Paul Reading. ABC of Sleep Medicine (ABC Series). BMJ Books (2013)
At a personal level, everyone appreciates how important good sleep is for optimum health and vitality. However, determining when a reportedly disturbed sleep–wake cycle reﬂects a deﬁned sleep disorder can be difﬁcult, since many of the associated symptoms form part of a normal spectrum. However, chronically poor sleep, particularly in association with the inevitable adverse effects of natural ageing, may actively fuel many common complaints, such as headaches, generalised pain and depressed mood.
Sleep is also an important and often overlooked consideration in the majority of general medical conditions. Because sleep medicine is a young and poorly deﬁned discipline in most countries, education given to medical students is generally limited. As a likely consequence, the quality of clinical practice varies enormously. The increasingly recognised relevance of sleep medicine to public health will hopefully improve future resources.
Таблица 1.3. «Красные флажки», которые могут служить направлением к врачу специалисту для дальнейшего обследования.
|Sleep-related symptom||Selected ‘red ﬂags’ from history that might indicate need for further specialist assessment|
|Excessive daytime sleepiness (not simple tiredness or fatigue)||Feeling the need to sleep in potentially dangerous situations, such as behind the steering wheelSudden episodes of sleep with little or no warning of the imperative to sleep (‘sleep attacks’)Historical evidence for overnight sleep apnoea or waking unrefreshed with severe dryness of mouthOther symptoms, such as cataplexy, that suggest a primary (central) sleep disorder|
|Sleep-onset insomnia||Evidence for signiﬁcant restless legs syndrome before sleep interfering with sleep onsetInability to rise at a conventional hour might suggest a ‘clock’ problem, such as delayed sleep phase syndrome|
|Sleep-maintenance insomnia||If there is accompanying frank daytime sleepiness, it is likely there is a deﬁned medical reason for poor quality sleepThe younger the patient, the more likely there is a deﬁned cause for interrupted overnight sleep|
|Nocturnal motor activity suggesting a parasomnia||Potentially dangerous or frequent behavioursAccompanying signiﬁcant daytime sleepiness might indicate presence of another sleep disorder fuelling parasomniaNew onset of parasomnia activity is unusual beyond 40 years of age and might suggest REM sleep abnormalities associated with other disorders such as Parkinson’s diseaseFeatures that might suggest an epileptic cause for nocturnal motor activity (Chapter 7)|
Treatments for the whole spectrum of sleep disorders are established and are becoming both evidence based and increasingly sophisticated. A common dilemma in general practice is when to refer to a sleep centre for specialist advice. Severity of symptoms is often a sufﬁcient prompt. However, Table 1.3 provides a selection of ‘red ﬂags’ which, if they accompany a sleep-related symptom, might merit referral for further assessment and possible investigation.
We are still some way from understanding the true function of sleep but the adverse consequences of its dysfunction are becoming clearer across all areas of general medicine and psychiatry.