Sleep medicine is a medical specialty or subspecialty devoted to the diagnosis and therapy of sleep disturbances and disorders.
Competence in sleep medicine requires an understanding of a plethora of very diverse disorders, many of which present with similar symptoms such as excessive daytime sleepiness, which, in the absence of volitional sleep deprivation, "is almost inevitably caused by an identifiable and treatable sleep disorder," such as sleep apnea, narcolepsy, idiopathic hypersomnia, Kleine-Levin syndrome, menstrual-related hypersomnia, idiopathic recurrent stupor, or circadian rhythm disturbances. Another common complaint is insomnia, a set of symptoms that can have many causes, physical and mental. Management in the varying situations differs greatly and cannot be undertaken without a correct diagnosis.
ICSD, The International Classification of Sleep Disorders, was restructured in 1990, in relation to its predecessor, to include only one code for each diagnostic entry and to classify disorders by pathophysiologic mechanism, as far as possible, rather than by primary complaint. Training in sleep medicine is multidisciplinary, and the present structure was chosen to encourage a multidisciplinary approach to diagnosis. Sleep disorders often do not fit neatly into traditional classification; differential diagnoses cross medical systems. Minor revisions and updates to the ICSD were made in 1997 and in following years. The present classification system in fact follows the groupings suggested by Nathaniel Kleitman, the "father of sleep research," in his seminal 1939 book Sleep and Wakefulness.
When sleep complaints are secondary to pain, other medical or psychiatric diagnoses, or substance abuse, it may be necessary to treat both the underlying cause and the sleep problems.
When the underlying cause of sleep problems is not immediately obvious, behavioral treatments are usually the first suggested. These range from patient education about sleep hygiene to cognitive behavioral therapy (CBT). Studies of both younger and older adults have compared CBT to medication and found that CBT should be considered a first-line and cost-effective intervention for chronic insomnia, not least because gains may be maintained at long-term follow-up. Sleep physicians and psychologists, at least in the US, are not in agreement about who should perform CBT nor whether sleep centers should be required to have psychologists on staff. In the UK the number of CBT-trained therapists is limited so CBT is not widely available on the NHS.
Behavioral therapies include progressive relaxation, stimulus control (to reassociate the bed with sleepiness), limiting time-in-bed to increase sleep efficiency and debunking misconceptions about sleep.
THE CONCEPT OF SLEEP MEDICINE BELONGS TO THE SECOND HALF OF THE 20TH CENTURY. DUE TO THE RAPIDLY INCREASING KNOWLEDGE ABOUT SLEEP, INCLUDUNG THE GROWTH OF THE RESEARCH FIELD CHRONOBIOLOGY FROM ABOUT 1960 AND THE DISCOVRIES OF REM SLEEP (1952-53) AND SLEEP APNEA ....Read More