Abnormal Sleep and Sleep Disorders

Abstract

Abstract Sleep disorders are a common source of major morbidity and impaired quality of life, with sleep-disordered breathing a risk to cardiovascular and brain health. Sleep disorders include insomnia (difficulty initiating and maintaining sleep with poor sleep quality), sleep-related breathing disorders, central disorders of hypersomnolence, circadian rhythm sleep-wake disorders, parasomnias, and sleep-related movement disorders. Evaluation should first include an appropriately tailored history and examination, aided by evaluation with extensions of the clinical method, including polysomnography or home sleep apnea testing, multiple sleep latency testing, and actigraphy monitoring, when appropriate. Therapy is tailored toward the specific sleep disorder(s). Insomnia is most often treated with cognitive behavioral therapy. Obstructive sleep apnea may be effectively treated with positive airway pressure therapy or other alternatives, while narcolepsy and the central disorders of hypersomnolence most often require stimulant and wake-promoting pharmacotherapies. Circadian rhythm sleep-wake disorders are addressed by counseling with appropriately timed bright light, light restriction, and melatonin therapies. The sleep-related movement disorder of restless legs syndrome should be investigated for iron deficiency with iron replacement therapy offered as a first-line therapeutic measure if appropriate and consideration of alpha-2 delta ligand calcium channel blockers, dopaminergic agonists, or opioids if necessary for symptomatic treatments. Timely diagnosis and treatment of sleep disorders benefits patients greatly and improves their functioning, health, and quality of life.