Sleep Medicine Topic Homepage
Sleep Medicine Overview
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...
... and affect sleep; through stress, jet-lag, and shift work.2
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
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.
Various methods are used to monitor the different stages of sleep. Sleep is not homogenous – its structure, characterised by a sequence of sleep stages, is referred to as ‘sleep architecture’
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.
Enter the Insomnia Knowledge Centre
References
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.
Clinical Case Studies
Guillain-Barré Syndrome
Respiratory Medicine & Allergy: Sleep apnoea/hypopnoea & respiratory failureNicholas Hopkinson, Consultant Respiratory Physician, Royal Brompton and Harefield NHS Foundation Trust, London, UK
Christopher Kosky, Consultant Respiratory Physicians, Guy's and St Thomas' NHS Foundation Trust, London, UK
Case History
A 34-year-old male civil servant presented to the emergency department with a three-day history of malaise and tingling in his hands and feet. He described weakness such that he was unable to get out of the bath unaided.
Obesity Hypoventilation Syndrome
Respiratory Medicine & Allergy: Sleep apnoea/hypopnoea & respiratory failureChristopher Kosky, Consultant Respiratory Physicians, Guy's and St Thomas' NHS Foundation Trust, London, UK
Boris Lams, Consultant Respiratory Physicians, Guy's and St Thomas' NHS Foundation Trust, London, UK
Case History
A 42-year-old man presents to your clinic because of paroxysmal nocturnal dyspnoea. For the last two years he wakes from sleep gasping for air.
Drug News
STAR study of Inspire UAS System (Inspire Medical Systems) shows benefits for Obstructive Sleep Apnea
09-06-2013Electronic stimulation therapy to reduce Obstructive Sleep Apnea (OSA) is safe and effective, according to results from the STAR Trial which evaluated the Inspire Upper Airway Stimulation System,...
Phase III studies of VEC 162 (Vanda Pharmaceuticals) meet primary endpoint for Non-24 Hour Disorder
07-06-2013Data from SET and RESET Phase III studies of VEC 162 (tasimelteon), from Vanda Pharmaceuticals, for the treatment of Non-24-Hour Disorder (Non-24) in totally blind individuals shows it achieved the...
Vanda Pharma files VEC 162 at FDA for treatment of Non 24 Hour Disorder
02-06-2013
Vanda Pharmaceuticals Inc. has announced the submission of a New Drug Application (NDA) to the FDA for VEC 162 (tasimelteon), a circadian regulator. Vanda is seeking FDA approval of tasimelteon...
Sleep Medicine Drug Data - A-Z
Possible searches include drugs or medicines (by brand, generic ingredient or drug class), diseases, conditions and more.
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Recent Drug Updates
CIRCADIN Prolonged-release Tablets
30-05-2013Circadin 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....
Nytol Original 25mg Tablets
20-03-2013An aid to the relief of temporary sleep disturbance....
Stilnoct 5mg Tablets
20-03-2013The short-term treatment of insomnia in situations where the insomnia is debilitating or is causing severe distress for the patient....
Clinical Guidelines
Non-continuous positive airway pressure (CPAP) therapies in obstructive sleep apnoea
May 2011In view of the high prevalence and the relevant impairment of patients with obstructive sleep apnoea..
... syndrome (OSAS) lots of methods are offered which promise definitive cures for or relevant improvement of OSAS.
This report summarises the efficacy of alternative treatment options in OSAS.
An interdisciplinary European Respiratory Society task force evaluated the scientific literature according to the standards of evidence-based medicine.
Management of narcolepsy in adults
Jan 2011The treatments used for narcolepsy, either pharmacological or behavioural, are diverse. However, the..
... quality of the published pieces of clinical evidence supporting them varies widely, and studies comparing the efficacy of different substances are lacking.
Clinical Trials
Obstructive Sleep Apneas in Elderly:Neuroimaging Changes and Neurocognitive Function Before and After Treatment
22-03-2013In 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..
... sleep breathing disorders (SBD) in the elderly has scarcely been observed.
The aim of this study is to investigate cognitive performance in elderly OSA patients, the corresponding brain morphology changes and biological markers and their reversibility with continuous positive airway pressure (CPAP) treatment.
Impact of CPAP Therapy in Obstructive Sleep Apnea on Parameters of Nocturnal Pulse Wave Analysis
11-03-2013The 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.
Medical Videos
Medical Journal Abstracts
Variance of melatonin and cortisol rhythm in patients with allergic rhinitis
American Journal of Otolaryngology
May 2013
Objectve: Allergic rhinitis is an IgE-mediated inflammatory disease which effects 10%–50% of the normal population. The mechanism of its formation and the circadian rhythm of cortisol and melatonin in allergic rhinitis have not been investigated. Study design: Salivary levels of melatonin and cortisol were measured by..
Obstructive sleep apnoea in adults: body postures and weight changes interactions
Journal of Sleep Research
Dec 2011
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..
Medical Apps
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Social Media
Medical myths in your specialty
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How many lives do you save a year?
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How many lives do you save a year?
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