The way that patients present for evaluation, testing and follow up is not always straightforward, and this is particularly true in the presence of mental health disorders. An understanding of mental health disorders, which often overlap with sleep disorders, is important. Being equipped to discern the differences and similarities in sleep and mental health disorders when reviewing a patient’s symptoms and history can assist the sleep technologist and the clinical sleep health educator (CCSH) to differentiate these disorders. Module six of the AAST Enhanced CCSH Designated Education Program outlines the important role that clinical evaluation plays in managing these patients.
“What’s in your wallet?” This is a popular refrain from a television commercial touting the benefits of a credit card. It promises that the card holder is ready for all situations that require some access or assistance for a situation at hand. As certified clinical sleep health (CCSH) educators, we too must be able to reach into our “knowledge” wallet and use the right “knowledge card” to assist and work with our patients. The information in the “Incidence & Prevalence of Sleep Disorders” module of the AAST CCSH Designated Education Program Recorded Modules will assist you to acquire this knowledge base.
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An essential element of the clinical sleep health educator (CCSH) role is an understanding of modes and rationale for sleep testing based on patient history and complaints. In addition, an understanding of the data derived from the various types of testing and the ability to evaluate that data is crucial. In module two of the AAST Enhanced CCSH Designated Education Program, Jon Atkinson, BS, RPSGT, CCSH, FAAST, discusses the rationale behind sleep testing, both in the laboratory and the home, and highlights the importance of a quality sleep history to ensure the appropriate level of testing and sleep environment is provided. Additionally, Atkinson gives an overview of the American Academy of Sleep Medicine (AASM) Multiple Sleep Latency Test (MSLT) and the Maintenance of Wakefulness Test (MWT) indications, recommended protocols and scoring process for each test.
While working at the Madigan Army Medical Center in Washington state, Vincent Mysliwiec, MD, FAASM, and his colleagues started to notice a unique phenomenon. Soldiers coming into the sleep lab were experiencing disruptive nocturnal behaviors and nightmares following traumatic experiences associated with their deployment. These symptoms which occurred frequently at home, would at times occur in the sleep lab where the patients would have REM without atonia (RWA) during polysomnography. It was odd — unlike other instances of PTSD-induced nightmares he had seen — and it made Mysliwiec think there was something more there. “It was definitely something distinct,” Mysliwiec said. “Everyone always goes, ‘That’s just PTSD.’ Yes, those with PTSD very frequently have nightmares, but nowhere in the PTSD criteria do they have disruptive nocturnal behaviors or dream reenactment.” Mysliwiec and his colleagues called the phenomenon “Trauma Associated Sleep Disorder” and classified it as a potential parasomnia. Their first paper on it was published in October 2014 in the Journal of Clinical Sleep Medicine. Since then, there are a growing number of clinicians and researchers finding evidence in their own labs that young soldiers, as well as veterans, might be experiencing something more intense than symptoms commonly associated with PTSD. Moreover, they believe further study of this proposed parasomnia could be a major preventative measure for long-term PTSD complications. “If you can actually say to a solider, veteran — or anyone suffering from traumatic exposure — that we have an established diagnostic criteria for the severe sleep disturbances you are experiencing, then you can begin to evaluate treatments for this disorder and prevent longterm adverse outcomes. We could potentially treat them for this potential parasomnia and improve their sleep and that of their bed partner.” he said. “It’s an important question — and we need researchers to develop the criteria.”
As a sleep professional, it's important that you educate your patients on parasomnias, such as a sleep-related eating disorder (SRED), since sleep disorders like these could negatively impact a patient’s health through weight gain and obesity. The journal Psychiatry provides these sleep-related eating disorder statistics:
This blog is based off of the AAST 2019 Annual Meeting Session "Parasomnias." For more information on this session and other session recordings click here. From nightmares to sleepwalking to REM sleep behavior disorder (RBD), parasomnias can occur in many forms without the patient even knowing they are experiencing an event. For sleep professionals, it is imperative they can educate patients with parasomnias as these sleep disorders can have lasting and physically damaging effects.
The neurocognitive disorder Alzheimer’s disease affects an estimated 5 million Americans. Its prevalence is expected to triple by 2060. People affected by Alzheimer’s disease have increasing problems with memory, judgement and doing daily tasks of living as the disease progresses. Various studies have indicated that obstructive sleep apnea (OSA) is associated with an increased risk of developing Alzheimer’s disease and that people with OSA have increased levels of certain biomarkers (e.g., amyloid beta protein) associated with Alzheimer’s disease. Scientists have recently noted increased levels of biomarkers associated with Alzheimer’s disease in young children with OSA.
Sleepwalking, yelling in your sleep, violently thrashing in bed and hurting those you love. No, it’s not a demonic possession; it is REM sleep behavior disorder, or RBD. RBD is a sleep disorder that common presents itself in older men and causes people who suffer from it to physically act out their dreams. Its cause is unknown, but its effects can be terrifying.
This article originally appeared in SleepyHeadCENTRAL.com on March 9, 2019. Reprinted by permission of the author. On Feb. 20 and 21, the National Safety Council (NSC) presented its first annual Workplace Fatigue Conference. It convened a diverse cross-section of leaders in the field of workplace fatigue management.
What does a German fairytale and a severe sleep disorder have in common? A lot, apparently.