Sleep and Neuropsychiatric Disorders

This book explores the intricate links between sleep and neuropsychiatric diseases. In clinical settings, understanding the development, treatment, and management of neuropsychiatric diseases poses a substantial challenge. Neuropsychiatric disorders place a significant cost on society, affecting the health of people affected, care providers, and the general community. Sleep and neuropsychiatric disease are inextricably linked. Sleep disorders are widespread in these populations and are frequently overlooked in neurology and psychiatry. The book offers readers up-to-date information on different facets of the bidirectional connections between sleep and neuropsychiatric diseases. Following the initial fundamental science part, a unique series of chapters concentrate on the behavioural manifestations of sleep problems, a hitherto unexplored field. Additional chapters include patient evaluation techniques as well as public health implications of sleep disorders. The individual chapters cover all main mental and neurological diseases where a change in sleep is evident, and recent concepts in pathogenesis, presentation, evaluation, and treatment. Neuropsychotropic drugs must be seen as a double-edged sword when it comes to sleep and sleep disorders. Overall, this book is an excellent resource for learning about neuropsychiatric diseases and how they affect sleep while simultaneously being impacted by sleep. Preface Acknowledgements Contents About the Editors Part I: Basic Sciences 1: Physiology of Normal Sleep 1.1 Introduction 1.2 Changes of Central and Peripheral Functions Across the Sleep/Wake Behavioral State 1.3 Brain Regions and Neurotransmitter Systems Involved in the Regulation of the Behavioral State 1.4 Wakefulness-Promoting Neurotransmitters 1.4.1 Serotonin 1.4.2 Norepinephrine 1.4.3 Dopamine 1.4.4 Histamine 1.4.5 Acetylcholine 1.4.6 Orexin 1.5 Sleep-Promoting Neurotransmitters 1.5.1 Upsi-Aminobutyric Acid 1.5.2 Melanin-Concentrating Hormone 1.5.3 Melatonin and Circulating Factors 1.5.4 Human Circadian Timing System 1.5.5 The Two-Process Model of Sleep Regulation 1.5.6 Polysomnography 1.6 Conclusions Glossary References 2: Why Sleep Is Altered Across a Wide Range of Neuropsychiatric Disorders (NPD)? 2.1 Introduction 2.2 Shared Genetics 2.3 Neurobiological Underpinnings Are Common to Both Sleep and Psychiatric Disorders 2.3.1 Role of Neurotransmitters-Dopamine 2.3.2 Role of Neurochemicals-BDNF 2.3.3 Role of Amygdala 2.3.4 Interhemispheric Functional Connectivity 2.3.5 Role of the DMN 2.4 Role of Circadian Rhythm in Sleep and Psychiatric Disorders 2.4.1 Role of Circadian Profile 2.4.2 Common Neurotransmitters and Pathways Underlying Circadian Processes and Psychiatric Disorders 2.4.3 Circadian Gene Variations Associated with Psychiatric Disorders 2.5 Role of Stress as Modulator of Zeitgebers 2.6 Behavioral Correlates of Psychiatric Disorders Impacting Sleep 2.7 Role of Psychotropic Medications 2.7.1 Sedative Hypnotics 2.7.2 Antidepressants 2.7.3 Antipsychotics 2.7.4 Other Psychotropics 2.8 Sleep Disorders Masquerading as Psychiatric Illnesses 2.9 Summary and Conclusion References 3: Biological Rhythm and Neuropsychiatric Disorders 3.1 Concept of Biological Rhythm 3.2 Human Circadian Rhythm-Concept of Central and Peripheral Clocks 3.3 Anatomy and Physiology of Mammalian Circadian Rhythm and Effect of Its Interaction on Other Body Functions 3.3.1 Role of Melatonin 3.3.2 Role of Corticosteroids 3.3.3 Molecular Mechanism of SCN 3.4 Chronobiological Basis of Neuropsychiatric Disorders 3.4.1 Role of Social Rhythm and Its Association with Neuropsychiatric Disorders 3.4.2 Circadian Rhythm Disruption in Neuropsychiatric Disorders 3.4.3 Probable Mechanism of Circadian Disruption and Neuropsychiatric Disorders References 4: Neurophysiology of Dreams 4.1 Functional Neuroimaging 4.2 Neurotransmitters of Dream Generation 4.2.1 Acetylcholine 4.2.2 Dopamine 4.2.3 Serotonin 4.3 A Descriptive Neural Model of Dream Phenomenology and Function 4.4 Areas 1 and 2: Ascending Arousal Systems 4.5 Area 3: Limbic Areas 4.5.1 Emotional Regulation and Dreaming 4.5.2 Differential Processing of Episodic and Declarative Memory 4.6 Area 4: Dorsolateral Prefrontal Executive Control Cortex 4.7 Area 5: Basal Ganglia 4.8 Areas 6 and 11: Thalamocortical Relay Centers and Thalamic Subcortical Circuitry 4.9 Area 9: Inferior Parietal Lobe 4.10 Area 11: Visual Association Cortex 4.11 Summary 4.12 Future Aspects References 5: Dream Consciousness and the Brain: Relevance to Psychopathology 5.1 Introduction 5.2 Sleep and Dreaming in Psychotic Disorders 5.3 Consciousness in Dreams and Psychosis 5.3.1 The Phenomenological Overlap Across Mental States 5.3.2 Frontal Brain Activity and Insight during Dreams and Psychosis 5.4 Dreaming in Patients with Complex Mental Disorders 5.4.1 Measuring Dream Recall Frequency 5.4.2 Content Analysis of Dreams 5.4.3 Formal Analysis of Dreams 5.4.4 Methodological Considerations 5.5 Conclusive Remarks References 6: Sleepiness, Fatigue, and Sleep Disorders 6.1 Introduction 6.2 Sleepiness 6.2.1 What Is Sleepiness? 6.3 Epidemiology 6.4 Etiology 6.5 Measuring Sleepiness 6.6 Subjective Sleepiness Measures 6.6.1 Sleep Diaries 6.6.2 Epworth Sleepiness Scale (ESS) 6.6.3 Stanford Sleepiness Scale (SSS) 6.6.4 Pittsburgh Sleep Quality Index (PSQI) 6.6.5 Functional Outcomes of Sleep Questionnaire 10 (FOSQ-10) 6.6.6 Time of Day Sleepiness Scale (ToDSS) 6.6.7 Horne and Östberg Morningness-Eveningness Questionnaire (MEQ) 6.6.8 Sleepiness-Wakefulness Inability and Fatigue Test (SWIFT) 6.6.9 Visual Analogue Scale (VAS) 6.6.10 Karolinska Sleepiness Scale (KSS) 6.7 Clinical History 6.8 Objective Sleepiness Measures 6.8.1 Multiple Sleep Latency Test (MSLT) 6.8.2 Maintenance of Wakefulness Test (MWT) 6.8.3 Polysomnography (PSG) 6.8.4 Vigilance Testing 6.8.5 Oxford Sleepiness Resistance (OSleR) Test 6.8.6 Pupillometry 6.8.7 Actigraphy 6.9 Causes of Sleepiness 6.9.1 Obstructive Sleep Apnea (OSA)/Sleep-Disordered Breathing (SDB) 6.9.2 Hypersomnia 6.9.2.1 Narcolepsy Type I (with Cataplexy) and Type II (without Cataplexy) 6.9.2.2 Idiopathic Hypersomnia (IH) 6.9.2.3 Circadian Rhythm Disorders (CRD) 6.9.2.4 Insufficient Sleep Syndrome 6.9.3 Restless Legs Syndrome (RLS) and Periodic Limb Movement Disorder (PLMD) 6.9.4 Other Untreated Medical Disorders 6.9.5 Sedating Medications 6.9.6 Important Note About Insomnia 6.10 Consequences of Sleepiness 6.10.1 Fatigue 6.10.2 Cognitive Dysfunction 6.10.3 Mood Disturbances 6.10.4 Performance Impairments (Home, Work, School, Etc.) 6.10.5 Safety Behaviors and Social Impact 6.10.6 Driving Safety/Operating Heavy Machinery Safety 6.11 Interventions and Management of Sleepiness 6.11.1 Pharmacological Management 6.11.2 Non-pharmacological/Behavioral Management 6.11.2.1 Bright Light Exposure 6.11.2.2 Scheduled Naps 6.11.2.3 Caffeine 6.11.2.4 Schedule Regularization 6.11.2.5 Extended Nocturnal Sleep Periods 6.12 Fatigue 6.12.1 What Is Fatigue? 6.13 Epidemiology 6.14 Etiology 6.15 Measuring Fatigue 6.15.1 Subjective Fatigue Measures (Table 6.4) 6.15.1.1 Sleep Diaries 6.15.1.2 Epworth Sleepiness Scale (ESS) 6.15.1.3 The Fatigue Questionnaire (FQ) 6.15.1.4 Fatigue Severity Scale (FSS) 6.15.1.5 Multidimensional Assessment of Fatigue (MAF) Scale 6.15.1.6 The Vitality Subscale (Energy/Fatigue) of the Short-Form Health Survey (SF-36) 6.15.1.7 Visual Analogue Scale to Evaluate Fatigue Severity (VAS-F) 6.16 Clinical History 6.16.1 Objective Fatigue Measures (Table 6.5) 6.16.1.1 Laboratory Evaluations/Blood Work 6.16.1.2 Polysomnography (PSG) 6.16.1.3 Actigraphy 6.16.1.4 Vigilance Testing 6.16.1.5 Electroencephalogram (EEG) 6.16.1.6 Neuroimaging 6.16.1.7 Other Studies and Evaluations 6.17 Causes of Fatigue (Table 6.6) 6.17.1 Insomnia Disorder 6.17.2 Obstructive Sleep Apnea (OSA)/Sleep-Disordered Breathing (SDB) 6.17.3 Hypersomnia 6.17.4 Circadian Rhythm Disorders (CRD) 6.17.5 Restless Legs Syndrome (RLS) and Periodic Limb Movement Disorder (PLMD) 6.17.6 Psychiatric Disorders 6.17.7 Other Medical Conditions 6.17.8 Fatigue Syndromes 6.17.9 Other Potential Causes 6.18 Consequences of Fatigue 6.18.1 Reduced Quality of Life 6.18.2 Poor Sleep Quality 6.18.3 Cognitive Deficits 6.18.4 Performance Impairments 6.18.5 Safety Behaviors 6.18.6 Mood Disturbances 6.19 Interventions and Management of Fatigue 6.19.1 Pharmacological Management 6.19.2 Non-pharmacological/Behavioral Management 6.19.2.1 Healthy Sleep Practices (a.k.a. Sleep Hygiene) 6.19.2.2 Schedule Regularization 6.19.3 Bright Light Exposure 6.19.4 Increasing Physical, Social, and Pleasant Activity 6.20 Summary References 7: Health Economics of Sleep Disorders 7.1 Introduction to Health Economics 7.1.1 Defining Key Outcomes: Health Economic Perspectives in Sleep Medicine 7.2 Measurement Matters: Costs Framework for Sleep Disorders 7.2.1 Direct and Indirect Costs 7.3 Health-Related Quality of Life (HRQoL) as a Measure of Morbidity 7.4 Quality-Adjusted Life Years (QALYs) 7.5 Monetizing QALYs: Cost-Effectiveness 7.6 Economic Aspects of Sleep Disorders and Their Treatments 7.7 The Direct Pathway 7.7.1 Obstructive Sleep Apnea (OSA) 7.7.1.1 Costs of Untreated OSA 7.7.1.2 Costs Associated with OSA Testing and Treatment 7.7.2 Insomnia 7.7.2.1 Cost of Untreated Insomnia 7.7.2.2 Insomnia Treatment Options and Their Costs Pharmacotherapy Behavioral Treatments 7.7.3 Restless Leg Syndrome 7.7.4 Narcolepsy 7.7.5 Shiftwork 7.7.6 Jetlag 7.8 The Indirect Pathway 7.8.1 The Economics as Sleep as a Comorbidity 7.8.1.1 OSA 7.8.1.2 Insomnia 7.8.1.3 Narcolepsy 7.8.2 The Economics of Sleep in the Workplace Productivity 7.8.2.1 OSA 7.8.2.2 Insomnia 7.8.2.3 Narcolepsy 7.8.3 The Economic Impact of Sleep on Accidents and Injuries 7.8.3.1 OSA 7.8.3.2 Insomnia 7.8.3.3 Insufficient Sleep and Fatigue 7.9 The Impact of Sleep on Health-Related Quality of Life 7.9.1 OSA 7.9.2 Insomnia 7.9.3 Other Sleep Disorders 7.10 Sleep and Social Disparities 7.11 Conclusions and Future Directions References 8: Approach to Sleep Complaints 8.1 Physical Examination 8.2 Laboratory Tests [4] 8.3 Imaging Tests [4] 8.4 Sleep Diary [5] 8.5 Questionnaires [5] 8.6 Home Sleep Apnea Test (HSAT) 8.7 In-Laboratory, Attended Polysomnography (PSG) [6] 8.8 Multiple Sleep Latency Test (MSLT) [7-9] 8.9 Maintenance of Wakefulness Test (MWT) [7] 8.10 Actigraphy [10-12] 8.11 Dim Light Melatonin Onset (DLMO) Secretion Test [13-15] 8.12 Conclusion References 9: Questionnaires for Screening of Sleep Disorders Appendix The Epworth Sleepiness Scale (ESS) The Fatigue Severity Scale (FSS) ZOGIM-A Questionnaire Morningness-Eveningness Questionnaire (Owl-Lark Self-Test) Non-restorative Sleep Scale Athens Insomnia Scale STOP-Bang The Restless legs Questionnaire Cataplexy Questionnaire Center for Epidemiological Studies Depression Scale (CES-D) Questionnaire Zung Self-Rating Anxiety Scale (SAS) Illness Intrusiveness Scale References 10: Methods of Evaluation of Sleep Disorders 10.1 Common Diagnoses 10.1.1 Obstructive Sleep Apnea (OSA) 10.1.2 Narcolepsy 10.1.3 Circadian Rhythm Disorder 10.1.4 Mood Disorder 10.1.5 Insomnia 10.1.6 Parasomnia/Non-rapid Eye Movement (NREM) Sleep Arousal Disorder 10.1.7 Sleep History 10.2 Physical Examination 10.3 Mental Status Examination and Neurological Examination 10.4 Investigations 10.4.1 Polysomnography (PSG) 10.4.2 Home Study 10.4.3 DLMO (Dim Light Melatonin Onset) Test 10.4.4 MSLT (Multiple Sleep Latency Test) 10.4.5 MWT (Maintenance of Wakefulness Test) 10.4.6 Actigraphy 10.5 Sleep Diary 10.6 Other Assessment Modalities 10.7 Summary References Part II: Behavioral Presentations of Sleep Disorders 11: Behavioral Presentations of Insomnia 11.1 Daytime Sequelae of Insomnia 11.2 Cognitive Effects of Insomnia 11.3 Differential Diagnosis 11.3.1 Chronic Insomnia Disorder 11.3.2 Short-term Insomnia Disorder and Other Insomnia Disorder 11.4 Assessment 11.5 3P Model of Insomnia 11.6 Treatment 11.6.1 Stimulus Control 11.6.2 Sleep Restriction Therapy 11.6.3 Cognitive Therapy 11.6.4 Sleep Hygiene 11.6.5 Relaxation 11.6.6 CBT-I and Improvement in Daytime Symptoms 11.7 Conclusion References 12: Behavioral Presentations of Sleep-Related Breathing Disorders 12.1 Introduction 12.2 Assessment of OSA 12.3 Management of OSA 12.4 OSA and Emotional Regulation 12.5 OSA and Depression 12.6 Effect of OSA Management on Mood Symptoms 12.7 OSA and Panic Disorder 12.8 OSA and Post-traumatic Stress Disorder 12.9 OSA and Nightmares 12.10 OSA and Parasomnias 12.11 OSA and Cognition 12.12 Neuroimaging and Behavioral Changes in OSA 12.13 OSA and Attention Deficit Hyperactivity Disorder 12.14 OSA and Personality Type 12.15 OSA and Behavioral Presentations in Children 12.16 Conclusion References 13: Behavioral Presentations of Central Disorders of Hypersomnolence 13.1 Narcolepsy 13.2 Idiopathic Hypersomnia 13.3 Kleine-Levin Syndrome 13.4 Hypersomnia Due to a Medical Disorder 13.5 Hypersomnia Due to a Medication or Substance 13.6 Hypersomnia Associated with a Psychiatric Disorder 13.7 Insufficient Sleep Syndrome 13.8 Evaluation of Excessive Daytime Sleepiness 13.9 Cognitive Dysfunction in Central Disorders of Hypersomnolence 13.10 Conclusion References 14: Behavioral Presentations of Circadian Rhythm Sleep Disorders 14.1 Introduction 14.2 Assessment and Measurements of CRSD 14.2.1 Sleep Logs/Diaries 14.2.2 Actigraphy-Watch Monitoring 14.2.3 Questionnaire 14.2.4 Patient ́s Medical History by Physicians 14.3 Risk Factors of CRSD 14.3.1 Head Trauma 14.3.2 Age 14.3.3 Gender 14.3.4 Drugs Side-Effect 14.3.5 Exposure to Artificial Light at Night (ALAN) 14.4 Advanced Sleep Wake Phase Disorder (ASWPD) 14.5 Delayed Sleep Wake Phase Disorder (DSWPD) 14.6 Irregular Sleep-Wake Rhythm (ISWR) 14.7 Non-24h Sleep Wake Rhythm Disorder (NSWRD) 14.8 Shift Work Disorder (SWD) 14.9 Jet Lag Disorder (JLD) 14.10 Types of Treatment for CRSD 14.10.1 Light Therapy 14.10.2 Melatonin Treatment 14.11 Psychological, Behavioral, and Cognitive Consequences of CRSD 14.11.1 Psychological and Emotional Aspects 14.11.2 Attentional, Memory, and Cognitive Performance 14.11.3 Behavioral and Physical Activity and CRSD 14.12 Conclusion References 15: Behavioral Presentations of Parasomnias 15.1 Introduction 15.2 History and Examination 15.3 Differentiating Nocturnal Seizures from Parasomnias: 15.4 What Is Sleep-Related Hypermotor Epilepsy (SHE)? 15.5 NREM Parasomnias (Disorders of Arousals) 15.5.1 Confusional Arousal 15.5.2 Sleep Walking 15.5.3 Sleep Terrors 15.6 Epidemiology and Pathogenesis of Disorders of Arousal 15.7 Onset, Course, and Complications 15.7.1 Sleep-Related Eating Disorder 15.8 Parasomnia Overlap Disorder 15.9 REM-Related Parasomnias 15.9.1 REM Sleep Behavior Disorder (RBD) 15.9.2 Recurrent Isolated Sleep Paralysis 15.10 Nightmare Disorder 15.10.1 Exploding Head Syndrome (Sensory Sleep Starts, Sensory Sleep Shocks) 15.10.2 Sleep Enuresis 15.11 Conclusion References 16: Behavioral Presentation of Sleep-Related Motor Disorders 16.1 Introduction 16.2 Behavioral Presentations of RLS 16.2.1 RLS and Depression 16.2.2 RLS and Anxiety Disorder 16.2.3 RLS and Schizophrenia 16.2.4 RLS and ADHD 16.2.5 RLS and Tourette ́s Syndrome 16.2.6 RLS and Impulse Control Disorder (ICD) 16.3 Behavioral Presentation of PLMD 16.4 Behavioral Presentation of Sleep-Related Bruxism 16.4.1 Sleep Bruxism and Depression 16.4.2 Sleep Bruxism and Anxiety Disorder 16.4.3 Sleep Bruxism and Perceived Stress 16.4.4 Sleep Bruxism and Psychopathological Factors in General 16.4.5 Sleep Bruxism and Quality of Life 16.4.6 Sleep Bruxism and Circadian Rhythm 16.5 Behavioral Presentation of Sleep-Related Rhythmic Movement Disorders 16.6 Conclusion References Part III: Sleep Disorders and Psychiatric Disorders 17: Sleep in Depression 17.1 Introduction 17.2 Epidemiologic Studies of Insomnia and Depression 17.3 Residual Insomnia Following Antidepressant Therapy 17.4 Hypersomnia and Depression 17.5 EEG and Polysomnographic Studies of Sleep in Depressed Patients 17.6 Sleep and Antidepressant Treatment 17.7 Sleep, Insomnia, and Suicide 17.8 Conclusions References 18: Sleep and Perinatal Depression 18.1 Introduction on Perinatal Depression 18.2 Sleep and Pregnancy 18.3 Sleep Disorders During Pregnancy 18.3.1 Sleep-Related Breathing Disorders (SRBDs) 18.3.2 Restless Legs Syndrome 18.3.3 Insomnia 18.3.4 Circadian Rhythm Sleep Disorders During Pregnancy 18.4 The Relationship Between Sleep Disturbances and Perinatal Depression 18.5 Sleep Loss and Puerperal Psychosis 18.6 Routine Monitoring and Treatment References 19: Sleep in Bipolar Disorders 19.1 Introduction 19.2 Sleep Disorders in BPAD 19.2.1 Sleep Disorders in Adults with BPAD 19.2.2 Sleep Disorders in Child and Adolescent with BPAD 19.3 Pathophysiology 19.3.1 Circadian Rhythm Dysfunctions 19.3.2 Role of CLOCK Genes 19.3.3 Chronotype 19.4 Effects of Sleep Disorder in BPAD 19.4.1 Contribution to Relapse 19.4.2 Role in Affective Regulation 19.4.3 Role in Cognitive Functioning 19.4.4 Role in Obesity 19.4.5 Substance Use Disorders 19.5 Effects of BPAD on Sleep Disorders 19.5.1 Obstructive Sleep Apnea 19.5.2 Hypersomnia 19.5.3 Insomnia 19.6 Bidirectionality in Relation Between Sleep Disorders and BPAD 19.7 Approach to Assessing Sleep Disturbance in BPAD 19.7.1 Investigations 19.7.1.1 Sleep Diary 19.7.1.2 Polysomnography 19.7.1.3 Actigraphy 19.8 Management of Sleep Disorder in BPAD 19.8.1 Non-pharmacological Management 19.8.1.1 Education for Sleep and Circadian Rhythm 19.8.1.2 Components of Behavioral Modification 19.8.1.3 Cognitive Components 19.8.1.4 Relapse Prevention 19.8.2 Other Non-pharmacological Methods 19.8.3 Pharmacological Management of Sleep Disorders in BPAD 19.8.4 Other Novel or Miscellaneous Management Techniques 19.9 Conclusion References 20: Sleep in Schizophrenia 20.1 Introduction 20.2 Characteristics of Sleep Disturbances in Schizophrenia 20.2.1 Subjective Sleep 20.2.2 Sleep Macrostructure 20.2.3 Sleep Microstructure 20.2.3.1 Reduced Sleep Spindles 20.2.3.2 Slow Wave Sleep (SWS) Deficits 20.2.4 Comorbid Sleep Disorders 20.2.4.1 Insomnia 20.2.4.2 Circadian Rhythm Disruption (CRD) 20.2.4.3 Restless Legs Syndrome (RLS) 20.2.4.4 Periodic Limb Movement Syndrome (PLMS) 20.2.4.5 Obstructive Sleep Apnea (OSA) 20.2.4.6 Narcolepsy 20.2.4.7 Parasomnias and Sleep State Misperception 20.3 Pathophysiology 20.3.1 Structural Correlates 20.3.2 Circuitry Correlates 20.3.3 Molecular Correlates 20.3.3.1 Neurotransmitters 20.3.3.2 Genes 20.4 Bidirectional Relationship 20.4.1 Psychotic Symptoms in Sleep Deprived Healthy Population 20.4.2 Psychotic (Schizophrenia) Symptoms in Sleep Disorders 20.4.3 Sleep Disturbances Across Various Stages of Schizophrenia 20.4.3.1 Prior to Illness Onset/Prodromal States/Clinical (or Ultra)-High-Risk (CHR/UHR) 20.4.3.2 Early/First-Episode Versus Chronic Schizophrenia 20.4.3.3 Relapse 20.4.3.4 Moderating Role of Cognitive Dysfunction 20.5 Treatment 20.5.1 Deep Sleep Therapy 20.5.2 Pharmacological Strategies (I): Insomnia 20.5.2.1 Antipsychotics 20.5.2.2 Melatonin 20.5.2.3 Zopiclone/Eszopiclone 20.5.2.4 Sodium Oxybate 20.5.3 Pharmacological Strategies (II): Other Comorbid Sleep Disorders 20.5.4 Non-pharmacological Strategies 20.6 Approach to a Patient 20.7 Conclusion References 21: Sleep and Substance-Use Disorder 21.1 Introduction 21.2 Extent of Problem 21.3 Individual Substances 21.3.1 Tobacco 21.3.2 Alcohol 21.3.2.1 Alcohol and Its Effects on Sleep in Patients with Alcohol Dependence 21.3.2.2 Sleep Disturbances and Relapse to Alcohol 21.3.3 Opioids 21.3.4 Cannabis 21.3.5 Stimulants Like Cocaine 21.4 Pathophysiological Aspects of the Relationship Between Sleep and Addiction 21.4.1 Neurotransmitters and Neurocircuitry 21.4.2 Genetics 21.4.3 Neuroendocrine, Neurocognitive, and Other Mediators 21.4.4 Relationship: Who Came First-Chicken or Egg? 21.4.5 Adolescent Substance Use and Sleep 21.4.6 Relationship between Sleep and Tobacco 21.4.6.1 Tobacco/Nicotine Affecting Sleep 21.4.6.2 Sleep and Chronotype Predicting Tobacco/Nicotine Use 21.5 Management 21.5.1 Assessment Box 1 Stepwise Management Plan of Substance Use and Comorbid Sleep Problems 21.5.2 Tobacco 21.5.3 Alcohol 21.5.4 Cannabis 21.5.5 Opioids 21.5.6 Cocaine 21.6 RLS and Substance Use 21.7 Sleep-Related Breathing Disorders and Substance Use 21.8 Policy 21.9 Conclusion and Future Aspects References 22: Sleep in Posttraumatic Stress Disorder 22.1 Overview of Sleep Disturbances Associated with PTSD 22.2 Other Sleep Disorders and PTSD 22.3 Explanations for the Relationship Between Sleep Disturbances and PTSD 22.4 Clinical Treatment Options 22.5 Conclusions References 23: Somatic Symptom Disorder and Sleep 23.1 Sleep Disorders and Somatic Symptoms 23.2 Sleep Deprivation 23.3 Obstructive Sleep Apnea (OSA) 23.4 Restless Legs Syndrome (RLS) 23.5 Other Sleep Disorders 23.6 Prevalence of Sleep Disorders and Sleep Architecture in Somatic Symptoms 23.6.1 Fibromyalgia 23.6.1.1 Sleep Architecture in Fibromyalgia 23.6.2 Chronic Fatigue Syndrome 23.6.2.1 Sleep Architecture in Chronic Fatigue Syndrome 23.7 Treatment 23.7.1 Pharmacological 23.7.2 Non-pharmacological 23.7.2.1 Balneotherapy References 24: Sleep, Sleep Disorders, and Sexual Dysfunctions 24.1 Introduction 24.2 Normal Sleep Pattern and Sexual Function 24.3 Sexual Dysfunction and Sleep Disorders 24.4 Etiopathogenesis, Approach, and Treatment to Sexual Dysfunction in Common Sleep Disorders 24.4.1 Obstructive Sleep Apnea 24.4.1.1 Approach to a Patient with Obstructive Sleep Apnea with Erectile Dysfunction Evaluation Treatment Approach to a Patient of Obstructive Sleep Apnea with Hypogonadism Evaluation Treatment 24.4.2 Narcolepsy 24.4.2.1 Treatment of Sexual Dysfunction in Narcolepsy 24.4.3 Insomnia, Chronic Sleep Insufficiency 24.4.3.1 Evaluation 24.4.3.2 Treatment 24.4.4 Circadian Disruption Sleep Disorder 24.4.5 Restless Leg Syndrome 24.4.6 Periodic Limb Movement During Sleep (PLMS) 24.4.7 Sleep Sex or Sexsomnia or Atypical or Abnormal Sexual Behaviors During Sleep (ASBS) 24.4.7.1 Approach/Treatment of Patients with ASBS or Sleep Sex or Sexsomnia (Fig. 24.4) 24.5 Conclusion 24.6 Summary References 25: Sleep and Attention-Deficit/Hyperactivity Disorder 25.1 Overview 25.2 Primary Sleep Disorders and ADHD 25.2.1 Restless Legs Syndrome 25.2.1.1 Clinical Characteristics Prevalence 25.2.1.2 Association of RLS and ADHD 25.2.1.3 Pathophysiology of RLS Dopaminergic Abnormalities Iron Insufficiency 25.2.1.4 Overlapping Pathophysiology 25.2.1.5 Implications for Treatment 25.2.2 Sleep Disordered Breathing 25.2.2.1 Clinical Characteristics Prevalence Prevalence of SDB and ADHD 25.2.2.2 Associations Between SDB/OSA and ADHD Symptoms 25.2.2.3 Pathophysiology of SDB/OSA 25.2.2.4 Overlapping Pathophysiology 25.2.2.5 Implications for Treatment Weight Loss Continuous Positive Airway Pressure Therapy (CPAP) Surgical Intervention 25.2.3 Delayed Sleep-Wake Phase Disorder 25.2.3.1 Clinical Characteristics Prevalence 25.2.3.2 Association of DSWPD and ADHD 25.2.3.3 Pathophysiology of DSWPD 25.2.3.4 Overlapping Pathophysiology 25.2.3.5 Implications for Treatment Chronotherapy Bright Light Therapy Melatonin 25.3 ADHD and Psychiatric Comorbidity 25.3.1 ADHD and Anxiety Disorders 25.3.2 ADHD and Autism Spectrum Disorder 25.3.3 ADHD and Mood Disorders 25.3.4 Treatment Implications 25.4 The Impacts of ADHD Medication on Sleep 25.4.1 Stimulants 25.4.1.1 Age 25.4.1.2 Medication Schedule 25.4.1.3 Doses 25.4.2 Nonstimulants 25.5 Summary References 26: Sleep Disorders and Autism: Behavioural Correlates, Diagnostic Tools and Treatment Strategies 26.1 Introduction 26.2 The Explanation of Sleep Disorders in Persons with Autism: A Conceptual Model of Interaction 26.2.1 Insomnia and Autism Could Share a Common Underlying Neurological Etiology? 26.2.2 Insomnia Can Be an Intrinsic Feature of the ASD 26.2.3 Insomnia Is More Frequent and Associated with Problematic Behaviours in People with Autism Spectrum Disorder? 26.3 Measuring Sleep in Persons with Autism 26.3.1 Diagnostic Tools 26.3.1.1 Parent-Report Measures 26.3.2 Children ́s Sleep Habits Questionnaire (CSHQ) 26.3.3 Family Inventory of Sleep Habits (FISH) 26.3.4 Sleep Disturbance Scale for Children (SDSC) 26.3.5 Sleep Disorders Inventory for Students (SDIS)-Children and Adolescent Form 26.3.5.1 Objective Measures 26.3.6 Recommendations and Strategies of Interventions 26.4 Behavioural Intervention 26.5 Pharmacological Treatment 26.5.1 Melatonin 26.6 Discussion and Conclusion References 27: Sleep in Dementia 27.1 Introduction 27.2 Normal Sleep and Sleep Architecture 27.3 Sleep and Ageing 27.4 Dementia and Sleep 27.4.1 Sleep Architecture in Alzheimer ́s Disease (AD) 27.4.2 Sleep and Lewy Body Dementia (DLB) 27.4.3 Sleep and Fronto-Temporal Dementia (FTD) 27.4.4 Sleep and Vascular Dementia 27.4.5 Sleep and Creutzfeldt-Jakob Disease (CJD) 27.4.6 Sleep and Other Neurodegenerative Disorders 27.5 Bidirectional Relationship 27.5.1 Pathogenesis of Sleep Disorders in AD 27.5.2 Sleep Disruption and Risk of AD 27.6 Common Sleep Disorders in Dementia 27.6.1 Sleep Disordered Breathing (SDB) 27.6.2 Insomnia 27.6.3 Circadian Rhythm Disorders 27.6.4 Sleep-Related Movement Disorders 27.6.4.1 Restless Leg Syndrome 27.6.4.2 Periodic Limb Movement Disorder (PLMD) 27.6.4.3 REM Behavioural Disorder 27.6.5 Secondary Sleep Disorders 27.6.5.1 Medical Disorders 27.6.5.2 Psychiatric Disorders 27.6.5.3 Medications and Substance Misuse 27.6.6 `Sundowning ́ 27.7 Assessment 27.7.1 Comprehensive Clinical Interview 27.7.2 Neuropsychological Evaluation 27.7.3 Polysomnography (PSG) 27.7.4 Other Methods 27.8 Treatment of Sleep Disorders in Dementia 27.8.1 Non-pharmacological Treatment 27.8.1.1 Physical and Social Activity 27.8.1.2 Bright Light Therapy 27.8.1.3 Sleep Hygiene 27.8.1.4 Alternate Medicine 27.8.2 Pharmacological Treatment 27.8.2.1 Melatonin 27.8.2.2 Melatonin Receptor Agonists 27.8.2.3 Benzodiazepine Receptor Agonists 27.8.2.4 Other Hypnotics 27.8.2.5 Antidepressants with Sedative Property 27.8.2.6 Stimulants 27.8.2.7 Recent Advances and Research 27.9 Conclusion 27.9.1 Future Research References 28: Sleep in Delirium 28.1 Introduction 28.2 Sleep Disturbance as a Symptom of Delirium 28.3 Sleep Disturbance as a Precipitating or Etiological Factor Associated with Development of Delirium 28.4 Evidence of Sleep-Related Interventions for Management of Delirium 28.5 Management of Delirium References 29: Sleep Disturbances and Functional Gastrointestinal Diseases 29.1 Introduction 29.2 Sleep Cycle and Its Role in Human Physiology 29.3 Gut-Brain Axis 29.4 Digestive Diseases and Sleep Disorders 29.4.1 Gastroesophageal Reflux Disease and Sleep 29.5 Functional Dyspepsia, Ulcer Disease, and Sleep 29.5.1 Functional Dyspepsia 29.5.2 Peptic Ulcer Disease 29.6 Irritable Bowel Syndrome and Sleep 29.7 Inflammatory Bowel Disease and Sleep 29.8 Chronic Liver Disease and Sleep 29.9 Conclusions References 30: Quality of Life in Patients with Sleep Disorders 30.1 Introduction 30.2 Epidemiology 30.2.1 Insomnia 30.2.2 Obstructive Sleep Apnoea (OSA) 30.2.3 Restless Leg Syndrome (RLS) 30.3 Quality of Life 30.4 Assessment of Quality of Life in Sleep Disorders 30.4.1 Generic Scales 30.4.2 Disease-Specific Scales 30.5 Scales Commonly Used for Assessment of QOL in Sleep Disorders 30.5.1 Medical Outcomes Study 36-Item Short Form Health Survey (SF-36) [42] and SF-12 [43] 30.5.2 The Nottingham Health Profile (NHP) [45] 30.5.3 Sickness Impact Profile [47] 30.5.4 World Health Organization Quality of Life-Brief Form (WHOQOL-BREF) [49] 30.5.5 The Quality of Life Enjoyment and Satisfaction Questionnaire Short-Form (Q-LES-Q) [51] 30.5.6 QOL Inventory [53] 30.5.7 Functional Outcomes of Sleep Questionnaire (FOSQ) [44] 30.5.8 Calgary Sleep Apnoea Quality of Life Index (SAQLI) [46] 30.5.9 Hotel-Dieu-16 (HD-16) [48] 30.5.10 Quality of Life of Insomniacs Questionnaire [50] 30.5.11 Insomnia Severity Index (ISI) [52] 30.5.12 Restless Leg Syndrome Quality of Life Questionnaire-Abetz [54, 59] 30.6 Sleep Disorders and Quality of Life 30.6.1 Insomnia 30.6.2 Obstructive Sleep Apnoea (OSA) 30.6.3 Restless Leg Syndrome 30.7 Effects of Treatment on Quality of Life in Patients with Sleep Disorders 30.7.1 Insomnia 30.7.2 Obstructive Sleep Apnoea 30.7.3 Restless Leg Syndrome 30.8 Conclusions References Part IV: Sleep and Neurological Disorders 31: Sleep in Parkinson ́s Disease 31.1 Introduction 31.2 Sleep Fragmentation 31.3 Excessive Daytime Sleepiness 31.4 Obstructive Sleep Apnea 31.5 REM Sleep Behavior Disorder 31.6 Restless Legs Syndrome and Periodic Limb Movements 31.7 Nocturia 31.8 Genetic Association Between PD and Sleep Disorders 31.9 Circadian Disruption in PD 31.10 Conclusion References 32: Sleep After Traumatic Brain Injury 32.1 Epidemiology of Traumatic Brain Injury 32.2 Sleep and Psychiatric Disorders After TBI 32.3 Presentation and Classification of Sleep Disorders 32.3.1 Insomnias 32.3.2 Sleep-Related Breathing Disorders 32.3.3 Hypersomnia of Central Origin 32.3.4 Circadian Rhythm Sleep Disorders 32.3.5 Parasomnias 32.3.6 Sleep-Related Movement Disorders 32.4 Sleep Disorders and Psychiatric Disorders in TBI 32.4.1 Sleep Disorders and Psychotic Disorders After TBI 32.4.2 Sleep and Adjustment Disorders 32.4.3 Sleep Disorders and Substance Use Disorders after TBI 32.4.4 Sleep in TBI Persons and Somatoform Disorders 32.5 Assessment of Sleep in TBI Patients 32.6 Treatment Considerations 32.7 Conclusions References 33: Sleep and Epilepsy 33.1 Introduction 33.2 Historical Introduction 33.3 Effects of Sleep on Epilepsy 33.3.1 Effects of Sleep Stages on Epilepsy 33.3.2 Cyclical Alternating Pattern (CAP) and Epileptic Phenomena 33.3.3 Effects of Sleep Fragmentation on Epilepsy 33.4 Circadian Rhythm and Epilepsy 33.5 Epilepsies Associated with Sleep 33.6 Comorbid Sleep Disorders in Epilepsy 33.6.1 Excessive Daytime Sleepiness 33.6.2 Obstructive Sleep Apnea (OSA) 33.6.3 Insomnia 33.6.4 Parasomnias 33.6.5 Effects of Epilepsy on Sleep Quality 33.7 Effects of ASMs on Sleep 33.8 Effect of Vagus Nerve Stimulation on Sleep 33.9 Sudden Unexpected Death in Epilepsy and Sleep 33.10 Conclusions References 34: Sleep Disorders in Multiple Sclerosis 34.1 Introduction 34.2 Fatigue in MS 34.3 Hypersomnia/Excessive Daytime Sleepiness 34.4 Insomnia in MS 34.5 Sleep-Related Breathing Disorders Box 34.1: Mythical story of Ondine ́s curse 34.6 Nocturnal Urinary Symptoms in MS 34.7 Narcolepsy in MS 34.8 REM Sleep Behaviour Disorder in MS 34.9 Circadian Rhythm in MS 34.10 Sleep-Related Movement Disorders in MS 34.11 Conclusion References 35: Sleep Disorders in Myopathies 35.1 Introduction 35.2 Functional Anatomy of Sleep and Awake State 35.3 Myopathies 35.4 Pathophysiology of Sleep Disorders in Myopathies 35.5 Patterns of Sleep Disorders in Myopathies 35.6 Various Sleep Disorders in Specific Myopathies Are as Follows 35.7 Clinical Manifestations 35.8 General Approach and Suggested Management 35.9 Consequences of Sleep Disorders 35.10 General Principles in the Treatment of Sleep Dysfunction in Myopathies 35.11 Treatment Options 35.12 Summary References 36: Sleep in Critically Ill Patient 36.1 Background 36.2 Prevalence of Sleep Deprivation in Critically Ill Patients Box 36.1: Source of Noise in ICU Setting 36.3 Factors Affecting Sleep in Critically Ill Patients 36.3.1 Environmental Factors 36.3.1.1 Noise 36.3.1.2 Light 36.3.1.3 ICU Structure Box 36.2: Common Time-Sensitive Routine Patient Care Activities 36.3.1.4 Discomfort 36.3.1.5 Treatment Modalities Frequent M