Reasons for why Medical Students Prefer Specific Sleep Management Strategies.

OBJECTIVES: Insomnia symptoms are common among medical students. This study explored the perspectives of medical students about which sleep management strategies to use. METHODS: Medical students responded to an online survey on their thoughts about the use of various sleep management strategies. RESULTS: Of the 828 respondents, 568 (69%) provided responses to questions about the most preferred strategies and 450 (54%) provided responses about their least preferred strategies. About 48.5% felt their insomnia symptoms were too mild to see a clinician and 23.9% did not think their symptoms warranted sleep medication. Over 40% of students could not avoid work before sleep, have consistent sleep/wake times, or engage in regular exercise because of their busy and inconsistent schedules. Approximately 40-60% could not improve their sleep environment (e.g. better heating and bed) because of the associated costs. Over 80% reported an inability to change their pre-sleep habits (e.g. using electronics close to bedtime, using bed for activities other than sleep or sex). Half of the students disliked relaxation techniques or felt they would not help. Around 30-50% did not believe that changing caffeine and/or alcohol intake would affect their sleep. CONCLUSIONS: Medical students may benefit from additional sleep education. Clinicians may need to discuss which strategies individual students prefer and modify their recommendations accordingly.

Sleep Management Strategies Among Medical Students At the University of Otago.

OBJECTIVES: We aim to investigate factors which might affect the sleep of medical students, and how they currently manage their sleep. METHODS: An online survey was sent to medical students at the University of Otago. RESULTS: After adjusting for gender, ethnicity and age, depressive symptoms (Mild: odds ratio (OR) = 6.3; Moderate: OR = 18.1; Severe: OR = 15.6), and sleep hygiene (OR = 1.07) were associated with insomnia symptoms. Commonly endorsed strategies for sleep management by students were undertaking regular exercise (80.1%), having consistent sleep-wake time (71.3%), and limiting caffeine intake (70.3%). Few were willing to see a clinician (23.4%) or take medication (22.3%). Participants with insomnia symptoms were more likely to prefer limiting their alcohol intake (OR = 1.8), limiting daytime naps (OR = 1.5), seeing clinicians (OR = 1.9), and taking sleep medication (OR = 4.0), but less likely to prefer avoiding intense work (OR = .71) or minimizing using electronics (OR = .60) close to bedtime than those without insomnia symptoms. High sleep self-efficacy was associated with lower odds for having insomnia symptoms (OR = .74 (.70, .77)). CONCLUSIONS: Increased awareness and greater resources are needed to support the sleep health of medical students.

Upper airway surgery benefits patients with obstructive sleep apnoea who cannot tolerate nasal continuous positive airway pressure.

Nasal continuous positive airway pressure (CPAP) is the mainstay of treatment for patients with moderate to severe obstructive sleep apnoea (OSA). However, tolerance and compliance are poor. An audit using the Christchurch Hospital ORL surgery database identified patients who underwent upper airway surgery for OSA. Tracheostomy and bimaxillary advancement patients were excluded. Adults with moderate to severe OSA (Desaturation Index (DI) >10 n.h(-1)), who had failed a trial of nasal CPAP, and had pre-operative and post-operative sleep study data were identified. Objective (DI) and Subjective (Epworth Sleepiness Score (ESS)) outcome measures were recorded. The database identified 69 patients who underwent surgery for snoring or OSA; of these, 25 patients formed the study group. Sixteen out of 25 improved (64 per cent) after surgery, seven out of 25 showed no change (28 per cent), two patients (eight per cent) showed deterioration in their DI. Forty-eight per cent of patients had >50 per cent post-operative improvement in DI. Fourteen out of 25 (56 per cent) had a post-operative DI <20 n.h(-1). Seven out of 25 (28 per cent) had a post-operative DI <10 n.h(-1). Upper airway surgery has a role in the management of selected patients with OSA who cannot tolerate nasal CPAP.

Assessment of snorers in primary care: straight path to treatment.

Habitual snoring needs to be taken seriously, both as a symptom of other sleep disorders and as a condition in its own right. GPs approached by patients with problematic snoring face a dilemma regarding whether (and to which service) those patients should be referred for a specialist opinion. Using the Sparks Chart, snoring patients can be grouped according to the two symptomatic dimensions of excessive daytime sleepiness and nocturnal hypoxaemia. We believe that the approach outlined in this article offers GPs a coherent and pragmatic guideline for referring and/or managing problematic snoring by using a simple questionnaire and pulse oximetry. The method has the potential to improve primary and secondary liaison. Most importantly, it offers patients a straight path to treatment.