Nutt David J. - Sleep disorders

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OXFORD PSYCHIATRY LIBRARY

Sleep Disorders

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OXFORD PSYCHIATRY LIBRARY

Second Edition

Dr Sue Wilson

Senior Research Fellow, Centre for Neuropsychopharmacology,
Division of Brain Sciences, Department of Medicine,
Imperial College London, London, UK

Prof. David J. Nutt

Professor of Neuropsychopharmacology,
Centre for Neuropsychopharmacology,
Division of Brain Sciences,
Department of Medicine, Imperial College London, London, UK

Great Clarendon Street, Oxford, OX2 6DP,
United Kingdom

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Sleep disorders are the orphans of medical practice, despite the fact that up to 40% of all primary care attendees have sleep symptoms, and in psychiatry practice this percentage rises; in depression almost everyone has a degree of sleep disturbance. In other psychiatric disorders the levels are lower but often highly importantfor example, circadian disruption in schizophrenia and dementia severely impacts on rehabilitation possibilities, and insomnia in bipolar disorder is an early warning of manic relapse. Sleep is also important in other medical conditions, most notably sleep breathing disorders with their attendant daytime risks of sleepiness-induced accidents. Finally, there are some disorders of sleep itself, such as narcolepsy and night terrors, which though rare do have major impacts on the lives of patients and their relatives, as well as revealing insights into the brain mechanisms underlying sleep processes.

Despite this wide impact of disordered sleep in medical practice and the major impairments it causes to quality of life, most doctors and other health professionals have only minimal training in sleep processes or their pathology. This short book sets out to redress this imbalance by giving a concise yet complete overview of the field. We cover the basics of sleep physiology and then describe the wide range of different disorders that can be seen in both primary and secondary care. The ways to diagnose these are described, and treatment approaches are summarized. There is a special chapter dedicated to the problems of sleep disruption that we as professionals inevitably experience and often suffer from.

We believe that this book will fulfill a useful role in the education of doctors, nurses and other healthcare professionals. In addition, we hope that it will communicate some of our enthusiasm for this area of medicine in which we have worked for over 25 years.

David Nutt, March 2008

Key points

Sleep is essential to normal brain function

Loss of sleep can result in changes in mood, cognitive impairment, and abnormal hormone rhythms

Most adults sleep for between 7 and 8 h a night; adults who sleep for less than 6 h are likely to report that they do not get enough sleep and that they are more dissatisfied with life

The sleepwake cycle is controlled by two separate but interacting processes: the circadian process and the homeostatic or recovery process

The typical sleep pattern consists of 4 or 5 cycles of quiet sleep, alternating with paradoxical or rapid-eye-movement (REM) sleep

Quiet sleep is often referred to as non-REM (NREM) sleep, and is divided further into four stages

Humans spend about a third of their lives asleep, but we know surprisingly little about the precise function of sleep. What we do know is that: