Reviews for Primary Care - Fall 2007 - (Page 51) Insomnia and Neurological Disorders medical illnesses, and sleep-wake schedule pattern. Treatment of potential underlying sleep disorders, such as PLMS, RLS, and sleep apnea, may improve sleep quality and correct insomnia. A carefully thought-out clinical decision-making process can greatly benefit the patient and family. Sleep problems in the setting of neurodegenerative disorders contribute heavily to the decision to institutionalize the patient and affect the psychological, social, and economic burden of institutional care. Consequently, it is important for neurologists and healthcare professionals to identify, manage, and follow sleep disturbances in their patients. Because the etiology of poor sleep quality is often multifactorial and may shift over time, a careful evaluation for insomnia should be an integral part of the routine care of all patients in neurological practice. 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Main Points • Complaints of insomnia are prevalent in neurodegenerative and neurological disorders. • Treatment of insomnia should start by addressing nonpharmacologic options, including improvements in sleep hygiene, improving sunlight exposure during the day, and searching for underlying reversible causes such as sleep apnea, restless legs syndrome, periodic leg movements, and circadian rhythm disturbances, all of which can precipitate insomnia when left untreated. • Patients with dementia are at risk for additional sleep disturbances, such as obstructive sleep apnea and periodic limb movement disorder of sleep, which occur at higher incidence with aging. • Treatment of potential underlying sleep disorders, such as periodic limb movement disorder of sleep, restless legs syndrome, and sleep apnea, may improve sleep quality and correct insomnia, avoiding patient institutionalization. VOL. 1 NO. 1 2007 REVIEWS FOR PRIMARY CARE 51
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