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Common disorders
Classifications
Treatments for sleep disorders generally can be grouped into four categories:
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
Main article: 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.
"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]
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
• Auditory masking
• Chronotypes
• Environmental noise health effects
• International Classification of Sleep Disorders
• Reversed vegetative symptoms
• Sleep hygiene
• Sundowning (dementia)
• White noise machine
• Sleep medicine
• Polysomnography
• Polysomnographic technician
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
• Sleep Disorders ePatient website
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Pathology of the nervous system, primarily CNS (G04–G47, 323–349)
Multi-infarct dementia
Mitochondrial
Leigh's
disease
both: ALS