- irresistible urge to nap
- drowsiness when driving or engaged in repeti-
tious activity - excessive snoring (OBSTRUCTIVE SLEEP APNEA) or
moving around (RESTLESS LEGS SYNDROME)
The diagnostic path begins with a comprehen-
sive medical examination to rule out physical
causes or health conditions, particularly obstruc-
tive sleep apnea. Evaluation in a sleep lab allows
observation of sleep patterns (polysomnography
study). The person may spend one to five nights
in the sleep lab, depending on the suspected
causes of sleep disturbances, during which techni-
cians observe, videotape, and record vital informa-
tion such as HEART RATE, BLOOD PRESSURE, and
electrical activity in the brain. ELECTROENCEPHALO-
GRAM (EEG) while awake and while asleep can
detect subclinical SEIZURE DISORDERSor other abnor-
malities of the brain’s electrical activity that may
interfere with sleep.
Treatment Options and OutlookLifestyle measures are often successful in improv-
ing the amount and quality of restful sleep. One of
the most important is going to bed at the same
time every night, which helps the body establish a
conscious rhythm of slowing down as that time
approaches. Other lifestyle approaches to improve
sleep include
- avoiding heavy meals, CAFFEINE, ALCOHOL, and
tobacco within four hours of bedtime - establishing quiet and darkness in the bedroom,
even if a daytime sleeper because of night shift
work - getting 20 to 30 minutes of physical exercise,
preferably outdoors, every day
Over-the-counter sleep aids often contain ANTI-
HISTAMINE MEDICATIONS, which induce sleep. Pre-
scription sleep aids are often sedatives. Though
sleep aids are effective for occasional use, over the
long term they are more likely to interfere with
sleep than improve its quality. Most medications
that induce sleep affect neuroreceptors in the
brain, which alters the way the brain functions
during sleep. The sleep aid may induce sleep but
prevent REM sleep and the dreams that occur
during it, reducing the restful quality of the sleep.
MELATONIN supplementation can sometimes
help readjust the body’s rhythms to encourage
sleep during daylight hours, particularly for night
shift workers. Melatonin is a HORMONEthe PITU-
ITARY GLANDproduces on a cyclic basis that initiates
sensations of drowsiness when it is time to sleep.
Warm chamomile tea, warm baths, or reading for
10 to 20 minutes before going to bed also may
help the transition from the activities of the day to
the calm that precedes restful sleep. Self-HYPNOSIS,
relaxation techniques or audiotapes, and BIOFEED-
BACKare other methods to prepare for sleep.TO NAP OR NOT TO NAP
For many people who do not get enough sleep,
the urge to nap during the day is irresistible.
Though napping often provides a boost of energy
and alertness in the short term, in the long term
it can contribute to sleep disturbances such as
insomnia.Risk Factors and Preventive Measures
People who work night shifts and sleep during the
day, which is counter to the body’s natural circa-
dian rhythm (cycle of sleep and wake), are most
likely to have sleep disorders. Sleep disorders may
result from physical conditions, such as obstruc-
tive sleep apnea or CHRONIC PAIN, as well as from
neurologic disorders that affect BREATHINGor MUS-
CLE control. OBESITY is the primary cause of
obstructive sleep apnea. Sleep disturbances are
common in many chronic health conditions, both
physical and psychologic. These factors are often
difficult for people to change. Other factors that
influence sleep are alcohol and tobacco use, EATING
HABITS and exercise patterns, and external envi-
ronment (quiet or noisy, bright or dark). These are
factors people can usually alter to improve the
potential for sleep, once they become aware of the
effects on sleep.
See also NARCOLEPSY.somatization disorder Chronic perception of
multiple illnesses and ailments for which doctors
can find no clinical evidence. Stress often exacer-
bates symptoms. Because the physical complaints
could indicate potentially serious illness, the most384 Psychiatric Disorders and Psychologic Conditions