The Medical journal of Australia
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Delayed sleep phase disorder (DSPD) - a circadian rhythm sleep disorder - is most commonly seen in adolescents. The differential diagnosis between DSPD and conventional psychophysiological insomnia is important for correct therapeutic intervention. Adolescent DSPD sleep duration is commonly 9 hours or more. ⋯ DSPD has a negative impact on adolescent academic performance. DSPD treatments include bright light therapy, chronotherapeutic regimens, and administration of melatonin as a chronobiotic (as distinct from a soporific). Attention to non-photic and extrinsic factors including healthy sleep parameters is also important to enable better sleep and mood outcomes in adolescents.
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Insomnia is common and can have serious consequences, such as increased risk of depression and hypertension. Acute and chronic insomnia require different management approaches. >Chronic insomnia is unlikely to spontaneously remit, and over time will be characterised by cycles of relapse and remission or persistent symptoms. Chronic insomnia is best managed using non-drug strategies such as cognitive behaviour therapy. For patients with ongoing symptoms, there may be a role for adjunctive use of medications such as hypnotics.
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To assess the population prevalence of property, income and emotional impacts of the 2010-2011 Queensland floods and cyclones. ⋯ Weather-related disasters exact a large toll on the population through property damage and resultant emotional effects. Vulnerable subpopulations are more severely affected. There is a need for realistic, cost-effective and rapid-deployment mass interventions in the event of weather disasters.
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Obstructive sleep apnoea (OSA) determined by polysomnography is highly prevalent, affecting about 25% of men and 10% of women in the United States, although most have few or no symptoms. Symptomatic moderate to severe OSA has major health implications related to daytime sleepiness, such as increased accidents, altered mood and loss of productivity in the workplace. Severe OSA may increase the risk of cardiovascular disease independent of daytime sleepiness. ⋯ However, these services may not always be easy to access. Controlled studies have shown that patients with a high pretest probability of symptomatic, moderate to severe OSA can be managed well in primary care, or by skilled nurses with appropriate medical backup, using simplified ambulatory models of care. The future of sleep apnoea assessment and management will likely include models of care that involve early referral to specialists of patients with complex or atypical presentations, and an upskilled and supported primary care workforce to manage symptomatic, uncomplicated, high pretest probability disease.