By Michael H Silber; Lois E Krahn; Timothy I Morgenthaler
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Example text
This includes indicating bedtime, rising time, time asleep, daytime naps, degree of alertness on waking and consumption of substances that may affect alertness. She would then wake at least three times during the night, taking 30–60min to fall asleep on each occasion. Finally, she described pain over the left hip whenever she rolled on that side, She did not snore. With these multiple interventions, the patient’s symptoms improved markedly. It was clear that the correct diagnosis was insufficient sleep syndrome and lifestyle changes were advised.
Hypocretins (orexins) Hypocretins (also known as orexins) are recently identified peptide neurotransmitters secreted by a small group of cells in the posterolateral hypothalamus10. The hypocretin system appears to act primarily to promote wakefulness by facilitating the release of wakeproducing monoamines. A number of substances enhance slowwave sleep, including the cytokines interleukin1 and tumor necrosis factor; a nonapeptide, delta sleepinducing peptide; and growth hormonereleasing hormone.
Hypersomnia may also be due to medical conditions, such as Parkinson’s disease and dementias (Chapter 17). Non24h sleepwake disorder occurs when the biological clock fails to entrain to the 24h geosynchronous cycle, resulting in the sleep period slowly rotating around the clock. This may be seen in blind patients with inadequate light stimulation of the hypothalamic suprachiasmatic nuclei. Several days are needed for the biological clock to adapt to such alterations and travellers develop insomnia, excessive sleepiness and mood and somatic symptoms.
