The Pharmacological Treatment of Sleep Disorders

Abstract

Sleep is closely related to every facet of daily life. In this respect, disturbed sleep affects not only our health and well-being but also our quality of life. Dement and Kleitman and Rechtschaffen and Kales provided a description of sleep cycles and a classification system of sleep stages that comprised four non-rapid-eye movement sleep (NREMS) stages and rapid-eye movement sleep (REMS). In 2007, the American Academy of Sleep Medicine introduced new guidelines to score all-night polysomnographic recordings, which seem to differ from those obtained after visual scoring following the Rechtschaffen and Kales rules in that light sleep (S1 vs. N1) and deep sleep (S3+S4 vs. N3) are significantly increased while intermediate sleep (S2 vs. N2) is reduced. Here, I will consider the evolution of the treatment of insomnia and excessive daytime sleepiness defined according to clinical and all-night polysomnographic recordings. Insomnia is a complaint characterized by difficulty in falling asleep, insufficient sleep, numerous nocturnal awakenings, and early morning awakening with inability to resume sleep, or non-restorative sleep. Common daytime complaints include somnolence, fatigue, irritability, and difficulty concentrating and performing everyday tasks. In addition, subjects with a diagnosis of insomnia are at risk of injury, drowsiness while driving, and illness. Before the advent of modern sleep medicine only two of these variables were usually considered by the physician when interacting with the patient, namely prolonged sleep-onset latency and reduced total sleep time. The severity and duration of insomnia have been considered important guides to its evaluation and treatment. With respect to patterns of insomnia, an effective program of pharmacological therapy must take into account all of the changing dynamics of the sleep disturbance, including both the difficulties of sleep initiation as well as that of sleep maintenance. As a chronic disorder insomnia affects about 10% of the population. Sleep professionals know now that its treatment is often challenging, and moreover, it is associated with a substantial number of comorbid symptoms. Chronic insomnia can manifest as primary or comorbid insomnia. The American Psychiatric Association considers primary insomnia as a complaint of difficulty initiating and maintaining sleep or nonrestorative sleep that lasts for at least one month and causes clinically significant distress in several areas. The determinants of comorbid insomnia include mental disorders, neurological diseases, medical conditions, another sleep disorder, and substance-induced sleep disorders. (PsycINFO Database Record (c) 2016 APA, all rights reserved)