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Chapter 19. Sleep-Wake Disorders

Martin Reite, M.D.; Michael Weissberg, M.D.
DOI: 10.1176/appi.books.9781585625031.641313

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Excerpt

In this chapter we review the current status of diagnosis and treatment of sleep-wake disorders for our target audience: clinicians in general psychiatric practice who are not specifically trained in sleep disorders medicine but who will nonetheless encounter sleep complaints in many (if not most) of their patients. We cannot be comprehensive in our coverage of sleep disorders: the current second edition of the International Classification of Sleep Disorders (American Academy of Sleep Medicine 2005), considered by many to be the definitive classification for sleep disorders, lists over 80 specific diagnoses in eight general categories. Instead, our intention is to provide sufficient information and guidelines so that the clinician is unlikely to miss major sleep disorders and their detrimental consequences.

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Relationship between various hormones and the sleep-wake cycle.The time scale of the x axis encompasses a 24-hour period from noon to noon, with the sleep period represented by the dark (night) section in the middle. Plasma cortisol secretion begins to increase before morning awakening and peaks in the early morning. Growth hormone secretion (which occurs during Stage III–IV [N3] sleep) peaks early in the night. Melatonin is secreted after dark and is suppressed by light. Body temperature peaks in the late afternoon to early evening and starts to decrease before sleep onset.Source. Reprinted from Reite M, Weissberg M, Ruddy J: Clinical Manual for the Evaluation and Treatment of Sleep Disorders. Washington, DC, American Psychiatric Publishing, 2009 (Figure 2–10, p. 39). Used with permission.

Insomnia road map: a guide to evaluation and treatment.Note.  More than one problem may impact sleep; for example, the patient may be a night owl with obstructive sleep apnea who develops hyperaroused/psychophysiological insomnia and struggles with bipolar depression. When identified, all problems are amenable to treatment. CBT = cognitive-behavioral therapy; OSA = obstructive sleep apnea; RLS = restless legs syndrome.
Anchor for Jump
Overview of circadian rhythm sleep-wake disorders
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Electroencephalographic sleep stages and their physiological correlates
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Commonly prescribed hypnotic medications
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Causes of excessive daytime sleepiness (EDS) and fatigue
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Behavioral symptoms of sleepiness
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Epworth Sleepiness Scale
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Disorders that may coexist with insomnia
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Sleep restriction and stimulus control
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Safety precautions for sleepwalkers

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