There's an interesting discussion about the possible relationship between SIDS and Slow Wave sleep here:
http://sleepdoctor.blogspot.com/2009/10/osa-sleep-deprivation-and-alcohol.html
Thursday, October 29, 2009
Sunday, October 11, 2009
OSA, Sleep Deprivation, and Alcohol
Once a person has one sleep problem, they are less able to cope with another one. For example, persons with obstructive sleep apnea are less able to cope with the demands of shift work.
A. Vakulin and colleagues pubished "Effects of Alcohol and Sleep Restriction on Simulated Driving Performance in Untreated Patients With Obstructive Sleep Apnea" in this months issue of Annals of Internal Medicine. This study compared patients with untreated OSA and matched controls on a driving simulator. The study found that "Patients with OSA are more vulnerable than healthy persons to the effects of alcohol consumption and sleep restriction on various driving performance variables. "
A. Vakulin and colleagues pubished "Effects of Alcohol and Sleep Restriction on Simulated Driving Performance in Untreated Patients With Obstructive Sleep Apnea" in this months issue of Annals of Internal Medicine. This study compared patients with untreated OSA and matched controls on a driving simulator. The study found that "Patients with OSA are more vulnerable than healthy persons to the effects of alcohol consumption and sleep restriction on various driving performance variables. "
Sunday, October 04, 2009
Alcohol, Sleep, and Pregnancy
Below is a small excerpt from the article "Sleep disorders associated with alcohol use and abuse," available at Medlink Neurology:
Alcohol use should be avoided during pregnancy. The potential adverse physical and neurocognitive effects, including fetal alcohol syndrome, of maternal alcohol consumption on the developing fetus have been extensively reviewed (Wattendorf and Muenke M 2005). Recent research has clarified the effects of prenatal alcohol consumption on the child’s postnatal sleep. Maternal prenatal consumption of alcohol results in infant postnatal sleep fragmentation as well as the suppression of spontaneous movements during sleep, at 6 to 8 weeks of age (Troese et al 2008). In utero alcohol exposure results in altered neonatal autonomic control during sleep, possibly increasing the risk of Sudden Infant Death Syndrome (Fifer et al 2009).
References:
Wattendorf DJ, Muenke M. Fetal alcohol spectrum disorders. Am Fam Physician 2005;72(2):279-82, 285.
Troese M, Fukumizu M, Sallinen BJ, Gilles AA, Wellman JD, Paul JA, Brown ER, Hayes MJ. Sleep fragmentation and evidence for sleep debt in alcohol-exposed infants. Early Hum Dev 2008;84(9):577-85.
Fifer WP, Fingers ST, Youngman M, Gomez-Gribben E, Myers MM. Effects of alcohol and smoking during pregnancy on infant autonomic control. Dev Psychobiol 2009;51(3):234-42.
Alcohol use should be avoided during pregnancy. The potential adverse physical and neurocognitive effects, including fetal alcohol syndrome, of maternal alcohol consumption on the developing fetus have been extensively reviewed (Wattendorf and Muenke M 2005). Recent research has clarified the effects of prenatal alcohol consumption on the child’s postnatal sleep. Maternal prenatal consumption of alcohol results in infant postnatal sleep fragmentation as well as the suppression of spontaneous movements during sleep, at 6 to 8 weeks of age (Troese et al 2008). In utero alcohol exposure results in altered neonatal autonomic control during sleep, possibly increasing the risk of Sudden Infant Death Syndrome (Fifer et al 2009).
References:
Wattendorf DJ, Muenke M. Fetal alcohol spectrum disorders. Am Fam Physician 2005;72(2):279-82, 285.
Troese M, Fukumizu M, Sallinen BJ, Gilles AA, Wellman JD, Paul JA, Brown ER, Hayes MJ. Sleep fragmentation and evidence for sleep debt in alcohol-exposed infants. Early Hum Dev 2008;84(9):577-85.
Fifer WP, Fingers ST, Youngman M, Gomez-Gribben E, Myers MM. Effects of alcohol and smoking during pregnancy on infant autonomic control. Dev Psychobiol 2009;51(3):234-42.
Tuesday, September 29, 2009
It's been a while...
It's been over a month since I even looked at the comments on this site. Things have been busy at the sleep centers I work at; I am currently reading about 200 sleep studies a month. Also I have been writing an article for Sleep Review , as well as working with some physicians, researchers, and statisticians analyzing data from the Jackson Heart Study.
I do expect things to slow down a little for the rest of the year. My association with Hancock Medical Center is ending. Dr. Brenda Hines is working with me and seeing patients at Somnus Sleep Clinic. She has been a big help.
I do plan on posting more for the rest of the year. I will be reading the comments over the next several days. Thanks for reading sleepdoctor!
I do expect things to slow down a little for the rest of the year. My association with Hancock Medical Center is ending. Dr. Brenda Hines is working with me and seeing patients at Somnus Sleep Clinic. She has been a big help.
I do plan on posting more for the rest of the year. I will be reading the comments over the next several days. Thanks for reading sleepdoctor!
Saturday, July 25, 2009
Sleep Disorders Linked to Aviation Accidents
Sleep disorders, especially obstructive sleep apnea, are common among truck drivers. USAToday reports that the National Transportation Safety Board is investigating fatigue as a cause of accidents in the aviation industry:
While efforts to reduce fatigue in aviation have focused on pilots' schedules, federal accident investigators say pilots and other vehicle operators also need to be screened for sleep disorders. The National Transportation Safety Board (NTSB) is preparing to take a stand on the issue within weeks, according to testimony at a recent public meeting.
Sunday, June 21, 2009
Preparing for a Sleep Fellowship
A reader asks:
I'm a current first year (almost second year) internal medicine resident and I'm currently looking into the possibility of sleep medicine as a fellowship choice. Everything I learn about sleep medicine sounds great and I find myself very interested in the subject of sleep and sleep disorders, so I think it would be a great choice for me. I was wondering if you could give me any pointers about the process of applying to sleep fellowships, doing rotations, building my application and so forth. Also, what sort of career options are there for internists who do a fellowship in sleep med? Any good textbooks that you would recommend me starting with?
I previously posted a little about sleep fellowships here.
As an internal medicine resident, elective rotations that would be helpful include pulmonary, psychiatry, neurology, ENT, and sleep medicine (if available). The ENT rotation should include a large outpatient component in which you learn the head and neck exam as well as gain expertise in evaluating and treating sinus problems.
Sleep medicine fellowships are becoming very competitive, especially for those who have only completed a general Internal Medicine residency. Research, especially something related to sleep, would be helpful in getting accepted to a sleep fellowship.
Join the American Academy of Sleep Medicine
Books that I recommend include Sleep Medicine Pearls by Richard Berry, MD. Unfortunately, the current (2002) edition obviously doesn't include the new AASM sleep scoring/staging guidelines.
I also recommend getting The AASM Manual for the Scoring of Sleep and Associated Events.
Principles and Practice of Sleep Medicine is the standard textbook. I would recommend waiting until the new (5th) edition comes out in several months.
Journals you should be reading include Sleep and The Journal of Clinical Sleep Medicine, which are availabe with membership in the American Academy of Sleep Medicine. Non-members can read older articles free on-line.
I have posted regarding career options previously in this blog, and will do so again later this month.
I'm a current first year (almost second year) internal medicine resident and I'm currently looking into the possibility of sleep medicine as a fellowship choice. Everything I learn about sleep medicine sounds great and I find myself very interested in the subject of sleep and sleep disorders, so I think it would be a great choice for me. I was wondering if you could give me any pointers about the process of applying to sleep fellowships, doing rotations, building my application and so forth. Also, what sort of career options are there for internists who do a fellowship in sleep med? Any good textbooks that you would recommend me starting with?
I previously posted a little about sleep fellowships here.
As an internal medicine resident, elective rotations that would be helpful include pulmonary, psychiatry, neurology, ENT, and sleep medicine (if available). The ENT rotation should include a large outpatient component in which you learn the head and neck exam as well as gain expertise in evaluating and treating sinus problems.
Sleep medicine fellowships are becoming very competitive, especially for those who have only completed a general Internal Medicine residency. Research, especially something related to sleep, would be helpful in getting accepted to a sleep fellowship.
Join the American Academy of Sleep Medicine
Books that I recommend include Sleep Medicine Pearls by Richard Berry, MD. Unfortunately, the current (2002) edition obviously doesn't include the new AASM sleep scoring/staging guidelines.
I also recommend getting The AASM Manual for the Scoring of Sleep and Associated Events.
Principles and Practice of Sleep Medicine is the standard textbook. I would recommend waiting until the new (5th) edition comes out in several months.
Journals you should be reading include Sleep and The Journal of Clinical Sleep Medicine, which are availabe with membership in the American Academy of Sleep Medicine. Non-members can read older articles free on-line.
I have posted regarding career options previously in this blog, and will do so again later this month.
Monday, June 08, 2009
The Future of Sleep Technicians
I'm in Seattle at the annual Sleep meeting. I'm about to go to the opening session and hear a talk by Dr. Howard Roffwarg on REM sleep.
I have a few minutes before the session starts and will take the time to answer a question from a few weeks ago:
A reader (TimRPSGT) asks:
I have a couple of questions about the future of sleep medicine. First, how do you see the role of the sleep technologist changing over the coming years? I'm also curious bout the new approval for home studies with type 2 and 3 devices. Is there a possible business opportunity here for RPSGT's to do home studies as independent contractors for doctors?
I don't see the role of sleep technologists changing much in sleep centers over the coming years. One trend that has been developing over the last several years is the movement towards certification of sleep technicians. Within several years all new sleep technicians will be required to complete commnunity/vocational college training program to work at an accredited sleep center. I am not totally up to date on RPSGT/AASM sleep tech requirements, but I believe that A-STEP was designed as a transitional program and will be phased out in several years in favor of community/vocational college-based programs (see this page for further details:
http://www.aasmnet.org/astep/RPSGTExam.aspx). On the job training of technicians is on the way out.
I don't see the role of sleep technicians changing much; they will still perform in-lab sleep studies as well as frequently perform administrative duties within the sleep lab.
Type 2 studies (full sleep study done at a patient's home)- I don't think many of this type of study will be done.
Type 3 studies (4-6 channel portable)- Reimbursement for these portable studies remain low.
The 2 ways to make a profit from type 3 studies is 1) use it as a loss leader for a sleep center or 2) do the study very cheaply. As margins at sleep centers are continually squeezed, I don't think it will be possible to portable studies as a loss leader much longer. As far as doing type 3 studies cheaply, the way to do this is to give the patient very little support. The patient picks up the device or has it shipped to them, and is given little instruction from a live person (and if there is any, it is from a secretary rather than a technician).
Neither of the 2 ways is appealing to me; I generally don't do home studies. There are business opportunities out there for entrepeneurial RPSGT's to work with doctors and provide home sleep studies., but I wouldn't recommend it.
I have a few minutes before the session starts and will take the time to answer a question from a few weeks ago:
A reader (TimRPSGT) asks:
I have a couple of questions about the future of sleep medicine. First, how do you see the role of the sleep technologist changing over the coming years? I'm also curious bout the new approval for home studies with type 2 and 3 devices. Is there a possible business opportunity here for RPSGT's to do home studies as independent contractors for doctors?
I don't see the role of sleep technologists changing much in sleep centers over the coming years. One trend that has been developing over the last several years is the movement towards certification of sleep technicians. Within several years all new sleep technicians will be required to complete commnunity/vocational college training program to work at an accredited sleep center. I am not totally up to date on RPSGT/AASM sleep tech requirements, but I believe that A-STEP was designed as a transitional program and will be phased out in several years in favor of community/vocational college-based programs (see this page for further details:
http://www.aasmnet.org/astep/RPSGTExam.aspx). On the job training of technicians is on the way out.
I don't see the role of sleep technicians changing much; they will still perform in-lab sleep studies as well as frequently perform administrative duties within the sleep lab.
Type 2 studies (full sleep study done at a patient's home)- I don't think many of this type of study will be done.
Type 3 studies (4-6 channel portable)- Reimbursement for these portable studies remain low.
The 2 ways to make a profit from type 3 studies is 1) use it as a loss leader for a sleep center or 2) do the study very cheaply. As margins at sleep centers are continually squeezed, I don't think it will be possible to portable studies as a loss leader much longer. As far as doing type 3 studies cheaply, the way to do this is to give the patient very little support. The patient picks up the device or has it shipped to them, and is given little instruction from a live person (and if there is any, it is from a secretary rather than a technician).
Neither of the 2 ways is appealing to me; I generally don't do home studies. There are business opportunities out there for entrepeneurial RPSGT's to work with doctors and provide home sleep studies., but I wouldn't recommend it.
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