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Sleep disorder
Classification and external resources
ICD-10 F51., G47.
ICD-9 307.4, 327, 780.5
DiseasesDB 26877
eMedicine med/609
MeSH D012893

A sleep disorder (somnipathy) is a medical disorder of the sleep patterns of a person or animal. Some sleep disorders are serious enough to interfere with normal physical, mental and emotional functioning. A test commonly ordered for some sleep disorders is the polysomnogram.

Contents

Common sleep disorders

The most common sleep disorders include:

Broad classifications of sleep disorders

General principles of treatment

Treatments for sleep disorders generally can be grouped into four categories:

  • behavioral/ psychotherapeutic treatments
  • rehabilitation/management
  • medications
  • other somatic treatments

None of these general approaches is sufficient for all patients with sleep disorders. Rather, the choice of a specific treatment depends on the patient's diagnosis, medical and psychiatric history, and preferences, as well as the expertise of the treating clinician. Often, behavioral/psychotherapeutic and pharmacological approaches are not incompatible and can effectively be combined to maximize therapeutic benefits. Management of sleep disturbances that are secondary to mental, medical, or substance abuse disorders should focus on the underlying conditions.

Medications and somatic treatments may provide the most rapid symptomatic relief from some sleep disturbances. Some disorders, such as narcolepsy, are best treated pharmacologically. Others, such as chronic and primary insomnia, may be more amenable to behavioral interventions, with more durable results.

Chronic sleep disorders in childhood, which affect some 70% of children with developmental or psychological disorders, are under-reported and under-treated. Sleep-phase disruption is also common among adolescents, whose school schedules are often incompatible with their natural circadian rhythm. Effective treatment begins with careful diagnosis using sleep diaries and perhaps sleep studies. Modifications in sleep hygiene may resolve the problem, but medical treatment is often warranted. [2]

Special equipment may be required for treatment of several disorders such as obstructive apnea, the circadian rhythm disorders and bruxism. In these cases, when severe, an acceptance of living with the disorder, however well managed, is often necessary.

Sleep medicine

Due to rapidly increasing knowledge about sleep in the 20th century, including the discovery of REM sleep and sleep apnea, the medical importance of sleep was recognized. The medical community began paying more attention than previously to primary sleep disorders, such as sleep apnea, as well as the role and quality of sleep in other conditions. By the 1970s in the USA, clinics and laboratories devoted to the study of sleep and sleep disorders had been founded, and a need for standards arose.

Pediatric polysomnography

Sleep Medicine is now a recognized subspecialty within internal medicine, family medicine, pediatrics, otolaryngology, psychiatry and neurology in the United States. Certification in Sleep Medicine shows that the specialist:

"has demonstrated expertise in the diagnosis and management of clinical conditions that occur during sleep, that disturb sleep, or that are affected by disturbances in the wake-sleep cycle. This specialist is skilled in the analysis and interpretation of comprehensive polysomnography, and well-versed in emerging research and management of a sleep laboratory."[3]

Competence in sleep medicine requires an understanding of a myriad of very diverse disorders, many of which present with similar symptoms such as excessive daytime sleepiness, which, in the absence of volitional sleep deprivation, "is almost inevitably caused by an identifiable and treatable sleep disorder", such as sleep apnea, narcolepsy, idiopathic central nervous system (CNS) hypersomnia, Kleine-Levin syndrome, menstrual-related hypersomnia, idiopathic recurrent stupor, or circadian rhythm disturbances.[4] Another common complaint is insomnia, a set of symptoms which can have a great many different causes, physical and mental. Management in the varying situations differs greatly and cannot be undertaken without a correct diagnosis.

Sleep dentistry (bruxism, snoring and sleep apnea), while not recognized as one of the nine dental specialties, qualifies for board-certification by the American Board of Dental Sleep Medicine (ABDSM). The resulting Diplomate status is recognized by the American Academy of Sleep Medicine (AASM), and these dentists are organized in the Academy of Dental Sleep Medicine (USA).[5] The qualified dentists collaborate with sleep physicians at accredited sleep centers and can provide oral appliance therapy and upper airway surgery to treat or manage sleep-related breathing disorders.[6]

In the UK, knowledge of sleep medicine and possibilities for diagnosis and treatment seem to lag. Guardian.co.uk quotes the director of the Imperial College Healthcare Sleep Centre: "One problem is that there has been relatively little training in sleep medicine in this country – certainly there is no structured training for sleep physicians."[7] The Imperial College Healthcare site[8] shows attention to obstructive sleep apnea syndrome (OSA) and very few other sleep disorders.

See also

http://www.youtube.com/watch?v=zhBHdfaeoGw

References

  1. ^ www.sleepfoundation.org
  2. ^ Ivanenko A and Massey C (October 1, 2006). "Assessment and Management of Sleep Disorders in Children". Psychiatric Times 23 (11). http://www.psychiatrictimes.com/sleep-disorders/article/10168/52051. 
  3. ^ "American Board of Medical Specialties : Recognized Physician Specialty and Subspecialty Certificates". http://www.abms.org/Who_We_Help/Physicians/specialties.aspx. Retrieved 2008-07-21. 
  4. ^ Mahowald, M.W. (March 2000). "What is causing excessive daytime sleepiness?: evaluation to distinguish sleep deprivation from sleep disorders" (Online, full text). Postgraduate Medicine 107 (3): 108–23. doi:10.3810/pgm.2000.03.932. http://www.postgradmed.com/issues/2000/03_00/mahowald.shtml. Retrieved 2008-07-27. 
  5. ^ "About AADSM". Academy of Dental Sleep Medicine. 2008. http://aadsm.org/. Retrieved 2008-07-22. 
  6. ^ "About the ADBSM". American Board of Dental Sleep Medicine. http://www.abdsm.org/. Retrieved 2008-07-22. 
  7. ^ Wollenberg, Anne (July 28 2008). "Time to wake up to sleep disorders". Guardian News and Media Limited. http://www.guardian.co.uk/commentisfree/2008/jul/28/health. Retrieved 2008-08-03. 
  8. ^ "Sleep services". Imperial College Healthcare NHS Trust. 2008. http://www.imperial.nhs.uk/services/sleepservices/index.htm. Retrieved 2008-08-02. 

External links

  • Sleep Problems - information leaflet from mental health charity The Royal College of Psychiatrists
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Simple English

A sleep disorder is a problem that stops people from sleeping normally. There are many sleep disorders, and some of them are very serious. A test commonly ordered for some sleep disorders is the polysomnogram.

Contents

Types of sleep disorders

Sleep disorders can be put into groups. These groups include:

  • Dysomnia - these are sleep disorders which cause too much or too little sleep. Some of these are caused within the body while some are externally caused. For example, insomnia and narcolepsy are two of the dysomnias.
  • Circadian rhythm sleep disorders - these cause sleeping at unusual times: too early, too late or not often. People with these disorders can usually get enough sleep, just at the "wrong" time of day. These disorders are sometimes included among the dysomnias. MeSH
  • Parasomnias - these are doing things not normally done while sleeping, without the person being aware of what they are doing. They include walking, eating, dressing, bedwetting and other events.
  • Medical or psychiatric disorders - these problems may also cause trouble sleeping. People with depression or alcoholism may sleep poorly.

(Sleeping sickness, a disease carried by the Tsetse fly, is not classified as a sleep disorder.)

Common sleep disorders

The most common sleep disorders include:

  • Bruxism: grinding or clenching the teeth while sleeping
  • Delayed sleep phase syndrome/disorder (DSPS): a circadian rhythm sleep disorder (see above): waking up and falling asleep much later than normal, but with no problem staying asleep
  • Hatzfeldt Syndrome, or Systemic Neuro-Epiphysial Disorder (SNED): an irregular sleep pattern, as well as irregular behavior
  • Hypopnea syndrome: abnormally shallow or slow breathing while sleeping
  • Narcolepsy: falling asleep spontaneously and unwillingly at the wrong times
  • Night terror disorder: sudden awakening from sleep showing fear or terror
  • Parasomnias, see above
  • Periodic limb movement disorder (PLMD): Sudden uncontrolled movement of arms and/or legs during sleep, for example kicking the legs. (Can seem like hypnic jerk, but hypnic jerk is not a disorder.)
  • Primary insomnia, inability to get to sleep or stay asleep, not caused by any other disorder
  • Rapid eye movement behavior disorder (RBD): acting out violent or dramatic dreams while in "rapid eye movement" (REM) sleep, also called dream sleep
  • Restless legs syndrome (RLS): urge or need to move legs. People with RLS often also have PLMD.
  • Shift work sleep disorder (SWSD)
  • Sleep apnea (obstructive type): often waking suddenly when breathing stops, and usually loud snoring
  • Sleep paralysis: temporary paralysis of the body shortly before or after sleep. Sleep paralysis may be accompanied by hallucinations of sight, hearing or touch. It is quite common.
  • Sleepwalking: one of the parasomnias, see above

Common causes of sleep disorders

Changes in life style, such as shift work change or travelling over several time zones, can cause sleep disorders. Some other problems that can cause sleeping problems include:

Treatment

A sleep diary or log can be used to help diagnose (define) the problem. It can also be used to measure improvements.

According to Dr. William Dement of the Stanford Sleep Center, anyone who snores and is sleepy in the daytime should see a doctor about sleep disorders.[needs proof]

In case of chronic pain, both the pain and the sleep problems should be treated. Pain can lead to sleep problems and vice versa.

The choice of a treatment for a sleep disorder depends on the patient's diagnosis, his/her medical and psychiatric history, and how she or he prefers to be treated. Medications sometimes work fast. On the other hand, sometimes behavioral treatment of insomnia may give more lasting results.


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