Sleep Medicine Pearls

Dr. Richard B. Berry is a professor of medicine at the University of Florida in Gainesville. He has been honored with the American Academy of Sleep Medicine awards for Excellence in Education (2010) and Distinguished Service to the Field of Sleep Medicine (2020). Dr. Berry is a fellow of the American Academy of Sleep Medicine. Dr. Mary H. Wagner is Director of the Pediatric Sleep Program at UF Health Sleep Disorders Center at Magnolia Parke, while also serving as Professor of Pediatrics in the Pediatric Pulmonary Division at the University of Florida (UF). She is board certified in Sleep Medicine, Pediatric Pulmonary and Pediatrics, and also serves as Director of the Pediatric Pulmonary Center Training Grant. Dr. Wagner received her MD from UF, where she also completed postgraduate training in Pediatrics and Pediatric Pulmonology. Before joining the faculty at UF she was Assistant Professor of Pediatrics at the Johns Hopkins Hospital in Baltimore, MD. Dr. Wagner brings over 20 years of experience to the Pediatric Sleep Clinic at Magnolia Parke, where the medical team helps patients with a multidisciplinary approach including nutrition, social work, respiratory therapy, nursing and clinical psychology.

Fundamentals of Sleep Medicine 1: Sleep Stages and Electroencephalographic Patterns 1. A 30-year-old man taking a hypnotic nightly 2. A 30-year-old man with insomnia

Fundamentals of Sleep Medicine 2: Electroencephalographic Lead Placement 3. A 50-year-old man with insomnia

Fundamentals of Sleep Medicine 3: Eye Movement Monitoring

Fundamentals of Sleep Medicine 4: Eye Movement Patterns 4. A 20-year-old man with excessive daytime sleepiness

Fundamentals of Sleep Medicine 5: Chin (Submental) Electromyography 5. A 40-year-old man experiencing difficulty falling asleep 6. A 30-year-old woman having trouble falling asleep 7. A 30-year-old man having difficulty staying awake during the day 8. A 35-year-old woman with insomnia 9. A 25-year-old man with a history of sleep-walking 10. A 20-year-old man with daytime sleepiness 11. A 40-year-old man with a history of snoring and daytime sleepiness 12. A 34-year-old man with sleep disturbance 13. A 22-year-old woman with frequent awakenings during sleep secondary to chronic pain 14. A 40-year-old man being treated for depression

Fundamentals of Sleep Medicine 6: Additional Sleep Staging Rules 15. A 30-year-old man with severe snoring and occasional breathing lapses 16. A 35-year-old woman experiencing uncontrollable episodes of sleep

Fundamentals of Sleep Medicine 7: Sleep Architecture Definitions 17. A 23-year-old man with difficulty sleeping 18. A 25-year-old man with daytime sleepiness and fatigue

Fundamentals of Sleep Medicine 8: Polysomnography 19. A 30-year-old man having difficulty staying awake during the day 20. A 25-year-old man complaining of excessive daytime sleepiness 21. A 30-year-old man with loud snoring 22. A 40-year-old man with complaints of snoring 23. Two patients with recording artifacts 24. A 29-year-old man struggling with daytime sleepiness

Fundamentals of Sleep Medicine 9: Multiple Sleep Latency Test and Maintenance of Wakefulness Test 25. A 25-year-old man with daytime sleepiness

Fundamentals of Sleep Medicine 10: Monitoring Respiration During Sleep 26. A 45-year-old man with possible sleep apnea 27. A 50-year-old man with possible central apnea 28. A 30-year-old man with heavy snoring 29. A 33-year-old man complaining of daytime sleepiness

Fundamentals of Sleep Medicine 11: Excessive Daytime Sleepiness 30. A 45-year-old man with a snoring problem 31. A 40-year-old woman with "mild” sleep apnea

Fundamentals of Sleep Medicine 12: Respiratory Arousals 32. A 30-year-old woman with severe fatigue 33. A 30-year-old man with heavy snoring and daytime sleepiness 34. A 45-year-old man with a distinct pattern of desaturation

Fundamentals of Sleep Medicine 13: Treatment of Obstructive Sleep Apnea 35. A 30-year-old man with weight loss and sleep apnea

Fundamentals of Sleep Medicine 14: Positive Airway Pressure Titration 36. A 55-year-old man with heavy nighttime snoring and daytime sleepiness 37. A 50-year-old man with problems during a CPAP titration 38. A patient refusing to accept treatment for obstructive sleep apnea

Fundamentals of Sleep Medicine 15: Positive Pressure Airway Treatment: Improving Acceptance & Adherence 40. A 55-year-old man with obstructive sleep apnea still sleepy on nasal CPAP 41. A 50-year-old man unable to sleep on CPAP due to mask leak and claustrophobia 42. A 55-year-old man having difficulty with CPAP because of nasal congestion 43. A 30-year-old man unable to tolerate nasal CPAP because of "too much pressure” 44. A 55-year-old man unable to use nasal CPAP due to intractable nasal congestion 45. A 45-year-old man with intolerance to nasal CPAP because of difficulty exhaling 46. A 60-year-old man with a suboptimal CPAP titration 47. A 55-year-old obese man with desaturation during a nasal CPAP trial 48. A 30-year-old woman with fatigue and mild daytime sleepiness 49. A 50-year-old man with a return of snoring 6 months after uvulopalatopharyngo-plasty 50. A 55-year-old man with severe daytime sleepiness and limited treatment options 51. A 40-year-old man with sleep apnea unable to tolerate nasal CPAP 52. A 45-year-old man still experiencing daytime sleepiness after uvulopalatopharyngo-plasty 53. A 50-year-old man needing objective confirmation of his ability to stay awake 54. A 45-year-old man falling asleep at the wheel while driving 55. A 30-year-old man with severe snoring 56. A 30-year-old choir singer with heavy snoring 57. A 50-year-old man with severe hypertension 58. A 55-year-old man with premature ventricular contractions during sleep 59. A 30-year-old pregnant woman with onset of snoring 60. A 45-year-old man with snoring and hypercapnia 61. A 55-year-old man with hypercapnic respiratory failure 62. A 57-year-old man with severe obstructive sleep apnea treated with oxygen 63. A 5-year-old child with behavior problems 64. A 6-year-old boy with large tonsils 65. A 20-year-old woman with daytime sleepiness since childhood 66. A 55-year-old man with chronic obstructive pulmonary disease and nocturnal desaturation 67. A 60-year-old man with leg swelling 68. A 55-year-old man with chronic obstructive pulmonary disease and severe pedal edema 69. A 60-year-old "pink puffer” with insomnia 70. A 52-year-old man with chronic obstructive pulmonary disease and pedal edema 71. A 35-year-old woman with asthma and poor sleep at night

Fundamentals of Sleep Medicine 16: Central Sleep Apnea 72. A 58-year-old man with daytime sleepiness 73. A 55-year-old man with central sleep apnea 74. A 70-year-old man with daytime sleepiness and pedal edema 75. A 60-year-old man with severe congestive heart failure and daytime sleepiness 76. A 60-year-old man with obstructive sleep apnea and numerous central apneas on CPAP 77. A 12-year-old boy with daytime CO2 retention 78. A 75-year-old man with a history of polio

Fundamentals of Sleep Medicine 17: The Restless Leg Syndrome and Periodic Leg Movements in Sleep 79. A 50-year-old man with snoring and leg kicks 80. A 56-year-old man with crawling sensations in his legs at bedtime 81. A 40-year-old man who kicks in his sleep 82. A 50-year-old man who kicks during sleep 83. A 72-year-old man with worsening symptoms during treatment for restless legs 84. A 58-year-old man with sleep apnea and leg jerks during sleep

Fundamentals of Sleep Medicine 18: Narcolepsy 85. A 30-year-old man with daytime sleepiness and episodes of weakness 86. A 23-year-old man with daytime sleepiness, but no symptoms of cataplexy 87. A 25-year-old man with narcolepsy who is still sleepy on medication 88. A 25-year-old man with frequent episodes of cataplexy 89. A 24-year-old man with narcolepsy who was irritable and lost weight on methylphenidate 90. A 35-year-old man with sleep apnea and a short REM latency 91. A 40-year-old man with sleep apnea and persistent daytime sleepiness 92. A 35-year-old man requesting stimulant medication 93. A 64-year-old man with daytime sleepiness since age 21 Fundamentals of Sleep Medicine 19: Parasomnias 94. A 20-year-old man with severe "nightmares” 95. A 25-year-old woman walking in her sleep 96. A 55-year-old man with violent dreams 97. A 50-year-old man with an interesting chin EMG

Fundamentals of Sleep Medicine 20: Monitoring for Nocturnal Seizures 98. A 55-year-old man with unusual movements during sleep 99. A 60-year-old man with a rhythmic EEG pattern during a CPAP titration 100. A 30-year-old man who got out of bed during sleep

Fundamentals of Sleep Medicine 21: Evaluation of Insomnia 101. A 30-year-old woman having difficulty falling asleep 102. A 30-year-old woman with insomnia 103. A 40-year-old man with difficulty falling asleep after the death of his brother

Fundamentals of Sleep Medicine 22: Circadian Sleep Disorders 104. A 40-year-old woman complaining of difficulty falling asleep 105. A 70-year-old man with early morning awakening 106. A 44-year-old man with jet lag 107. A 40-year-old woman with fibromyalgia 108. A 40-year-old woman with fatigue and disturbed sleep 109. A 45-year-old man with persistent insomnia while on treatment for depression 110. A 45-year-old man with hyperphagia and hypersomnia 111. A 50-year-old veteran of the Vietnam War with upsetting dreams 112. A 40-year-old woman with terrifying awakenings