Sleep medicine is a specialty or subspecialty devoted to the diagnosis and treatment of sleep disturbances and disorders. From the middle of the 20th century, research has provided increased knowledge about the circadian rhythm, and has answered many questions surrounding the impact of sleep, or lack of it.1
Sleep represents more than a third of life, however, the sustained rhythms of life imposed by society unsettle...
Sleep is an essential component of life, and the diseases that affect sleep (insomnia, narcolepsy, restless legs syndrome, sleep apnoea) have a significant impact on one’s health2, social life2, academic3 and professional life4. The prevalence of sleep disorders increases with age, and can have a significant impact on a person’s overall health.5
Some diseases exclusively related to sleep can cause insomnia:
- Restless legs syndrome is a condition which causes very unpleasant sensations in the legs that require one to stand and to move.6 It typically presents itself in the evening, causing disrupted sleep which in turn affects quality of life.6
- Sleep apnoea, characterised by abnormal pauses in breathing (ranging from seconds to minutes), indicates a struggle to breathe and result in disturbed and fragmented sleep.7
Other sleep disorders are often secondary to chronic diseases such as fibromyalgia8, Parkinson's disease9, Alzheimer’s disease10 and various types of cancer.11 All these disorders and sleep disturbances are common and can have significant consequences for affected individuals, as well as economic consequences for society (through absenteeism or accident).4 Sleep (or lack of it) is therefore a major public health issue.
1. Morgenthaler T. I. et al. Practice parameters for the clinical evaluation and treatment of circadian rhythm sleep disorders. Sleep. November 2007 ; 1 (30) : 1445-59.
2. Bixler E. Sleep and society: An epidemiological perspective. Sleep Medicine. September 2009 ; 10 (1) : S3-S6.
3. Curcio G. et al. Sleep loss, learning capacity and academic performance. Sleep Medicine Reviews. October 2006 ; 10 (5) : 323-337.
4. Léger D. Economical consequences from sleep disorders and its impact on the quality of life. Médecine du Sommeil. December 2008 ; 5 (18) : 19-23.
5. Phillips B. et al. Sleep disorders in the elderly. Sleep Medicine. March 2001 ; 2 (2) : 99-114.
6. Hening W. A. et al. Restless legs syndrome: A common disorder in patients with rheumatologic conditions. Seminars in Arthritis and Rheumatism. August 2008 ; 38 (1) : 55-62.
7. Banno K. et al. Sleep apnea: Clinical investigations in humans. Sleep Medicine. June 2007 ; 8 (4) : 400-426.
8. Russell I. J. et al. The effects of pregabalin on sleep disturbance symptoms among individuals with fibromyalgia syndrome. Sleep Medicine. June 2009 ; 10 (6) : 604-610.
9. Brotini S. et al. Epidemiology and clinical features of sleep disorders in extrapyramidal disease. Sleep Medicine. March 2004 ; 5 (2) : 169-179.
10. Moran M. et al. Sleep disturbance in mild to moderate Alzheimer's disease. Sleep Medicine. July 2005 ; 6 (4) : 347-352.
11. Benezech J-P. Sleep troubles and cancer. Médecine Palliative : Soins de Support - Accompagnement - Éthique. August 2010 ; 9 (4) : 184-190.
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Insomnia is a very common and debilitating disease with major morbidity and social consequences. Despite the negative impact on the ability to function well during the day, insomnia is underdiagnosed and undertreated. Insomnia is therefore, important to treat. However, treatment has been difficult due to concerns over current treatment options, both from a patient and physician perspective.
Traditionally insomnia has been diagnosed on the basis of quantity of sleep
- Sleep latency (time taken to get to sleep)
- Sleep duration (length of time spent asleep)
While it is important not to ignore quantity of sleep, epidemiological surveys show that poor quality of sleep has a greater negative impact on health, well-being and satisfaction with life than the quantity of sleep a person gets.1,2
Hormones released in the body are involved in certain aspects of homeostasis, including regulating the circadian rhythms established by the SCN of the hypothalamus. Melatonin is an endocrine hormone that is principally produced and released into the blood by the pineal gland. The levels of melatonin fluctuate according to light exposure (highest during darkness and sleep, and lowest in bright sunlight) and it is proposed that melatonin acts as a time ‘cue’, entraining the body’s circadian rhythm to conventional environmental patterns.
Although behavioural and psychological factors have been shown to play an important causative role in many sleep disorders, non-pharmacological /behavioural approaches are underused in the management of these conditions.3,4
A number of resources for both patients and physicians are avaliable within this Insomnia website.
1. Zammit GK, Weiner J, Damato N et al. Quality of life in people with insomnia. Sleep 1999; 22 Suppl 2: S379-85
2. Pilcher JJ. Sleep quality versus sleep quantity: relationships between sleep and measures of health, well-being and sleepiness in college students. J Psychosom Res. 1997; 42(6): 583-96
3. National Institute of Health. NIH State of the Science Conference statement on manifestations and management of chronic insomnia in adults statement. J Clin Sleep Med 2005; 1 (4): 412–421.
4. Subramanian S, Surani S. Sleep disorders in the elderly. Geriatrics 2007; 62 (12): 10–32.
The FDA has on 1 May 2013, approved the prescription medication Vyvanse (lisdexamfetamine dimesylate) Capsules, (CII) from Shire ,as a maintenance treatment in children and adolescents with Attention-Deficit/Hyperactivity Disorder (ADHD). Vyvanse is currently approved as a maintenance treatment in adults with ADHD. With this new approval, Vyvanse becomes the only stimulant approved for...
Vanda Pharmaceuticals Inc. has announced top-line results of the Phase IIb/III clinical study (MAGELLAN) in Major Depressive Disorder (MDD), investigating the efficacy and safety of tasimelteon as a monotherapy in the treatment of patients with MDD. The clinical study did not meet the primary endpoint of change from baseline in the Hamilton Depression Scale (HAMD-17) after 8 weeks of...
Vanda Pharmaceuticals has announced positive results from the SET (Safety and Efficacy of Tasimelteon) Phase III study, evaluating tasimelteon, a circadian regulator for the treatment of Non-24-Hour Disorder (Non-24). Tasimelteon succeeded in the primary endpoint of Entrainment of the melatonin (aMT6s) rhythm as compared to placebo. Additionally, tasimelteon demonstrated significant improvements...
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Circadin is indicated as monotherapy for the short-term treatment of primary insomnia characterised by poor quality of sleep in patients who are aged 55 or over....
An aid to the relief of temporary sleep disturbance....
The short-term treatment of insomnia in situations where the insomnia is debilitating or is causing severe distress for the patient....
In view of the high prevalence and the relevant impairment of patients with obstructive sleep apnoea..
The treatments used for narcolepsy, either pharmacological or behavioural, are diverse. However, the..
Obstructive Sleep Apneas in Elderly:Neuroimaging Changes and Neurocognitive Function Before and After Treatment22-03-2013
In the near future more than 20% of the European population will be over 65 years old and the prevalence of obstructive sleep apnea (OSA) in this aged population is known to be higher than 50%. OSA is a risk factor for cognitive dysfunction in middle-aged subjects, but the relationship between cognitive impairment and..
The present study aims to document and assess changes in single parameters of pulse wave analysis (ASI single parameters) as well as to evaluate ASI cardiovascular risk assessment before initiation of CPAP therapy and after 6 months of CPAP therapy in patients with obstructive sleep apnea.
Journal of Sleep Research
The aim of this work was to study the relationship between changes of body posture dominance and changes of body weight overtime in adults with obstructive sleep apnoea. The participants were 112 non-treated adults with obstructive sleep apnoea who underwent two polysomnographic evaluations at our Sleep Disorders Unit..
Short and long sleep duration are associated with prevalent cardiovascular disease in Australian adults
Journal of Sleep Research
A growing number of studies from a range of different countries have observed an association between sleep duration and cardiovascular disease. The objective of this paper was to examine the associations between sleep duration and prevalent cardiovascular disease in a large sample of Australian adults, and identify the..
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