CHAPTER 1 Normal Sleep Physiology SAMUEL A. MICKELSON, MD, FACS, ABSM   WHAT IS SLEEP? Sleep is a reversible physical and mental state during which a person becomes inactive and relatively unresponsive and unaware of the environment. Behavioral changes typically associated with sleeping include a recumbent posture and closed eyes. During sleep, there typically is a decrease in body temperature, blood pressure, breathing rate, and most body functions. In some individuals, however, waking type beh -- CHAPTER 2 The Evaluation of Upper Airway Structure for Obstructive Sleep Apnea B. TUCKER WOODSON MD, FACS OMER KARAKOC, MD   It is widely accepted that obstructive sleep apnea (OSA) results from the combination of a structurally small upper airway and a loss of compensatory muscle tone during sleep. Most agree that structure is a major if not required contributor for airway obstruction to occur during sleep. Despite this, results of upper airway surgery, which theoretically improves or corrects -- CHAPTER 3 Evaluation of Patients with Sleep Disorders KATHLEEN YAREMCHUK, MD, ABSM   To accurately assess patients with sleep disorders, a complete history and physical examination that is significantly different than the usual otolaryngologic history and physical that most surgeons are used to doing needs to be performed. Kryger's Textbook of Sleep Medicine1 lists 76 different diagnoses for sleep disorders. Obstructive sleep apnea (OSA) is the most common and, although that is what most otolary.

CHAPTER 4 Overview of Sleepiness PELL ANN WARDROP, MD, ABSM   Patients with sleepiness frequently are seen in the otolaryngologist's office, particularly if they snore. Sleep-disordered breathing is only one cause of sleepiness and fatigue so awareness of the differential diagnosis and diagnostic workup of this complaint is important. Patients also may have more than one sleep disorder that is contributing to their symptoms. Evaluation of the sleepy patient can be challenging as a precise defini -- CHAPTER 5 Sleep Testing NOAH S. SIEGEL, MD   The evaluation of patients with sleep-related complaints involves eliciting a history and performing a physical examination as well as quantitative assessment of an individual's sleep. In some sleep disorders, a history is sufficient to establish a diagnosis. However, quantitative sleep testing often is necessary. Multiple testing modalities are available in the quantitative assessment of an individual's sleep. This chapter provides an overview of the -- CHAPTER 6 Imaging of the Airway SHEHANAZ K. ELLIKA, MD, DNB, DMSURESH C. PATEL, MD   INTRODUCTION Obstructive sleep apnea (OSA) is a condition characterized by repeated episodes of pharyngeal wall collapse during sleep, causing apnea (complete obstruction of the airway) or hypopnea (incomplete obstruction with decreased ventilation). Airway obstruction typically occurs during REM sleep -- however an abnormal airway is present in OSA patients even when awake. Imaging is used primarily for treatment.

CHAPTER 7 Sleep-Disordered Breathing IEE CHING ANDERSON, MD NANCY A. COLLOP, MD   Sleep-disordered breathing refers to the occurrence of abnormal respiration during sleep. As defined by the 2nd edition of the International Classification of Sleep Disorders (ICSD-2),1 disorders of sleep-disor dered breathing are classified into 4 categories: (1) obstructive sleep apnea syndromes, (2) central sleep apnea syndromes, (3) sleep-related hypoventilation/hypoxemia syndromes, and (4) other sleep-related -- CHAPTER 8 Cardiovascular Effects of Sleep-Disordered Breathing ANDREW D. CALVIN, MD, MPH VIREND K. SOMERS, MD, D.PHIL   INTRODUCTION Sleep-related breathing disorders include both obstructive sleep apnea (OSA) and central sleep apnea. Central sleep apnea affects up to 40% of heart failure patients, and may be a consequence of heart failure rather than a cause.1 This review will focus on OSA, which has been linked to the development and progression of cardiovascular disease and is a frequent como -- CHAPTER 9 Insomnia, Circadian Rhythm Disorders, and Sleep Deprivation RUSSELL ROSENBERG, PHD   INTRODUCTION TO INSOMNIA Insomnia is the most commonly occurring of all sleep disorders.1 Approximately 10 to 15% of adults suffer from chronic insomnia, and an additional 25 to 35% have transient or occasional insomnia.2 Some data suggest that although the prevalence of insomnia has increased in recent years it remains underrecognized, underdiagnosed, and undertreated. Providing effective and timely t.

CHAPTER 10 Narcolepsy and Hypersomnias NEERAJ KAPLISH, MD SHELLEY D. HERSHNER, MD   INTRODUCTION Somnolence is a normal physiologic process. All people will be somnolent at certain times of the day. For example, people with a normal circadian rhythm, somnolence is at peak between 2 to 6 AM with another peak is in the afternoon. This afternoon episode may have been the impetus for the development of the siesta. Somnolence becomes pathologic, or consistent with "excessive daytime somnolence," when -- CHAPTER 11 Movement Disorders in Sleep NANCY F. FISHBACK, MD   INTRODUCTION A variety of movement disorders may manifest during sleep. These include sleepwalking, restless legs syndrome (RLS), periodic limb movements of sleep, and REM-behavior disorder (RBD). Although sleep terrors are classified as parasomnias rather than movement disorders, they are discussed here. Movement disorders are common, easily diagnosed, and generally treatable. They may be incidental findings on a polysomnogram or re -- CHAPTER 12 Drugs That Affect Sleep and Cause Sleepiness SURILLA RANDALL, PHD TIMOTHY A. ROEHRS, PHD   NORMAL SLEEP Normal Sleep Physiology and Architecture Sleep architecture refers to the structure and organization of sleep defined by continuous electrophysiological monitoring of eye movements, muscle tone, and brain activity measured by an electroencephalogram (EEG), termed a polysomnography. Sleep is divided into nonrapid eye movement (NREM) and rapid eye movement (REM), two distinct brain st.

CHAPTER 13 Treatment of Sleep Apnea with Positive Pressure Therapy: The Nuts and Bolts of Nasal CPAP WILLANE S. KRELL, MD M. SAFWAN BADR, MD   CONTINUOUS POSITIVE AIRWAY PRESSURE FOR TREATMENT OF OBSTRUCTIVE SLEEP APNEA Obstructive sleep apnea syndrome (OSAS) is a relatively common disorder1 that afflicts both men and women of all ages. Epidemiologic studies suggest the prevalence of OSAS is 2% in women and 4% in men.2 OSAS is characterized by repeated complete or partial closures of the upper a -- CHAPTER 14 Oral Appliances for Snoring and Sleep Apnea BRYAN A. WILLIAMS, DDS, MS SAMUEL R. ZWETCHKENBAUM, DDS, MPH   BACKGROUND Upper airway sleep disorders (UASDs) have become increasingly more important to medical and dental professionals. These disorders include upper airway resistance syndrome (UARS) and obstructive sleep apnea syndrome (OSAS).1 Snoring is a common symptom associated with both UARS and OSAS, but is not necessarily pathognomonic for either condition. The treatment of these c -- CHAPTER 15 The Role of Psychology in the Treatment of Sleep Disorders RYAN G. WETZLER, PSYD, CBSM JONATHAN D. COLE, PHD   AN INTRODUCTION TO SLEEP PSYCHOLOGY Sleep psychology and the field of behavioral sleep medicine refer to a subspecialty of clinical sleep medicine and health psychology that: Focuses on the identification of psychological (eg, cognitive and/or behavioral) factors that contribute to the development and/or maintenance of sleep disorders. Specializes in developing and providing.

CHAPTER 16 Weight Management for Patients With Obstructive Sleep Apnea JONATHAN K. EHRMAN, PHD DAVID C. MURDY, MD   INTRODUCTION There is an association of an increased incidence of obstructive sleep apnea (OSA) in those who are overweight and obese. In fact, being overweight is considered the most important risk factor for OSA development.1 Specifically, central (abdominal or android) obesity and increased neck thickness (specifically in the lateral parapharyngeal fat pads) are known body/anato.