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Review
. 2019 Oct 11;116(41):681-688.
doi: 10.3238/arztebl.2019.0681.

Sleep-Related Disorders in Neurology and Psychiatry

Affiliations
Review

Sleep-Related Disorders in Neurology and Psychiatry

Jan Rémi et al. Dtsch Arztebl Int. .

Abstract

Background: Sleep-related disorders are a group of illnesses with marked effects on patients' quality of life and functional ability. Their diagnosis and treatment is a matter of common interest to multiple medical disciplines.

Methods: This review is based on relevant publications retrieved by a selective search in PubMed (Medline) and on the guide- lines of the German Society for Sleep Medicine, the German Neurological Society, and the German Association for Psychiatry, Psychotherapy and Psychosomatics.

Results: A pragmatic classification of sleep disorders by their three chief complaints-insomnia, daytime somnolence, and sleep-associated motor phenomena-enables tentative diagnoses that are often highly accurate. Some of these disorders can be treated by primary care physicians, while others call for referral to a neurologist or psychiatrist with special experience in sleep medicine. For patients suffering from insomnia as a primary sleep disorder, rather than a symptom of another disease, meta-analyses have shown the efficacy of cognitive behavioral therapy, with high average effect sizes. These patients, like those suffering from secondary sleep disorders, can also benefit from drug treatment for a limited time. Studies have shown marked improvement of sleep latency and sleep duration from short-term treatment with benzodiazepines and Z-drugs (non- benzodiazepine agonists such as zolpidem and zopiclone), but not without a risk of tolerance and dependence. For sleep disorders with the other two main manifestations, specific drug therapy has been found to be beneficial.

Conclusion: Sleep disorders in neurology and psychiatry are a heterogeneous group of disorders with diverse manifestations. Their proper diagnosis and treatment can help prevent secondary diseases and the worsening of concomitant conditions. Care structures for the treatment of sleep disorders should be further developed.

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Figures

Figure 1
Figure 1
Actimetry of a shift worker over a 2-week period. Four days of morning shift are followed by three days off work and then five days of late shift, identified by the significantly higher level of activity (height of the black bars) on the way to work at the beginning and end of the working day. The sleep is disturbed by frequent awakenings, no consolidated circadian activity–rest rhythm can be identified.
Figure 2
Figure 2
Diagnostic flowchart for daytime sleepiness/daytime tiredness. The diagnoses are only examples, comorbid causes may be present. ASPS/DSPS, advanced/delayed sleep phase syndrome; DDx, differential diagnosis; MS, multiple sclerosis; Non24, non–24-hour sleep–wake disorder; PLMD, periodic leg movement disorder; RLS, restless legs syndrome; SRBD, sleep-related breathing disorders

Comment in

  • Unidentified Nocturnal Epileptic Seizures.
    Riemer G. Riemer G. Dtsch Arztebl Int. 2020 Feb 14;116(7):118. doi: 10.3238/arztebl.2020.0118a. Dtsch Arztebl Int. 2020. PMID: 32164827 Free PMC article. No abstract available.

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