Proper Diagnosis for Sleep Disorders Needed When Linked to Neurology, Psychiatry

A recent review examined sleep-related disorders linked to neurology and psychiatry, noting that the disorders degrade quality of life and functional ability, and recommended that when taking a patient history, specific questions are needed to probe the exact symptoms so as to enable strategic treatments.

The 3 main complaints of sleep disorders—insomnia, daytime somnolence, and sleep-associated motor phenomena—usually lead to tentative diagnoses. But the proper diagnosis and treatment can help prevent secondary diseases and the worsening of related conditions, the authors said.

Some conditions can be treated by primary care physicians, while others need a neurologist or psychiatrist with special experience in sleep medicine, the authors wrote.

When insomnia is the primary condition, it is also called nonorganic insomnia; it affects 6% of the population in Western industrialized countries. It is growing in prevalence and is a risk factor for diabetes, cardiovascular disease, depression, and suicidality.

More than 70% of persons with insomnia still meet the diagnostic criteria after 1 year. Women are 1.5 times as likely to suffer from insomnia as men and the condition is more prevalent among older people.

When insomnia is the primary sleep disorder (and not a symptom of another disease) meta-analyses have shown the efficacy of cognitive behavioral therapy, with high average effect sizes, the authors wrote.

However, sleeping pills are not recommended for this form of insomnia, except for short-term relief. Sleep latency and sleep duration may benefit from short-term treatment with benzodiazepines and nonbenzodiazepine agonists such as zolpidem and zopiclone, but there is a risk of tolerance and dependence.

Sleep disorders in neurology and psychiatry are a heterogeneous group of disorders with diverse manifestations.

Secondary insomnias may stem from psychiatric disorders, disorders of the central nervous system or of the peripheral nervous system, restless legs syndrome, sleep apnea, or other causes. More complex cases may require the intervention of a sleep specialist.

Narcolepsy and idiopathic hypersomnia are different than normal daytime sleepiness, marked by uncontrollable episodes of falling asleep during the daytime. Narcolepsy is diagnosed by the multiple sleep latency test and usually responds well to treatment.

The researchers said care systems for the treatment of sleep disorders should be further developed.

Reference

Rémi J, Pollmächer T, Spiegelhalder K, Trenkwalder C, Young P. Sleep-related disorders in neurology and psychiatry. Dtsch Arztebl Int. 2019;116(41):681-688. doi: 10.3238/arztebl.2019.0681.