European Sleep Research Society

ESRS European Sleep Medicine

Textbook

Editors-in-Chief: Claudio L. Bassetti, Zoran Đogaš, Philippe Peigneux

Jsr_23_A101_title.indd 3 11/12/2014 2:30:47 PM

 ISBN 9781119038931
© 2014 European Sleep Research Society
All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any
means, electronic, mechanical, photocopying, recording or otherwise without the prior permission of the publisher.

Designations used by companies to distinguish their products are often claimed as trademarks. All brand names and product names
used in this book are trade names, service marks, trademarks or registered trademarks of their respective owners. The publisher is not
associated with any product or vendor mentioned in this book. This publication is designed to provide accurate and authoritative
information in regard to the subject matter covered. It is sold on the understanding that the publisher is not engaged in rendering
professional services. If professional advice or other expert assistance is required, the services of a competent professional should be
sought.

Cover image: Pablo Picasso, Sleeping Woman, 9.8.52, © Succession Picasso / VG Bild-Kunst, Bonn 2014

Jsr_23_A101_title.indd 4 11/12/2014 2:30:47 PM

 Table of Contents
Preface 1

A. Physiological basis of sleep

(Section Editors: R. Amici, Z. Ðogaš, P. Peigneux)

1. The neurophysiology and neurobiology of sleep

P.-H. Luppi, A. Adamantidis and P. Fort 3
2. Regulation of sleep and wakefulness
Z. Ðogaš, R. Pecotic and M. Valic 13
3. Adaptation of bodily functions to sleep
R. Amici and G. Zoccoli 27
4. Theories on the functions of sleep
P. Peigneux and R. Leproult 39
5. Effects of acute and chronic sleep deprivation
H.-P. Landolt, A. Sousek and S.C. Holst 49
6. Sleep and dreaming
M. Schredl 63
7. Ageing and sleep: sleep in all stages of human development
N. Olini and R. Huber 73
8. Gender differences in sleep
T. Porkka-Heiskanen, T. Saaresranta and Polo-Kantola 83

B. Assessment of sleep disorders and diagnostic procedures

(Section Editors: T. Penzel, M. Zucconi)

1. Classification of sleep disorders

M. Zucconi and R. Ferri 95
2. The clinical interview and clinical examination
L. Grote and F. J. Puertas 111
3. Measuring – monitoring sleep and wakefulness
J. Mathis, S. de Lacy and C. Roth 125
4. Other tests and examinations
T. Penzel and C. Schöbel 145

C. Insomnia
(Section Editors: C. Espie, T. Pollmächer, D. Riemann)

1. Nosological classification, definitions, epidemiology

J.G. Ellis 151
2. Pathophysiology
K. Spiegelhalder and C. Baglioni 165
3. Clinical picture and diagnosis
D. Riemann and K. Spiegelhalder 171
4. Comorbidities and special populations
T. Pollmächer 177
5.1. Treatment—practical skills for applying CBT-I
C. Baglioni and D. Riemann 183
5.2. Tailoring cognitive–behavioural therapy for insomnia to specific needs: a personalized
behavioural medicine approach
C.A. Espie, S.D. Kyle, P.R. Gehrman, J.C. Ong and P. Hames 193
5.3. Pharmacological treatment of insomnia
D. Leger 207

D. Sleep-related breathing disorders

(Section Editors: W. McNicholas, D. Pevernagie)

1. Nosological classification, definitions, epidemiology

W. T. McNicholas 215
2. Pathophysiology
W.J. Randerath 221
3. Clinical picture and diagnosis
S. Mihaicuta, L. Grote 233
4. Comorbidities and special populations
J.-L. Pépin, J.-C. Borel, A.-L. Borel, P. Lévy and R. Tamisier 251
5. Treatment of respiratory sleep disorders
D. Pevernagie, M. Sastry and O. Vanderveken 259

E. Hypersomnias of central origin

(Section Editor: C. Bassetti)

1. Nosological classification, definitions, epidemiology

C. R. Baumann 275

Jsr_23_A101_toc.indd 3 11/21/2014 11:08:53 AM

 2. Pathophysiology
C.L. Bassetti and G.J. Lammers 281
3. Hypersomnias of central origin: clinical picture and diagnosis
C.L. Bassetti and G.J. Lammers 293
4. Comorbidities and special populations
F. Pizza, G. Plazzi and Y. Dauvilliers 303
5. Treatment
Y. Dauvilliers and C.L. Bassetti 313

F. Circadian rhythm sleep disorders

(Section Editors: C. Gronfier, D. Skene)

1. Nosological classification, definitions, epidemiology

B. Bjorvatn and C. Gronfier 321
2. Pathophysiology
V. Bromundt, M. Taddio and C. Cajochen 327
3. Clinical picture and diagnosis
C. Gronfier and B. Bjorvatn 337
4. Comorbidities and special populations
C. M. Schroder, M. Bataillard and P. Bourgin 343
5. Treatment
Ü. Kilic Huck, J. Hubbard and P. Bourgin 357

G. Parasomnias
(Section Editors: C. Bassetti, L. Nobili)

1. Nosological classification, definitions, epidemiology

H. Gast and C. L. Bassetti 369
2. Pathophysiology and psychopathology
L. Nobili and I. Arnulf 377
3. Clinical picture and diagnosis
J. Santamaria 389
4. Comorbidities and special populations
A. Iranzo 399
5. Treatment
L. Nobili and R. Manni 409

H. Sleep-related movement disorders

(Section Editor: C. Bassetti)

1. Nosological classification, definitions, epidemiology

C. L. Bassetti and U. Kallweit 417
2. Pathophysiology
M. Manconi, L. F.- Strambi and C. L. Bassetti 423
3. Clinical picture and diagnosis
I. Arnulf 433
4. Comorbidities and special populations
F. J. Puertas 447
5. Treatment of sleep-related movement disorders
D. Garcia-Borreguero, M. Sweeney, A. M. Williams and C. Trenkwalder 461

I. Miscellaneous sleep-related conditions and disorders

(Section Editors: I. Arnulf, Z. Ðogaš)

1. Nosological classification, definitions, epidemiology

Z. Ðogaš 471
2. Treatment
T. C. Wetter and G. Klösch 479

J. Societal, economic, organizational and research aspects

(Section Editors: Z. Ðogaš, P. Peigneux, D. Pevernagie)

1. Demographic and socioeconomic aspects of sleep disorders

P. Jennum and J. Kjellberg 487
2. Forensic aspects of sleep medicine
F. Siclari and T. Penzel 495
3. Organization of Sleep Medicine Centres
D. Pevernagie, J. Fischer and C. Bassetti 503
4. Training initiatives in sleep medicine
Z. Ðogaš 513
5. Research design and quantitative methods
P. Achermann, L. Tarokh and P. Peigneux 517

Jsr_23_A101_toc.indd 4 11/21/2014 11:08:53 AM

Preface
Friend or foe, sleep accompanies us all along our life from
birth to death. Taking a toll that may amount, on average, to
one-third of the 24-h cycle, it fulfils essential functions to keep
brain and body able to answer the challenges of wakeful-
ness. Lack of sleep and sleep disruptions lead rapidly to
detrimental changes in physical and psychological wellbeing.
Conversely, sleep is one of the most sensitive markers of
health problems. Indeed, most diseases accompany changes
in quantitative and qualitative patterns of sleep, which may
even anticipate the occurrence of critical symptoms by years,
for instance in some neurodegenerative diseases. This
makes sleep medicine a central component in modern
multi-disciplinary health-care systems, and calls for the in-
depth specialization and training of sleep medicine special-
ists to benefit higher accuracy in diagnosis, and improved
treatment and intervention methods. This also calls for unified
approaches and the development of standard European
curricula in sleep medicine.
The European Sleep Research Society (ESRS) Sleep
Medicine Textbook aims to address this challenge by
providing a comprehensive basis and knowledge of sleep
medicine, serviceable across all countries in a broadly
defined European zone. It also logically follows the publica-
tion of the ‘Catalogue of knowledge and skills for sleep
medicine’ in the Journal of Sleep Research (Penzel et al.,
2014), the official publication of the ESRS. This Catalogue
was a joint action of the Board and the Sleep Medicine
Committee of the ESRS, in cooperation with members of the
Assembly of National Sleep Societies (ANSS), a constituent
body of the ESRS. The Catalogue was intended to be the
basis for sleep medicine education, for sleep medicine
courses and for sleep medicine examinations, servicing not
only physicians with a medical speciality degree, but also
PhD and MSc health professionals such as clinical psychol-
ogists and scientists, technologists and nurses, all of whom
are involved professionally in sleep medicine. The ESRS
Sleep Medicine Textbook is one of the educational actions
advocated in the Catalogue, as it proposes a systematic
knowledge base that will be used from now on as the
reference for the ESRS Examination/Certification in Sleep
ª 2014 European Sleep Research Society
Medicine and the ESRS Examination/Certification in Sleep
Medicine for Sleep Technologists.
Accordingly, the ESRS Sleep Medicine Textbook develops
state-of-the-art knowledge over 10 sections that parallel the
domains defined in the Catalogue, comprising physiology,
pathology, diagnosis and treatment procedures to societal
and organizational aspects of sleep medicine. This structured
material also provides a comprehensive basis for the
development of teaching modules and the collection of
European Credit Transfer and Accumulation System (ECTS)
points in the framework of standard education study pro-
grammes conducted at the European level, to be developed
in close cooperation with universities or with other expert
societies collaborating in the sleep medicine domain.
Recognized sleep medicine and sleep research experts
have written all the chapters, which have been subjected to
peer-review evaluation. The three Editors-in-Chief warmly
thank all the Authors, Section Editors and Reviewers for
their outstanding contribution to this ESRS action. We also
warmly thank ESRS assistant, Mrs Brigitte Knobl, for her
enthusiastic and highly professional support in the manage-
ment and realization of this book. We sincerely hope that
the ESRS Sleep Medicine Textbook will serve future
students of newly developed integrated sleep medicine
curricula, and support the continuous medical education of
sleep experts all over Europe and worldwide. We trust that
this textbook will attract new students and fellows in the
exciting fields of sleep medicine and sleep research, and
ultimately benefit the numerous worldwide patients suffering
from sleep disorders.
Prof. Claudio Bassetti (ESRS President 2008–12),
Prof. Zoran Dogas (ESRS Education Committee 2012–14)
and Prof. Philippe Peigneux (ESRS President 2012–16)
REFERENCE
Penzel, T., Pevernagie, D., Dogas, Z., et al. Catalogue of knowledge
and skills for sleep medicine. J. Sleep Res., 2014, 23: 222–238.
1