Sleep disorders: a practical guide for Australian health care practitioners

Shedding light on common but under-recognised individual and community problemsBy the time the average person reaches his or her average life expectancy of around 80 years, they will have invested 28 years of their lives in sleep. It is remarkable that an activity of this scale is so taken for granted. Ironically, it is the defining characteristic of sleep — perceptual disengagement from the environment — that ...

Darren R Mansfield MB BS, FRACP · David R Hillman MB BS, FANZCA, FRCPE · Nicholas A Antic MB BS, FRACP, PhD · R Doug McEvoy MB BS, FRACP · Shantha M W Rajaratnam PhD

Poor sleep imparts a significant personal and societal burden. Therefore, it is important to have accurate estimates of its causes, prevalence and costs to inform health policy. A recent evaluation of the sleep habits of Australians demonstrates that frequent (daily or near daily) sleep difficulties (initiating and maintaining sleep, and experiencing inadequate sleep), daytime fatigue, sleepiness and irritability are highly prevalent (20%–35%). These difficulties ...

David R Hillman MB BS, FANZCA, FRCPE · Leon C Lack PhD

About 1.5 million Australians are shift workers. Shift work is associated with adverse health, safety and performance outcomes. Circadian rhythm misalignment, inadequate and poor-quality sleep, and sleep disorders such as sleep apnoea, insomnia and shift work disorder (excessive sleepiness and/or insomnia temporally associated with the work schedule) contribute to these associations. Falling asleep at work at least once a week occurs in 32%–36% of shift ...

Shantha M W Rajaratnam PhD · Mark E Howard MB BS, FRACP, PhD · Ronald R Grunstein FRACP, MD, PhD

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. Depression may be comorbid with DSPD. DSPD has a negative impact on adolescent academic performance. DSPD treatments include ...

Delwyn J Bartlett PhD, MAPS · Sarah N Biggs PhD · Stuart M Armstrong BSc, PhD, MAPS

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 ...

Darren R Mansfield MB BS, FRACP · Nicholas A Antic MB BS, FRACP, PhD · R Doug McEvoy MB BS, FRACP

Obstructive sleep apnoea (OSA) is a potential cause of systemic hypertension in young and middle-aged people, and treatment helps reduce blood pressure in some patients. Severe OSA (apnoea–hypopnoea index [AHI] > 30/h) is strongly associated with increased mortality, stroke and cardiovascular disease in middle-aged populations. The cardiovascular risk from moderate OSA (AHI, 15–30/h) is uncertain, particularly if the oxygen desaturation index is low, although ...

Garun S Hamilton MB BS, PhD, FRACP · Matthew T Naughton MB BS, MD, FRACP

Sleep disorders are very common in childhood and are often amenable to simple advice and parental education. Questions about sleep should be an integral part of every paediatric consultation. Children with underlying syndromes or complex medical conditions often have multiple sleep issues. Excessive sleepiness in children requires careful history-taking and consideration of specialised investigation. Obstructive sleep apnoea (OSA) is a common ...

Karen A Waters MB BS, FRACP, PhD · Sadasivam Suresh MB BS, MRCPCH, FRACP · Gillian M Nixon MB ChB, MD, FRACP

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 ...

David Cunnington MB BS, MMedSc, FRACP · Moira F Junge BA, BAppSc(Hons), DPsych (Health) · Antonio T Fernando MD, FRANZCP