-
Annals of Internal Medicine Mar 2021Insomnia-the unwelcome experience of difficulty sleeping-is common and can be acute, intermittent, or chronic. Insomnia can be the presenting symptom for several common... (Review)
Review
Insomnia-the unwelcome experience of difficulty sleeping-is common and can be acute, intermittent, or chronic. Insomnia can be the presenting symptom for several common sleep disorders, but it also often occurs comorbidly with mental and physical health conditions. Evaluating the symptom of insomnia requires assessing-largely by history-whether an underlying condition explains it. is the diagnostic term for the symptom of insomnia that merits specific attention. Cognitive behavioral therapy for insomnia is the preferred treatment approach because of its efficacy, safety, and durability of benefit, but pharmaceutical treatments are widely used for insomnia symptoms.
Topics: Humans; Hypnotics and Sedatives; Risk Factors; Sleep Initiation and Maintenance Disorders
PubMed: 33683929
DOI: 10.7326/AITC202103160 -
The American Journal of Medicine Mar 2019Sleep disorders are frequent and can have serious consequences on patients' health and quality of life. While some sleep disorders are more challenging to treat, most... (Review)
Review
Sleep disorders are frequent and can have serious consequences on patients' health and quality of life. While some sleep disorders are more challenging to treat, most can be easily managed with adequate interventions. We review the main diagnostic features of 6 major sleep disorders (insomnia, circadian rhythm disorders, sleep-disordered breathing, hypersomnia/narcolepsy, parasomnias, and restless legs syndrome/periodic limb movement disorder) to aid medical practitioners in screening and treating sleep disorders as part of clinical practice.
Topics: Central Nervous System Depressants; Central Nervous System Stimulants; Chronobiology Disorders; Cognitive Behavioral Therapy; Continuous Positive Airway Pressure; Disorders of Excessive Somnolence; Humans; Mass Screening; Melatonin; Narcolepsy; Nocturnal Myoclonus Syndrome; Parasomnias; Phototherapy; Polysomnography; Restless Legs Syndrome; Sleep Aids, Pharmaceutical; Sleep Apnea Syndromes; Sleep Initiation and Maintenance Disorders; Sleep Latency; Sleep Wake Disorders
PubMed: 30292731
DOI: 10.1016/j.amjmed.2018.09.021 -
Continuum (Minneapolis, Minn.) Aug 2020This article provides updated information regarding the diagnosis and treatment of chronic insomnia disorder. In addition to discussing the latest recommendations... (Review)
Review
PURPOSE OF REVIEW
This article provides updated information regarding the diagnosis and treatment of chronic insomnia disorder. In addition to discussing the latest recommendations regarding pharmacotherapeutic options for insomnia, this article also discusses the increased use of nonpharmacologic treatment approaches, including cognitive-behavioral therapy intervention, integrative medicine, mindfulness and meditation, and other therapeutic options in clinical practice.
RECENT FINDINGS
Insomnia is one of the most common sleep disorders in patients with other neurologic disorders. The definition and criteria for insomnia were updated with the release of the International Classification of Sleep Disorders, Third Edition. The American Academy of Sleep Medicine has updated clinical practice guidelines for the pharmacologic treatment of chronic insomnia in adults. New diagnostic and therapeutic options (eg, pharmacologic and behavioral therapies, at-home devices) have emerged to optimize and personalize the evaluation and management of sleep disorders such as insomnia. Although some of these devices and treatment options are still in the early stages of development, several are currently in clinical trials or will soon be available.
SUMMARY
This article emphasizes complexities related to the evaluation and management of patients with chronic insomnia disorder and describes alternative therapeutic options for patients with this common sleep disorder.
Topics: Humans; Sleep Initiation and Maintenance Disorders
PubMed: 32756233
DOI: 10.1212/CON.0000000000000879 -
Science (New York, N.Y.) Nov 2016Disruptions of normal circadian rhythms and sleep cycles are consequences of aging and can profoundly affect health. Accumulating evidence indicates that circadian and... (Review)
Review
Disruptions of normal circadian rhythms and sleep cycles are consequences of aging and can profoundly affect health. Accumulating evidence indicates that circadian and sleep disturbances, which have long been considered symptoms of many neurodegenerative conditions, may actually drive pathogenesis early in the course of these diseases. In this Review, we explore potential cellular and molecular mechanisms linking circadian dysfunction and sleep loss to neurodegenerative diseases, with a focus on Alzheimer's disease. We examine the interplay between central and peripheral circadian rhythms, circadian clock gene function, and sleep in maintaining brain homeostasis, and discuss therapeutic implications. The circadian clock and sleep can influence a number of key processes involved in neurodegeneration, suggesting that these systems might be manipulated to promote healthy brain aging.
Topics: Aging; Alzheimer Disease; Animals; Brain; Circadian Clocks; Circadian Rhythm; Dyssomnias; Humans; Mice; Sleep; Suprachiasmatic Nucleus
PubMed: 27885006
DOI: 10.1126/science.aah4968 -
Lancet (London, England) Sep 2022Excessive daytime sleepiness (EDS) is a public health issue. However, it remains largely undervalued, scarcely diagnosed, and poorly supported. Variations in the... (Review)
Review
Excessive daytime sleepiness (EDS) is a public health issue. However, it remains largely undervalued, scarcely diagnosed, and poorly supported. Variations in the definition of EDS and limitations in clinical assessment lead to difficulties in its epidemiological study, but the relevance of this symptom from a socioeconomic perspective is inarguable. EDS might be a consequence of several behavioural issues leading to insufficient or disrupted sleep, as well as a consequence of sleep disorders including sleep apnoea syndrome, circadian disorders, central hypersomnolence disorders (narcolepsy and idiopathic hypersomnia), other medical or psychiatric conditions, or medications. Furthermore, EDS can have implications for health as it is thought to act as a risk factor for other conditions, such as cardiovascular and neurodegenerative disorders. Because of the heterogeneous causes of EDS and the complexity of its pathophysiology, management will largely depend on the cause, with the final aim of making treatment specific to the individual using precision medicine and personalised medicine.
Topics: Causality; Disorders of Excessive Somnolence; Humans; Narcolepsy; Risk Factors; Sleep Wake Disorders
PubMed: 36115367
DOI: 10.1016/S0140-6736(22)01018-2 -
The Lancet. Neurology May 2015Chronic insomnia is defined by difficulties in falling asleep, maintaining sleep, and early morning awakening, and is coupled with daytime consequences such as fatigue,... (Review)
Review
Chronic insomnia is defined by difficulties in falling asleep, maintaining sleep, and early morning awakening, and is coupled with daytime consequences such as fatigue, attention deficits, and mood instability. These symptoms persist over a period of at least 3 months (Diagnostic and Statistical Manual 5 criteria). Chronic insomnia can be a symptom of many medical, neurological, and mental disorders. As a disorder, it incurs substantial health-care and occupational costs, and poses substantial risks for the development of cardiovascular and mental disorders, including cognitive deficits. Family and twin studies confirm that chronic insomnia can have a genetic component (heritability coefficients between 42% and 57%), whereas the investigation of autonomous and central nervous system parameters has identified hyperarousal as a final common pathway of the pathophysiology, implicating an imbalance of sleep-wake regulation consisting of either overactivity of the arousal systems, hypoactivity of the sleep-inducing systems, or both. Insomnia treatments include benzodiazepines, benzodiazepine-receptor agonists, and cognitive behavioural therapy. Treatments currently under investigation include transcranial magnetic or electrical brain stimulation, and novel methods to deliver psychological interventions.
Topics: Chronic Disease; Humans; Sleep Initiation and Maintenance Disorders
PubMed: 25895933
DOI: 10.1016/S1474-4422(15)00021-6 -
High Blood Pressure & Cardiovascular... Jan 2022Obstructive sleep apnea is a frequent finding in clinical practice especially with the obesity epidemic and the growing awareness of sleep-disordered breathing as a... (Review)
Review
Obstructive sleep apnea is a frequent finding in clinical practice especially with the obesity epidemic and the growing awareness of sleep-disordered breathing as a potential and treatable risk factor for cardiovascular diseases. It frequently coexists undiagnosed activating pathophysiological mechanisms known to participate in development and progression of cardiovascular diseases and resistance to therapeutical strategies. The sympathetic activation and the baroreflex and chemoreflex impairment appear to be the main pathophysiological factors that activating several mechanisms elicit cardiac and vascular damage. Data from cross-sectional population-based studies, prospective studies and meta-analysis have clearly shown the implication of OSA in the development of the hypertensive state and the benefits obtained by continuous positive airway pressure on daytime blood pressure and cardiovascular risk.
Topics: Continuous Positive Airway Pressure; Cross-Sectional Studies; Humans; Hypertension; Prospective Studies; Sleep Apnea Syndromes; Sleep Apnea, Obstructive
PubMed: 34739711
DOI: 10.1007/s40292-021-00484-4 -
Sleep Medicine Clinics Jun 2023Narcolepsy types 1 and 2 and idiopathic hypersomnia are primary Central Nervous System (CNS) disorders of hypersomnolence characterized by profound daytime sleepiness... (Review)
Review
Narcolepsy types 1 and 2 and idiopathic hypersomnia are primary Central Nervous System (CNS) disorders of hypersomnolence characterized by profound daytime sleepiness and/or excessive sleep need. Onset of symptoms begins typically in childhood or adolescence, and children can have unique presentations compared with adults. Narcolepsy type 1 is likely caused by immune-mediated loss of orexin (hypocretin) neurons in the hypothalamus; however, the causes of narcolepsy type 2 and idiopathic hypersomnia are unknown. Existing treatments improve daytime sleepiness and cataplexy but there is no cure for these disorders.
Topics: Adult; Adolescent; Child; Humans; Idiopathic Hypersomnia; Narcolepsy; Disorders of Excessive Somnolence
PubMed: 37120161
DOI: 10.1016/j.jsmc.2023.01.003 -
Respiratory Investigation Jan 2022The prevalence of sleep disordered breathing (SDB) is reportedly very high. Among SDBs, the incidence of obstructive sleep apnea (OSA) is higher than previously...
The prevalence of sleep disordered breathing (SDB) is reportedly very high. Among SDBs, the incidence of obstructive sleep apnea (OSA) is higher than previously believed, with patients having moderate-to-severe OSA accounting for approximately 20% of adult males and 10% of postmenopausal women not only in Western countries but also in Eastern countries, including Japan. Since 1998, when health insurance coverage became available, the number of patients using continuous positive airway pressure (CPAP) therapy for sleep apnea has increased sharply, with the number of patients about to exceed 500,000 in Japan. Although the "Guidelines for Diagnosis and Treatment of Sleep Apnea Syndrome (SAS) in Adults" was published in 2005, a new guideline was prepared in order to indicate the standard medical care based on the latest trends, as supervised by and in cooperation with the Japanese Respiratory Society and the "Survey and Research on Refractory Respiratory Diseases and Pulmonary Hypertension" Group, of Ministry of Health, Labor and Welfare and other related academic societies, including the Japanese Society of Sleep Research, in addition to referring to the previous guidelines. Because sleep apnea is an interdisciplinary field covering many areas, this guideline was prepared including 36 clinical questions (CQs). In the English version, therapies and managements for SAS, which were written from CQ16 to 36, were shown. The Japanese version was published in July 2020 and permitted as well as published as one of the Medical Information Network Distribution Service (Minds) clinical practice guidelines in Japan in July 2021.
Topics: Adult; Continuous Positive Airway Pressure; Female; Humans; Male; Prevalence; Sleep Apnea Syndromes; Sleep Apnea, Obstructive; Surveys and Questionnaires
PubMed: 34986992
DOI: 10.1016/j.resinv.2021.08.010 -
Endocrine Reviews Dec 2016Circadian (∼24-hour) timing systems pervade all kingdoms of life and temporally optimize behavior and physiology in humans. Relatively recent changes to our... (Review)
Review
Circadian (∼24-hour) timing systems pervade all kingdoms of life and temporally optimize behavior and physiology in humans. Relatively recent changes to our environments, such as the introduction of artificial lighting, can disorganize the circadian system, from the level of the molecular clocks that regulate the timing of cellular activities to the level of synchronization between our daily cycles of behavior and the solar day. Sleep/wake cycles are intertwined with the circadian system, and global trends indicate that these, too, are increasingly subject to disruption. A large proportion of the world's population is at increased risk of environmentally driven circadian rhythm and sleep disruption, and a minority of individuals are also genetically predisposed to circadian misalignment and sleep disorders. The consequences of disruption to the circadian system and sleep are profound and include myriad metabolic ramifications, some of which may be compounded by adverse effects on dietary choices. If not addressed, the deleterious effects of such disruption will continue to cause widespread health problems; therefore, implementation of the numerous behavioral and pharmaceutical interventions that can help restore circadian system alignment and enhance sleep will be important.
Topics: Chronobiology Phenomena; Humans; Sleep Deprivation; Sleep Disorders, Circadian Rhythm
PubMed: 27763782
DOI: 10.1210/er.2016-1083