Sleep and Neuropsychiatric Disorders

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 Monitoring and Patient Care Activities
			36.3.2 Medication
				36.3.2.1 Sedatives
				36.3.2.2 Analgesics
				36.3.2.3 Antipsychotics
				36.3.2.4 Antidepressants
				36.3.2.5 Cardiovascular (CVS) Drugs
				36.3.2.6 Respiratory System Medication
				36.3.2.7 Other Medications
			36.3.3 Mechanical Ventilation
			36.3.4 Nutritional Support
			36.3.5 Patient Factors
				36.3.5.1 Patient Demographics
				36.3.5.2 Patient´s Conditions
				36.3.5.3 Sleep Knowledge Deficit among Healthcare Professionals
		36.4 Effects of Sleep Deprivation on Physiological Processes of Critically Ill Patients
			36.4.1 Changes in Temperature Regulation
			36.4.2 Changes in Respiratory Function
			36.4.3 Changes in Cardiovascular Function
			36.4.4 Changes in Gastrointestinal Function
			36.4.5 Changes in Endocrine Function
			36.4.6 Changes in Hematologic/Immunologic Function
			36.4.7 Changes in Psychological/Neurocognitive Function
		36.5 Management of Sleep Problems of Critically Ill Patients
			36.5.1 Non-pharmacologic Strategies
				36.5.1.1 Control of Noise
				36.5.1.2 Measures to Control Unnecessary Noise in Critical Care Unit
				36.5.1.3 Other Strategies
				36.5.1.4 Minimizing Lights
					Proposed Interventions for Minimizing the Light During Night in the ICU
				36.5.1.5 Rescheduling of Patient Care Activities
				36.5.1.6 Motivation and Encouragement
				36.5.1.7 Proper Communication
				36.5.1.8 Raising Staff Awareness of Nursing and Medical Staff
				36.5.1.9 Possible Remedies to Improve Sleep with Mechanical Ventilation
				36.5.1.10 Illness-Specific Management
				36.5.1.11 Complementary Therapies
				36.5.1.12 Cognitive Behavioral Therapy (CBT)
				36.5.1.13 Other Interventions
			36.5.2 Pharmacological Consideration
				36.5.2.1 Antidepressant
				36.5.2.2 Antihistamines
		36.6 Nursing Process in Management of Sleep Problems in Critically Ill Patients
		36.7 Desired Outcomes/Goal
			36.7.1 Short Term
			36.7.2 Long Term
		36.8 Nursing Interventions
			36.8.1 Environmental Management
			36.8.2 Promoting Sleep Hygiene Activities
		References
Part V: Sleep and Neuropsychopharmacology
	37: Sleep in Patients with Schizophrenia or Unipolar or Bipolar Disorder: The Effect of Second-Generation Antipsychotic Drugs
		37.1 The Sleep-Wakefulness Cycle in Man
		37.2 Sleep Disturbances in Patients with Unipolar and Bipolar Disorder
		37.3 Sleep Disturbances in Schizophrenia Patients
		37.4 Pharmacotherapy of Schizophrenia and Unipolar and Bipolar Disorder
		37.5 Receptor-Binding Affinity of Second-Generation Antipsychotic Drugs
		37.6 Pharmacokinetics of Second-Generation Antipsychotic Drugs
		37.7 Effects of Second-Generation Antipsychotic Drugs on Sleep Variables in Patients with Schizophrenia and Unipolar and Bipol...
			37.7.1 Patients with Unipolar and Bipolar Disorder
			37.7.2 Patients with Schizophrenia
		37.8 Conclusions
		References
	38: Effect of Antiepileptics on Sleep
		38.1 Chrono-Epileptology
		38.2 Chronobiologic Changes of Sleep in Epilepsy
		38.3 Macro and Micro-Architectural Changes
		38.4 Impact of Antiepileptic Drugs on Sleep Indices
		38.5 Prevalence and Risk Factors
		38.6 How to Manage
		38.7 Summary and Conclusion
		References
	39: Sleep During Hypnotic Therapy
		39.1 Types of Insomnia
		39.2 Management of Insomnia
		39.3 Historical Aspect of Hypnotic Drugs Use
		39.4 Properties Required in Ideal Hypnotic Agent
		39.5 Medications Used in Insomnia
		39.6 Currently Approved Hypnotic Agents
			39.6.1 Benzodiazepines (BZD)
			39.6.2 Adverse Effect Profile
			39.6.3 Drug Interactions
			39.6.4 Clinical Indication
		39.7 Nonbenzodiazepine BZRA
			39.7.1 Pharmacokinetics
			39.7.2 Adverse Effect Profile
			39.7.3 Clinical Indication
		39.8 Low-Dose Doxepin
			39.8.1 Pharmacokinetics
			39.8.2 Clinical Indication
		39.9 Melatonin Receptor Agonist
			39.9.1 Pharmacokinetics
			39.9.2 Adverse Effect
			39.9.3 Clinical Indication
		39.10 Orexin/Hypocretin Receptor Antagonist
			39.10.1 Pharmacokinetics
			39.10.2 Adverse Effect
			39.10.3 Clinical Indication
		39.11 Alternate Medications Prescribed for Sleep
		39.12 Newer Agents in Pipeline
			39.12.1 Lemborexant
			39.12.2 Lumateperone
			39.12.3 Piromelatine
			39.12.4 Lorediplon
		39.13 Hypnotic Medications and EEG Changes
		39.14 Conclusion
		References
	40: Stimulants and Sleep
		40.1 Introduction
			40.1.1 Nicotine
				40.1.1.1 Sleep Findings in Acute Administration and Intoxication of Nicotine
				40.1.1.2 Sleep Findings in Nicotine Dependence
				40.1.1.3 Sleep Findings in Nicotine Withdrawal
				40.1.1.4 Factors Affecting Sleep in Nicotine Use
				40.1.1.5 Smoking Cessation and Sleep Disturbances
			40.1.2 Caffeine
				40.1.2.1 Sleep Findings in Acute Administration of Caffeine
				40.1.2.2 Sleep Findings in Chronic Administration of Caffeine
				40.1.2.3 Laboratory Studies of Sleep Disturbance with Caffeine Use
				40.1.2.4 Individual Sensitivity to Effect of Caffeine on Sleep Architecture
				40.1.2.5 Perinatal Effects of Caffeine on Sleep
			40.1.3 Cocaine
				40.1.3.1 Acute Effects of Cocaine on Sleep
				40.1.3.2 Sleep in Cocaine Withdrawal and Abstinence
				40.1.3.3 Mediating Factors for Sleep Disturbance in Cocaine Users
			40.1.4 Methamphetamine
				40.1.4.1 Acute Use
				40.1.4.2 Amphetamine Withdrawal and Sleep
				40.1.4.3 Mediating Factors for Sleep Disturbance in Methamphetamine Users
				40.1.4.4 Amphetamines and Mood Disorders
			40.1.5 Ecstasy
				40.1.5.1 Effects of Ecstasy Use on Sleep
			40.1.6 Khat
				40.1.6.1 Sleep Problems in Khat Users
				40.1.6.2 Management of Sleep Problems in Psychostimulant Users
		40.2 Conclusion
		References
	41: Effect of Dopamine Agonists on Sleep
		41.1 Introduction
		41.2 DA Receptor Family and Sleep
		41.3 Dopamine Receptor Agonists and Sleep: Evidence from Animal Model Studies
		41.4 Dopamine Agonists and Sleep in Humans
			41.4.1 Excessive Daytime Sleepiness and Sleep Attacks
			41.4.2 Risk Factors for EDS and Sleep Attacks with DA Agonists
			41.4.3 Evaluation of Sleep Dysfunction Due to DA Agonists
			41.4.4 Management of EDS and Sleep Attacks
			41.4.5 Pharmacological Measures
				41.4.5.1 Modification in Dopaminergic Therapy
				41.4.5.2 Specific Pharmacological Agents
			41.4.6 Non-pharmacological Approach
				41.4.6.1 Hallucinations
		41.5 Conclusion
		References