Sleep Disorder

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Contents 1 More Specific Terms 2 Etiology 3 Epidemiology 4 Laboratory 5 Complications 6 Management 7 More General Terms 8 Additional Terms 9 References

More Specific Terms

• advanced sleep-phase syndrome; familial advanced sleep-phase syndrome (FASPS)
• chronic sleep disorder
• fibromyalgia syndrome (fibromyositis, fibrositis)
• hypersomnia (hypersomnolence, excessive sleepiness)
• insomnia
• irregular sleep/wake rhythm disorder
• Kleine-Levin syndrome
• narcolepsy
• parasomnia
• shift work sleep disorder
• sleep apnea
• sleep attack
• sleep deprivation
• sleep paralysis

Etiology

• disturbances of the sleep-wake cycle

• travel across time zones
• shift work
• advanced sleep phase
• pharmaceutical agents

• insomnia (disorders of initiating or maintaining sleep)

• transient or short-term

• acute psychologic stress

• bereavement
• anxiety

• pharmaceutical agents*
• acute physical illness
• hot flashes in menopausal women [5]
• dyspepsia [6]

• long-term

• psychiatric disorders
• systemic illness
• alcohol or substance abuse
• chronic pain
• gastroesophageal reflux disease ( GERD)

• hypersomnia (excessive daytime somnolence)

• sleep apnea
• narcolepsy/ cataplexy
• depression
• alcohol or drug-induced
• systemic illness
• head injury

• parasomnias (partial arousal with episodic movement)

• sleepwalking ( somnambulism)
• nightmares & night terrors
• periodic leg movements during sleep
• restless legs syndrome
• sleep-related enuresis
• nocturnal seizures
• sleep-related cluster headaches
• sleep palsies
• bruxism
• REM behavior disorder

• * pharmacologic agents:

• anorexic agents
• levodopa
• monoamine oxidase ( MAO) inhibitors
• sympathomimetics

Epidemiology

• 1/7 of Americans are affected by a sleep disorder [4]

• difficulty falling asleep (37%)

• prevalence > women than men
• prevalence increases with age in men (65-85 years of age)

• nighttime awakening (29%)

• no sex difference
• prevalence increases with age (65-85 years of age)

• early morning awakening (19%)
• daytime sleepiness (19%)

• common in patients with Parkinson's disease

Laboratory

• polysomnography with multiple sleep latency test
• bilateral anterior tibialis EMG for restless legs syndrome
• actigraphy may be useful for assessment of sleep disorders

Complications

• use of hypnotics in older individuals increases the risk of falls & fractures
• insomnia & self-medication to improve sleep are associated with increased mortality
• sleep deprivation associated with hypertension & obesity

Management

• exposure to bright lights

• exposure in the morning shortens onset of onset of sleep at night
• exposure in the evening delays onset of onset of sleep at night

• it is easier to lengthen a sleep cycle than to shorten it

• traveling from west to east takes one day per time zone to adjust
• traveling from east to west takes less time
• melatonin 5 mg PO QHS at the point of destination for jet lag

More General Terms

• sign/symptom
• disease/disorder primarily affecting brain

Additional Terms

• age-associated changes in sleep
• bruxism
• cluster headache (suicide headache)
• enuresis
• International classification of sleep disorders
• melatonin
• nightmare
• nocturnal myoclonus (periodic limb movement disorder, PLMD, periodic limb movements of sleep, PLMS)
• restless legs syndrome (RLS)

References

1. Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 1038-40
2. Harrison's Principles of Internal Medicine, 13th ed. Companion Handbook, Isselbacher et al (eds), McGraw-Hill Inc. NY, 1995, pg 829-39
3. Medical Knowledge Self Assessment Program (MKSAP) 11, American College of Physicians, Philadelphia 1998
4. Alessi C In: Intensive Course in Geriatric Medicine & Board Review, Marina Del Ray, CA, Sept 29-Oct 2, 2004
5. Freedman RR, Roehrs TA. Sleep disturbance in menopause. Menopause. 2007 Sep-Oct;14(5):826-9. PMID: [1]
6. Lacy BE et al. Functional dyspepsia is associated with sleep disorders. Clin Gastroenterol Hepatol 2011 May; 9:410. PMID: [2]
7. Sleep Disorders: NIH Institute & Center Resources [3]
   - The Treatment of Sleep Disorders of Older People. NIH Consensus Statement Online 1990 Mar 26-28;8(3):1-22 [4]
   - Facts About Problem Sleepiness [5]
8. National Guideline Clearinghouse Sleep disorders. ngc-guideline: [6]
   - Practice parameters for the clinical evaluation and treatment of circadian rhythm sleep disorders. American Academy of Sleep Medicine ngc-guideline: [7]
   - Report of an EFNS task force on management of sleep disorders in neurologic disease (degenerative neurologic disorders and stroke). ngc-guideline: [8]

sleep disorder