Evaluation, Diagnosis, and Treatment of Clinical Conditions Related to Sleep

Specific sleep stages are associated with or altered by clinical conditions such as aging, disease states, sleep disorders, and drug use. Gastric acid secretion in patients with duodenal ulcers and nocturnal angina attacks in patients with coronary disease are associated with rapid eye movement (REM) sleep. Sleepwalking and night terrors occur predominantly during stage 4 sleep, while attacks of dyspnea in asthmatic children occur in all stages except stage 4. Enuretic episodes occur predominantly in nonrapid eye movement (NREM) sleep. In treating insomnia, drugs which are effective in the sleep laboratory are recommended. Following the withdrawal of REM suppressant hypnotics, insomnia, increased dreaming, and nightmares may occur and lead to drug dependence. If these drugs are withdrawn, very gradual withdrawal is recommended as well as informing the patient of possible increases in dream frequency and intensity.