway Pressure and Oral Devices for the Treatment of Obstructive Sleep Apnea Policy Number: Original Effective Date: MM.01.009 11/01/2009 Line(s) of Business: Current Effective Date: HMO; PPO;
Your consent to our cookies if you continue to use this website.