A Clinical Casebook of Sleep Disorders in Women

Description:

Sleep disorders are very common among women during their lifespan, presenting in isolation or in combination with other illnesses particularly psychiatric and neurologic disorders. Pregnancy-related sleep disorders pose an interesting dilemma as this is a transient phase; these are associated with potential long-term effects on maternal and fetal health. Menopause and pre-menopausal stages lead to a significant change in sleep architecture, sometimes associated with insomnia with or without sleep related breathing disorder. Sleep architecture in men and women varies due to significant hormonal differences between the genders. However, sleep complaints are disproportionately higher among women.

This book presents 20 clinical cases to understand the differences in presentation of symptoms and treatment options for various sleep disorders that are more commonly noted among women. These cases cover a spectrum of sleep related breathing disorders, sleep related movement disorders, hypersomnias, parasomnias, issues of sleep fragmentation leading to insomnia in association with hormonal changes and some unique cases encountered in our clinical practices.

This compilation of interesting clinical cases presents trainees and experienced physicians with a useful guide to assist in their clinical practices and will stimulate further research and studies.

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Preface

Whether presenting in isolation or combination with other illnesses, sleep disorders are prevalent among women during their lifespans. Sleep architecture and physiology reveal subtle differences among the sexes although sleep disorders are disproportionately higher among women. This book will go through a series of clinical cases to understand the presentation and management of various sleep disorders, focusing on women in various stages of their life cycle.

In the first two books, Comorbid Sleep and Psychiatric Disorders: A Clinical Casebook and Sleep Disorders in Selected Psychiatric Settings: A Clinical Casebook, editors Imran S. Khawaja and Thomas D. Hurwitz explored the association between sleep and psychiatric disorders.

In this third volume, we discuss 20 cases to highlight unique aspects of sleep disorders among women, the primary audience being all clinicians taking care of women’s health. We review cases of sleep disturbance among young teenagers, adolescents, and middle-aged women with a spectrum of sleep-related breathing disorders, sleep-related movement disorders, hypersomnia, parasomnias, insomnia with hormonal changes, and some unique cases encountered in our clinical practices. Pregnancy-related sleep disorders pose an interesting dilemma as this is a transient phase. Menopause and pre-menopausal stages lead to a noteworthy change in sleep architecture, sometimes associated with insomnia with or without sleep-related breathing disorders.

Sleep disturbances in pregnancy can lead to long-term adverse maternal and fetal health effects.

This book will present trainees and experienced clinicians with a valuable guide to managing sleep disorders among women. This book is a compilation of succinct, interesting clinical cases, each followed by relevant questions to stimulate the reader. We thank our contributing authors for their dedication to the field of medicine and hope this book will spark further research to enhance our knowledge in the arena of sleep disorders in women.

Dallas, TX, USA Safia S. Khan
Grapevine, TX, USA Imran S. Khawaja

Table of contents :
Preface
Contents
About the Editors
Part I: Menstrual Cycle and Sleep Changes
1: Sleep Changes with Menarche
Clinical Case
General Discussion
Menarche and Sleep
Sleep Evaluation Questionnaires
Physiologic changes of Sleep during Adolescence
Treatment
Consequences of Inadequate Sleep
Take Home Points
References
2: Insomnia in Pregnancy: A Review
Clinical History
Discussion
References
3: Restless Legs Syndrome in Women: A Case Report
Introduction
Case Report
Discussion and Conclusions
References
4: Sleep Deprivation in a Postpartum Woman with Short Sleeper Syndrome
Clinical History
Physical Exam
Lab Results
Differential Diagnoses
Diagnosis
Discussion
Pearls/Take-Home Points
References
Part II: Sleep-related Disorders of Breathing in Women
5: Can Snoring Cause Me to Be Tired and Sleepy? Upper Airway Resistance Syndrome in Women
Clinical Case History
Examination and Mental Status Exam
Special Studies
Results
Diagnosis, Differential Diagnosis, and Discussion
Conclusion
Pearls/Take-Home Points
References
6: Is It Snoring or Sleep Apnea; Should I Be Worried?
Clinical Case 1
Special Studies
Case Follow Up
Clinical Case 2
Discussion
Diagnostic Testing; Utility of in-Lab Versus Home Testing
Treatment
Conclusion
Take Home Points
References
7: Case of Obesity Hypoventilation in an African American Lady with Underlying Hypertension, Diabetes and Mood disorder
Clinical History/Case
Examination
Special Studies
Final Diagnosis
General Remarks
Clinical Pearls
References
Part III: Hypersomnias in Women
8: Idiopathic Hypersomnia
History
Physical Examination
Laboratory Tests
Actigraphy and Sleep Log
Polysomnogram and MSLT
Diagnosis and Treatment
Differential Diagnoses
Discussion
Treatment of Idiopathic Hypersomnia
Outcome of the Case
Take Home Pearls
Reference
9: Complicated Delayed Sleep Wake Phase Disorder in a 59-Year-Old Woman
Clinical History
Physical Examination
Data
Discussion
Treatment
Behavioral Interventions
Medication
Light Therapy
Clinical Pearls
References
10: Medication Management of Patient with Narcolepsy During Pregnancy and Lactation
Clinical History
Physical Exam
Sleep Study Results
General Discussion
Treatment of Narcolepsy in Non-pregnant Women and Men
Change in Labelling of Drugs Safety for Pregnancy and Lactation
Treatment of Narcolepsy in Pregnant Women
Treatment of Narcolepsy During Labor and Delivery
Prescribing in Breast-Feeding Mothers
Take Home Points
References
Part IV: Menopause Related Sleep Disorders
11: Sleep Disturbances Due to Hot Flashes in the Post-Menopausal State
Clinical History
Special Studies
Differential Diagnosis and Diagnosis
Discussion
Treatment
Pearls/Take Home Points
References
12: Hypoglossal Nerve Stimulator in the Treatment of Obstructive Sleep Apnea in a Menopausal Woman with CPAP Intolerance
Clinical Case
Physical Exam
Discussion
Definition and Diagnosis of Obstructive Sleep Apnea
Treatment Options for Obstructive Sleep Apnea
Obstructive Sleep Apnea in Menopausal Women
Hypoglossal Nerve Stimulator Device
Indications
Contraindications
Limitations
Take Home Points
References
13: Onset of Chronic Insomnia Due to COVID-19 Pandemic in the Setting of Severe Anxiety in an Elderly Widow
Clinical History
Physical Examination
Lab Test Results
Differential Diagnoses
Diagnosis
General Remarks
Best Answers
Pearls/Take Home Points
References
Part V: Sleep and Psychiatric Disorders in Women
14: Bipolar Disorder Related Sleep Disturbances in Women
Clinical Case
Physical Exam
Discussion
Hypomania Vs. Mania
Depressive Episodes
Influence of Family History
Diagnosing Bipolar Disorder
Differential Diagnosis
Special Considerations for Bipolar in Women
Treatment and Referral to Psychiatry
Take Home Points
References
Part VI: Special Topics
15: Intractable Insomnia in a Woman with Otherwise Successful Treatment of Breast Cancer
Clinical History
Examination/Mental Status Exam
Discussion
Take Home Pearls
References
16: Parasomnias in Women
Case 1
Discussion
Outcome of Case
Case 2
Discussion
Outcome
Teaching Points
References
17: Fatigue in a Transgender Man
Clinical History
Physical Examination and Objective Metrics
Lab Results
Special Studies
Results
Question: What Is the Diagnosis?
Differential Diagnosis and Diagnosis
General Remarks
Sleep-Disordered Breathing
OSA: Clinical Screening, Diagnosis, and Consequences
Gender Affirming Care: Hormonal Treatment for Transgender Persons
Anatomical Oropharyngeal Differences Between Genders
Effects of Hormones on Airway Collapse
OSA in Transgender People
Pearls/Take Home Points
References
Part VII: Neurologic Disorders with Sleep Disturbance
18: Parkinson Disease and REM Sleep Behavior Disorder in Women
Case 1
Discussion
Outcome of Case
Case 2
Discussion
Outcome of Case
Take Home Points
References
19: Disordered Sleep in a Female Caregiver
Clinical History/Case
Examination/Mental Status Exam
Differential Diagnosis and Diagnosis
General Remarks
Non-pharmacologic Therapy
Pharmacologic Therapy
Pearls/Take Home Points
References
20: Poor Sleep in a Cancer Patient Receiving Palliative Care
Clinical History/Case
Physical/Mental Status Examination
Results (Abnormal Bolded)
Differential Diagnoses
Discussion
Hypersomnia Versus Insomnia in Delirium
Reversible Versus Irreversible Delirium
Hyperactive Versus Hypoactive Delirium
Treatment
Clinical Pearls/Take Home Points
References
Index