Basic aspects of sleep–wake disorders

A sound working knowledge of the diagnosis, significance, and treatment of sleep disorders is essential in all branches of clinical psychiatry. Unfortunately, however, psychiatrists and psychologists share with other specialties and disciplines an apparently universal neglect of sleep and its disorders in their training. Surveys in the United States and Europe point to the consistently meagre coverage of these topics in their courses at both undergraduate and postgraduate levels. The following account is an introductory overview of normal sleep, the effects of sleep disturbance, sleep disorders and the risk of failure to recognize them in psychiatric practice, assessment of sleep disturbance, and the various forms of treatment that are available. The aim is to provide a background for the other chapters in this section. The close links between the field of sleep disorders and psychiatry which make it essential that psychiatrists are familiar with the field are as follows: ♦ Sleep disturbance is an almost invariable feature and complication of psychiatric disorders from childhood to old age, with the risk of further reducing the individual's capacity to cope with their difficulties (see Table 4.14.1.3 for further details). ♦ Sleep disturbance can presage psychiatric disorder. ♦ Some psychotropic medications produce significant sleep disturbance. ♦ Of importance to liason psychiatry is the fact that many general medical or paediatric disorders disturb sleep sufficiently to contribute to psychological or psychiatric problems. ♦ Because of lack of familiarity with sleep disorders and their various manifestations, such disorders may well be misinterpreted as primary psychiatric disorders (or, indeed, other clinical conditions) with the result that effective treatments for the sleep disorder are unwittingly withheld (see later). Some of these points will be amplified in later sections of this chapter.