Institute for Continuing Education

Sleep Disorders and Sleep Deprivation

Course Objectives

Upon successful completion of this module, you will be able to:

• Classify and analyze sleep-related breathing disorders including obstructive sleep apnea, central sleep apnea, sleep-related hypoventilation, and sleep-related hypoxemia disorders, with emphasis on pathophysiology, clinical consequences, diagnostic criteria per AASM guidelines, and evidence-based treatment approaches.
• Identify and differentiate REM sleep-related disorders including REM sleep behavior disorder, recurrent isolated sleep paralysis, and nightmare disorder, with focus on clinical presentation, polysomnographic features, associated neurodegenerative conditions, and current management strategies.
• Evaluate circadian rhythm sleep-wake disorders including delayed sleep-wake phase disorder, advanced sleep-wake phase disorder, irregular sleep-wake rhythm disorder, non-24-hour sleep-wake disorder, and shift work disorder, applying knowledge of circadian physiology, diagnostic criteria, and treatment modalities including chronotherapy and pharmacotherapy.
• Assess the physiological, cognitive, and health consequences of acute and chronic sleep deprivation, including impacts on neurocognitive performance, metabolic function, cardiovascular health, immune function, and safety, while applying evidence-based strategies for sleep extension and recovery.
• Apply polysomnographic interpretation skills to identify characteristic patterns of breathing disorders, REM abnormalities, and circadian misalignment in clinical sleep studies.

Course Information

It is estimated that 50 to 70 million Americans chronically suffer from a disorder of sleep and wakefulness, hindering daily functioning and adversely affecting health and longevity. There around 90 distinct sleep disorders; most are marked by one of these symptoms: excessive daytime sleepiness, difficulty initiating or maintaining sleep, and abnormal events occurring during sleep. The cumulative long-term effects of sleep loss and sleep disorders have been associated with a wide range of deleterious health consequences including an increased risk of hypertension, diabetes, obesity, depression, heart attack, and stroke.

After decades of research, the case can be confidently made that sleep loss and sleep disorders have profound and widespread effects on human health. This course focuses on manifestations and prevalence, etiology and risk factors, and comorbidities of the most common sleep conditions, including sleep loss, sleep-disordered breathing, insomnia, narcolepsy, restless legs syndrome, parasomnias, sleep-related psychiatric disorders, sleep-related neurological disorders, sleep-related medical disorders, and circadian rhythm sleep disorders.

Sleep loss and sleep disorders are among the most common yet frequently overlooked and readily treatable health problems. It is estimated that 50 to 70 million Americans chronically suffer from a disorder of sleep and wakefulness, hindering daily functioning and adversely affecting health and longevity (NHLBI, 2003). Questions about sleep are seldom asked by physicians (Namen et al., 1999, 2001). For example, about 80 to 90 percent of adults with clinically significant sleepdisordered breathing remain undiagnosed (Young et al., 1997b). Failure to recognize sleep problems not only precludes diagnosis and treatment—it also precludes the possibility of preventing their grave public health consequences.

The public health consequences of sleep loss and sleep-related disorders are far from benign. The most visible consequences are errors in judgment contributing to disastrous events such as the space shuttle Challenger (Walsh et al., 2005). Less visible consequences of sleep conditions are far more prevalent, and they take a toll on nearly every key indicator of public health: mortality, morbidity, performance, accidents and injuries, functioning and quality of life, family well-being, and health care utilization. Some of these consequences, such as automobile crashes, occur acutely within hours(or minutes) of the sleep disorder, and thus are relatively easy to link to sleep problems. Others—for example, obesity and hypertension—develop more insidiously over months and years of chronic sleep problems. After decades of research, the case can be confidently made that sleep loss and sleep disorders have profound and widespread effects on human health.

Although there are around 90 distinct sleep disorders, according to the International Classification of Sleep Disorders (AASM, 2005), most are marked by one of these symptoms: excessive daytime sleepiness, difficulty initiating or maintaining sleep, or abnormal movements, behaviors, and sensations occurring during sleep. The cumulative effects of sleep loss and sleep disorders have been associated with a wide range of deleterious health consequences including an increased risk of hypertension, diabetes, obesity, depression, heart attack, and stroke.

This module focuses on the most common sleep conditions, including sleep loss, sleep-disordered breathing, insomnia, narcolepsy, restless legs syndrome (RLS), parasomnias, sleep-related psychiatric disorders, sleeprelated neurological disorders, sleep-related medical disorders, and circadian rhythm sleep disorders. The manifestations and prevalence, etiology and risk factors, and comorbidities for each condition are briefly described. There is a large body of data on these disorders, in part because they encompass the most frequently cited sleep disorders or they carry the greatest public health burden. As such, the committee chose to focus primarily on these disorders.