Sleep Medicine Pearls

Fundamentals of Sleep Medicine 1: Sleep Stages and Electroencephalographic Patterns
1. A 30-year-old man taking a hypnotic nightly
2. A 30-year-old man with insomnia

Fundamentals of Sleep Medicine 2: Electroencephalographic Lead Placement
3. A 50-year-old man with insomnia

Fundamentals of Sleep Medicine 3: Eye Movement Monitoring

Fundamentals of Sleep Medicine 4: Eye Movement Patterns
4. A 20-year-old man with excessive daytime sleepiness

Fundamentals of Sleep Medicine 5: Chin (Submental) Electromyography
5. A 40-year-old man experiencing difficulty falling asleep
6. A 30-year-old woman having trouble falling asleep
7. A 30-year-old man having difficulty staying awake during the day
8. A 35-year-old woman with insomnia
9. A 25-year-old man with a history of sleep-walking
10. A 20-year-old man with daytime sleepiness
11. A 40-year-old man with a history of snoring and daytime sleepiness
12. A 34-year-old man with sleep disturbance
13. A 22-year-old woman with frequent awakenings during sleep secondary to chronic pain
14. A 40-year-old man being treated for depression

Fundamentals of Sleep Medicine 6: Additional Sleep Staging Rules
15. A 30-year-old man with severe snoring and occasional breathing lapses
16. A 35-year-old woman experiencing uncontrollable episodes of sleep

Fundamentals of Sleep Medicine 7: Sleep Architecture Definitions
17. A 23-year-old man with difficulty sleeping
18. A 25-year-old man with daytime sleepiness and fatigue

Fundamentals of Sleep Medicine 8: Polysomnography
19. A 30-year-old man having difficulty staying awake during the day
20. A 25-year-old man complaining of excessive daytime sleepiness
21. A 30-year-old man with loud snoring
22. A 40-year-old man with complaints of snoring
23. Two patients with recording artifacts
24. A 29-year-old man struggling with daytime sleepiness

Fundamentals of Sleep Medicine 9: Multiple Sleep Latency Test and Maintenance of Wakefulness Test
25. A 25-year-old man with daytime sleepiness

Fundamentals of Sleep Medicine 10: Monitoring Respiration During Sleep
26. A 45-year-old man with possible sleep apnea
27. A 50-year-old man with possible central apnea
28. A 30-year-old man with heavy snoring
29. A 33-year-old man complaining of daytime sleepiness

Fundamentals of Sleep Medicine 11: Excessive Daytime Sleepiness
30. A 45-year-old man with a snoring problem
31. A 40-year-old woman with “mild” sleep apnea

Fundamentals of Sleep Medicine 12: Respiratory Arousals
32. A 30-year-old woman with severe fatigue
33. A 30-year-old man with heavy snoring and daytime sleepiness
34. A 45-year-old man with a distinct pattern of desaturation

Fundamentals of Sleep Medicine 13: Treatment of Obstructive Sleep Apnea
35. A 30-year-old man with weight loss and sleep apnea

Fundamentals of Sleep Medicine 14: Positive Airway Pressure Titration
36. A 55-year-old man with heavy nighttime snoring and daytime sleepiness
37. A 50-year-old man with problems during a CPAP titration
38. A patient refusing to accept treatment for obstructive sleep apnea

Fundamentals of Sleep Medicine 15: Positive Pressure Airway Treatment: Improving Acceptance & Adherence
40. A 55-year-old man with obstructive sleep apnea still sleepy on nasal CPAP
41. A 50-year-old man unable to sleep on CPAP due to mask leak and claustrophobia
42. A 55-year-old man having difficulty with CPAP because of nasal congestion
43. A 30-year-old man unable to tolerate nasal CPAP because of “too much pressure”
44. A 55-year-old man unable to use nasal CPAP due to intractable nasal congestion
45. A 45-year-old man with intolerance to nasal CPAP because of difficulty exhaling
46. A 60-year-old man with a suboptimal CPAP titration
47. A 55-year-old obese man with desaturation during a nasal CPAP trial
48. A 30-year-old woman with fatigue and mild daytime sleepiness
49. A 50-year-old man with a return of snoring 6 months after uvulopalatopharyngo-plasty
50. A 55-year-old man with severe daytime sleepiness and limited treatment options
51. A 40-year-old man with sleep apnea unable to tolerate nasal CPAP
52. A 45-year-old man still experiencing daytime sleepiness after uvulopalatopharyngo-plasty
53. A 50-year-old man needing objective confirmation of his ability to stay awake
54. A 45-year-old man falling asleep at the wheel while driving
55. A 30-year-old man with severe snoring
56. A 30-year-old choir singer with heavy snoring
57. A 50-year-old man with severe hypertension
58. A 55-year-old man with premature ventricular contractions during sleep
59. A 30-year-old pregnant woman with onset of snoring
60. A 45-year-old man with snoring and hypercapnia
61. A 55-year-old man with hypercapnic respiratory failure
62. A 57-year-old man with severe obstructive sleep apnea treated with oxygen
63. A 5-year-old child with behavior problems
64. A 6-year-old boy with large tonsils
65. A 20-year-old woman with daytime sleepiness since childhood
66. A 55-year-old man with chronic obstructive pulmonary disease and nocturnal desaturation
67. A 60-year-old man with leg swelling
68. A 55-year-old man with chronic obstructive pulmonary disease and severe pedal edema
69. A 60-year-old “pink puffer” with insomnia
70. A 52-year-old man with chronic obstructive pulmonary disease and pedal edema
71. A 35-year-old woman with asthma and poor sleep at night

Fundamentals of Sleep Medicine 16: Central Sleep Apnea
72. A 58-year-old man with daytime sleepiness
73. A 55-year-old man with central sleep apnea
74. A 70-year-old man with daytime sleepiness and pedal edema
75. A 60-year-old man with severe congestive heart failure and daytime sleepiness
76. A 60-year-old man with obstructive sleep apnea and numerous central apneas on CPAP
77. A 12-year-old boy with daytime CO2 retention
78. A 75-year-old man with a history of polio

Fundamentals of Sleep Medicine 17: The Restless Leg Syndrome and Periodic Leg Movements in Sleep
79. A 50-year-old man with snoring and leg kicks
80. A 56-year-old man with crawling sensations in his legs at bedtime
81. A 40-year-old man who kicks in his sleep
82. A 50-year-old man who kicks during sleep
83. A 72-year-old man with worsening symptoms during treatment for restless legs
84. A 58-year-old man with sleep apnea and leg jerks during sleep

Fundamentals of Sleep Medicine 18: Narcolepsy
85. A 30-year-old man with daytime sleepiness and episodes of weakness
86. A 23-year-old man with daytime sleepiness, but no symptoms of cataplexy
87. A 25-year-old man with narcolepsy who is still sleepy on medication
88. A 25-year-old man with frequent episodes of cataplexy
89. A 24-year-old man with narcolepsy who was irritable and lost weight on methylphenidate
90. A 35-year-old man with sleep apnea and a short REM latency
91. A 40-year-old man with sleep apnea and persistent daytime sleepiness
92. A 35-year-old man requesting stimulant medication
93. A 64-year-old man with daytime sleepiness since age 21
Fundamentals of Sleep Medicine 19: Parasomnias
94. A 20-year-old man with severe “nightmares”
95. A 25-year-old woman walking in her sleep
96. A 55-year-old man with violent dreams
97. A 50-year-old man with an interesting chin EMG

Fundamentals of Sleep Medicine 20: Monitoring for Nocturnal Seizures
98. A 55-year-old man with unusual movements during sleep
99. A 60-year-old man with a rhythmic EEG pattern during a CPAP titration
100. A 30-year-old man who got out of bed during sleep

Fundamentals of Sleep Medicine 21: Evaluation of Insomnia
101. A 30-year-old woman having difficulty falling asleep
102. A 30-year-old woman with insomnia
103. A 40-year-old man with difficulty falling asleep after the death of his brother

Fundamentals of Sleep Medicine 22: Circadian Sleep Disorders
104. A 40-year-old woman complaining of difficulty falling asleep
105. A 70-year-old man with early morning awakening
106. A 44-year-old man with jet lag
107. A 40-year-old woman with fibromyalgia
108. A 40-year-old woman with fatigue and disturbed sleep
109. A 45-year-old man with persistent insomnia while on treatment for depression
110. A 45-year-old man with hyperphagia and hypersomnia
111. A 50-year-old veteran of the Vietnam War with upsetting dreams
112. A 40-year-old woman with terrifying awakenings

Sleep Medicine is a rapidly growing and changing field. Experienced sleep medicine clinicians and educators Richard B. Berry MD and Mary H. Wagner MD present the completely revised third edition of Sleep Medicine Pearls featuring 150 cases that review key elements in the evaluation and management of a wide variety of sleep disorders. The cases are preceded by short fundamentals chapters that present enough basic information so that a physician new to sleep medicine can start reading page 1 and quickly learn the essential information needed to care for patients with sleep disorders. A concise practical format makes this an ideal resource for sleep medicine physicians in active practice sleep fellows learning sleep medicine and physicians studying for the sleep boards.

• Stay current with knowledge about the latest developments in sleep medicine by reading updated chapters using the new diagnostic criteria of the recently published International Classification of Sleep Disorder, 3rd Edition and sleep staging and respiratory event scoring using updated versions of the scoring manual of the American Academy of Sleep Medicine Manual for the Scoring of Sleep and Associated Events.
• Benefit from Drs. Berry and Wagner’s 25+ years of clinical experience providing care for patients with sleep disorders and educational expertise from presenting lectures at local, regional and national sleep medicine courses. Dr Berry was awarded the AASM Excellence in Education Award in 2010.
• Access the full contents online at ExpertConsult.