Sleep Disorders - Conclusions

The high prevalence of sleep disorders and their effect on both longevity and quality of life have brought increased attention to the treatment of these conditions. Treatment guidelines and practice parameters are becoming available for an increasing number of sleep disorders.

The effective clinical management of all sleep disorders rests on an accurate diagnosis. This general principle, which is true of any psychiatric disorder, is even more relevant for sleep disorders, because sleep is affected by a host of medical, psychological, pharmacological, environmental, and circadian factors. The differential diagnosis of sleep disorders requires a comprehensive and multifaceted evaluation involving a clinical interview, physical and psychological examinations, daily diary monitoring, and sometimes more specialized laboratory procedures, including nocturnal polysomnography and a multiple sleep latency test.

Treatment plans should be tailored according to the individual patient's sleep disorder, its presumed causative factors, the presence of comorbid medical or psychiatric conditions, and the patient's preference for a given intervention. Some sleep disorders (e.g., narcolepsy) are best treated pharmacologically, whereas others (e.g., insomnia) are more amenable to behavioral treatments. In most cases, clinical interventions can be effectively combined to maximize therapeutic benefits.

The treatment of sleep disorders is still at an early stage relative to the treatment of other psychiatric disorders. Additional research is needed on the comparative and combined efficacy and the sequential applications of behavioral and pharmacological therapies for sleep disorders.

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