What Is Causing The Disorders?
Sleep disorder treatment depends on what is causing the disorder. For example, if major depression is the cause of insomnia, then treatment of the depression with antidepressants should resolve the insomnia.
Sleep Disorder Medications
Sedative or hypnotic medications are generally recommended only for insomnia related to a temporary stress (like surgery or grief) because of the potential for addiction or overdose.
Sedating Antidepressant
Trazodone, a sedating antidepressant, is often used for chronic insomnia that does not respond to other treatments. Sleep medications may also cause problems for elderly patients because of possible interactions with their other prescription medications. Among the safer hypnotic agents are lorazepam, temazepam, and zolpidem.
Short-Term Treatment
Chloral hydrate is often preferred for short-term treatment in elderly patients because of its mildness. Short-term treatment is recommended because this drug may be habit forming.Narcolepsy is treated with stimulants such as dextroamphetamine sulfate or methylphenidate.
Nocturnal Myoclonus
Nocturnal myoclonus has been successfully treated with clonazepam. Children with sleep terror disorder or sleepwalking are usually treated with benzodiazepines because this type of medication suppresses stage 3 and stage 4 NREM sleep.
Sleep Disorder Psychotherapy
Psychotherapy is recommended for patients with sleep disorders associated with other mental disorders. In many cases the patient's scores on the Beck or Zung inventories will suggest the appropriate direction of treatment. The multiple sleep latency test (MSLT) is frequently used to measure the severity of the patient's daytime sleepiness.
The Tests
The test measures sleep latency (the speed with which the patient falls asleep) during a series of planned naps during the day. The test also measures the amount of REM sleep that occurs. Two or more episodes of REM sleep under these conditions indicates narcolepsy. This test can also be used to help diagnose primary hypersomnia.
Test Of Sustained Wakefulness
The repeated test of sustained wakefulness (RTSW) is a test that measures sleep latency by challenging the patient's ability to stay awake. In the RTSW, the patient is placed in a quiet room with dim lighting and is asked to stay awake. As with the MSLT, the testing pattern is repeated at intervals during the day.
Sleep Education
"Sleep hygiene" or sleep education for sleep disorders often includes instructing the patient in methods to enhance sleep. Patients are advised to:
Things To Stop
Patients with sleep apnea or hypopnea are encouraged to stop smoking, avoid alcohol or drugs of abuse, and lose weight in order to improve the stability of the upper airway. In some cases, patients with sleep disorders related to jet lag or shift work may need to change employment or travel patterns. Patients may need to avoid rapid changes in shifts at work. Children with nightmare disorder may benefit from limits on television or movies. Violent scenes or frightening science fiction stories appear to influence the frequency and intensity of children's nightmares.
Sleep Disorder Surgery
Although making a surgical opening into the windpipe (a tracheostomy) for sleep apnea or hypopnea in adults is a treatment of last resort, it is occasionally performed if the patient's disorder is life threatening and cannot be treated by other methods. In children and adolescents, surgical removal of the tonsils and adenoids is a fairly common and successful treatment for sleep apnea. Most sleep apnea patients are treated with continuous positive airway pressure (CPAP). Sometimes an oral prosthesis is used for mild sleep apnea.