Neurological conditions associated with sleep disorders include cerebral degenerative disorders, dementia, parkinsonism, fatal familial insomnia, sleep-related epilepsy, electrical status cpilepticus of sleep, and sleep-related headaches.4-10 Sleep disorders can occur with medical disorders, such as sleeping sickness, nocturnal cardiac ischemia, chronic obstructive pulmonary disease, sleep-related asthma, sleeprelated gastroesophageal reflux, peptic ulcer disease, irritable bowel syndrome and fibromyalgia.-4,11-14 Proposed sleep disorders include short sleeper, long sleeper, subwakefulness
syndrome, fragmentary myoclonus, sleep hyperhidrosis, menstrual-associated Inhibitors,research,lifescience,medical sleep disorder, pregnancy-associated sleep disorder, terrifying hypnagogic hallucinations, sleep-related neurogenic tachypnea, sleep-related laryngospasm, and sleep choking syndrome.4 Approach to sleep disorders History and physical examination An accurate and detailed history from Inhibitors,research,lifescience,medical the patient, bed partner, or family member combined with a sleep questionnaire can elicit Inhibitors,research,lifescience,medical critical information. Most sleep complaints fall into three categories: insomnia (sleep onset, maintenance, or early morning awakening); excessive sleepiness; or abnormal
behaviors during sleep. The procedure is as follows. Inquire into the chief complaint, when symptom(s) started, the pattern since onset, and associated factors (medical, environmental, occupational,
psychological/stress, Inhibitors,research,lifescience,medical lifestyle choices) that may have predisposed to or precipitated the illness, perpetuated the condition, and improved or worsened symptoms.7 Assess the impact of the sleep complaint on the patient’s life, and inquire about meal Inhibitors,research,lifescience,medical and sleep schedules, sleep hygiene, restless legs sensation, snoring, witnessed apneic episodes, sweating, coughing, gasping/ choking/snorting, dryness of the mouth, bruxism, excessive movements during sleep, periodic limb movements, any abnormal behaviors during sleep, daytime sleepiness, presence of cataplexy, sleep paralysis, and hypnagogic or hypnapompic hallucinations. Ask about caffeine intake, alcohol and nicotine use, as well as use of illicit drugs. Review the pertinent medical/surgical/psychiatric history and past treatments, and their efficacy or lack thereof. Determine if there is all any family history of sleep disorders (snoring, OSAS, narcolepsy, RLS). A completed 2-week sleep log or sleep diary can be utilized to compute sleep efficiency, total sleep time, and number of awakenings during the night, and can be used to diagnose sleep disorders and monitor efficacy of treatment. On the basis of the information from questionnaires and sleep diary, the chief complaint, and the history, a working learn more diagnosis is outlined.