Sleep disorders can be divided into those producing insomnia, those causing daytime sleepiness, and those disrupting sleep. Transient insomnia is extremely common, afflicting up to 80% of the population. Chronic insomnia affects 15% of the population. Benzodiazepines are frequently used to treat insomnia; however, there may be a withdrawal syndrome with rapid eye movement (REM) rebound. Two newer benzodiazepine-like agents, zolpidem and zaleplon, have fewer side effects, yet good efficacy. Other agents for insomnia include sedating antidepressants and over-the-counter sleep products (sedating antihistamines). Nonpharmacologic behavioral methods may also have therapeutic benefit. An understanding of the electrophysiologic and neurochemical correlates of the stages of sleep is useful in defining and understanding sleep disorders. Excessive daytime sleepiness is often associated with obstructive sleep apnea or depression. Medications, including amphetamines, may be used to induce daytime alertness. Parasomnias include disorders of arousal and of REM sleep. Chronic medical illnesses can become symptomatic during specific sleep stages. Many medications affect sleep stages and can thus cause sleep disorders or exacerbate the effect of chronic illnesses on sleep. Conversely, medications may be used therapeutically for specific sleep disorders. For example, restless legs syndrome and periodic limb movement disorder may be treated with dopamine agonists. An understanding of the disorders of sleep and the effects of medications is required for the appropriate use of medications affecting sleep.

By utilizing our current experimental and theoretical knowledge base, the potential etiology of a majority of reported drug effects on nightmares can be classified. These data support current neurochemical theories of dreaming, as well as suggesting that the biochemical basis for dreaming and nightmare induction may be more complex than generally suggested.

The clear association between reports of sleep disturbance and poor school performance has been documented for sleepy adolescents. This study extends that research to students outside the adolescent age grouping in an associated school setting (98 middle school students, 67 high school students, and 64 college students). Reported restless legs and periodic limb movements are significantly associated with lower GPA's in junior high students. Consistent with previous studies, daytime sleepiness was the sleep variable most likely to negatively affects high school students. Sleep onset and maintenance insomnia were the reported sleep variables significantly correlated with poorer school performance in college students. This study indicates that different sleep disorder variables negatively affect performance at different age and educational levels.

This paper presents data evidence supporting the value of diagnosing and treating obstructive sleep apnea (OSA) in reducing morbidity and mortality, improving comorbid disease processes, and improving patient quality of life. These data are derived from a PubMed-based meta-analysis of recent cost effectiveness, standards of practice, and epidemiological studies of OSA, which are ranked using a hierarchical strength of recommendation taxonomy. Cost and health care utilization data have been calculated for OSA and hypersomnolence as well as for diagnostic testing. Strong evidence (which is indicated by a strength of recommendation rating of "A") exists for the association of adult OSA with obesity, daytime sleepiness, hypertension, and motor vehicular accidents. Strong evidence also exists for requiring full-night or split-night attended polysomnography (PSG) for the diagnosis and treatment of adult OSA and for patients with systolic or diastolic heart failure not responding to optimal medical management. Good evidence (B) exists for the association of adult OSA with congestive heart failure, coronary artery disease, cerebral vascular accidents, metabolic syndrome, and increased mortality. Good evidence also exists to indicate that the nonattended PSG can be used to diagnose sleep breathing disorders, that autotitration systems can be used to titrate continuous positive airway pressure ( This year the field of sleep medicine becomes a fully accredited American Medical Association subspecialty and an area of potential subspecialization for family physicians interested in a Certificate of Added Qualification (CAQ) in sleep medicine. The field of sleep medicine has shown remarkable growth in the last decades. The number of boardcertified sleep physicians have grown from Ͻ500 to Ͼ3000 in the last 15 years. Yet the overwhelming majority of people who suffer from disorders of sleep and wakefulness are undiagnosed and untreated. The field is relatively new, with few physicians having expertise or training in the area because sleep medicine is not regularly taught in medical schools or in physician training programs.Many practicing physicians complete training without a clear understanding of obstructive sleep apnea (OSA), the most physiologically disruptive and dangerous of the sleep-related diseases (Table 1). 1Most patients with sleep disturbance receive their medical care in the primary care setting. Life stressors, concomitant illness, and family and social structure can precipitate sleep complaints. The primary care physician often has a more complete knowledge of these factors than the polysomnographic-oriented sub-specialist. This paper presents evidence data documenting the importance of the diagnosis and treatment of OSA in reducing morbidity and mortality, improving comorbid disease processes, and improving patient quality of life in the primary care setting. These data are derived from a PubMed-based meta-analysis of recent cost effectiveness, standards of practice, and epidemiologic studies of OSA, which are ...

A single definition for dreaming is most likely impossible given the wide spectrum offields engaged in the study of dreaming, and the diversity in currently applied definitions. Many studies do not specify a definition, yet results are likely to be comparable only when comparable definitions of the topic are used. The alternative is to develop a classification system organizing the multiplicity of definitions for dream. A dream should not be exclusively defined as a non-conscious electrophysiologic state. Dreaming is, at least in part, a mental experience that can be described during waking consciousness. Definitions for dreaming should be utilized in research and discussion which address the various axes which define dreaming: Wake/sleep, Recall, and Content.