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  • Image not available. Common causes of insomnia include concomitant psychiatric disorders, significant psychosocial stressors, excessive alcohol use, caffeine intake, and nicotine use.
  • Image not available. Good sleep hygiene, including relaxing before bedtime, exercising regularly, establishing a regular bedtime and wake-up time, and discontinuing alcohol, caffeine, and nicotine, alone and in combination with drug therapy, should be part of patient education and treatments for insomnia.
  • Image not available. Long-acting benzodiazepines should be avoided in the elderly.
  • Image not available.Benzodiazepine tolerance and dependence are avoided by using low-dose therapy for the shortest possible duration.
  • Image not available. Obstructive sleep apnea may be an independent risk factor for the development of hypertension. When hypertension is present, it is often refractory to drug therapy until sleep-disordered breathing is alleviated.
  • Image not available. Nasal continuous positive airway pressure is the first-line therapy for obstructive sleep apnea, and weight loss should be encouraged in all obese patients.
  • Image not available. Pharmacologic management of narcolepsy is focused on two primary areas: treatment of excessive daytime sleepiness and cataplexy.
  • Image not available. Short-acting benzodiazepine receptor agonists or melatonin taken at appropriate target bedtimes for east or west travel reduce jet lag and shorten sleep latency.
  • Image not available.Dopamine agonists are effective for restless legs syndrome and have replaced levodopa as first-line therapy.

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Upon completion of the chapter, the reader will be able to:

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  • 1. Explain physiologic and systemic changes that occur during sleep.
  • 2. Classify and discuss the etiologies for sleep disorders.
  • 3. Discuss the association between specific sleep disorders and quality of life and risk for systemic diseases.
  • 4. Appropriately identify and evaluate specific sleep disorders; insomnia, sleep apnea, narcolepsy, restless legs syndrome, periodic limb movements, circadian rhythm disorders.
  • 5. Develop patient specific nondrug and drug treatment plans for specific or coexisting sleep disorders, including insomnia, sleep apnea, narcolepsy, restless legs syndrome, periodic limb movements, and circadian rhythm disorders.
  • 6. Apply principles of pharmacokinetics and pharmacodynamics to appropriately select a benzodiazepine receptor agonist for the treatment of insomnia.
  • 7. Identify relevant adverse effects of benzodiazepine and GABA-A agonist therapy and how to manage them during the treatment of insomnia.
  • 8. Distinguish between the various wake-promoting therapies and their appropriate use for the treatment of narcolepsy.
  • 9. Identify adverse effects and precautions of therapies for restless legs syndrome.
  • 10. Differentiate between non-REM and REM parasomnias and recommend appropriate management and therapy.
  • 11. Describe the differences in significance and management between PLMS and RLS.
  • 12. Utilize standardized questionnaires and sleep laboratory findings to assess severity of sleep disorders.
  • 13. Assess the effectiveness of and optimize nonpharmacologic and pharmacologic therapies for sleep disorders.
  • 14. Educate and counsel patients on the importance of sleep and good sleep hygiene.
  • 15. Discuss how unrecognized and poorly treated sleep disorders may affect the treatment and severity of concomitant systemic diseases.

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Approximately 70 million Americans suffer with a sleep-related problem, and as many as 60% of those experience a chronic disorder.1 In a study by the National Institute of Aging, of 9,000 patients age 65 years and older, more than 80% report a sleep-related disturbance.1

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