Vol 5 n° 4 - Chronobiology and Mood Disorders
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3 7 1 orty million Americans are afflicted with chronic disorders of sleep and wakefulness, which interfere with work, driving, and social activities. Sleep disorders cause 38 000 cardiovascular deaths and cost over $16 billion annually.1 Indirect costs of accidents, property destruc- tion, litigation, hospitalization, and death add another $50 to  $100  billion.1  The  most  common  sleep  disorders include insomnia, sleep apnea, restless legs syndrome, and narcolepsy.1-3 Classification of sleep disorders The International Classification of Sleep Disorders diag- nostic and coding manual 2000 lists four major categories of sleep disorders: dyssomnias; parasomnias; sleep disor- ders associated with mental, neurologic, or other medical disorders; and proposed sleep disorders (Table I).4-7 Dyssomnias are disorders characterized by either exces- sive sleepiness or difficulty initiating or maintaining sleep.4 On the basis of pathophysiological mechanisms, they can be  subdivided  into  intrinsic,  extrinsic,  and  circadian rhythm sleep disorders.4-9 Intrinsic sleep disorders are dis- orders that originate or develop within the body or that arise from causes within the body. Common intrinsic sleep disorders  include  idiopathic  and  psychophysiological insomnia, narcolepsy, obstructive sleep apnea syndrome (OSAS), periodic limb movement disorder (PLMD), and restless legs syndrome (RLS).4-7 Sleep disorders caused by external factors are termed extrinsic sleep disorders and include inadequate sleep hygiene, environmental sleep disorder, adjustment sleep disorder, insufficient sleep syn- drome, limit-setting sleep disorder, sleep-onset association C l i n i c a l   r e s e a r c h Keywords:  diagnosis;  treatment;  sleep  disorder;  insomnia;  circadian  rhythm disorder; excessive somnolence; parasomnia Author affiliations:  Stanford University Sleep Disorders Clinic and Research Center, Stanford University, School of Medicine, Stanford, Calif, USA Address   for   correspondence:   Christian   Guilleminault,   MD,   Professor   of Psychiatry and Behavioral Sciences and Director of Training, Stanford Sleep Disorders Center, 401 Quarry Road, Suite 3301, Stanford, CA 94305, USA (e-mail: cguil@stanford.edu) F Copyright © 2003 LLS SAS.  All rights reserved www.dialogues-cns.org Diagnosis and treatment of sleep disorders: a brief review for clinicians Vivien C. Abad, MD, MBA; Christian Guilleminault, MD Sleep disorders encompass a wide spectrum of diseases with significant individual health consequences and high economic costs to society. To facilitate the diagnosis and treatment  of  sleep  disorders,  this  review  provides  a framework using the International Classification of Sleep Disorders. Primary and secondary insomnia are differen- tiated, and pharmacological and nonpharmacological treatments are discussed. Common circadian rhythm dis- orders are described in conjunction with interventions, including chronotherapy and light therapy. The diagno- sis and treatment of restless legs syndrome/periodic limb movement disorder is addressed. Attention is focused on obstructive sleep apnea and upper airway resistance syn- drome, and their treatment. The constellation of symp- toms and findings in narcolepsy are reviewed together with diagnostic testing and therapy. Parasomnias, includ- ing sleep terrors, somnambulism, and rapid eye move- ment  (REM)  behavior  sleep  disorders  are  described, together with associated laboratory testing results and treatment. © 2003, LLS SAS Dialogues Clin Neurosci. 2003;5:371-388.