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This chapter primarily focuses on sleep and sleep disorders in adults. While many basic and clinical aspects are similar in children, developmental issues and some disorders not present in adults, for example, sudden infant death syndrome, are beyond the scope of this chapter. For further information the reader is referred to Principles and Practice of Sleep Medicine in the Child (Ferber and Kryger, 1995).

General Approach to the Patient

Office Evaluation

Clinicians should ask routinely about sleep and wakefulness. A thorough sleep history lays the foundation for accurate diagnosis and effective treatment of sleep disorders (Table 27–1). Patients’ sleep complaints will usually fall into four general categories: Complaints of difficulty initiating sleep or staying asleep (insomnia), difficulty staying awake during the day (hypersomnia); abnormal movements or behavior during sleep (parasomnia), timing of the sleep–wake cycle at undesired or inappropriate times over a 24-hour day (circadian rhythm disorder), or a combination of the above (see Figure 27–1).

Table 27–1. Office Evaluation of Chronic Sleep Complaints
Figure 27–1.

Steps for a sleep disturbance algorithm. (Adapted from Gillin JC, Ancoli-Israel S, Erman M: Sleep and sleep–wake disorders. In: Tasman A, Kay J, Lieberman JA (eds). Psychiatry. 2nd edn. Philadelphia: Saunders, 1996, pp. 1217–1248.)

During the evaluation, the patient's bed partner or other informants should be included whenever possible. Since the ...

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