AANN Core Curriculum, 7th Edition, Ch. 25 Sleep and Sleep Disorders: Digital Version-Chapter 25

Chapter 25
Pdf Summary
Sleep is a complex interaction between brain networks governing wakefulness, nonrapid eye movement (NREM), and rapid eye movement (REM). It supports restoration, energy conservation, memory consolidation, and brain plasticity. In healthy young adults, sleep cycles recur every 70–120 minutes: NREM comprises about 75% of sleep, including light N1 and N2 and deep restorative N3; REM accounts for about 25% and becomes more prominent toward morning. Sleep patterns change across life: newborns sleep extensively in short, un consolidated cycles, adolescents commonly experience a delayed schedule, and older adults tend to awaken more often and spend less time in deep sleep.<br /><br />Disorders can disrupt sleep quality, quantity, or timing. Common conditions include insomnia; obstructive and central sleep apnea; narcolepsy; circadian rhythm disorders; parasomnias; and restless legs syndrome (RLS) or periodic limb movement disorder. Illness, pain, mental health conditions, medications, substances, aging, and environmental factors may contribute. Sleep history, physical assessment, and tools such as sleep diaries help guide evaluation. Polysomnography assesses sleep stages, breathing, oxygenation, heart activity, and movement; actigraphy tracks sleep–wake patterns over multiple days. Multiple sleep latency testing helps assess suspected narcolepsy or idiopathic hypersomnia.<br /><br />Management depends on the disorder. Insomnia is initially addressed with behavioral approaches, including sleep education, stimulus control, relaxation, and sleep scheduling; medication requires consideration of adverse effects and dependence risks. Sleep apnea may be treated with positive airway pressure, positional measures, weight loss, or oral appliances. Narcolepsy management combines wake-promoting medication, regular sleep schedules, and safety precautions. Circadian disorders may respond to timed light exposure, melatonin, or schedule adjustment. Parasomnia management emphasizes adequate sleep and safety, while RLS treatment may include iron or medication and improved sleep habits.<br /><br />Neurological conditions—including dementia, Parkinson disease, epilepsy, stroke, traumatic brain or spinal cord injury, and neuromuscular disease—commonly disturb sleep and may cause breathing disorders. Care should address the underlying condition, medication effects, respiratory risks, pain, safety, and sleep environment. Consistent schedules, daytime activity, and limiting nighttime disruption support healthier sleep.
Keywords
sleep
NREM
REM
insomnia
sleep apnea
narcolepsy
circadian rhythm disorders
parasomnias
restless legs syndrome
polysomnography