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A sleep disorder (somnipathy) is a medical disorder of the sleep patterns of a person or animal. Some sleep disorders are serious enough to interfere with normal physical, mental and emotional functioning. A test commonly ordered for some sleep disorders is the polysomnogram.

Common sleep disorders

The most common sleep disorders include:

Broad classifications of sleep disorders

  • Sleeping sickness - a parasitic disease which can be transmitted by the Tsetse fly
  • Snoring - Not a disorder in and of itself, but it can be a symptom of deeper problems.

Common causes of sleep disorders

Changes in life style, such as shift work change (SWC), can contribute to sleep disorders.

Other problems that can affect sleep:

A sleep diary can be used to help diagnose, and measure improvements in, sleep disorders. The Epworth Sleepiness Scale and the Morningness-Eveningness Questionnaire.[1]

According to Dr. William Dement, of the Stanford Sleep Center, anyone who snores and has daytime drowsiness should be evaluated for sleep disorders.

Any time back pain or another form of chronic pain is present, both the pain and the sleep problems should be treated simultaneously, as pain can lead to sleep problems and vice versa.

General principles of treatment

Treatments for sleep disorders generally can be grouped into four categories:

  • behavioral/ psychotherapeutic treatments
  • rehabilitation/management
  • medications
  • other somatic treatments

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.

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.

Blood pressure and short sleep

People who sleep less than 5 hours a night are 5 times more likely to have high blood pressure than people who sleep well, according to researchers from Penn State College of Medicine, Pennsylvania in June 2008. Researchers studied 1,741 people and the link between sleep problems and high blood pressure, and found that those people at the highest risk of hypertension had a low number of hours slept and insomnia.[2]

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.

Sleep Medicine is now a recognized subspecialty within internal medicine, family medicine, pediatrics, otolaryngology, psychiatry and neurology in the United States. Certification in Sleep Medicine shows that the specialist:

"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]

Competence in sleep medicine requires an understanding of a plethora of very diverse disorders, many of which present with similar symptoms such as excessive daytime sleepiness, which, in the absence of volitional sleep deprivation, "is almost inevitably caused by an identifiable and treatable sleep disorder", such as sleep apnea, narcolepsy, idiopathic central nervous system (CNS) hypersomnia, Kleine-Levin syndrome, menstrual-related hypersomnia, idiopathic recurrent stupor, or circadian rhythm disturbances.[4] Another common complaint is insomnia, a set of symptoms which can have a great many different causes, physical and mental. Management in the varying situations differs greatly and cannot be undertaken without a correct diagnosis.

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. 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 apnoea syndrome (OSA) and very few other disorders, specifically not including insomnia.

See also

External links

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  1. Horne J A (Jim), Ostberg O (Olov Östberg) (1976). A self-assessment questionnaire to determine morningness-eveningness in human circadian rhythms. International journal of chronobiology 4 (2): 97–110.
  2. Lack of sleep increases blood pressure.
  3. American Board of Medical Specialties : Recognized Physician Specialty and Subspecialty Certificates. URL accessed on 2008-07-21.
  4. Mahowald, M.W. (March 2000). What is causing excessive daytime sleepiness?: evaluation to distinguish sleep deprivation from sleep disorders. Postgraduate Medicine 107 (3): 108–23.
  5. (2008). About AADSM. Academy of Dental Sleep Medicine. URL accessed on 2008-07-22.
  6. About the ADBSM. American Board of Dental Sleep Medicine. URL accessed on 2008-07-22.
  7. includeonly>Wollenberg, Anne. "Time to wake up to sleep disorders", Guardian News and Media Limited, July 28 2008. Retrieved on 2008-08-03.
  8. (2008). Sleep services. Imperial College Healthcare NHS Trust. URL accessed on 2008-08-02.