Excessive daytime sleepiness in childhood might be abnormal phenomenon and often related to the sleep disorders or insufficient sleep duration. The most common cause of excessive daytime sleepiness would be insufficient sleep. However, narcolepsy, idiopathic hypersomnia, circadian rhythm sleep disorders, medication, medical illness and other sleep disorders that could cause insomnia and poor quality of sleep also result in excessive daytime sleepiness. The misdiagnosed and untreated excessive daytime sleepiness in childhood can lead to serious developmental and educational problem.
Child ; Humans ; Hypersomnolence, Idiopathic ; Narcolepsy ; Sleep Wake Disorders ; Sleep Wake Disorders, Circadian Rhythm ; Sleep Initiation and Maintenance Disorders

A condition of underestimation of sleep is classified as paradoxical insomnia or sleep state misperception. However, overestimation of sleep, so called positive sleep state misperception has not been clearly described. Here we report a middle-aged woman with positive sleep state misperception who presented excessive sleepiness mimicking hypersomnia.
Disorders of Excessive Somnolence* ; Female ; Humans ; Sleep Disorders, Intrinsic* ; Sleep Initiation and Maintenance Disorders

A total of 85 sleep disorders are described in the International Classification of Sleep Disorders, 2nd ed. Knowledge about those sleep disorders will be essential not only for good and healthy sleep but also for maintaining adequate physical and mental function during daytime. Sleep medicine has a relatively short history compared to other medical fields, thus, many sleep disorders are not familiar to the general public and even to physicians. In this small review about various sleep disorders, I will briefly introduce basic concepts about insomnia, sleep-related breathing disorder, hypersomnia, circadian rhythm sleep disorders, parasomnia and sleep-related movement disorders. These sleep disorders are frequently encountered in clinical settings, and understanding them will give us insight about the basic mechanism of sleep-wake states.
Classification ; Diagnosis ; Disorders of Excessive Somnolence ; Movement Disorders ; Parasomnias ; Respiration ; Sleep Wake Disorders* ; Sleep Disorders, Circadian Rhythm ; Sleep Initiation and Maintenance Disorders

Narcolepsy is a central neurologic system disease. It begins early in life with disabling symptoms including excessive daytime sleepiness, cataplexy, sleep paralysis, hypnagogic hallucination and nocturnal sleep fragmentation. Patient with typical symptoms of narcolepsy is diagnosed by objective data from nocturnal polysomnography and multiple sleep latency tests. Narcolepsy is controlled with various medications. Nowadays, modafinil with favorable side effects profiles compared with traditional stimulant is mainly used. Gamma hydroxyl butyrate is effective in cataplexy. Cataplexy is also controlled with antidepressant such as Venlafaxine, SSRI, and TCA. As the knowledge of pathophysiology of narcolepsy expands, new treatment including immunological method, application of hypocretin and histamine systems have been tried.
Benzhydryl Compounds ; Butyrates ; Cataplexy ; Cyclohexanols ; Disorders of Excessive Somnolence ; Hallucinations ; Histamine ; Humans ; Intracellular Signaling Peptides and Proteins ; Narcolepsy ; Neuropeptides ; Polysomnography ; Sleep Deprivation ; Sleep Paralysis ; Orexins ; Venlafaxine Hydrochloride

BACKGROUND/AIMS: Zolpidem is a safe and effective drug for the treatment of insomnia. However, there are some reports of adverse effects, such as delirium, after administration of zolpidem. The aim of this study was to evaluate the incidence of and risk factors for zolpidem-induced delirium. METHODS: This retrospective study enrolled 481 patients who were admitted to hospital and received zolpidem between January and May 2011. We analyzed the incidence and risk factors associated with zolpidem-induced delirium. RESULTS: Zolpidem-induced delirium occurred in 19 of 481 (4.0%) patients. Zolpidem-induced delirium was significantly associated with old age (> or = 65 years; odds ratio [OR] = 4.35, 95% confidence interval [CI] = 1.52-12.44, p = 0.006) and co-administration of benzodiazepine (OR = 4.30, 95% CI = 1.52-12.12, p = 0.006). When males > 65 years-old took both benzodiazepine and zolpidem simultaneously, the incidence of delirium was notably elevated (OR = 6.04, 95% CI = 1.80-20.20, p = 0.003). Other factors, including dosage, did not influence the occurrence of delirium. CONCLUSIONS: Old age and co-administration of benzodiazepine were independent risk factors for zolpidem-induced delirium. Therefore, a detailed medical history should be taken before prescribing zolpidem to an older person, and zolpidem should be used cautiously, with careful monitoring, in these patients.
Benzodiazepines ; Delirium ; Dyssomnias ; Humans ; Incidence ; Male ; Odds Ratio ; Pyridines ; Retrospective Studies ; Risk Factors ; Sleep Initiation and Maintenance Disorders

Narcolepsy is characterized by excessive daytime sleepiness, cataplexy, sleep paralysis and hypnagogic hallucinations. Only a few studies have focused on non-rapid eye movement (NREM) and REM parasomnias in narcolepsy. We report a narcolepsy without cataplexy patient presenting parasomnia as an initial symptom. A 18-year-old boy was admitted to hospital for abnormal behavior of sitting up during sleep over 2 years. He had a symptom of lethargy without cataplexy and subjective excessive daytime sleepiness, but his family found him often asleep during daytime. He underwent 3 times of polysomnography (PSG) including 1 multiple sleep latency test (MSLT) after the last PSG. The last PSG showed 1 episode of abrupt sitting. Three sleep REM onset period was observed in MSLT which was not detect in PSG. Parasomnia as an initial symptom of narcolepsy is a rare clinical entity. The MSLT may be useful in the evaluation of patients with parasomnia and unexplained hypersomnia.
Adolescent ; Cataplexy ; Disorders of Excessive Somnolence ; Eye Movements ; Hallucinations ; Humans ; Lethargy ; Male ; Narcolepsy ; Parasomnias ; Polysomnography ; Sleep Arousal Disorders ; Sleep Paralysis

Sleep comprises one third of human life and is very important for maintaining healthy mental and physical states. Sleep disorders disturbing normal sleep are very common and may induce serious consequences. Sleep disorder medicine is based on the concept of two different states (waking and sleep) of the human brain. The problems of the waking conscious state affect sleep and problems during sleep also affect daytime mental and physical activities. The common symp-toms of patients with sleep disorders are excessive daytime sleepiness, a decrease in alertness, and fatigue. To detect sleep disorders, we should understand the physiology of normal sleep. Normal sleep consists of non-rapid eye movement (75% to 80%) and rapid eye movement (20% to 25%) sleep. The International Classification of Sleep Disorders second edition lists 77 different sleep disorders divided into 8 categories. Clinical approaches to sleep disorder patients should include detailed history taking including sleep history, a sleep questionnaire, sleep diary, physical examination including the nasal/oral cavities and airway, and neurological/psychological examination. The common sleep disorders are obstructive sleep apnea, insomnia, narcolepsy, restless legs syndrome, rapid eye movement sleep behavior disorder, and circadian rhythm sleep disorder. We should learn the characteristic clinical features of each sleep disorder and how to detect and treat them. We need a more active effort to educate physicians about sleep disorder medicine and should try large sample, long-term, and prospective studiesto reveal the pathophysiology and enhance the treatment of sleep disorders. Sleep disorders are common, serious, and treatable. However, most patients with sleep disorders are underdiagnosed and not treated appropriately due to lack of knowledge of sleep disorder medicine. The Ministry of Health and Welfare of South Korea should focus more attention on and provide more support for timely diagnosis and treatment of sleep disorders.
Brain ; Circadian Rhythm ; Eye Movements ; Fatigue ; Humans ; Motor Activity ; Narcolepsy ; Physical Examination ; Surveys and Questionnaires ; REM Sleep Behavior Disorder ; Republic of Korea ; Restless Legs Syndrome ; Sleep Apnea, Obstructive ; Sleep Initiation and Maintenance Disorders ; Sleep Wake Disorders ; Sleep, REM

Sleep disturbances such as insomnia, hypersomnia, and circadian rhythm disturbance are common in normal elderly and Alzheimer's disease (AD) patients. To date, special attention has been paid to sleep disturbance in the clinical course of AD insofar as the interaction of sleep disturbance with the pathogenesis of AD may impact the clinical course and cognitive function of AD patients. This review covers the bidirectional relationship between sleep disturbance and AD pathogenesis; the associations between sleep disturbance and AD-specific neurotransmitters, brain structure, and aspects of sleep disturbance in each phase of AD; and the effects of sleep disturbance on the cognitive functions of patients in each phase of AD. We consider several factors required to exactly interpret the results and suggest a direction for future studies on the role of sleep disturbance in AD.
Aged ; Aging ; Alzheimer Disease* ; Amyloid beta-Peptides ; Brain ; Circadian Rhythm ; Cognition ; Disorders of Excessive Somnolence ; Humans ; Mild Cognitive Impairment ; Neurotransmitter Agents ; Sleep Initiation and Maintenance Disorders

The prevalence of sleep disorder is about 30% of the population. Common sleep disorders are insomnia, obstructive sleep apnea, narcolepsy, restless legs syndrome, rapid eye movement sleep behavior disorder and parasomnia. These sleep disorders lead various medical and mental complications. However, most sleep disorders are underdiagnosed and not treated appropriately. Sleep medicine is important for treating these sleep disorders and maintaining general healthy conditions. Specialized and comprehensive treatments for sleep disorder are important in sleep medicine.
Narcolepsy ; Parasomnias ; Prevalence ; REM Sleep Behavior Disorder ; Restless Legs Syndrome ; Sleep Apnea, Obstructive ; Sleep Wake Disorders* ; Sleep Initiation and Maintenance Disorders

Alcohol has been used as sedatives historically. The effect of alcohol on sleep is different according to its dose, timing of ingestion, and drinking frequency. Sleep problems may play a role in the development and course of alcohol-related disorders. Insomnia in alcohol-dependent patients is common and early treatment of insomnia may reduce the rate of relapse. Sleep apnea, restless legs syndrome, periodic limbs movement disorder, and altered circadian rhythm may be more frequent in this patients. Management of sleep and alcohol problems is important in treating alcohol-related disorder and sleep disorders, respectively.
Alcohol-Related Disorders ; Circadian Rhythm ; Drinking ; Eating ; Extremities ; Humans ; Hypnotics and Sedatives ; Movement Disorders ; Recurrence ; Restless Legs Syndrome ; Sleep Apnea Syndromes ; Sleep Wake Disorders ; Sleep Initiation and Maintenance Disorders