Treatment Of Sleeping Disorders

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Treatment Of Sleeping Disorders

The goals of therapy of sleep disorders can be classified as:

* Reducing morbidity;
* Reducing excess mortality; and
* Improving quality of life for patient and family.

Sleep disorders have been classified extensively. The major focus of this conference could, however, be summarized as dealing with two primary types of complaints or disorders, for which there is evidence to suggest that treatment is beneficial. These consist of:

* The hypersomnias, primarily represented by obstructive sleep apnea;

* The insomnia complaints, which can be due to a variety of psychiatric and medical disorders.

Treatment of Obstructive Sleep Apnea

Obstructive sleep apnea is a potentially reversible cause of daytime hypersomnia, which may be associated with comorbid conditions and even excess mortality. Effective treatment is available for many patients. Development of better and more effective treatment strategies should, however, be encouraged. Treatment is recommended for more severe degrees of this disorder. Objective indices of severity elicited by polysomnography should include a high index of respiratory disturbances per hour,

Repetitive episodes of hypoxemia, and an abnormally shortened sleep latency. Strict guidelines for therapy have not been adequately validated to dictate thresholds for distinguishing less severely affected patients. At the present time, considerable reliance is made on clinical judgment to initiate a therapeutic trial or regimen.

Treatment of Insomnia Complaints

Complaints of insomnia are very common in the older patient. Insomnia is a symptomatic expression of a constellation of medical conditions that are not entirely related one to another. Insomnia may be of psychiatric (e.g., depression, anxiety), physiological (e.g., central apnea, limb movement), pharmacological (e.g., prescribed or unprescribed drugs or alcohol), or of medical origin. It may coexist with other sleep disorders (such as apnea), but this may be merely coincidental.

Since insomnia has many causes, the indications for treatment are dependent on the etiology. A thorough medical evaluation is essential prior to initiating treatment. Indications for therapy will be driven by the underlying cause and severity of symptoms.

Attention was given to periodic movements in sleep which appear to be very common in the older patient. Certain pharmacological treatments appear to be effective in patients who find this condition distressing. There is, however, insufficient evidence at this time to indicate whether or not the disease state or its treatment affect morbidity in the older patient. Moreover, the long-term benefits and risks of treatment of periodic movements in sleep are unknown, and, therefore, further investigations are recommended.

Insomnia may also be related to circadian rhythm disorders. Amplitude and phase relationships are often altered in the older person. These changes may produce a variety of somatic complaints and sleep disturbances. Such alterations occur during shift work, transmeridian travel, or changes in daily routine or sleep patterns (earlier arousal and earlier bedtime tendency), or they may occur spontaneously.

Therapy should be directed toward appropriate control of the environment and adequate counseling of the patient and the employer. It may include appropriately timed bright light exposure.

Insomnia resulting from medical or psychiatric causes should be managed primarily by appropriate treatment of the underlying condition.

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