page_title: Sleep medicine
section_title: Treatments
hierarchical_section_title: Sleep medicine / Treatments
caption_attribution_description: English: This is my own machine of which I took the picture.
context_page_description: Sleep medicine is a medical specialty or subspecialty devoted to the diagnosis and therapy of sleep disturbances and disorders. From the middle of the 20th century, research has provided increasing knowledge and answered many questions about sleep-wake functioning. The rapidly evolving field has become a recognized medical subspecialty in some countries. Dental sleep medicine also qualifies for board certification in some countries. Properly organized, minimum 12-month, postgraduate training programs are still being defined in the United States. In some countries, the sleep researchers and the physicians who treat patients may be the same people.
  The first sleep clinics in the United States were established in the 1970s by interested physicians and technicians; the study, diagnosis and treatment of obstructive sleep apnea were their first tasks. As late as 1999, virtually any American physician, with no specific training in sleep medicine, could open a sleep laboratory.
  Disorders and disturbances of sleep are widespread and can have significant consequences for affected individuals as well as economic and other consequences for society.
context_section_description: When sleep complaints are secondary to pain, other medical or psychiatric diagnoses, or substance abuse, it may be necessary to treat both the underlying cause and the sleep problems.
  When the underlying cause of sleep problems is not immediately obvious, behavioral treatments are usually the first suggested. These range from patient education about sleep hygiene to cognitive behavioral therapy (CBT). Studies of both younger and older adults have compared CBT to medication and found that CBT should be considered a first-line and cost-effective intervention for chronic insomnia, not least because gains may be maintained at long-term follow-up. Sleep physicians and psychologists, at least in the US, are not in agreement about who should perform CBT nor whether sleep centers should be required to have psychologists on staff. In the UK the number of CBT-trained therapists is limited so CBT is not widely available on the NHS.
  Behavioral therapies include progressive relaxation, stimulus control (to reassociate the bed with sleepiness), limiting time-in-bed to increase sleep efficiency and debunking misconceptions about sleep.
  Pharmacotherapy is necessary for some conditions. Medication may be useful for acute insomnia and for some of the parasomnias. It is almost always needed, along with scheduled short naps and close follow-up, in the treatment of narcolepsy and idiopathic hypersomnia.
  Chronic circadian rhythm disorders, the most common of which is delayed sleep phase disorder, may be managed by specifically-timed bright light therapy, usually in the morning, darkness therapy in the hours before bedtime, and timed oral administration of the hormone melatonin.  Chronotherapy has also been prescribed for circadian rhythm disorders, though results are generally short-lived. Stimulants may also be prescribed. When these therapies are unsuccessful, counseling may be indicated to help a person adapt to and live with the condition. People with these disorders who have chosen a lifestyle in conformity with their sleeping schedules have no need of treatment, though they may need the diagnosis in order to avoid having to meet for appointments or meetings during their sleep time.
  Continuous positive airway pressure (CPAP), Bilevel Continuous Positive Airway Pressure (BiPAP), or similar machines can be used nightly at home to effectively manage sleep-related breathing disorders such as apnea. In milder cases, oral appliances may be effective alternate treatments. For mild cases in obese people, weight reduction may be sufficient, but it is usually recommended as an adjunct to CPAP treatment since sustaining weight loss is difficult. In some cases, upper airway surgery, generally performed by an otolaryngologist/head & neck surgeon or occasionally an oral and maxillofacial surgeon, is indicated. The treatments prevent airway collapse, which interrupts breathing during sleep. A 2001 study published by Hans-Werner Gessmann in the Journal of Sleep Medicine and Sleep Psychology found that patients who practiced a series of electrical stimulations of suprahyoidal tongue muscles for 20 minutes a day showed a marked decline in sleep apnea symptoms after two months. Patients experienced an average of 36% fewer apnea episodes after successfully completing the treatments. 
  The Effect of Cancer on Sleep, according to the National Cancer Institute (NCI), about 50% of cancer patients have trouble sleeping. Difficulty sleeping can include Restless Leg Syndrome (RLS), sleeping that is fragmented, or insomnia. Some reports show that up to 80% of patients who are undergoing cancer treatments experience some form of insomnia.
  One of the significant reasons for sleeping problems is stress, uncertainty, and fear. Other patients have difficulty sleeping directly due to their treatments while others experience pain that affects sleep quality. Other factors include diet and less than optimum sleeping conditions. Cancer has also been shown to be a cause of increased sleep apnea, which adds to the potential issues.
caption: CPAP (positive airway pressure) machine
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