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

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

Parasomnia overlap disorder is characterized by coexisting rapid eye movement (REM) sleep behavior disorder and non-REM parasomnia. We report herein an 8-year-old boy with REM sleep behavior disorder, sleep talking, and confusional arousal. Polysomnography revealed REM sleep without atonia, and arousal disorder. Neurological examination revealed bilateral ptosis, lateral gaze palsy, facial palsy, vertical nystagmus, and dysmetria. A pontine glioblastoma was found on brain magnetic resonance imaging, which could have been responsible for his neurologic deficit and sleep problem.
Arousal ; Brain ; Cerebellar Ataxia ; Child ; Facial Paralysis ; Glioblastoma ; Humans ; Magnetic Resonance Imaging ; Neurologic Examination ; Neurologic Manifestations ; Nystagmus, Pathologic ; Paralysis ; Parasomnias ; Polysomnography ; REM Sleep Behavior Disorder ; Sleep Arousal Disorders ; Sleep, REM ; Sleep-Wake Transition 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

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

BACKGROUND: Although actigraphy has been used to evaluated sleep-wake patterns and quality of sleep disorders patients, its usefulness in obstructive sleep apnea syndrome (OSAS) and primary insomnia is unclear. To investigate the value of actigraphy in OSAS and differentiating OSAS from primary insomnia, night polysomnography (PSG) and actigraphy were performed simultaneously. METHODS: 31 OSAS patients and 21 primary insomnia patients were included (16 females, 36 males). Sleep latency, total sleep time, sleep efficiency and actual wake time, movement and fragmentation index (MFI) were obtained in actigraphy and compared with PSG results. Spearmann correlation analysis and Mann-Whitney U test were used. RESULTS: The sleep efficiency and total sleep time are highly correlated in PSG and actigraphy (p<0.05, p<0.01). Respiratory disturbance index and arousal index in PSG was relatively correlated with MFI in actigraphy (p<0.05). Sleep latency is not correlated in PSG and actigraphy (p>0.05). OSAS had a significantly higher movement and fragmentation index (MFI) than that of primary insomnia (p<0.05) CONCLUSIONS: Actigraphy is a useful and convenient test in differentiating OSAS from insomnia as well as sleep-wake cycle disorders.
Actigraphy* ; Arousal ; Female ; Humans ; Polysomnography* ; Sleep Apnea, Obstructive* ; Sleep Wake Disorders* ; Sleep Disorders, Circadian Rhythm ; 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

Sleepwalking is a rare parasomnia in the elderly. We report two cases of the patients who presented complex motor behaviors during sleep triggered by hypoglycemia. A 76-year-old male patient with diabetes mellitus presented to the sleep clinic for recurrent sleepwalking with amnesia. Night polysomnogram showed REM sleep without atonia with sleep talking and distal arm movements. While taking clonazepam, he had a few more episodes of sleepwalking. The last episode finally revealed severe hypoglycemia when he was found very far from his house. The second patient, a 67-year-old male showed four episodes of nocturnal confusion and sleepwalking lasting 20 minutes during sleep. His blood glucose and HbA1c were low. After decrease of the dose of oral hypoglycemic agent, no more recurrent sleepwalking occurred. Our cases showed hypoglycemia can induce sleepwalking in the older adults, rather than decreased mentality. Metabolic workup should perform for evaluation of sleepwalking, especially in the elderly.
Adult ; Aged ; Amnesia ; Arm ; Blood Glucose ; Clonazepam ; Diabetes Mellitus ; Humans ; Hypoglycemia* ; Male ; Parasomnias ; Polysomnography ; Sleep, REM ; Sleep-Wake Transition Disorders ; Somnambulism*

Rapid-eye-movement (REM) sleep behavior (RBD) is a form of REM sleep motor dyscontrol characterized by complex, vigorous, and frequently violent behaviors without atonia during the REM sleep. The motor dyscontrol may include not only cataplexy and sleep paralysis but alto periodic limb movements during REM and non-REM sleep. We examined two patients with charateristic episodes of behavioral manifestations during the REM sleep as well as with other sleep disorders such as narcolepsy and periodic limb movement disorder. The one patina was an 18 year-old man who had childhood-onset RBD associated with narcolepsy since 10 years old. The polysomnographic studies showed excessive augmentation of chin EMG and 6 attacks of violent behavior during REM sleep. He also complained of cataplexic symptomes. Multiple sleep latency tests (MSLT) showed four sleep onset REMs and two episodes of violent behavior during the REM sleep. The other patient was a 74 year-old man who complained of violent behaviors during the REM sleep and polysomnographic studies showed excessive augmentation of chin EMG during the REM sleep and periodic leg movements for 24min. And 14sec. During the sleep. We report two patients with RBD which were associated with narcolepsy, and periodic limb movememt disorder irrespectively, suggesting that RBD, narcolepsy and periodic limb movement disorder could occur coincidently and be understood as a motor dyscontrol during REM sleep.
Adolescent ; Aged ; Cataplexy ; Child ; Chin ; Extremities ; Humans ; Leg ; Mental Disorders* ; Narcolepsy* ; Nocturnal Myoclonus Syndrome* ; REM Sleep Behavior Disorder ; Sleep Wake Disorders ; Sleep Paralysis ; Sleep, REM*

Sleep changes substantially with age. There is a phase advance in the circadian sleep cycle and increased waking after sleep onset. The elderly people wake more frequently during the night and experience fragmented sleep and excessive daytime sleepiness. The prevalence of sleep disorders increases with age, and the composition of sleep disorders in the elderly differs from that in the young. The most frequently encountered sleep disorders are psychophysiologic insomnia, sleep disturbance due to dementia, sleep-related respiratory disorder, restless legs syndrome and periodic limb movement disorder, and REM sleep behavior disorder. To treat the elderly sleep problem appropriately, it is important to know how sleep pattern changes as we age and to understand the cause of sleep-related symptoms. This article will review the sleep physiology and common sleep disorders in the elderly.
Aged* ; Dementia ; Humans ; Nocturnal Myoclonus Syndrome ; Physiology* ; Prevalence ; REM Sleep Behavior Disorder ; Restless Legs Syndrome ; Sleep Wake Disorders* ; Sleep Initiation and Maintenance Disorders