Sleep disorders

Disturbances of sleep are commonly seen in many of the DSM-IV Axis I psychiatric disorders. Furthermore, psychiatric symptoms are commonly experienced in association with sleep disorders. This chapter reviews some basic physiology of sleep-wake regulation as well as the most common sleep disorders of importance to the practicing psychiatrist. Included are insomnia, restless legs syndrome, obstructive sleep apnea, narcolepsy, idiopathic and other hypersomnias, and parasomnias such as sleepwalking/sleep terrors and rapid eye movement (REM) sleep behavior disorder. In each case, diagnostic criteria are described, based both on the American Psychiatric Association Diagnostic and Statistical Manual, 4th edition, text revision (DSM-IV-TR) and the International Classification of Sleep Disorders, 2nd edition (ICSD-2). Discussions of epidemiology, clinical features, typical case examples, laboratory findings, course, differential diagnosis, etiology, and treatment considerations will enable the reader to recognize these disorders in their patients and to facilitate their treatment.