neurologic disorders
Approach to the Patient With a Sleep or Wakefulness Disorder
Key Points
Poor sleep hygiene and situational disruptors (eg, shift work, emotional stressors) are common causes of insomnia. Consider medical disorders (eg, sleep apnea syndromes, pain disorders) and psychiatric disorders (eg, mood disorders) as possible causes. Usually, consider sleep studies (eg, polysomnography) when sleep apnea syndromes, periodic limb movements, or other sleep disorders are suspected, when the clinical diagnosis is in doubt, or when response to initial presumptive treatment is inadequate. Good sleep hygiene, sometimes as part of cognitive-behavioral therapy, is first-line treatment. Use hypnotics and sedatives with caution, especially in older people. 