|
We’re Not Sleeping Enough!
|
|
2/8/2010
|
|
Fearful Sleeping and Waking
|
With strong encouragement from his parents and girlfriend, a young man sought help for the unusual things he was doing during the night. His sound sleep had become interrupted by a variety of behaviors that he often did not remember.
|
11/5/2009
|
|
Sleep and Memory
|
Forgetfulness is a common complaint of people who do not get enough sleep, whether it is due to sleep deprivation from an overly busy schedule or the result of insomnia.
|
8/4/2009
|
|
Introduction: Difficulties with Sleep or Wakefulness
|
I am delighted to have the opportunity to write about sleep and sleep disorders in Primary Psychiatry. I aim to bridge the emerging neuroscience of sleep with the clinical realities of sleep disorders and, along the way, share with readers the stories of some of the patients I see at the Sleep Disorders Center at Johns Hopkins in Baltimore, Maryland.
|
1/7/2009
|
|
Narcolepsy: What an Old Disorder Can Teach Us About New Science
|
The disorder we now call narcolepsy was first named and described as a specific disorder by Gelineau in France in 1880. It can be argued that this recognition signaled the start of the field of sleep medicine. Gelineau coined the term “narcolepsy” to describe a syndrome of excessive sleepiness, characterized by an irresistable urge to sleep, at times accompanied by falls.
|
9/26/2008
|
|
Parasomnias: Rapid Eye Movement Sleep Behavior Disorder
|
A 70-year-old female patient is screaming out at night. This has been going on for several decades but has been getting worse lately and is disturbing her husband’s sleep. She also has Parkinson’s disease, but this has only been present for approximately 10 years. Is this a sleep disorder? What stage of sleep is it likely occurring from?
|
6/26/2008
|
|
“Doc, I am Tired”: Evaluating Sleepiness in Psychiatric Practice
|
Complaints of fatigue and sleepiness are common in psychiatric patients. Their expression may reflect core components of various psychiatric disorders, may relate to comorbid conditions which may affect their emotional state, or may occur as a side effect of medications used to treat psychiatric disorders.
|
4/29/2008
|
|
Cognitive Behavior Therapy for Insomnia: Can I Incorporate It Into My Practice?
|
Cognitive behavioral therapy for insomnia is well documented as an effective non-pharmacologic therapy for insomnia, but it is not widely understood or utilized in clinical practice.
|
2/25/2008
|
|
Is It a Sleeping Pill?
|
When I am lecturing to physician groups on treatment of insomnia, I am struck by the frequency with which I am asked about the use of “non-hypnotic hypnotics.”
|
12/27/2007
|
|
Increased Brain MAO-A Levels in Major Depressive Disorder
|
Deficiency of monoamine neurotransmitter levels was proposed as the underlying cause of depressive disorders over 40 years ago. Extensive biochemical studies and pharmacologic evidence show that all antidepressants modulate functional levels of monoamine neurotransmitters implicated in depression (ie, serotonin, norepinephrine, and dopamine).
|
11/28/2007
|
|
The Role of Cognitive and Behavioral Therapies in the Treatment of Insomnia
|
Insomnia can be a symptomatic complaint or a disorder. When insomnia presents as an uncomplicated symptomatic complaint, ie, transient insomnia associated with travel or stress, the use of a hypnotic medication as a “solo therapy” may not only be appropriate but advisable.
|
10/29/2007
|
|
Pharmacologic Therapy: Melatonin, Antidepressants, and Other Agents
|
Medications are never entirely “risk free,” but the various agents used to treat insomnia have always been a source of concern for practicing physicians and regulatory bodies. Various classes of agents have been shown to be associated with risks of abuse, dependency, and toxicity with overdosage, but among classes of agents perceived to be more safe have been the antidepressants, various herbal reparations thought to be effective in promoting and sustaining sleep, and the naturally occurring hormone melatonin.
|
8/29/2007
|
|
Pharmacologic Therapy: Benzodiazepines
|
Current practice for treating insomnia is often different from the recommendations of various professional bodies and sleep authorities, including the recommendations of the National Institute of Health State of the Science Panel. For example, the benzodiazepine receptor agonists are effective in the treatment of insomnia. They have been widely used throughout the world for >40 years and have demonstrated a remarkable safety record.
|
7/26/2007
|
|
Development and Treatment of Insomnia
|
Understanding insomnia and how it can most effectively be treated continues to challenge psychiatrists and other clinicians. Insomnia may be acute or chronic, but the majority of patients presenting for evaluation to treating physicians complain of chronic insomnia.
|
6/25/2007
|
|
Insomnia: Comorbidities and Consequences
|
In most areas of medical practice, an understanding of the etiology of a clinical condition is helpful in making appropriate choices about the need to treat, about which treatments should be given, and when treatment is appropriate. In the assessment and treatment of insomnia such information is critical and contributes strongly to the physician’s capacity to develop a treatment plan that is likely to be effective for the treatment of the insomniac patient.
|
5/26/2007
|
|
Introduction to Chronic Insomnia:
Classification and Prevalence
|
Despite the dramatic scientific advances in the field of sleep research of the last 50 years, medical students receive little if any teaching about sleep physiology and sleep disorders. In most residency training programs, no instruction is provided to help physicians learn how to diagnose and treat sleep disorders they will see in their practices. As is true for psychiatric disorders, effective treatment of sleep disorders requires the capacity to make the correct diagnosis; this in turn is dependent on an understanding of how various disorders develop and present, how they may progress over the life cycle, and how treatment interventions may affect their course and may lead to remission or resolution of symptoms. I hope that the information presented in this series will help readers open at least one eye to the challenges and opportunities associated with the treatment of sleep disorders!
|
4/23/2007
|