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LEARNING OBJECTIVES

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LEARNING OBJECTIVES

Upon completion of the chapter, the reader will be able to:

  1. List the sequelae of undiagnosed or untreated sleep disorders and appreciate the importance of successful treatment of sleep disorders.

  2. Articulate the incidence and prevalence of sleep disorders.

  3. Describe the pathophysiology and characteristic features of the sleep disorders covered in this chapter, including insomnia, narcolepsy, restless legs syndrome (RLS), obstructive sleep apnea (OSA), and parasomnias.

  4. Assess patient sleep complaints, conduct sleep histories, and evaluate sleep studies to recognize daytime and nighttime symptoms and characteristics of common sleep disorders.

  5. Recommend and optimize appropriate sleep hygiene and nonpharmacologic therapies for the management and prevention of sleep disorders.

  6. Recommend and optimize appropriate pharmacotherapy for sleep disorders.

  7. Describe the components of a monitoring plan to assess safety and efficacy of pharmacotherapy for common sleep disorders.

  8. Educate patients about preventive behavior, appropriate lifestyle modifications, and drug therapy required for effective treatment and control of sleep disorders.

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KEY CONCEPTS

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  • Image not available. Insomnia is most frequently a symptom or manifestation of an underlying disorder (comorbid or secondary insomnia) but may occur in the absence of contributing factors (primary insomnia).

  • Image not available. Patients with sleep complaints should have a careful sleep history performed to assess for possible sleep disorders and to guide diagnostic and therapeutic decisions.

  • Image not available. Although the clinical history guides diagnosis and therapy, only overnight polysomnography and multiple sleep latency tests (MSLTs) can definitively diagnose and/or guide therapy for OSA, narcolepsy, and periodic limb movements of sleep (PLMS).

  • Image not available. Treatment goals vary among 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.

  • Image not available. Early treatment of insomnia may prevent the development of persistent psychophysiologic insomnia.

  • Image not available. Benzodiazepine receptor agonists (including traditional benzodiazepines, zolpidem, zaleplon, and eszopiclone) and ramelteon are approved by the Food and Drug Administration for the treatment of insomnia and are first-line therapies.

  • Image not available. 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.

  • Image not available. RLS treatment involves suppression of abnormal sensations and leg movements and consolidation of sleep. Dopaminergic and sedative–hypnotic medications are commonly prescribed.

  • Image not available. The primary therapy for OSA is nasal continuous positive airway pressure therapy because of its effectiveness.

  • Image not available. 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.

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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, ...

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