Sleep Disorders

A Case a Week from the Cleveland Clinic

Second Edition

Edited by Nancy Foldvary-Schaefer,DO , Madeleine Grigg-Damberger,MD , and Reena Mehra,MD

Extensively focuses on sleep comorbidities, including psychiatric, neurologic, cardiovascular, pulmonary and metabolic diseases
Includes high-quality polysomnogram tracings
Boasts the most extensive video library of any sleep book

Sleep Disorders

A Case a Week from the Cleveland Clinic

Second Edition

Edited by Nancy Foldvary-Schaefer,DO , Madeleine Grigg-Damberger,MD , and Reena Mehra,MD

Description

The second edition of Sleep Disorders: A Case a Week from Cleveland Clinic continues to offer a practical approach to the introduction of sleep medicine via an easy-to-use and concise volume that uses actual patient cases from the Cleveland Sleep Disorders Clinic. This edition includes new features, such as multiple choice questions, more than 30 enhanced patient and polysomnogram videos, and a wealth of high quality polysomnographic tracings. Printed in 4-color for the first time, this book uses various imaging techniques, like clinically relevant radiography and neuroimaging, in the diagnosis and treatment of sleep disorders, serving as a resource for medical students, residents, and experienced clinicians to hone their diagnostic skills. 52 chapters - a case a week - are written to illustrate the signs and symptoms, diagnostic criteria, workup, and routine treatment of unique patient cases presented to the sleep clinic. With updates covering comprehensive discoveries, an extensive focus on comorbidities, and typical and atypical presentations of sleep disorders, this book is a valuable guide to the latest discoveries in sleep medicine.

Sleep Disorders

A Case a Week from the Cleveland Clinic

Second Edition

Edited by Nancy Foldvary-Schaefer,DO , Madeleine Grigg-Damberger,MD , and Reena Mehra,MD

Table of Contents
Foreward: Kingman P. Strohl
Acknowledgments
Chapter 1 Introduction to the Sleep Clinic Evaluation
Reena Mehra MD, MS; Nancy Foldvary-Schaefer, DO, MS; Madeleine Grigg-Damberger MD
Chapter 2 Introduction to Sleep Testing
Nancy Foldvary-Schaefer, DO, MS; Madeleine Grigg-Damberger, MD; Reena Mehra, MD, MS
Chapter 3 Introduction to Pediatric Sleep Clinic and Sleep Testing
Madeleine M. Grigg-Damberger, MD and Kathy M. Wolfe, MD
Chapter 4 LA Night Moves
Alon Y. Avidan, MD, MPH
Chapter 5 Is Resistance Futile?
Harneet Walia, MD, FAASM
Chapter 6 More Sleep is a Slam Dunk
Ralph Downey, III, PhD
Chapter 7 Re-writing One Patient's Story of Disrupted Sleep
Samantha Domingo, PsyD
Chapter 8 No Easy Way Down
Frank M. Ralls, MD
Chapter 9 But I Need Marijuana to Function as a Mother
Sasikanth Gorantla, MD
Chapter 10 Too Much of a Good Thing
Charles Bae, MD
Chapter 11 A Journey Through Time and Sleep
Vidya Krishnan, MD, MHS
Chapter 12 Like Clockwork
Silvia Neme-Mercante, MD
Chapter 13 Turn up the Volume
Harneet Walia, MD, FAASM
Chapter 14 CPAP, What's Not to Love?
Edwina Polk, RPSGT, RST
Chapter 15 Figuring Out Fitful Feet
Roxanne Valentino, MD
Chapter 16 To Treat or Not to Treat-That is the Central Question
Saif Mashaqi, MD
Chapter 17 Pregnancy and Health: Let's Sleep on It
Sally Ibrahim, MD
Chapter 18 Whoever Wanted to Catch a Worm, Anyway?
Robert Hiensch, MD
Chapter 19 Stimulation Ultimately Prevails
Alan Kominsky, MD
Chapter 20 Paralysis Lost in a Dream
Carlos L. Rodriguez, MD
Chapter 21, Napping the Day Away
Erin Golden
Chapter 22 Tormented Sunrises
Maha Alattar, MD
Chapter 23 Oh My, Wet Bed and Dry Mouth Lead to Wet Eyes
Jyoti Krishna, MD
Chapter 24 On the Cutting Edge: Breathe on
Todd Coy, DMD
Chapter 25 Mr. Potato Head
Nancy Foldvary-Schaefer, DO, MS
Chapter 26 Wakeup to Reality!
Madeline Grigg-Damberger, MD
Chapter 27 My Husband Tells Me I'm Lazy
Erin Bremer, MSN, NP
Chapter 28 Unwanted Overtures by Night
Muna Irfan
Chapter 29 There Was a Crooked Man Who Could Not Breathe Day or Night
Nattapong Jaimchariyatam, MD
Chapter 30 What A Pain! My Childhood Leg Cramps are Back
Li Ling Lim, MBBS, MRCP (UK)
Chapter 31 The Chicken And/Or the Egg?
Ketan Deoras, MD, FAPA
Chapter 32 A Case of Sleepiness and Turbulent Dreams
Mohammed Alzoubaidi, MBBS, MPH
Chapter 33 Digital in Her DNA!!!
Rasintra Siriwat, MD
Chapter 34 Deep into that darkness peering …. stood there wondering, fearing
Carlos L. Rodriguez, MD
Chapter 35 Bonnie and Clyde, the Overlap Syndrome
Hugo Paz y Mar, MD
Chapter 36 Seizures, Stimulators and Stimulators, Oh My
Thapanee Somboon, MD
Chapter 37 Help, I Can't Breathe!
Ai Ping Chua, MBBS
Chapter 38 All Fall Down
Fareeha Ashraf, MD
Chapter 39 A Painful Trifecta
Ralph Downey, III, PhD
Chapter 40 Our Baby Can't Eat, Can't Breathe, and Can't Sleep!
Libby Blasberg, MD
Chapter 41 Spikes, Spikes Go Away
Elia M. Pestana-Knight, MD
Chapter 42 Dying to Fall Asleep
Hillor Mehta, MD
Chapter 43 Is the Jury Out or In?
Anna M. May, MD
Chapter 44 Midnight Mystery: The Case of the Midnight Fog and Missing Food
Megan Lavery, PsyD
Chapter 45 Not for the Faint of Heart
Anna M. May, MD
Chapter 46 He Sounds Like a Crow and Leaps from the Bed
Alexa Hoy, BS, BA
Chapter 47 The Curious Incident of the Toddler Who Wakes and Flails in Pain in the Night-time
Carolyn E. Levers-Landis, PhD, CBSM
Chapter 48 Did Cancer Kill My Sleep?
Kathleen Ashton, PhD, ABPP
Chapter 49 Bilevel PAP Transforms this Teen's Life: “I can't believe how good I feel”
Frederick H. Royce, MD
Chapter 50 She Works Hard for her Sleep
Robon Vanek, APRN
Chapter 51 Terror at Northfield
Frank M. Ralls, MD
Chapter 52 Pulmonary Arterial Hypertension
Hugo Paz y Mar, MD
Chapter 53 My Father Went Down the Rabbit Hole
Frank M. Ralls, MD
Chapter 54 Moving Forward When CPAP Fails
Michael Horan, MD
Chapter 55 Sooner than Later if not Right after Stroke
Amy K. Dadisman, MS
Appendix 1 International Classification of Sleep Disorders, 3rd Edition
Appendix 2 Adult and pediatric sleep instruments
Glossary of Terms
Videos List

Sleep Disorders

A Case a Week from the Cleveland Clinic

Second Edition

Edited by Nancy Foldvary-Schaefer,DO , Madeleine Grigg-Damberger,MD , and Reena Mehra,MD

Author Information

Edited by Nancy Foldvary-Schaefer, DO, Professor of Medicine (Neurology), Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Edited by Madeleine Grigg-Damberger, MD, Professor of Neurology, University of New Mexico School of Medicine, and Edited by Reena Mehra, MD, Associate Professor of Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University

Nancy Foldvary-Schaefer, DO, MS is Director of the Sleep Disorders Center at Cleveland Clinic and Professor, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University. An active clinician and leading researcher in the area of sleep disorders and epilepsy at the Cleveland Clinic since 1995, she has over 180 publications including original investigations, reviews, editorials and chapters. Madeleine Grigg-Damberger, MD is a Professor of Neurology at the University of New Mexico School of Medicine in Albuquerque, New Mexico and is the Medical Director of Pediatric Sleep Medicine Services at the University Hospital Sleep Disorders Center and Associate Director of the University of New Mexico Clinical Neurophysiology Laboratory. She writes peer-reviewed journal invited reviews on a wide range of topics related to sleep medicine and is often invited to organize and lecture at national (and even international) courses in sleep medicine, neurology, child neurology and clinical

neurophysiology. Reena Mehra MD, MS is Professor of Medicine of the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University and serves as the Director of Sleep Disorders Research in the Sleep Center of the Neurologic Institute with joint appointments in the Respiratory Institute, Molecular Cardiology Department of the Lerner Research Institute and the Heart and Vascular Institute. She is involved in media relations to increase awareness of the importance of sleep disorders, has appeared on numerous national news broadcasts and has been an invited lecturer in national and international forums.

Contributors:

Loutfi S. Aboussouan, MD, FAASM, FCCP
Cleveland Clinic Sleep Disorders Center
Associate Professor of Medicine, Cleveland Clinic Lerner College of Medicine
Medical Director, Respiratory Neuromuscular Program
Staff, Respiratory and Neurological Institutes
Cleveland Clinic, OH

Maha Alattar, MD
Associate Clinical Professor of Neurology and Sleep Medicine
Virginia Commonwealth University
Richmond, Virginia

Zahr Alsheikhtaha, RPSGT, MBBS
PSG reader
Cleveland Clinic Sleep Disorders Center
Cleveland, Ohio

Mohammed S Alzoubaidi MBBS, MPH
Clinical Assistant Professor
Internal Medicine
University of South Dakota Sanford School of Medicine
Sioux Falls, SD

Noah D. Andrews, RPSGT
Sleep Disorder Center, Neurology Institute
Cleveland, OH

Fareeha Ashraf, MD
Department of Neurology
Case Western Reserve University
Cleveland, OH

Kathleen Ashton, PhD, ABPP
Associate Professor, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University
Staff, Cleveland Clinic Breast Center
Cleveland, OH

Alon Y. Avidan MD, MPH
Professor, UCLA Department of Neurology
Director, UCLA Sleep Disorders Center
Chair, Faculty Executive Committee
David Geffen School of Medicine at UCLA
Los Angeles, CA

Charles Bae, MD, FAASM
Associate Professor of Clinical Medicine and Neurology
CPAP Program and Clinical Outcomes Program
Director University of Pennsylvania Perelman School of Medicine Penn Sleep Center
Philadelphia, PA

Elizabeth Anne Blasberg, MD
Resident Physician
Div. Otolaryngology Head and Neck Surgery at The University of New Mexico School of Medicine
Albuquerque, NM

Erin Bremer, BSN, NP
Instructor, Nell Hodgson Woodruff School of Nursing, Emory University
Nurse Practitioner, Emory Sleep Center, The Emory Clinic
Atlanta, GA

Sushruta Cerejo, MD
Staff, Critical Care and Sleep Medicine
Allegheny Health Network
Pittsburgh, PA

Neal F. Chaisson, MD
Director, Critical Care Medicine Fellowship
Assistant Professor, Cleveland Clinic Lerner College of Medicine
Respiratory Institute
Cleveland Clinic
Cleveland, OH

Subhra Chakrabarti, MS, RPSGT, RST, CCSH
Cleveland Clinic Sleep Disorders Center
Cleveland Clinic
Cleveland, OH

Todd Coy, DMD
Qualified Dentist, American Academy of Dental Sleep Medicine
Section Head for Dentistry and Maxillofacial Prosthetics
Cleveland Clinic
Cleveland, OH

Amy Dadisman, MS
Cleveland Clinic
Cleveland, OH

Sara Davin, PsyD, MPH
Director, Center for Comprehensive Pain Recovery
Neurological Institute
Cleveland Clinic
Cleveland, OH

Ketan Deoras, M.D., FAPA
Department of Psychiatry
Department of Sleep Medicine
Cleveland Clinic Foundation
Cleveland, OH

Mita S. Deoras, MD
Staff neurologist, Summa Health System
Akron, OH

Samantha Domingo, PsyD
Samaritan Health Services
Corvallis, OR

Ralph Downey III, Ph.D, FAASM
Staff, Sleep Disorders Center
Neurological Institute, Cleveland Clinic
Cleveland, OH

Michelle L. Drerup, PsyD, D.BSM
Assistant Professor of Medicine
Cleveland Clinic Lerner College of Medicine
Director of Behavioral Sleep Medicine
Cleveland Clinic Sleep Disorders Center
Cleveland, OH

Nancy Foldvary-Schaefer, DO, MS
Professor, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University
Director, Cleveland Clinic Sleep Disorders Center
Staff, Cleveland Clinic Epilepsy Center
Cleveland, OH

Thomas R. Gildea MD MS FACP FCCP
Head, Section of Bronchoscopy
Respiratory Institute
Department of Pulmonary, Allergy and Critical Care Medicine & Transplant Center
Cleveland Clinic
Cleveland, OH

Elyssa Glassheim, BS
University of New Mexico School of Medicine
Albuquerque, NM

Erin Golden MD
Assistant Professor of Neurology
University of Minnesota
Staff, Minnesota Regional Sleep Disorders Center
Hennepin Healthcare
Minneapolis, MN

Sasikanth Gorantla, MD
Clinical Assistant Professor
Department of Neurology
University of Illinois College of Medicine at Peoria
OSF Health Care Illinois Neurological Institute
Peoria, IL

Robert Hiensch, MD
Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine
Icahn School of Medicine at Mount Sinai
New York, NY

Michael P. Horan, MD, DDS, PhD, FACS
Cleveland Clinic Head and Neck Institute
Section head of Oral and Maxillofacial Surgery
Assistant Professor Case Western Reserve School of Dental Medicine
Assistant Professor Cleveland Clinic Lerner College of Medicine
Cleveland, OH

Michael Howell MD, FAAN, FAASM
Associate Professor
Vice-Chair, Education
Department of Neurology
University of Minnesota
Medical Director, Fairview Sleep Services-Edina
Minneapolis, MN

Alexa Hoy, BS, BA
Cleveland Clinic Clinical Research Unit
Cleveland, OH

Sally Ibrahim, MD, FAAP
Assistant Professor, CCLCM
Cleveland Clinic Sleep Disorders Center
Cleveland, OH

Carolyn E. Ievers-Landis, PhD, CBSM
Rainbow Babies & Children's Hospital
University Hospitals Cleveland Medical Center
Cleveland, OH

Muna Irfan MBBS
Assistant Professor of Neurology
University of Minnesota
Medical Director- Sleep Services VA Minneapolis
Minneapolis, MN

Nattapong Jaimchariyatam, MD, MS, FCCP
Associate Professor of Medicine
Division of Pulmonary and Critical Care Medicine
Department of Medicine
Chulalongkorn University
Bangkok, Thailand
and
Excellence Center for Sleep Disorders and Excellence Center for Organ Transplantation
King Chulalongkorn Memorial Hospital
Thai Red Cross Societ
Bangkok, Thailand

Nancy Kempke, MSN, CNP
Sleep Disorders Center
Neurological Institute, Cleveland Clinic
Cleveland, OH

Elia M Pestana Knight, MD
Staff Physician, Cleveland Clinic Epilepsy Center
Assistant Professor, Cleveland Clinic Learner College of Medicine
Cleveland, OH

Alan Kominsky, MD, FACS
Otolaryngology and Sleep Medicine
Head and Neck Institute Residency Program Director
Head, Section of Surgical Sleep and Snoring
Assistant Professor of Surgery
Cleveland Clinic
Cleveland, OH

Jyoti Krishna, MD, FAAP, FAASM
Associate Professor of Pediatrics
North East Ohio Medical University
Director, Sleep Medicine
Akron Children's Hospital
Robert T. Stone Respiratory Center
Akron, OH

Vidya Krishnan, MD, MHS
Case Western Reserve University School of Medicine
MetroHealth Medical Center
Cleveland, OH

Megan E. Lavery, PsyD
Washington Crossing, PA

Judette Louis MD, MPH
Associate Professor
Division of Maternal Fetal Medicine, Department of OB/GYN
Morsani College of Medicine and
Department of Community and Family Health, College of Public Health
University of South Florida
Tampa, FL

Dr Li Ling Lim, MBBS, MMed (Int.Med.), MRCP (UK), ABPN, ABCN, ABEM, ABSM (USA)
Singapore Neurology & Sleep Centre
Gleneagles Medical Centre
Singapore

Meghna P. Mansukhani, MD
Associate Professor, Mayo Clinic College of Medicine
Consultant, Center for Sleep Medicine, Mayo Clinic
Rochester, MN

Saif Mashaqi, MD, FCCP
Associate Professor of Medicine
University of North Dakota School of Medicine
Director of Sanford Sleep Center- Jamestown, ND
Fargo, ND

Anna M. May, MD, MS
Assistant Professor
Case Western Reserve University
Louis Stokes Cleveland VA Medical Center
Cleveland, OH

Reena Mehra, MD, MS, FCCP, FAASM
Professor, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University
Director of Research, Cleveland Clinic Sleep Disorders Center
Staff, Neurologic, Respiratory, Heart and Vascular Institute and Lerner Research Institutes
Cleveland, OH

Hillor Mehta, MD
Mercy Regional Medical Center
Lorain, OH

Babak Mokhlesi, MD, MSc
Professor of Medicine
Section of Pulmonary and Critical Care
Director, Sleep Disorders Center
Director, Sleep Medicine Fellowship
The University of Chicago Pritzker School of Medicine
Chicago, IL

Silvia Neme-Mercante, MD
Staff
Cleveland Clinic Epilepsy Center
Cleveland, Ohio

Jonathan Oliver, MD
Sleep Disorders Center
Neurological Institute, Cleveland Clinic
Cleveland, OH

Petra Olivieri, DMD
Case Western Reserve University
School of Dental Medicine
Department of Oral and Maxillofacial Surgery
Cleveland, OH

Hugo Paz y Mar, MD
Assistant Professor, Case Western Reserve University
Associate Program Director for the Pulmonary Critical Care Medicine Fellowship
Division of Pulmonary, Sleep and Critical Care Medicine
MetroHealth Medical Center
Cleveland, OH

Jagan A Pillai MBBS, PhD
Department of Neurologiy
Lou Ruvo Center for Brain Health
Cleveland Clinic
Cleveland, OH

Chua Ai Ping, MBBS (S'pore), MRCP (UK), MMed (Internal Med), MPH (S'pore), European Dip (Intensive Care), MMed (Sleep Med), FCCP (USA)
Senior Consultant
JurongHealth Campus
National University Health System
Singapore

Edwina Polk, RPSGT
Sleep Lab Supervisor
Cleveland Clinic
Cleveland, OH

Frank M. Ralls MD
Associate Professor Internal Medicine
Program Director: UNM Sleep Medicine Fellowship
Division of Pulmonary, Critical Care, and Sleep Medicine
Department of Internal Medicine
University of New Mexico
Albuquerque, NM

Carlos L. Rodriguez, MD
Staff, Cleveland Clinic
Cleveland, OH

Carol Lynn Rosen, MD
J. S. Rube Professor of Pediatric Sleep Medicine
Professor of Pediatrics, Case Western Reserve University School of Medicine
University Hospitals, Cleveland Medical Center, Rainbow Babies and Children's Hospital
Cleveland, Ohio

Asim Roy, MD
Medical Director
Ohio Sleep Medicine Institute
Assistant Clinical Professor
Northeast Ohio Medical University
Rootstown, OH

Frederick H Royce, Jr MD
Cleveland, OH

Jessica Vensel Rundo, MD, MS
Cleveland Clinic Sleep Disorders Center
Director of Sleep Clinic Operations
Sleep Medicine Fellowship Program Director
Cleveland, OH

Neomi Shah, MD, MPH, MS
Associate Professor of Medicine
Program Director, Sleep Medicine Fellowship
Icahn School of Medicine at Mount Sinai
Division of Pulmonary, Critical Care and Sleep
New York, NY

Vaishal Shah, MD, MPH
Staff, Pediatric and Adult Sleep Disorders
Department of Pediatric Pulmonary Medicine, Cleveland Clinic Children's
Sleep Disorder Center, Neurology Institute
Cleveland, OH

Rasintra Siriwat, MD
Staff, Department of Pediatrics, Phramongkutklao College of Medicine, Bangkok, Thailand
Research Fellowship in sleep medicine, Cleveland Clinic Sleep Disorders Center
Cleveland, OH

Thapanee Somboon MD.
Epilepsy Unit
Neurological Department
Prasat Neurological Institute
Bangkok, Thailand

Cheryl L. Thompson, PhD
Assistant Dean of Educational Initiatives, School of Medicine
Associate Professor
Department of Nutrition
Case Comprehensive Cancer Center
Case Western Reserve University
Cleveland, OH

Maja Tippmann-Peikert. MD
Assistant Professor of Neurology and Medicine , Mayo Clinic College of Medicine
Center for Sleep Medicine and Department of Neurology
Mayo Clinic
Rochester, MN

Lynn Marie Trotti, MD, MSc
Associate Professor of Neurology
Emory University School of Medicine
Atlanta, GA

Babak Tousi MD, FACP
Associate Professor of Medicine
Head, Clinical Trials Program
Cleveland Clinic Lou Ruvo Center for Brain Health
Las Vegas, NV

Roxanne Valentino, MD, FAAN, FAASM
St. Thomas Medical Partners
Nashville, TN

Robon Vanek, APRN
Sleep Disorders Center
Neurological Institute, Cleveland Clinic
Cleveland, OH

Harneet K. Walia, MD, FAASM
Associate Professor, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University
Staff, Center for Sleep Disorders,
Neurological Institute,
Cleveland Clinic
Cleveland, OH

Tina E. Waters, MD
Staff, Clinical Assistant Professor
Diplomat, American Board of Psychiatry and Neurology
Neurological Institute Sleep Disorders Center
Cleveland Clinic Lerner College of Medicine of Case Western Reserve University
Cleveland Clinic
Cleveland, OH

Emily K. White, PhD
Department of Psychiatry
MetroHealth Medical Center
Cleveland, OH

Alireza Yarahmadi, MD
Case Western Reserve University
Cleveland, OH

Andrew S. Zeft, MD, MPH
Director, Cleveland Clinic Pediatric Rheumatology
Staff, Cleveland Clinic
Cleveland, OH

Sleep Disorders

A Case a Week from the Cleveland Clinic

Second Edition

Edited by Nancy Foldvary-Schaefer,DO , Madeleine Grigg-Damberger,MD , and Reena Mehra,MD

Reviews and Awards

"Praise for the First Edition: "...accessible and generously illustrates the fascinating spectrum of symptoms and problems seen in a specialized sleep clinic. Whether a useful guide for dipping into or simply a cure for insomnia, it represents good value and is thoroughly recommended." - Advances in Clinical Neuroscience and Rehabilitation

"A Case a Week: Sleep Disorders from the Cleveland Clinic is a fantastic resource for trainees just getting started in sleep medicine as well as for those already deeply immersed in its practice. One of the hallmarks of any good nonfiction book is that it brings the reader to look at an Prold problem from a new angle and to consider aspects not previously seen. This compilation of clinical cases does exactly that, many times over." - Journal of Clinical Sleep Medicine

"This is a worthwhile contribution to the field of sleep medicine. It presents in a concise and simple to read format a wide variety of sleep disorders presented as actual cases encountered in the Cleveland Clinic." - Doody's