Update on Research and Practices in Major Sleep Disorders: Part II—Insomnia, Willis‐Ekbom Disease (Restless Leg Syndrome), and Narcolepsy

Abstract

Purpose This review (Part II of a series on sleep disorders) presents an update of the characteristics, epidemiology, assessment, and latest management of insomnia, restless legs syndrome (Willis‐Ekbom disease; RLS/WED), and narcolepsy. Insomnia, the most common sleep disorder and most prevalent of all psychological health disorders, is a problem of difficulty initiating and maintaining sleep and early morning awakenings. RLS/WED is characterized by a crawling sensation or urge to move the legs in the evening and nighttime. Narcolepsy is a sleep disorder that commonly results in chronic daytime sleepiness and cataplexy. Nonpharmacological management, which includes education, cognitive behavioral therapy, and complementary therapy, is used as primary or adjunctive to pharmacotherapy for the treatment of these disorders. Methods This narrative review utilized medical databases such as PubMed to identify relevant English‐language original and systematic review articles predominantly from peer‐reviewed journals from 2012 to 2019. However, as background, findings from classic articles prior to 2012 were also included. Clinical Relevance Assessment of sleep problems, excessive sleepiness, and difficulty performing activities or being productive should be routine in the care of all patients. Utilization of behavioral interventions, including cognitive behavioral therapy, in addition to education and sleep hygiene, can promote sleep quality. Management of insomnia, RLS/WED, and narcolepsy should include helping patients adjust to treatment, managing cataplexy triggers in narcolepsy, and initiating strategies to live with chronic illness to improve quality of life.

Valerian Root in Treating Sleep Problems and Associated Disorders—A Systematic Review and Meta-Analysis

“…7,8 Typical manifestation of sleep disorders include sleep deprivation or fragmentation and events that occur during sleep. 4 The major sleep disorders are insomnia, restless leg syndrome (RLS), 9 obstructive sleep apnea syndrome, and narcolepsy, 10,11 among which insomnia is the most common. 12 Sedative-hypnotic medications commonly prescribed for insomnia are γ-aminobutyric acid type A (GABA A ) receptor agonists, antidepressants, and antihistamines.…”

Machine Learning Directed Interventions Associate with Decreased Hospitalization Rates in Hemodialysis Patients

“…The DHRP root cause assessments covered these categories, as well as other key areas such as nutrition, dialysis access, glycemic control, and ulcers. While most of these are fundamental areas of focus in dialysis care, psychosocial and behavioral health barriers are often not fully identified in standard care and span outside the field of nephrology [23, 24]. High risk patients, in fact, are often seen by the medical team as “too ill” to receive behavioral health intervention and, thus its value is forfeited.…”

Restless legs syndrome: An overview of pathophysiology, comorbidities and therapeutic approaches (Review)

“…In the case of acute insomnia, the symptoms last less than three months and more than three months for chronic insomnia (occurring more than three times a week). Acute insomnia is usually linked to a stressor or event that led to insomnia in the first place ( 67 ).…”

“…Subjects are advised to engage in motivational coaching and/or cognitive-behavioral therapy and to develop their own warning strategies when their own behavior becomes sedentary. Pneumatic foot compression, near-IR light spectroscopy (NIRS) have also been used, although there is insufficient evidence of their efficacy as adjuvants to pharmacological treatments ( 67 , 69 , 92 ). Complementary therapies such as acupuncture, transcranial magnetic stimulation, vibration equipment applied to muscles during exercise, cryotherapy and aromatherapy should not be overlooked ( 67 , 93 , 94 ).…”

“…Pneumatic foot compression, near-IR light spectroscopy (NIRS) have also been used, although there is insufficient evidence of their efficacy as adjuvants to pharmacological treatments ( 67 , 69 , 92 ). Complementary therapies such as acupuncture, transcranial magnetic stimulation, vibration equipment applied to muscles during exercise, cryotherapy and aromatherapy should not be overlooked ( 67 , 93 , 94 ). Antipsychotics have the potential to increase the symptoms of RLS or periodic limb movement disorder and upon pertinent evaluation, the clinician is required to make an effective differential diagnosis with hypochondria (or even delusional somatic disorder) to avoid this group of drugs ( 3 ).…”