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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. State 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 the patient care process to implement and 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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INTRODUCTION

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Individuals with normal sleep patterns sleep up to one-third of their lives and spend more time sleeping than in 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 enable one to maintain wakefulness and good health. Disruption of normal sleep is a major cause of societal morbidity, lost productivity, and reduced quality of life.1 Sleep disturbances may contribute to the development and progression of comorbid medical conditions.1

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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, during which eye movements and dreaming occur but the body is mostly paralyzed, and non–rapid eye movement (NREM) 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 NREM sleep. Stages 3 and 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.

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EPIDEMIOLOGY AND ETIOLOGY

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Approximately 50% of adults will report a sleep complaint over the course of their lives.2 In general, sleep disturbances increase with age, and each disorder may have gender differences. The full extent and impact of disordered sleep on our society are not known because many patients’ sleep disorders remain undiagnosed. Normal sleep, by definition, is “a reversible behavioral state of perceptual disengagement from and unresponsiveness to the environment.”3 Individuals with sleep disorders exhibit or complain about consequent symptoms (eg, daytime sleepiness) or a bed partner often observes hallmark characteristics of the sleep disorder. Insomnia, RLS, and sleep-related breathing disorders are ...

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