Assessing and Treating Patients with Sleep/Wake Disorders
Sleep/wake disorders are a group of conditions that affect the quality, timing, and duration of sleep. They can have significant impacts on the physical, mental, and emotional health of patients, as well as their social and occupational functioning. Some of the common sleep/wake disorders include insomnia, obstructive sleep apnea, narcolepsy, restless legs syndrome, circadian rhythm disorders, and parasomnias.
The assessment and treatment of sleep/wake disorders require a multidisciplinary approach that involves medical, psychological, and behavioral interventions. The first step is to conduct a comprehensive evaluation of the patient’s sleep history, symptoms, risk factors, comorbidities, and preferences. This may include the use of standardized questionnaires, sleep diaries, actigraphy, polysomnography, or other objective measures of sleep quality and quantity. The diagnosis of sleep/wake disorders is based on the criteria of the International Classification of Sleep Disorders (ICSD-3).
The treatment of sleep/wake disorders depends on the specific diagnosis, the severity of the condition, and the patient’s goals and expectations. The main modalities of treatment include pharmacological agents, cognitive-behavioral therapy (CBT), stimulus control, sleep hygiene, relaxation techniques, bright light therapy, chronotherapy, or positive airway pressure (PAP) devices. The choice of treatment should be individualized and tailored to the patient’s needs and preferences. The efficacy and safety of the treatment should be monitored and evaluated regularly. The treatment may also require collaboration with other health professionals, such as primary care physicians, psychiatrists, psychologists, neurologists, pulmonologists, dentists, or otolaryngologists.
Sleep/wake disorders are prevalent and often underdiagnosed and undertreated. They can cause significant impairment in the quality of life and well-being of patients. Therefore, it is essential to identify and address these conditions in a timely and effective manner. By applying a multidisciplinary approach that combines medical, psychological, and behavioral interventions, clinicians can help patients achieve optimal sleep quality and quantity, and improve their overall health outcomes.
References:
– American Academy of Sleep Medicine. (2014). International classification of sleep disorders (3rd ed.). Darien: American Academy of Sleep Medicine.
– Edinger JD & Means MK (2005). Cognitive-behavioral therapy for primary insomnia. Clinical Psychology Review 25(5): 539–558.
– Kryger MH et al. (eds.) (2017). Principles and practice of sleep medicine (6th ed.). Philadelphia: Elsevier.
– Morin CM et al. (2006). Psychological and behavioral treatment of insomnia: update of the recent evidence (1998–2004). Sleep 29(11): 1398–1414.
– Patel SR & Hu FB (2008). Short sleep duration and weight gain: a systematic review. Obesity 16(3): 643–653.
– Weaver TE & Grunstein RR (2008). Adherence to continuous positive airway pressure therapy: the challenge to effective treatment. Proceedings of the American Thoracic Society 5(2): 173–178.
