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Polysomnographic diagnoses of insomniac patients. SDB: sleep disordered breathing; SSM: sleep state misperception; ADS: alpha-delta sleep; PLM: periodic limb movement.
Source publication
We conducted this study to assess the usefulness of polysomnography (PSG) in patients referred to the sleep disorders center (SDC) with chronic insomnia. Sixty-seven patients with chronic insomnia who underwent overnight polysomnography were included in the study. Clinical diagnoses were reported using the second revision of the International Class...
Context in source publication
Context 1
... the study period, 67 patients with chronic insomnia underwent PSG. This represents 9.3% of the total performed PSGs during the study period. Only, thirteen (19.4%) visits were physician-initiated and the rest were patient-initiated. Among the physician-initiated visits, seven visits were from psychiatry, two from neurology, two from primary care and two from internal medicine. The mean age of the studied group was 43±1.5 years and males comprised 53.7%. Figure 1 demonstrates the polysomnograp- hic diagnoses of all patients. SSM (subjective insomnia) represented 40.3% of studied insomniacs. SDB, PLM, ADS and idiopathic insomnia represented 25.4%, 7.5%, 10.4% and 16.4%, respectively. Table 2 compares patients with subjective insomnia (SSM) to the rest of the group. Females were more than males in the SSM group while males were more in the non-SSM group. TST, sleep efficiency, deep sleep, and REM sleep were significantly more in the SSM group. On the other hand, SOL and arousal index were significantly less in the SSM group. In general, polysomnographic data in the SSM group were within normal limits. ...
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Purpose:
Chronic primary insomnia (CPI) is the most prevalent sleep disorder worldwide. CPI manifests as difficulties in sleep onset, maintaining sleep, prolonged sleep latency, and daytime impairment and is often accompanied by cognitive problems such as poor academic performance, poor attention, and decreased memory. The most popular explanation...
Citations
... Likewise, postgraduate doctors do not receive enough training or education on sleep medicine during their residency program (Bahammam, 2011). This may explain the limited knowledge about sleep disorders among practicing general physicians, which has been demonstrated in several studies (Alotair and Bahammam, 2008;Saleem et al., 2017;BaHammam, 2000BaHammam, , 2004. This lack of knowledge and education on sleep medicine and its disorders is responsible for the under-recognition and diagnosis of sleep disorders leading to delays in treatment (Almeneessier and BaHammam, 2017). ...
Human being spends around one third of life in sleep, so normal sleep characteristics and its disorders have been the focus of attention of many scientists and physicians since long ago. The historical art works and scientific documents about sleep are the proof of this reality. However, modern sleep medicine with its own diagnostic procedures, therapeutic strategies, and sleep monitoring techniques is a new branch of medicine that has been introduced to the world not more than half a decade ago, primarily in the second half of the 20th century.
Physicians and scientists in any branch of medicine have encountered challenges and obstacles while taking their primary steps. It is not surprising that we, as sleep specialists and scientists, may encounter many problems during the process of developing this new branch of medicine in our country. Although these problems differ in many aspects among various countries, there are some similarities.
Since the development of sleep medicine, many professional sleep societies have evolved, many exclusive sleep journals have been published, guideline for accreditation of centers have been developed and also formalized fellowship training programs in medical universities all over the world have been established. Such developments have been helpful in reaching some milestones in overcoming some obstacles and challenges, although there is still a long way to reach the peak. Sharing the information regarding the situation of sleep medicine practice and training as well as challenges that each of us face in our daily practice and research can help us continue to improve global sleep health.
While writing this chapter we connected to the major sleep scientists and physicians all over the world and asked for sharing their knowledge of development of sleep medicine in their countries. We discovered extremely valuable resources of what is going on in the practice of sleep medicine each country. In this chapter we will discuss the topic of sleep medicine in a couple of countries including China, Iran, South Korea, Russia, India, Saudi Arabia, Vietnam, Egypt, Armenia, Turkey, Nigeria and Morroco. For each country, we will first give some general information about the countries, their health care systems, sleep medicine practices, training, fellowship programs, and sleep medicine societies. Finally, we will discuss the costs of practicing sleep medicine and go through the challenges of practicing in this new field of medicine in each country.
... 34,35 One study assessed the referral pattern among patients with insomnia and reported that only 19.4% of patients were referred to the sleep disorders center by their primary care physicians; the remaining referrals were patient initiated. 36 Another study reported that referrals by otolaryngologists represented 8% of patients with OSA compared with 17.4% in the United States. 37,38 ...
The practice of sleep medicine in Saudi Arabia began in the mid to late 1990s. Since its establishment, this specialty has grown, and the number of specialists has increased. Based on the available data, sleep disorders are prevalent among the Saudi population, and the demand for sleep medicine services is expected to increase significantly. Currently, two training programs are providing structured training and certification in sleep medicine in this country. Recently, clear guidelines for accrediting sleep medicine specialists and technologists were approved. Nevertheless, numerous obstacles hamper the progress of this specialty, including the lack of trained technicians, specialists and funding. Increasing the awareness of sleep disorders and their serious consequences amongst healthcare workers, healthcare authorities and insurance companies is another challenge. Future plans should address the medical educational system at all levels to demonstrate the importance of early detection and the treatment of sleep disorders. This review discusses the current position of and barriers to sleep medicine practice and education in Saudi Arabia.
... of 9.2% to 40.3% (BaHammam, 2004; Coleman et al., 1982; Dorsey & Bootzin, 1997; Edinger et al., 2000). Although paradoxical insomnia appears to be a prevalent subtype of chronic insomnia, little is known about its etiology, the course of the disorder, or its treatment responsivity. ...
This case study series investigated a new treatment for paradoxical insomnia patients as there is no standard treatment for this patient group at this time. Four paradoxical insomnia patients had a polysomnography (PSG) sleep study, an unsuccessful brief course of behavioral treatment for insomnia, and then a novel sleep education treatment comprising review of their PSG with video and exploration of the discrepancy between their reported and observed sleep experience. Two patients responded well to sleep education, mainly with improved self-reported sleep onset latency, total sleep time, and Insomnia Severity Index scores; and the other two, who exhibited sleep architecture anomalies, were unresponsive. These findings suggest that sleep education holds promise for some paradoxical insomnia patients. Suggestions for future studies are given.
... annot be attributed to the lack or reduced access to the health care services as the diagnosis was missed by the treating clinicians in most of the studied patients. [26] Another study reported that 19.4% of patients with insomnia were referred by their primary physician to the sleep disorders clinic; the remaining were patient-initiated referrals. [40] A third study reported that referrals by otolaryngologists represented 8% of OSA patients, compared to 17.4% in the US. [41,42] The health system in the KSA relies on the referral system, where the patient's first exposure is usually to the PHC physician, who assesses and decides the patient's plan of management. Thus, early detection a ...
Sleep medicine is a relatively new specialty in the medical community. The practice of sleep medicine in Saudi Arabia (KSA) began in the mid to late nineties. Since its inception, the specialty has grown, and the number of specialists has increased. Nevertheless, sleep medicine is still underdeveloped in the KSA, particularly in the areas of clinical service, education, training and research. Based on available data, it appears that sleep disorders are prevalent among Saudis, and the demand for sleep medicine service is expected to rise significantly in the near future. A number of obstacles have been defined that hinder the progress of the specialty, including a lack of trained technicians, specialists and funding. Awareness about sleep disorders and their serious consequences is low among health care workers, health care authorities, insurance companies and the general public. A major challenge for the future is penetrating the educational system at all levels to demonstrate the high prevalence and serious consequences of sleep disorders. To attain adequate numbers of staff and facilities, the education and training of health care professionals at the level of sleep medicine specialists and sleep technologists is another important challenge that faces the specialty. This review discusses the current position of sleep medicine as a specialty in the KSA and the expected challenges of the future. In addition, it will guide clinicians interested in setting up new sleep medicine services in the KSA or other developing countries through the potential obstacles that may face them in this endeavor.
... Another study reported a higher prevalence of OSA in insomnia patients with a prevalence of 64.4% for respiratory disturbance index (RDI)>5/h and 40% for RDI>10/h [21] . A third study conducted on middleaged patients with chronic insomnia reported an OSA (defined as AHI>5/h) prevalence of 25.4% [22]. The highest prevalence of SBD, 83% (67% OSA and 15.7% UARS), was reported in a cohort of postmenopausal women with chronic insomnia [23]. ...
Background:
In the clinical practice of sleep medicine, the coexistence of common sleep disorders is not uncommon. Patients with sleep disordered breathing (SDB) may present with insomnia, and studies have shown that SDB is common among insomnia patients. Little is known about the pathophysiological mechanisms underlying this coexistence, and limited information is available regarding the impact of each disorder on the other. It is essential to consider the effect of each disorder on the other and to understand the clinical consequences anticipated when treating each disorder in isolation. The management plan should be directed toward both disorders in a systematic and evidence-based approach. Unfortunately, a consensus standard approach for the management of comorbid insomnia and SDB is not yet available.
Methods:
Therefore, we have reviewed published studies that investigated insomnia in patients with different types of SBD; obstructive sleep apnea, central sleep apnea, and hypoventilation syndromes, as well as studies that assessed SBD in patients with insomnia. In addition, we reviewed the effects of SBD treatment modalities on insomnia and the effects of insomnia treatments on SBD.
Sleep medicine as an independent medical specialty is relatively new in Saudi Arabia. Since its foundation, there has been significant growth and an increase in the number of sleep medicine physicians and technologists to meet the continuous increase in demand among the Saudi population. In response to the expansion of sleep medicine in Saudi Arabia, the Saudi Commission for Health Specialties (SCHS) established clear guidelines for the accreditation of sleep medicine physicians and technologists in 2012. Currently, there are two training programs providing structured training and certification in sleep medicine in Saudi Arabia. Despite this progress, there are still many difficulties hindering sleep medicine growth in Saudi Arabia, including the shortage of trained technicians and specialists, the lack of financial support, and awareness of sleep disorders and their profound effects among healthcare workers and healthcare authorities. In the future, it is essential to introduce sleep medicine in the medical educational system at all levels to show the importance of early recognition and management of sleep disorders in addition to developing research that is necessary to build knowledge about the prevalence of many sleep disorders in order to help to plan the number of sleep specialists and sleep facilities needed to meet the increasing demands. This chapter discusses the current practice of sleep medicine, and the challenges it faces in Saudi Arabia, in addition to the available data and research about common sleep disorders among the Saudi population.
Sleep disorders are prevalent in the Saudi population, and the demand for sleep
medicine services is expected to increase significantly. The prevalence of various
sleep disorders in the Kingdom of Saudi Arabia (KSA) is comparable to that in
Western countries. The practice of sleep medicine in the KSA began in the mid to
late 1990s and continued to expand since. Clear guidelines for accrediting sleep
medicine specialists and technologists were developed recently. Nevertheless, there remain numerous challenges to the progress of this specialty, including the
lack of trained technicians, specialists, and funding. To meet these challenges,
two training programs that provide structured training and certification in sleep
medicine have been established. Additionally, special training programs and
courses are organized for sleep technologists. In this chapter, we address the
current structure of sleep medicine practice in the KSA and the Arab world, the
prevalence of sleep disorders, and the strategies needed to overcome the current
challenges that hamper the progress of sleep medicine as a specialty in the
country.
