Narcolepsy, a chronic disorder that
usually begins during adolescence, is characterized by
excessive sleepiness, daytime sleep episodes, cataplexy,
and abnormalities of REM sleep. It has prevalence of
about 1 in 3000, and affects men and women equally.
Chronic sleepiness often leads to impaired work
performance, psychosocial problems, and increases the
risk of accidents. Treatment with stimulant medication
for sleepiness and tricyclic antidepressants for
cataplexy leads to substantial improvement in symptoms
for most patients.
Periodic Limb Movements in Sleep:
Parkinsonism and Sleep
Christopher F. O’Brien, MD
Involuntary jerking or kicking of
the arms or legs during sleep signal a variety of
underlying medical conditions. Periodic Limb Movements of
Sleep are evident on the polysomnographic record.
Treatment of PLMS may significantly improve patient
quality of life.
Restless Legs Syndrome
Lauren C. Seeberger, MD
Restless Legs Syndrome (RLS) can be
very difficult to recognize and diagnose. Patients who
suffer from this malady describe an intense,
uncomfortable sensation in the legs accompanied by an
irresistible need to move the legs, thus temporarily
relieving their distress. This article focuses on
diagnoses, symptoms, pathophysiology, and treatment of RLS.
Parasomnias
Kirsten Bracht, MD
Parasomnias are a group of disorders
which take place around sleep. They may occur with
arousal, partial arousal, or sleep transition. Most
parasomnias are a manifestation of central nervous system
activations, and as a result they are expressed primarily
through motor or autonomic arousal.
Clinical Management of Adult Insomnia
Jay Schneiders, PhD
An approach to psychophysiological
insomnia for the clinician is described with suggestions
for diagnosing and treating sleep complaints with greater
sophistication and precision. The epidemiology of
insomnia and the role of comorbid
psychological/psychiatric conditions are discussed.
Finally, guidelines for appropriate referral of insomnia
patients to sleep centers are presented in the context of
a description of specialized behavioral treatments
offered in such settings.
Pharmacotherapy of Insomnia
Ronald E. Kramer, MD
The key issue in treating insomnia
is to diagnose the specific medical condition or
underlying issue that is creating the symptom of
insomnia. Indiscriminate use of the classic sleeping
pills is to be avoided. In this article we will discuss
the use of the newer sleep promoting agents.
Controversies regarding chronic use will also be
discussed. Recent insights into the use of melatonin and
antidepressants as treatment for chronic insomnia is
highlighted. As with any pharmacotherapeutic agent,
patient selection and close follow-up is needed when
prescribing these agents.
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