Band 100, Heft s8

Sleep encompasses approximately a third of our lives; however, sleep and the disorders of sleep are not widely understood. Data suggest that sleep plays a restorative role in physiologic mechanisms and that long-term disruption of sleep may contribute to the development of disease. Nearly a third of the adult population is chronically afflicted by sleep disorders, and substantial economic loss is attributable to these disorders in terms of lost time, inefficiency, and accidents. Of the sleep disorders, obstructive sleep apnea (OSA) is one of the more common, clinically affecting up to 5% of the adult population. Obstructive sleep apnea contributes to the development of disease and has an adverse impact on daytime functioning in those affected by the disease. This article reviews basic sleep physiology, how these physiologic mechanisms are disrupted by OSA, and some of the techniques for treating patients with this disorder.

Sleepiness occurs in almost everyone at some time during each day. If sleepiness becomes moderate to severe, it can have an impact on an individual's ability to perform tasks that are prolonged or require a high degree of concentration. Driving is a daily activity that usually involves repetitive behaviors over a prolonged period, and it may be adversely affected by an individual who is sleepy. Data from the Department of Transportation show that sleepiness and fatigue contribute to numerous accidents on the road. This article reviews information related to the effects of sleepiness on driving, the types of sleepiness, and some tools for assessing sleepiness.

"Night owls" and "morning larks" are descriptive terms used to characterize individuals who go to sleep or awaken differently than most individuals. Many of these individuals have a primary circadian sleep dysrhythmia. Identification and proper treatment of a specific condition can markedly improve their quality of life. Secondary circadian dysrhythmias are very common. Nearly everyone at some time in his or her life experiences jet lag or shift work sleep disorder, two conditions in which we ignore our biologic rhythms. The impact of these conditions on performance and judgment can be tempered by certain pharmacologic and nonpharmacologic strategies. A better understanding of both primary and secondary circadian rhythm sleep disorders will be valuable to the primary care physician, leading to earlier diagnosis and improved treatment of patients with these conditions.

A significant proportion of the population has chronic sleep problems necessitating an increasing involvement by the primary care physician. Also, the general patient population is becoming more familiar with these disorders and is seeking assistance. Because sleep studies are expensive and time consuming, adhering to the recognized indications for testing reduces the number of inappropriate studies. Under most circumstances, individuals with excessive daytime sleepiness and symptoms suggestive of obstructive sleep apnea are candidates for polysomnography. Other individuals with parasomnias or difficult-to-treat insomnia are also candidates for testing. In some circumstances, procedures designed to assess sleepiness may also need to be used to ascertain the impact of the disorder on daytime functioning and may be part of evaluations involving the transportation industry. Only after taking a thorough history and doing a physical examination can the physician make an accurate determination of the appropriate study type.