Sleep Medicine and Physical Therapy: A Comprehensive Guide for Practitioners 3030850730, 9783030850739

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Sleep Medicine and Physical Therapy A Comprehensive Guide for Practitioners Cristina Frange Fernando Morgadinho Santos Coelho Editors

Sleep Medicine and Physical Therapy

Cristina Frange Fernando Morgadinho Santos Coelho Editors

Sleep Medicine and Physical Therapy A Comprehensive Guide for Practitioners

Editors Cristina Frange Neurology and Neurosurgery Department Escola Paulista de Medicina Federal University of São Paulo São Paulo, Brazil

Fernando Morgadinho Santos Coelho Neurology and Neurosurgery Department

Escola Paulista de Medicina Federal University of São Paulo São Paulo, Brazil

ISBN 978-3-030-85073-9    ISBN 978-3-030-85074-6 (eBook) https://doi.org/10.1007/978-3-030-85074-6 © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2022, corrected publication 2022 This work is subject to copyright. All rights are solely and exclusively licensed by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors, and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, expressed or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. This Springer imprint is published by the registered company Springer Nature Switzerland AG The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland

This book is dedicated to our families: Matheus and Mauricio, Lucimar and Geraldo, Felício, and Ilza Fernando, Ana Carolina, and Amanda And to our patients

Foreword

The Sleep Medicine and Physical Therapy book justifies its subtitle with its content, as it really represents a comprehensive guide for physiotherapy practitioners dealing with the field of sleep. Through the chapters of the book, the authors, who are both recognized researchers and experts in sleep medicine, neurology and physiotherapy, excellently describe and illustrate the importance of sleep for overall health, sleep-­ related pathologies or disturbances and the role of physiotherapists in dealing with such issues. Dealing with sleep and its disturbances is relatively a new area of work for physiotherapists, although they are in terms of their competencies known as experts in physical (in)activity, sedentary behavior, and exercise for all ages and specific vulnerable target groups. However, effective healthy lifestyle counselling must be multidisciplinary and must cover the entire 24-hour wake-sleep human cycle, which is why every physiotherapist as a health promoter must be able to provide not only counselling in preventing sedentary behavior and improving active lifestyle, but also in providing at least basic counselling around sleeping matters. Studies have shown that regular sleep is associated with a better quality of life at all ages. On the other hand, sleep is associated with a number of physiological systems, such as memory consolidation, immune response, hormone and body temperature regulation, cardiovascular regulation, and many other important functions, so lack and poor quality of sleep are associated with detrimental health outcomes. Short sleep has been shown to impair cognitive and executive functions, and poor sleep is associated with poor mental health. Sufficient length of uninterrupted and deep enough sleep is thus important for quality of sleep. During the current Covid-19 pandemic, it is especially important to sleep well and take care of our sleep order. Good sleep protects us from infections, facilitates the course of the disease and improves the immune response to the vaccine, and protects us from infection in the long run. It helps us manage stress and adapt effectively to the current situation. Reading this book, you as a reader will get an overview about basic concepts of sleep and sleep medicine including why this is important for physical therapists. You will learn about physiotherapeutic management of sleep disturbances such as vii

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insomnia, restless legs symptom and periodic limb movement of sleep, circadian rhythm sleep disturbances, sleep bruxism, obstructive and central sleep apnea, upper airway resistance syndrome, narcolepsy, excessive daytime sleepiness, and parasomnias. Furthermore, you will improve your knowledge about sleep in specific conditions across the lifespan including gender differences, neurological disease, and pain in relation to sleep. Of course, you as a reader will get familiar in more detail with various physiotherapeutic resources, methods, and techniques to improve sleep, such as exercise, hydrotherapeutic resources, optimizing behavior strategies, and sleep ergonomics. You will also learn more about evidence-based physiotherapy in sleep medicine (especially in sleep physiotherapy and sleep and musculoskeletal system). At the end, you will learn in detail about the subjective and objective sleep assessment in physical therapy practice. Overall, the content of this book constantly reminds you that sleep problems require multidisciplinary approaches. So, as a physiotherapist, a national health promoter, a health educator, and a senior lecturer, I would highly recommend this excellent and one-of-a-kind literature to all physiotherapists (and also other related health professionals) around the globe, who are dealing with sleep problems in their everyday clinical or education practice. This is a professional book that every physiotherapist should own, read, and use. Andrea Backović Juričan, World Physiotherapy Network for Health Promotion in Life and Work Ljubljana, Slovenia  Andrea Backović Juričan

Preface

Many of the ideas seen in this book were germinated in a discussion section held at the World Physical Therapy Congress (WCPT) in Geneva, Switzerland, in 2019, toghether with the routine of the Excessive Daytime Sleepiness and Hypersomnia Outpatient Clinic, several supervision meetings, and physical therapy sessions (between a neurologist and a physical therapist) in São Paulo (Brazil) were fundamental for ideas, brainstorming and clinical experiences shared from both of us to become a book. There is a set of core ideas that underlies all the chapters in this book. Some of these ideas have been roughly investigated while others are more hypotheses until this moment. Indeed, the physiotherapeutic practices and the regulation of the profession, and education policies regarding sleep health may vary between countries and cultures. In Brazil, only recently the sleep health was stated as a role for the physical therapist. This book highlights many points of sleep medicine and discusses how physical therapists can help within the interdisciplinary approach and their role in sleep medicine. The mission of physiotherapists is to promote wellness, mobility, and independence developing people’s abilities to move during the course of their lives. Physiotherapists also prevent and treat several issues related to pain, illness, disability and disease, sport and work-related injuries, aging, and inactivity. Sleep and its disturbances are related to health in general. Sleep is an example of new areas that have been constantly developed into health sciences. Continuing education ensures that they keep up to date with the latest advances in physical therapy research and practice. This book will give a basic grounding in sleep medicine to physiotherapists, healthcare providers, and related specialties, as well as to younger professionals. The book itself has been divided into seven main parts. The first part focuses on fundamental concepts of sleep, explaining sleep and discussing disturbances and other factors that impact a good night’s sleep. Part of sleep medicine history is remembered. The knowledge of our history is fundamental to understand the present approach and drive to beyond. The second part focuses on the basic conceptions of physical therapists’ understanding and working in clinical practice and research with sleep. Both sides must be seen: sleep ix

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impacting on rehabilitation/physical therapy and vice versa. The third part focuses on the most prevalent sleep disorders. There is a brief explanation of sleep diseases in each chapter, followed by evidence-based research and clinical reports by physicians, physical therapists, and other health professionals that already work with sleep issues. The fourth part focuses on specific particularities of sleep during childhood, adolescence, and old age, as well as differences between genders and women’s phases during her lifespan. The clinical practice of many physiotherapists is to treat patients with pain and neurological conditions. We also debate about neurological diseases and pain, discussing the intrinsic relationship between sleep and pain/neurological diseases. In the fifth part, the chapters discuss physical therapy resources (exercise, hydrotherapy, ergonomics during sleep, and cognitive behavioral therapy) to improve sleep and to treat sleep disturbances. There is much to grow in the interface between sleep and physical therapy field. It requires the improvement of basic sleep science knowledge, including experiment-­ based research (i.e., animal experiments). The sixth part explains the importance of basic research and its results from investigations on the musculoskeletal system and sleep (or lack of sleep). Finally, the seventh part focuses on subjective and objective tools to assess sleep and sleep disturbances. These tools provide useful information to practical clinics with fundamental importance in a interdisciplinary set of approaches. The editorial process has been a pleasure due to intense work with many professionals who dedicated a lot of time and effort to this project. All these chapters have been written by experts in their respective areas, and we are extremely grateful for their contributions and willingness to donate their experience and time for this book. This book would not be possible without the authors and their wholehearted contributions and keeping up with deadlines. We hope that this book will improve clinical practice, interdisciplinarity of healthcare professionals of many health professions and physiotherapists, and stimulate further researches in this important area. It is important always to take sleep into account on behalf of our patient’s (and our) lives. São Paulo, Brazil  Cristina Frange November 2021   Fernando Morgadinho Santos Coelho

Acknowledgments

São Paulo Research Foundation (Fundação de Amparo à Pesquisa do Estado de São Paulo, FAPESP) Department of Neurology and Neurosurgery from Universidade Federal de São Paulo Post-Graduate Program of Neurology and Neurosciences, Universidade Federal de São Paulo Department of Psychobiology from Universidade Federal de São Paulo Post-graduate students and fellows from Excessive Daytime Sleepiness and Hypersomnia Outpatient Clinic, Universidade Federal de São Paulo Liliane Martins Frange and Luíz Alexandre Berclaz Pinto, for the unconditional support We are also thankful to Erika de Cassia Ferraz, Henry Rodgers, Abha Krishnan, Sasirekka Nijanthan, Arul Viveaun Sagayanathan and their staff at Springer, who were involved in the development, production and design of this volume, both online and printed ones

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Contents

Part I Basic Concepts  Sleep: Definition, Concept, New Area for Physical Therapy ����������������������    3 Cristina Frange, Ana Carolina Aguilar, and Fernando Morgadinho Santos Coelho  Normal Sleep: Interindividual Differences and Sleep Variability ��������������   13 Maria Júlia Figueiró Reis  Brief History of Sleep Medicine and Its Importance for Overall Health������   21 Monica Levy Andersen and Sergio Tufik Part II Sleep Medicine for the Physical Therapist  Basic Principles of Sleep Physiotherapy Practice ����������������������������������������   31 Cristina Frange, Cristina Staub, and Stavros Stathopoulos  Sleep Physiology and Neuroendocrinology for Physiotherapists����������������   39 Priscila Farias Tempaku Part III Physiotherapeutic Management of Sleep Disturbances Insomnia: An Overview ����������������������������������������������������������������������������������   53 Ana Carolina Aguilar and Cristina Frange Insomnia: Physiotherapeutic Approach��������������������������������������������������������   61 Carolina Vicaria Rodrigues D’Aurea, Giselle Soares Passos, and Cristina Frange  Restless Legs Syndrome (Willis-Ekbom Disease) and Periodic Limb Movements of Sleep: An Overview����������������������������������������������������������������   75 Ana Carolina Dias Gomes and Fernando Morgadinho Santos Coelho

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 Restless Legs Syndrome (Willis-Ekbom Disease) and Periodic Limb Movements of Sleep: Physiotherapeutic Approach��������������������������������������   89 Simone Barreto dos Santos and Cristina Frange  Circadian Rhythm Sleep-Wake Disorders: An Overview����������������������������  103 Melissa Araújo Ulhôa and Claudia R. C. Moreno  Physical Therapy in Circadian Rhythm Disorders: Chronorehabilitation?��������������������������������������������������������������������������������������������������  115 Cristina Frange Sleep Bruxism: An Overview��������������������������������������������������������������������������  125 Cibele Dal Fabbro and Gilles J. Lavigne Sleep Bruxism: Physiotherapeutic Approach������������������������������������������������  139 Cinthia Santos Miotto and Amélia Pasqual Marques Obstructive Sleep Apnea: An Overview��������������������������������������������������������  147 Fernanda Louise Martinho Haddad, Lia Rita Azeredo Bittencourt, Renato Stefanini, Débora Strose Villaça, and Sônia Maria Guimarães Pereira Togeiro Obstructive Sleep Apnea: Physiotherapeutic Approach������������������������������  157 Moara Gomes da Rocha Cruz and Rafaela Garcia Santos de Andrade Central Sleep Apnea: An Overview����������������������������������������������������������������  171 Luciane Impelliziere Luna Mello and Luciana Palombini Central Sleep Apnea: Physiotherapeutic Approach��������������������������������������  181 Juliana Arcanjo Lino and Vivien Schmeling Piccin  Upper Airway Resistance Syndrome: An Overview ������������������������������������  197 Luciana Palombini, Luciane Impelliziere Luna Mello, and Avram R. Gold  Upper Airway Resistance Syndrome: Physiotherapeutic Approach����������  203 Evelyn Brasil Narcolepsy: An Overview��������������������������������������������������������������������������������  207 Fernando Morgadinho Santos Coelho and Ana Carolina Dias Gomes  Excessive Daytime Sleepiness: An Overview ������������������������������������������������  223 Lúcio Huebra Pimentel Filho and Fernando Morgadinho Santos Coelho  Excessive Daytime Sleepiness and Narcolepsy: Physiotherapeutic Approach����������������������������������������������������������������������������������������������������������  233 Morgana Nicolodelli and Cristina Frange Parasomnias������������������������������������������������������������������������������������������������������  239 Giselle de Martin Truzzi, Cristina Frange, and Fernando Morgadinho Santos Coelho

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Part IV Sleep in Specific Conditions  Sleep-Wake Disturbances in Childhood and Adolescence ��������������������������  247 Giuliano da Paz Oliveira and Marcia Pradella-Hallinan Sleep and Aging������������������������������������������������������������������������������������������������  261 Ligia Mendonça Lucchesi and Ronaldo Delmonte Piovezan  Sleep and Gender Differences������������������������������������������������������������������������  275 Glaury A. Coelho  Sleep in Neurologic Diseases ��������������������������������������������������������������������������  285 Lúcio Huebra Pimentel Filho, Marcos Manoel Honorato, and Fernando Morgadinho Santos Coelho  Sleep and Chronic Pain Interlaced Influences: Guidance to Physiotherapy Practice��������������������������������������������������������������������������������  297 Cristina Frange, Alberto Herrero Babiloni, Jacqueline Tu Anh Thu Lam, and Gilles J. Lavigne Part V Physiotherapeutic Resources to Improve Sleep Exercise and Sleep��������������������������������������������������������������������������������������������  317 Ozeas Lins-Filho, Maria Julia Lyra, and Christopher E. Kline  Hydrotherapeutic Resources for Sleep Management ����������������������������������  329 Sandra Souza de Queiroz  Optimizing Behavior Strategies for Sleep������������������������������������������������������  335 Luciane Bizari Coin de Carvalho Sleep Ergonomics ��������������������������������������������������������������������������������������������  345 Silmara Bueno and Cristina Frange Part VI Evidence from Basic Science and Its Contribution to Physical Therapy in Sleep Medicine  Basic Research for Sleep Physiotherapy��������������������������������������������������������  359 Monica Levy Andersen and Sergio Tufik  Sleep and Musculoskeletal System ����������������������������������������������������������������  367 Helton de Sá Souza, Ana Claudia Pelissari Kravchychyn, and Sara Quaglia de Campos Giampá

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Part VII Sleep Assessment for Physical Therapy Clinical Practice Subjective Assessment of Sleep ����������������������������������������������������������������������  381 Cristina Frange, Maria Júlia Figueiró Reis, Eliana Lottenberg Vago, and Fernando Morgadinho Santos Coelho Objective Assessment of Sleep������������������������������������������������������������������������  401 Maria Júlia Figueiró Reis, Eliana Lottenberg Vago, Cristina Frange, and Fernando Morgadinho Santos Coelho Actigraphy��������������������������������������������������������������������������������������������������������  411 Mario A. Leocadio-Miguel and John Fontenele-Araújo  Correction to: Normal Sleep: Interindividual Differences and Sleep Variability. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C1 Maria Júlia Figueiró Reis Index������������������������������������������������������������������������������������������������������������������  425

Contributors

Ana Carolina Aguilar, MD, MSc  Department of Psychobiology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil Monica  Levy  Andersen, BS, PhD, Associate Professor  Department of Psychobiology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil Alberto Herrero Babiloni, DDS, MS, PhD (c)  Division of Experimental Medicine and Faculty of Dentistry, McGill University, Montreal, QC, Canada Research Center of CIUSSS Nord Ile de Montréal, Sleep and Trauma Unit, Montréal, Montreal, QC, Canada Lia  Rita  Azeredo  Bittencourt, MD, PhD, Associate Professor  Department of Psychobiology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil Evelyn Brasil, PT, MSc  Department of Severe Patients, Hospital Israelita Albert Einstein, Certified in Sleep Physiotherapy by the Brazilian Sleep Society (ABS), and The Brazilian Association of Cardiorespiratory Physiotherapy and Physiotherapy in Intensive Care (ASSOBRAFIR), São Paulo, SP, Brazil Silmara Bueno, PT  Personal do Sono Sleep Consulting, São Paulo, SP, Brazil Fernando  Morgadinho  Santos  Coelho, MD, PhD, Full Professor  Neurology and Neurosurgery Department; Department of Psychobiology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil Glaury A. Coelho, Psy, MSc, PhD (c)  Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil Carolina Vicaria Rodrigues D’Aurea, PT, PhD  Hospital Israelita Albert Einstein, São Paulo, SP, Brazil

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Contributors

Giuliano da Paz Oliveira, MD, PhD  Universidade Federal do Delta do Parnaíba and Instituto de Educação Superior do Vale do Parnaíba, Parnaíba, Piauí, Brazil Neurology and Neurosurgery Department, Escola Paulista de Medicina Universidade Federal de São Paulo, São Paulo, SP, Brazil Moara  Gomes  da Rocha  Cruz, PT  Certified in Sleep Physiotherapy by the Brazilian Sleep Society (ABS), and The Brazilian Association of Cardiorespiratory Physiotherapy and Physiotherapy in Intensive Care (ASSOBRAFIR), Aracaju, Sergipe, Brazil Rafaela  Garcia  Santos  de Andrade, PT, PhD  Department of Pneumology and Heart Institute, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil Certified in Sleep Physiotherapy by the Brazilian Sleep Society (ABS), and The Brazilian Association of Cardiorespiratory Physiotherapy and Physiotherapy in Intensive Care (ASSOBRAFIR), São Paulo, SP, Brazil Sara Quaglia de Campos Giampá, BPhEd, PhD (c)  Department of Cardiology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil Luciane  Bizari  Coin  de Carvalho, Psy, PhD  Neurology and Neurosurgery Department, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil Giselle de Martin Truzzi, MD, PhD (c)  Psychobiology Department, Universidade Federal de São Paulo, São Paulo, SP, Brazil Luciane  Impelliziere  Luna  de Mello, MD, PhD  Sleep Institute, Associação Fundo Incentivo à Pesquisa, São Paulo, SP, Brazil Sandra Souza de Queiroz, PT, PhD  School of Sciences and Health, Universidade Anhembi Morumbi, São Paulo, SP, Brazil Helton  de Sá  Souza, BPhEd, PhD  Department of Physical Education, Universidade Federal de Viçosa, Viçosa, MG, Brazil Simone  Barreto  dos Santos, PT  Sleep Institute, Associação Fundo Incentivo à Pesquisa; Certified in Sleep Physiotherapy by the Brazilian Sleep Society (ABS), and The Brazilian Association of Cardiorespiratory Physiotherapy and Physiotherapy in Intensive Care (ASSOBRAFIR), São Paulo, SP, Brazil Cibele  Dal  Fabbro, DDS, Ms, PhD  Center for Advanced Research in Sleep Medicine, Faculty of Dental Medicine, Université de Montréal and CIUSSS Nord Île de Montreal, Montreal, QC, Canada Lúcio  Huebra  Pimentel  Filho, MD, MSc  Neurology and Neurosurgery Department, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil

Contributors

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John  Fontenele-Araújo, MD, PhD  Department of Physiology and Behavior, Postgraduate Course on Psychobiology, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil Cristina  Frange, PT, PhD  Department of Neurology and Neurosurgery, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil Certified in Sleep Physiotherapy by the Brazilian Sleep Society (ABS), and The Brazilian Association of Cardiorespiratory Physiotherapy and Physiotherapy in Intensive Care (ASSOBRAFIR), São Paulo, SP, Brazil World Physiotherapy Network for Health Promotion in Life and Work, São Paulo, SP, Brazil Avram R. Gold, MD, PhD  Department of Medicine and Stony Brook University Sleep Disorders Center, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA Ana  Carolina  Dias  Gomes, MD, MSc (c)  Psychobiology Department, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil Fernanda  Louise  Martinho  Haddad, MD, PhD  Department of Otorhinolaryngology and Head and Neck Surgery, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil Marcos Manoel Honorato, MD, PhD  Neurology and Neurosurgery Department, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil Universidade do Estado do Pará, Santarém, Pará, Brazil Christopher  E.  Kline, BPhEd, PhD  Department of Health and Human Development, University of Pittsburgh, Pittsburgh, PA, USA Ana  Claudia  Pelissari  Kravchychyn, Clin Nutr, PhD  Department of Physical Education and Department of Nutrition, University Center of Volta Redonda, Unifoa, Volta Redonda, Rio de Janeiro, Brazil Jacqueline Tu Anh Thu Lam, PT, FCAMPT, PhD (c)  School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada Gilles J. Lavigne, DMD, PhD, hc (U Zurich)  Faculties of Dental Medicine and Medicine, Université de Montréal; Research Center of CIUSSS Nord Ile de Montréal, Sleep and Trauma Unit and CHUM, Stomatology Department, Montreal, QC, Canada Mario A. Leocadio-Miguel, PT, PhD  Department of Physiology and Behavior, Postgraduate Course on Psychobiology, Federal University of Rio Grande do Norte; Brazilian Sleep Society, Natal, Rio Grande do Norte, Brazil

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Juliana Arcanjo Lino, PT, PhD  Medical Sciences, Federal University of Ceará (UFC), Fortaleza, Ceará, Brazil Certified in Sleep Physiotherapy by the Brazilian Sleep Society (ABS), and The Brazilian Association of Cardiorespiratory Physiotherapy and Physiotherapy in Intensive Care (ASSOBRAFIR), São Paulo, Brazil Ozeas  Lins-Filho, BPhEd, PhD  Sleep and Heart Laboratory, Cardiovascular Emergency Room of Pernambuco, University of Pernambuco, Recife, PE, Brazil Ligia Mendonça Lucchesi, MD, PhD  Sleep Institute, Associação Fundo Incentivo à Pesquisa, São Paulo, SP, Brazil Maria  Julia  Lyra, BPhEd, PhD (c)  Associate Graduate Program in Physical Education, University of Pernambuco, Recife, PE, Brazil Amélia  Pasqual  Marques, PT, PhD  Department of Physical Therapy, Speech Therapy and Occupational Therapy, and Post-Graduate Program in Rehabilitation Sciences, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil Cinthia Santos Miotto, PT, PhD  Department of Physiotherapy, Speech Therapy and Occupational Therapy, Faculty of Medicine, University of São Paulo, São Paulo, SP, Brazil Claudia R. C. Moreno, BIOL, PhD, Associate professor  Department of Health, Life Cycles and Society, School of Public Health, University of São Paulo (USP), São Paulo, SP, Brazil Stress Research Institute, Psychology Department, Stockholm University, Stockholm, Sweden Morgana Nicolodelli, PT  Hipnos Sleep Consulting, Curitiba, Paraná, Brazil Luciana  Palombini, MD, PhD  Sleep Institute, Associação Fundo Incentivo à Pesquisa, São Paulo, SP, Brazil Giselle  Soares  Passos, BPhEd, PhD  Health Sciences, Universidade Federal de Jataí, Jataí, Goiás, Brazil Vivien Schmeling Piccin, PT, PhD  Sleep Medicine, Pulmonary Division, Heart Institute, São Paulo, SP, Brazil Certified in Sleep Physiotherapy by the Brazilian Sleep Society (ABS), and The Brazilian Association of Cardiorespiratory Physiotherapy and Physiotherapy in Intensive Care (ASSOBRAFIR), São Paulo, SP, Brazil Ronaldo  Delmonte  Piovezan, MD, PhD  Sleep Institute, Associação Fundo Incentivo à Pesquisa, São Paulo, SP, Brazil Marcia  Pradella-Hallinan, MD, PhD  Treatment Center for Neuromuscular Diseases (TDN-AFIP) and Sleep Medicine Lab of Sirio Libanês Hospital, São Paulo, SP, Brazil

Contributors

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Maria  Júlia  Figueiró  Reis, MD, MSc (c)  Psychobiology Department, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil Stavros  Stathopoulos, PT, PhD  Physical Therapy Department, Evaggelismos General Hospital, Athens, Greece Postgraduate Program of the Medical School of National and Kapodistrian, University of Athens, Athens, Greece Marconi University of Rome, Rome, Italy Cristina  Staub, PT, PhD  International Organization of Physical Therapy in Mental Health, Swiss Group of Physiotherapy in Mental Health, Pro Dormo Switzerland, Zurich, Switzerland Renato  Stefanini, MD, PhD  Otorhinolaryngology and Head and Neck Surgery Department, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil Priscila Farias Tempaku, BS, PhD  Psychobiology Department, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil Sônia  Maria  Guimarães  Pereira  Togeiro, MD, PhD  Department of Clínica Médica e Medicina Laboratorial, Department of Pneumology and Department of Psychobiology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil Sergio  Tufik, MD, PhD, Full Professor  Department of Psychobiology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil Melissa Araújo Ulhôa, PT, PhD  Faculty of Medicine of Vale do Aço, School of Health and Education, Centro Universitário Católico do Leste de Minas Gerais; Centro Universitário de Caratinga, Ipatinga, Minas Gerais, Brazil Eliana Lottenberg Vago, DMD, MSc  Neurology and Neurosurgery Department, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil Débora  Strose  Villaça, Clin Nutr, PhD  Department of Pneumology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil

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About the Editors Cristina Frange  Physical therapist specialized in neurorehabilitation (2010), Master of Communication (2004) from Pontificia Universidade Católica de São Paulo, and PhD in Science, Sleep Division from Universidade Federal de São Paulo, UNIFESP. Postdoctoral research fellow at Neurology and Neurosurgery Department, UNIFESP (2021). Received funding from Sao Paulo Research Foundation (FAPESP) for PhD and postdoctoral studies. Certified in Sleep Physiotherapy by the Brazilian Sleep Society (ABS), and The Brazilian Association of Cardiorespiratory Physiotherapy and Physiotherapy in Intensive Care (ASSOBRAFIR). Executive board member of the World Physiotherapy Network for Health Promotion in Life and Work. Clinical experience in neurorehabilitation, pain, and sleep medicine. Research focuses on non-­pharmacological interventions to improve sleep in various population, particularly people after stroke or in chronic pain conditions. Scientific interest is the treatment of sleep disorders with physiotherapy and the improvement of rehabilitation sessions by enhancing sleep. Fernando  Morgadinho  Santos  Coelho  Neurologist, Medical degree from Universidade Federal do Espírito Santo (1995), Master’s degree (2005) and PhD (2009) in Science, Sleep Division from UNIFESP. Postdoctoral research fellow at the University of Toronto (2011). Full professor in the Neurology and Neurosurgery Department at UNIFESP (since 2013). Clinical experience in neurology and sleep medicine. Development of research in neurology (stroke and rehabilitation) and in sleep diseases (narcolepsy, periodic limb movements of sleep, restless legs syndrome, and obstructive sleep apnea). Author of the Sleep and Stroke book published in Brazilian Portuguese and of many book chapters. Highest scientific interest is the overlap between sleep and neurology focusing on an interdisciplinary approach.

Abbreviations

ACTH adrenocorticotropic hormone ADHD attention deficit hyperactivity disorder AHI apnea hypopnea index ARDS ascending activator reticular system ASD autism spectrum disorder ASV adaptive servo-ventilation BFD biofeedback BiPAP bilevel ventilation BMI body mass index BZD benzodiazepines CAI central apnea index CBT cognitive-behavioral therapy CBT-I cognitive-behavioral therapy for insomnia CBT-P cognitive-behavioral therapy for pain CBT-S cognitive-behavioral therapy for sleep CES contingent electrical stimulation CHF congestive heart failure CNS central nervous system carbon dioxide CO2 CRSWD circadian rhythm sleep-wake disorders CSB Cheyne-Stokes breathing CSF cerebrospinal fluid Ct clinical trial CT computer assisted tomography DSM-V Diagnostic and Statistical Manual for Mental Disorders, Fifth Edition ECG electrocardiogram EDS excessive daytime sleepiness EEG electroencephalogram EMG electromyogram EOG electrooculogram ESS Epworth sleepiness scale xxiii

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Abbreviations

FDA Food and Drug Administration GABA gamma aminobutyric acid GERD gastroesophageal reflux disorder GH growth hormone GHB sodium oxybate HCRT-1 hypocretin-1 or orexin HF heart failure HI hypopnea events HLA human leukocyte antigens HPA hypothalamus-pituitary-adrenal axis Hz hertz IASP International Association for the Study of Pain ICF International Classification of Functioning, Disability and Health ICSD International Classification of Sleep Disorders ICSD-3 International Classification of Sleep Disorders, Third Edition IGF-1 insulin-like growth factor 1 IRLSSGS International RLS Study Group Scale KLS Kline-Levin syndrome LVEF left ventricular ejection fraction MAD mandibular advancement device MENS microcurrent electrical nerve stimulation MMA masticatory muscle activity MRT magnetic resonance tomography MSLT multiple sleep latency test NCDs non-communicable diseases NIV non-invasive ventilation NREM non-REM sleep NT1 narcolepsy type 1 NT2 narcolepsy type 2 O2 oxygen OAI obstructive apnea index ODI oxygen desaturation index OFP orofacial pain OHS obesity hypoventilation syndrome OSA obstructive sleep apnea PAP positive airway pressure therapy PCO2 pressure of arterial carbon dioxide PLMD periodic limb movement disorder PLMDi periodic limbs movement disorder index PLMS periodic limbs movement during sleep PMR progressive muscle relaxation PO2 pressures of arterial oxygen PSG polysomnography PSQI Pittsburgh Sleep Quality Index PT physical therapist or physiotherapist

Abbreviations

PTs physiotherapists QoL quality of life RBD REM sleep behavior disorder RCT randomized controlled trial RDI respiratory disturbance index REM rapid eye movement REML REM sleep latency RERA respiratory effort related arousal RLS restless legs syndrome RR risk ratio SB sleep bruxism SDB sleep disordered breathing SE sleep efficiency SL sleep latency SOL sleep onset latency SOREMP periods of sleep onset REM periods SPECT single-photon emission computed tomography Stage N1 stage NREM 1 Stage N2 stage NREM 2 Stage N3 stage NREM 3 Stage R stage REM Stage W awake SWS slow wave sleep TECSA treatment-emergent central sleep apnea TENS transcutaneous electrical nerve stimulation TMD temporomandibular disorder TST total sleep time (sleep duration) UA upper airway UARS upper airway resistance syndrome VLPO ventrolateral pre-optic area WASO wake after sleep onset WED Willis-Ekbom disease WHO World Health Organization WMT wakefulness maintenance test

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Part I

Basic Concepts

Sleep: Definition, Concept, New Area for Physical Therapy Cristina Frange, Ana Carolina Aguilar, and Fernando Morgadinho Santos Coelho

Sleep is often characterized by a reversible reduction in consciousness, an increase in arousal threshold, behavioral quiescence, closed eyes, and a recumbent body posture. Sleep is an essential physiological phenomenon for the maintenance of homeostasis of our organism, being a state of intense brain activity. Yes, you read it right: intense activity! Sleep was considered a passive state until the discovery of rapid eye movements (REM) sleep in 1951, today called R stage [1]. At that time, and prior to that time, no distinction was seen between sleep and other states of quiescence such as comma, stupor, intoxication, hypnosis, anesthesia, and hibernation. Sleep represents an essential element for health and well-being, including cognitive performance, physiological processes, emotion regulation, physical development, and quality of life [2]. Sleep (and why we sleep) remains a scientific enigma and we do not know sleep functions precisely. We do know that we cannot survive without it. Many scientific investigations on the function of sleep have proposed a variety of theories: sleep serves an immune function, reduces caloric usage, restores brain energy stores, has a glymphatic function (house cleaning duties such as removal of extracellular amyloid-β from the brain), restores waking-induced performance degradation, and C. Frange (*) Department of Neurology and Neurosurgery, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil Certified in Sleep Physiotherapy by the Brazilian Sleep Society (ABS), and The Brazilian Association of Cardiorespiratory Physiotherapy and Physiotherapy in Intensive Care (ASSOBRAFIR), São Paulo, SP, Brazil World Physiotherapy Network for Health Promotion in Life and Work, São Paulo, SP, Brazil A. C. Aguilar Department of Psychobiology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil F. M. S. Coelho Neurology and Neurosurgery Department; Department of Psychobiology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil © The Author(s), under exclusive license to Springer Nature Switzerland AG 2022 C. Frange, F. M. S. Coelho (eds.), Sleep Medicine and Physical Therapy, https://doi.org/10.1007/978-3-030-85074-6_1

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may also serve a neuronal/glial connectivity (plasticity) function [3]. In addition, we have many investigations on this active process providing daily restoration due to the production of fundamental anabolic hormones, involved in cellular growth and regeneration, such as growth hormone, testosterone, and prolactin [4]. Theories as to the function of sleep have naturally focused on the brain. The synaptic homeostasis theory [5], the brain energetic restoration theory [6], the memory consolidation theory [7], and the macromolecular biosynthesis theory [8] have all cited a central emphasis on the significance of sleep for the brain. Unforgettable, there is a famous declaration of sleep being a product “of the brain, by the brain, and for the brain” [9]. The effects of sleep and sleep deprivation on the body are hard to ignore. In humans, there are well characterized physiological and behavioral changes known to impact the pathophysiology of several diseases such as metabolic dysfunction [10], hypertension, stroke [11, 12], diabetes, neurocognitive diseases [13], heart diseases [14–17], musculoskeletal function [18], and altered immune function [19, 20]. Taken together, these comorbidities increase morbimortality associated with sleep and sleep deprivation [21]. Given this context, it is reasonable to suspect that sleep state impacts a broader array of peripheral tissues in addition to the brain. In this sense, transcriptional effects of sleep outspread further than the brain to include peripheral tissues [22]. In each specific tissue of our body, sleep seems to provide a temporal compartment to cope with the tissue-specific molecular consequences of wakefulness. Here is another point to consider: not only sleep is important but also the relationship between sleep and wakefulness is imperative. We need to broaden our vision beyond what happens withing our body during sleep, but also what happens to our body prior to and after sleep. Sleep prepares our body for the awake state, and the hormones (likewise the lack of some of them during the day) are responsible for many physiological processes. The propensity to sleep is determined by two of the interviewed processes: the circadian and the homeostatic processes [23, 24]. The two intertwined process model postulates that the homeostatic process increases during waking and decreases during sleep, and interacts with a circadian process that is not directly dependent on sleep and waking. In the circadian process exists a timing mechanism of the body, where hormones are produced and released (e.g., glucocorticoids, melatonin, cortisol), influencing endocrine function.  There are  either fluctuations of core temperature, performance, muscle strength, rhythms in behavioral processes (e.g., locomotor activity and feeding). In humans, the circadian rhythm is about ±24 hours and, for our biological clocks to be effective, they must accurately keep time and adjust to environmental signals (e.g. light and dark cicles, feeding and fasting, activity and rest). In the homeostatic process, sleep pressure is increased as longer as we are awake, and consequently, there is an increase in adenosine, an endogenous hormone that promotes sleep [25]. Adenosine also dissipates during sleep, and thus induces wakefulness for the next day toghether with an orchestra of other hormones. That is, sleep is also regulated by the accumulation of its debt: the more the wakefulness, the more the need to sleep accumulates, until the moment when this accumulation becomes unbearable, and it is necessary to sleep (Fig. 1). We sleep when these two processes are in tune: the circadian process indicating that it is the time to sleep, and the homeostatic process indicating that there is an accumulation of need for sufficient sleep. The interaction of both processes determines the time of sleeping and waking up.

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Sleep homeostatic drive

Wake propensity

9h

15h awake

21h

3h asleep

9h

Fig. 1  Circadian and homeostatic processes of sleep. A two-process model of sleep. A linearly accumulating and dissipating homeostatic (Process S) drive to sleep counteracted by a circadian alerting signal that has approximately 24-hour birhythmicity (Process C). The homeostatic process represents a sleep pressure that accumulates in a nonlinear progression from the time of the last sleep episode. With a subsequent sleep episode, the signal strength representing the homeostatic process declines at an exponential rate. The circadian processes follow a nearly sinusoidal pattern, repeating independently of sleep episodes. Sleep and wakefulness are only maintained in a consolidated fashion when the signals from both processes must be appropriately aligned. (Adapted with permission from Ref. [26])

The desynchrony of these processes can lead to many diseases. According to the third International Classification of Sleep Disorders (ICSD-3), American Academy of Sleep Medicine (AASM) [14], there exists a variety of sleep disorders.1

1  Insomnia: chronic insomnia disorder, short-term insomnia disorder, and other insomnia disorders such as excessive time in bed or short sleepers. Sleep-related breathing disorders: obstructive sleep apnea, central sleep apnea (primary, due to a medical disorder, with Cheyne-Stokes breathing, due to high-altitude periodic breathing, due to a medication or substance, treatment-emergent central sleep apnea, sleep-related hypoventilation disorders such as upper airway resistance syndrome, obesity hypoventilation syndrome, sleep-related hypoxemia, and snoring. Central disorders of hypersomnolence such as narcolepsy, idiopathic hypersomnia, Kleine-Levin syndrome, hypersomnia due to a medical disorder or a medication or substance, or associated with a psychiatric disorder, and insufficient sleep syndrome. Circadian rhythm sleep-wake disorders, such as delayed sleep-wake phase disorder, advanced sleep-wake phase disorder, irregular sleep-wake rhythm disorder, non-24-hour sleep-wake rhythm disorder, shift work disorder, jet lag disorder, circadian sleep-wake disorder, not otherwise specified. Parasomnias such as NREM-related parasomnias (disorders of arousal, confusional arousals, sleepwalking, sleep terrors, sleep-related eating disorder), REM-related parasomnias (REM sleep behavior disorder, recurrent isolated sleep paralysis, nightmare disorder), other parasomnias (exploding head syndrome, sleep-related hallucinations, sleep enuresis, parasomnia due to a medical disorder, due to a medication or substance), and somniloquy (sleep talking). Sleep related movement disorders (restless legs syndrome (also called Willis-Ekbom disease), periodic limb movement disorder, sleep bruxism, sleep related rhythmic movement disorder benign sleep myoclonus of infancy, propriospinal myoclonus at sleep onset, due to a medical disorder or a medication or substance).

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The identification and classification of sleep stages are made by polysomnography examination (PSG, see Chap. 36 for more information). In PSG, the characteristics of each of the stages are well defined and measured through the electroencephalography (EEG) waves, according to their frequency and amplitude. Sleep has two separate stages, defined based on an assemblage of physiologic parameters: the R stage (REM sleep) and the non-REM stage (NREM). The NREM stage is further subdivided into stage 1 (N1), stage 2 (N2), and stage 3 (N3) sleep. A sleep cycle is composed of consecutive alternations between the NREM and R stage and lasts about 70–110 minutes each. Humans experience about 4 to 6 sleep cycles per night, with different proportions of each stage throughout the night (Fig. 2) [27] and vary according to age, sex, exposition to daylight, diseases, etc. In normal individuals, NREM sleep predominates in the first half of the night, while REM sleep is more frequent in the second half of the night. The schematic representation of sleep architecture (sleep structure, sleep pattern) can be seen in polysomnographic examination in the hypnogram, a graph that characterizes the sleep stages as a function of time (Fig. 3). There exists a protocol defined by the AASM for sleep scoring. Normal sleep pattern begins at the N1 stage of NREM sleep, which constitutes the transition from wakefulness to sleep and is predominantly characterized by the transition from alpha rhythm to theta rhythm, from 4 to 7.5 Hz. From the time an individual goes to bed to sleep and the time he/she effectively starts to sleep is called sleep latency. During stage N1 sleep, the heart rate decreases and the eyes exhibit lenient movement. N1 sleep stage presents typical graphic elements in the EEG, such as the vertex waves (i.e., focal sharp transients’ waves with duration