Sleep … is the first great natural resource to be exhausted by modern man. The erosion of the nerves, not to be halted by any reclamation project, public or private. Irwin Shaw, ‘The Climate of Insomnia’, The New Yorker, 1949
Sleep is one of the five great innate drives in humans. Disorder of this basic function is one of the most common health-related problems presenting to the GP. It may represent the clue to some very important disorders, such as depression, anxiety, adverse drug reactions, drug abuse and obstructive sleep apnoea (OSA). About half of the population report having some sleep-related problem in a year, with 25% of the Australian population reporting trouble getting enough sleep.1 Normal sleep requirement varies considerably.
Sleep is divided into rapid eye movement (REM—also called dream sleep), as shown by EEG studies, and non-rapid REM sleep, which is subdivided into stages 1, 2 and 3. Most stage 3 sleep (deepest) occurs in the first hours. REM sleep is accompanied by dreaming and physiological arousals.
Disorders of the sleep–wake cycle, which are invariably caused by a disruption of the body's endogenous time clock, can result in insomnia or hypersomnolence (excessive sleepiness) or a combination of both. This is a feature of people experiencing the jet lag of international travel and shift workers.
Key facts and checkpoints
Normal sleep: in a fit young person the ideal is 7.5–8 hours; latency <30 minutes; wakefulness within sleep usually <5% of time.
Humans can stay awake without a problem for 16–18 hours. Sleepiness is wake-state instability.
The evaluation of sleep disorders involving the sleep–wake cycle is enhanced by the patient keeping a sleep chart.
It is important to take a drug history from patients complaining of insomnia or hypersomnolence.
Drugs that can disturb sleep include alcohol, nicotine, antihistamines, selective serotonin reuptake inhibitors (SSRIs), caffeine, hypnotics, venlafaxine, selected β-blockers, β2-agonists, theophylline, corticosteroids, sympathomimetic agents.
Sleep disorders in children, including snoring, should be taken seriously and investigated. They have many consequences, such as learning difficulties, hyperactivity, behavioural disorders, failure to thrive and short stature.
Be wary of young people and others presenting with insomnia with some urgency, especially requesting temazepam capsules—they may be dependent on benzodiazepines.
People with OSA usually present with the TATT syndrome—‘tired all the time’. These patients are often unaware of waking or becoming aroused during the night.
A patient who snores, has witnessed apnoeas and sleepiness is likely to have OSA.
The majority of cases of excessive somnolence are caused by OSA and narcolepsy.2
Non-pharmacological therapies, which include basic education and practice of sleep hygiene and behavioural therapy, should be used in management wherever possible.
Referral to the new generation, specialist sleep disorder centres provides enhanced objective evaluation, diagnosis and treatment of the more complex disorders.
It is illegal for a driver with a commercial driver's licence to continue to drive while ...
Log In to View More
If you don't have a subscription, please view our individual subscription options below to find out how you can gain access to this content.
Want remote access to your institution's subscription?
Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.
If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.
Murtagh Collection Full Site: One-Year Subscription
Connect to a suite of general practice resources from one of the most influential authors in the field. Learn the breadth of general practice, including up-to-date information on diagnosis and treatment, as well as key clinical skills like communication.
Pay Per View: Timed Access to all of Murtagh Collection
48 Hour Subscription $34.95
Pop-up div Successfully Displayed
This div only appears when the trigger link is hovered over.
Otherwise it is hidden from view.