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3. How would you suggest that this patient improve his sleep hygiene? A number of improvements can be made, including maintaining a regular sleep/wake schedule that allows for adequate sleep, avoiding caffeine after the early afternoon, avoiding alcohol before bedtime, unwinding before bedtime and leaving the day’s troubles behind, and ensuring a good sleep environment. CASE HISTORY 3: Key aspects Diagnosis Matching symptoms From Primary Information • Patient in generally good health • Sleepwalking as a child • Vivid dreams that are acted out • Sleep-related behaviors acted out late in the sleep period • Patient relatively young and female • No other apparent sleep disorders present Parasomnia (REM motor behavior disorder) • Movement to another location (is excessive for REM motor behavior disorder) • Acting out vivid dreams • Behavior occurs later in sleep period • The patient presents symptoms that do not indicate a clear diagnosis. Both sleepwalking and REM motor behavior disorder are possibilities. After reading Secondary Information Is your initial diagnosis confirmed? If no, what is your new diagnosis? If no, what caused you to change your mind? Recommended treatment Expected outcome (effect of treatment on patient symptoms) Answers will vary. Answers will vary. Secondary information is consistent with diagnosis of REM motor behavior disorder. • Improved sleep hygiene, getting enough sleep, maximize safety of sleeping environment, and consult a specialist for an evaluation • Possibly medication Reduced frequency of parasomnia episodes 111 Student Lesson 4
Sleep, Sleep Disorders, and Biological Rhythms CASE HISTORY 4: Key aspects Diagnosis Matching symptoms Is your initial diagnosis confirmed? If no, what is your new diagnosis? ANSWERS TO DISCUSSION QUESTIONS 1. The patient reports these episodes occurring at 3:30 a.m. and 4:00 a.m. Is this important? Yes. Sleepwalking, another disorder characterized by walking or moving about during sleep, typically occurs during the first third of a night’s sleep. This patient’s abnormal episodes occur later than that. 2. In general terms, what would you expect this patient’s EMG during sleep to look like if she is experiencing REM motor behavior disorder and not sleepwalking? One would expect to see periods during REM sleep in which muscle activity increases if the patient is experiencing REM motor behavior disorder. Sleepwalking occurs during NREM sleep. From Primary Information • Patient is male and relatively young • Has no trouble falling asleep • Has multiple awakenings during the night • Excessive daytime sleepiness • Recently gained weight Obstructive sleep apnea • Has multiple awakenings during the night • Excessive daytime sleepiness • Obesity After reading Secondary Information Answers will vary. Answers will vary. If no, what caused you to change your mind? Patient snores, and stops breathing for up to 30 seconds. Recommended treatment Expected outcome (effect of treatment on patient symptoms) Use a positive airway pressure device, weight loss, avoid alcohol, avoid sleeping on back, possibly surgery More normal breathing during sleep and less snoring 112
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Sleep, Sleep Disorders, and Biologi
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BSCS Development Team Rodger Bybee,
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3.5 Biological clock . . . . . . .
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About the National Institutes of He
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Introduction to Sleep, Sleep Disord
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Implementing the Module The six les
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Content Standards: Grades 9-12 Stan
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Teaching Standards The suggested te
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shot” of what the students unders
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What the Students Do Stage Engage E
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Using the Student LessonsL The hear
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Using the Web Site The Sleep, Sleep
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Glossary amplitude: Magnitude, grea
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References 1. Aserinsky, E. 1999. E
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Sleep Diary Pre-lesson Activity Eng
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tions, medications, or drugs affect
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Pre-lesson Organizer Pre-lesson Act
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Recording Bedtimes and Wake Times I
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Calculating Average Bedtime and Wak
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