Principles And Practice Of Sleep Medicine Pdf

principles and practice of sleep medicine pdf

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In the last half century, remarkable progress has been made in our understanding of the science of sleep. Concomitantly, practitioners have begun to delve into the art of the practice of sleep medicine. This third edition of Principles and Practice of Sleep Medicine , published 11 years after the first publication, admirably combines the basic science and clinical aspects of sleep medicine to produce an excellent text on sleep disorders medicine. As the authors state in the preface of the third edition, the changing landscape in the field of sleep medicine necessitated substantial changes in the organization and content of the book. As a result, this third edition is considerably enriched.

Principles and Practice of Sleep Medicine

Patient Safety Primer. Sleep is one of many physiologic functions that operates in a circadian rhythm, triggered by light—dark changes in the hour cycle. Fatigue is the feeling of tiredness and decreased energy that results from inadequate sleep time or poor quality of sleep. Fatigue can also result from increased work intensity or long work hours. Sleep deprivation has long been known to impair various cognitive functions, including mood, motivation, response time, and initiative.

The need for sleep varies individually. The absolute amount of sleep required per 24 hours is generally understood to be a minimum of 5 hours. Most healthy adults need between 7.

At least two components regulate human sleep: the drive to sleep and circadian wakefulness. The physiologic drive for sleep increases with time awake and decreases during time asleep. As awake time surpasses 12—16 consecutive hours, the drive for sleep becomes increasingly powerful.

Wakefulness, like sleep, also has a circadian rhythm: it is highest in the late afternoon and lowest in the early morning hours. Indeed, the strength of the circadian cycle has led researchers to argue that human beings are "biologically hard-wired to be active during the day and sleepy at night. Working at night must therefore be regarded as an inherently unnatural act.

Shiftwork: basic principles. Principles and Practice of Sleep Medicine. Philadelphia, PA: Elsevier; Given the importance of sleep and its known effect on cognitive performance, the link between sleep and patient safety has garnered considerable attention.

In , AHRQ funded the National Academy of Medicine to synthesize evidence on medical resident schedules and health care safety as well as to recommend strategies to enable optimization of work schedules and patient safety.

In this report, fatigue is characterized as a latent hazard and "an unsafe condition" in health care that leads to increased medical error rates. In a classic review of sleep deprivation and decision-making, investigators argued that effective performance in health care environments requires naturalistic decision-making and situation awareness.

This type of thinking involves assessing and planning for rapidly changing situations, forming mental models and future status projections, evaluating risks, appreciating the consequences of actions, and rapidly revising plans in light of changing information.

These cognitive activities place significant loads on prefrontal cortex functions, such as memory and tracking capacity, which are particularly sensitive to sleep deprivation and related fatigue. Both acute and chronic sleep deprivation result in cumulative deficits in executive function and mood, as well as heightened irritability—and all of these can impair communication and coordination in health care teams.

Chronic sleep deprivation can also contribute to burnout , which is increasingly recognized as a threat to patient safety. In contrast to dynamic, naturalistic decision-making, certain types of cognitive performance are less sensitive to sleep deprivation. Complex tasks that are rule-based and interesting or require critical reasoning in logical well-practiced tasks show less sleep-related degradation of performance.

Thus in the context of acute sleep deprivation, individuals may be better able to compensate for cognitive impairment when tasks are complex and interesting e. On the other hand, they may be more susceptible when tasks are rote or rely primarily on vigilance such as reviewing laboratory tests or ordering medications. This difference may explain why evidence on the effects of acute sleep deprivation e.

The effects of sleep deprivation will become increasingly important as health care moves to more shift-based physician staffing. There is good evidence of increased nursing errors when shifts last longer than 12 hours, nurses work overtime, or nurses do not receive adequate rest breaks.

Similarly, in a classic study of resident work hours , Landrigan and colleagues found medical and diagnostic error were significantly more common in residents working traditional long shifts of more than 24 hours. Studies—including research supported by AHRQ—have shown that residents make fewer errors in the setting of closely monitored, comprehensive interventions to reduce work hours and improve sleep.

Despite ongoing controversies regarding the impact of resident work hour restrictions and physician sleep deprivation on surgical outcomes, The Joint Commission has issued several reports alerting health care providers and the public to the potential for serious adverse effects of lack of sleep.

In a Sentinel Event Alert , The Joint Commission called on health care organizations to take steps to mitigate the impact of extended work hours on clinician sleep deprivation and fatigue. These steps include conducting a risk assessment; ensuring robust handoff practices; involving staff in design of work schedules; implementing a fatigue management plan including strategic use of caffeine and planned naps; educating personnel about sleep hygiene; and ensuring an adequate environment for sleep breaks.

However, more evidence is needed to determine optimal practices for scheduling , planned napping , and other fatigue mitigation strategies. The AGCME revised its work hour standards in to provide more flexibility to physician learners and training programs. Trials are underway to build more evidence for the effect of physician learner work schedules on patient outcomes. One challenge in addressing sleep deprivation among clinicians is that adequate sleep time requires a combination of effective organizational policies regarding work hours, shift rotation, and sleep policies , as well as personal commitment to good sleep habits.

Work hour restrictions alone will be ineffective if, when working nights, clinicians do not also limit daytime activities in order to obtain adequate sleep. Sort by Relevance Published Date. Search Tips. Username or e-mail address Enter your email address or username.

Password Enter the password that accompanies your email address. Remember me. Log in. Register Reset password. Use quotes to search for an exact match of a phrase:. Last Updated: September Fatigue, Sleep Deprivation, and Patient Safety. Sections Background Current Context. Approach to Improving Safety. Duty Hour Limitation. Resource Type. Patient Safety Primers. Safety Target. Fatigue and Sleep Deprivation. Clinical Area. Target Audience. Health Care Providers.

Health Care Executives and Administrators. Error Types. Epidemiology of Errors and Adverse Events. Facebook Twitter Linkedin Email.

Background Sleep is one of many physiologic functions that operates in a circadian rhythm, triggered by light—dark changes in the hour cycle. Current Context Despite ongoing controversies regarding the impact of resident work hour restrictions and physician sleep deprivation on surgical outcomes, The Joint Commission has issued several reports alerting health care providers and the public to the potential for serious adverse effects of lack of sleep.

Related Patient Safety Primers. Duty Hours and Patient Safety. Editor's Picks. Journal Article. The Journal of nursing administration. BMC Med Edu. Am J Crit Care. Journal of hospital medicine. Rosenbluth G, Landrigan CP.

Pediatric clinics of North America. Journal of graduate medical education. Chronobiology International. Anesthesia and analgesia. Archives of surgery Chicago, Ill. Clinical orthopaedics and related research. The New England journal of medicine. New Engl J Med. ISBN: Sentinel Event Alerts.

Sentinel event alert. Related Resources. Perspectives on Safety. Arpana R. Vidyarthi, MD; Robert B. Baron, MD, MS. Myers, MD. Cassel, MD.

Principles and practice of sleep medicine, 6th ed.

Kryger, Alon Y. Avidan, and Richard B. Accurately diagnose and treat adult and pediatric sleep disorders with exceptional visual guidance from world-renowned sleep expert Dr. Meir H. Effectively diagnose and manage adult and pediatric sleep disorders with help from Atlas of Sleep Medicine, the most comprehensive and detailed source of pictorial and video guidance available. A full-color design with an entirely new image collection and video segments facilitates the observation and interpretation of sleep-related events and recordings. Bronchoscopy and Central Airway Disorders provides the guidance you need to plan and implement the most effective bronchoscopy procedure for every patient.

Dement, MD, PhD, delivers the comprehensive, dependable guidance you need to effectively diagnose and manage even the most challenging sleep disorders. Updates to genetics and circadian rhythms, occupational health, sleep in older people, memory and sleep, physical examination of the patient, comorbid insomnias, and much more keep you current on the newest areas of the field. A greater emphasis on evidence-based approaches helps you make the most well-informed clinical decisions. And, a new more user-friendly, full color format - both in print and online, lets you find the answers you need more quickly and easily. Whether you are preparing for the new sleep medicine fellowship examination, or simply want to offer your patients today's best care, this is the one resource to use! Lowell W. As a textbook, it will be useful to trainees in the field of sleep medicine whether they are medical students, residents or sleep fellows.

This content was uploaded by our users and we assume good faith they have the permission to share this book. If you own the copyright to this book and it is wrongfully on our website, we offer a simple DMCA procedure to remove your content from our site. Start by pressing the button below! Principles and Practice of Geriatric Sleep Medicine. Read more.

Principles and Practice of Sleep Medicine, 3rd ed

Robert R. Comment on this article. Jason, age 16, has had difficulty with sleep initiation for 2 years. He describes going to bed at PM on school nights but falling asleep no sooner than midnight and typically after AM. He does not sleep better with a change in environment.

Patient Safety Primer. Sleep is one of many physiologic functions that operates in a circadian rhythm, triggered by light—dark changes in the hour cycle. Fatigue is the feeling of tiredness and decreased energy that results from inadequate sleep time or poor quality of sleep. Fatigue can also result from increased work intensity or long work hours. Sleep deprivation has long been known to impair various cognitive functions, including mood, motivation, response time, and initiative.

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Это вам не Америка - никаких предупреждающих знаков, никаких поручней, никаких табличек с надписями, что страховые компании претензий не принимают. Это Испания. Если вы по глупости упадете, то это будет ваша личная глупость, кто бы ни придумал эти ступени. Халохот остановился у одного из окон, расположенных на уровне его плеча, и посмотрел на улицу. Он находился на северной стороне башни и, по всей видимости, преодолел уже половину подъема. За углом показалась смотровая площадка. Лестница, ведущая наверх, была пуста.

Я в плену абсурдного сна. Проснувшись утром в своей постели, Беккер заканчивал день тем, что ломился в гостиничный номер незнакомого человека в Испании в поисках какого-то магического кольца. Суровый голос Стратмора вернул его к действительности. Вы должны найти это кольцо. Беккер глубоко вздохнул и перестал жаловаться на судьбу. Ему хотелось домой. Он посмотрел на дверь с номером 301.

 - Если Северная Дакота заподозрит, что мы его ищем, он начнет паниковать и исчезнет вместе с паролем, так что никакая штурмовая группа до него не доберется. - Все произойдет, как булавочный укол, - заверила его Сьюзан.  - В тот момент, когда обнаружится его счет, маяк самоуничтожится. Танкадо даже не узнает, что мы побывали у него в гостях. - Спасибо, - устало кивнул коммандер.

Он не хотел, чтобы оно попало в АНБ. Но чего еще можно было ждать от Танкадо - что он сохранит кольцо для них, будучи уверенным в том, что они-то его и убили. И все же Сьюзан не могла поверить, что Танкадо допустил бы. Ведь он был пацифистом и не стремился к разрушению.

 Открыть. Ну и ну, - ужаснулась.  - Шестьсот сорок семь ссылок на уран, плутоний и атомные бомбы. Похоже, это то, что нам .

А вы тем временем погибаете.  - Он посмотрел на экран.  - Осталось девять минут. Сьюзан, не слушая его, повернулась к Соши.

 Он был крайне со мной любезен, - просияв, сказал Бринкерхофф, довольный тем, что ему удалось остаться в живых после телефонного разговора.  - Он заверил меня, что ТРАНСТЕКСТ в полной исправности. Сказал, что он взламывает коды каждые шесть минут и делал это даже пока мы с ним говорили.

Ответа не последовало. Сьюзан спустилась по лестнице на несколько ступенек. Горячий воздух снизу задувал под юбку. Ступеньки оказались очень скользкими, влажными из-за конденсации пара.

 Хуже. Если Танкадо убьют, этот человек опубликует пароль. - Его партнер опубликует ключ? - недоуменно переспросила Сьюзан.

Глаза его расширились. Это явно не было составной частью плана. - У них там прямо-таки дискотека! - пролопотал Бринкерхофф.

Principles and practice of sleep medicine, 6th ed.

Это не принесет тебе радости. У нас много денег - какая разница, кто из нас их получает. Но это была чужая епархия.

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