Advances and New Directions

By Silvano Arieti; H. Keith H. Brodie | Go to book overview

CHAPTER 22

SLEEP DISORDERS:
EVALUATION AND
MANAGEMENT IN THE
OFFICE SETTING

Anthony Kales

Constantin R. Soldatos

Joyce D. Kales


¶ Introduction

THE evaluation and treatment of sleep disorders constitute an important area of psychiatric practice. Psychological factors are prominent in the etiology of insomnia, certain cases of hypersomnia, secondary enuresis, and in cases of adults who suffer from sleepwalking, night terrors, and nightmares. In childhood the development of sleepwalking, night terrors, and nightmares is usually related to maturational factors ; psychiatric disturbances are occasionally primary. In other sleep disorders such as narcolepsy, primary enuresis, and sleep apnea, psychological factors are rarely causative. However, since these disorders often have extensive psychosocial consequences, they are frequently the cause of psychological disturbances.

Disturbance of sleep is a common symptom of such psychiatric conditions as depression, mania, schizophrenia, or anxiety. Even when disturbed sleep is associated with a medical illness, psychological factors such as anxiety, depression, insecurity, lowered self‐ esteem, and fear of a more permanent invalidism or death are often causative.

The prevalence of sleep disorders in the general population is quite striking. In a survey 17 of representative households in the Los

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