Sleep Disorders

Many patients find cognitive behavioral therapy effective for management of their insomnia, but there aren’t enough clinical psychologists trained in the area.

Skills quiz: Chondrodermatitis nodularis helices; Keratoses; OSA; Parotid swelling and HIV; Limbal flush

Short-term sleep deprivation reduces insulin sensitivity in peripheral tissue, including fat cells, possibly leading to type 2 diabetes mellitus or obesity.

Insomnia can have serious consequences for patients who already have high blood pressure, according to a new study presented at the American Heart Association’s High Blood Pressure Research 2012 Scientific Sessions.

October 11th is National Depression Screening Day. But how do you screen, diagnose, and treat effectively given the time constraints of busy office practice?

Consider OSA in your the differential diagnosis in patients who present with nightmarers. Continuous positive airway pressure (CPAP) can provide effective treatment.

Benzodiazepines are overprescribed and abused; are increasingly responsible for emergency room visits; and are contraindicated for patients with chronic pain.

For many patients with diabetic peripheral neuropathy, severe pain can be controlled to a degree sufficient to improve their quality of life. Here: effective management strategies, including topical agents, oral medications, and nonpharmacological therapies (eg, acupuncture and transcutaneous nerve stimulation).

Neither chlorthalidone nor spironolactone can be ignored in today's antihypertensive armamentarium. Both agents, alone or in combination, have appealing indications.

For most patients who have had low back pain for less than 6 weeks, there is little need for imaging studies.

Obesity hypoventilation syndrome (OHS) shares clinical symptoms with obstructive sleep apnea (OSA) such as daytime sleepiness, headaches, and memory problems. Both the symptoms and their sequelae, however, can be much more severe in OHS. Here, guidance on what to look for and how to manage OHS.

A 62-year-old man with a persistent snoring problem presented for an oral medicine consultation. There was no history of jaw trauma or jaw fracture; jaw function was normal and the patient was not in pain.

These innocuous lesions of the outer ear may arise spontaneously or after trauma or surgery. Both auricular seroma and pyogenic granuloma usually resolve satisfactorily after minor surgery, though they may recur.

Diagnostic challenge: Two case reports of easily treated and innocuous causes of lesions in the outer ear. Chondrodermatitis nodularis helicis is associated with long cellphone use. Verruca vulgaris is caused, like all other warts, by human papillomavirus.

A 52-year-old woman presents with severe intra-oral ulceration and oral pain. She reports that several years earlier, she had been taking cephalexin when severe intra-oral ulceration developed.

I recently read a study in JAMA entitled “Quality of Life, Burnout, Educational Debt, and Medical Knowledge among Internal Medicine Residents.” Over half (51.5%) of the 15,000 medical residents in the study cohort reported overall burnout and high levels of emotional exhaustion and depersonalization.

Following on the heels of the obesity epidemic, a second epidemic has become apparent-sleep-disordered breathing and its effect on esophageal conditions, primarily gastroesophageal reflux disease (GERD). Many, many primary care providers have heard the following complaint: “I gained 10 pounds and now I have heartburn/cough/worsening asthma” (take your pick). What’s going on?

Prevalence for overweight (BMI 24.9 to 29.9) and obesity (BMI > 30) have been steadily rising for the past 30 years-two-thirds of Americans now qualify as overweight or heavier. Hypertension, hyperlipidemia, coronary artery disease, type 2 diabetes, sleep apnea, and GERD prevalence are following this epidemic. Obesity is now the second most common preventable cause of death, exceeded only by smoking.

Mention GERD and most of patients probably think of heartburn. But the GERD story does not begin and end with the esophagus. The connection between GERD and laryngeal, pharyngeal, and pulmonary symptoms is the focus of a seminar, “An Eye and Nose Opening Experience-Chronic Complications of GERD,” at the upcoming American College of Gastroenterology Annual Scientific Meeting, October 31 to November 2 in Washington, DC.

Prof. Dominic Fitzgerald, a pediatric respiratory and sleep physician, reviews the basics about spirometry, and explains its use in children.

Despite its caveats and good intentions, the AAP guideline will surely invite an inappropriate glut of medication for preschoolers . . .

A 71-year-old man was admitted to the MICU for weaning from mechanical ventilation. The history revealed a global decline over the previous 3 to 4 weeks predominated by cognitive impairment, mood swings, somnolence, and limb weakness. No respiratory symptoms were noted.

We have long known that many adolescents have chronic pain. A new study highlights just how widespread it is-and the significant impact it can have.

Typically, antihypertensive medications are taken in the morning. But typically does not always equal correct! Preliminary studies have documented that a more appropriate approach would be to take them (or at least some of them) at bedtime.

A recent commentary of mine regarding hypertension was entitled, “Are Prescribing Practices for Antihypertensives Primitive? The Truth Hurts."

In medical school, many of us were taught that ADD and ADHD generally affected boys who would eventually outgrow the disorder. We now know better. Girls have ADD/ADHD. And many children never outgrow the disorder.

When counting sheep fails as first line therapy, what measures can you recommend to help your patient get some sleep?

Twenty years ago, the American College of Rheumatology (ACR) introduced the following clinical criteria for the diagnosis of fibromyalgia (FM) . . .

A variety of effective treatments are available for diabetic peripheral neuropathic pain (DPNP), including topical agents, oral medications, and nondrug approaches. The lidocaine patch 5% is recommended for relatively localized pain.