Key concepts

O Insomnia is most frequently a symptom or manifestation of an underlying disorder (comorbid insomnia) but may occur in the absence of contributing factors (primary insomnia). Early treatment of insomnia may prevent the development of persistent psychophysiologic insomnia.

Patients with sleep complaints should have a careful sleep history performed to assess for possible sleep disorders and to guide diagnostic and therapeutic decisions.

Although clinical history guides diagnosis and therapy, only overnight polysomnography and multiple sleep latency tests (MSLTs) can definitively diagnose and/ or guide therapy for obstructive sleep apnea (OSA), narcolepsy, and periodic limb movements of sleep.

^^ Treatment goals vary between different sleep disorders but generally include restoration of normal sleep patterns, elimination of daytime sequelae, improvement in quality of life, and prevention of complications and adverse effects from therapy.

© Benzodiazepine receptor agonists, including traditional benzodiazepines, Zolpidem, zaleplon, and eszopiclone, are approved by the FDA for the treatment of insomnia and are first-line therapies.

© Treatment of excessive daytime sleepiness in narcolepsy and other sleep disorders may require the use of sustained- and immediate-release stimulants to effectively promote wakefulness throughout the day and at key times that require alertness.

Restless-legs syndrome (RLS) treatment involves suppression of abnormal sensations and leg movements, and consolidation of sleep. Dopaminergic and sedative-hypnotic medications are commonly prescribed.

© The primary therapy for OSA is nasal continuous positive airway pressure (CPAP) therapy because of its effectiveness.

© It is important to review patient medication profiles for drugs that may aggravate sleep disorders. Patients should be monitored for adverse drug reactions, potential drug-drug interactions, and adherence to their therapeutic regimens.

Normal humans sleep up to one-third of their lives and spend more time sleeping compared with any other single activity. Despite this, our understanding of the full purpose of sleep and the mechanisms regulating sleep homeostasis remains incomplete. Sleep is necessary to maintain wakefulness, health, and welfare. Unfortunately, disruption of normal sleep is prevalent and represents a major cause of societal morbidity, lost productivity, and reduced quality of life.1 The link between adequate sleep and optim al health is becoming increasingly apparent, and sleep disturbances may contribute to the development and progression of comorbid medical conditions.

Sleep is governed and paced by the suprachiasmic nucleus in the brain that regulates circadian rhythm. Environmental cues and amount of previous sleep also influence sleep on a daily basis. There are two main types of sleep: rapid-eye-movement (REM) sleep, where eye movements and dreaming occur but the body is mostly paralyzed, and non-REM sleep, which consists of four substages (stages 1-4). Stage 1 serves as a transition between wake and sleep. Most of the time asleep is spent in stage 2 non-REM sleep. Stage 3 and stage 4 sleep often are grouped together and referred to as deep sleep, or delta sleep, because prominent delta waves are seen on the electroencephalogram (EEG) during these sleep stages.

Anxiety and Depression 101

Anxiety and Depression 101

Everything you ever wanted to know about. We have been discussing depression and anxiety and how different information that is out on the market only seems to target one particular cure for these two common conditions that seem to walk hand in hand.

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