Sleep Disorders & Treatment

Sleep disorders are a common complaint in the primary care setting and have important medical and social consequences. Diagnosis can usually be made through history and physical. Polysomnography is useful for the diagnosis of obstructive sleep apnea and limb movement disorders. Insomnia is the most common sleep disorder and numerous treatment options are available. Non-pharmacologic treatment of insomnia is the preferred first line treatment. Circadian rhythm sleep disorders are a shift in the normal timing of a 24 hour sleep wake cycle and standard treatment include melatonin and bright light therapy. Obstructive sleep apnea is characterized by repeated episodes of apnea and should be diagnosed by in home or in lab sleep study. Standard treatment is with CPAP or an oral appliance. Sleep behavior disorders can be classified as occurring during REM sleep or non REM sleep. Treatments depend on the disorder, but supportive care such as a safe sleep environment are crucial. Daytime sleepiness disorders include narcolepsy and idiopathic hypersomnia, both are treated with stimulants to increase wakefulness. Sleep movement disorders include restless leg syndrome and periodic limb movement disorder. RLS is associated with low ferritin and can be readily treated with iron or other specific medications. Sleep bruxism is best treated with a dental device to protect the teeth from damage.