Narcolepsy is clinically associated with
cataplexy,
sleep paralysis and
hypnagogic hallucinations. It is treated by reassurance (that there is no physical disease) and by stimulants such as
ephedrine and
amphetamine on an intermittent basis. The special
tricyclic antidepressant clomipramine is also used, and mono-
amine oxidase inhibitors (MAOIs) are useful in theory. Obstructive sleep apnoea is an important and often unrecognised cause of
daytime somnolence. It is treated by
weight reduction (
pickwickian syndrome),
hormones, or recently, with continuous positive pressure apparatus.
Night terrors (
pavor nocturnus) and
sleepwalking typically occur during deep sleep (stage 3 and 4 throughout the episode) in children. In a night terror the child
sits up with a scream, with eyes open, but inaccessible. He eventually falls asleep calmly.
Sleepwalking, too, shows the features of inaccessibility and subsequent
amnesia for the episode. Both conditions are normally treated with reassurance (to the parents) but may occasionally warrant
benzodiazepines.
Enuresis usually occurs in non-rapid eye movement (NREM) sleep, especially stages 3 and 4. The reason for the efficacy of
tricyclic antidepressants is not precisely known.
Delirium tremens (DT) is treated as a rebound excess of REM sleep, with
benzodiazepines and other drugs. It is the withdrawal syndrome (with or without major
seizures) to the
barbiturate-alcohol group of drugs, which includes alcohol,
chloral,
paraldehyde,
glutethimide, methylprylone,
ethchlorvynol,
meprobamate and
meprobamate-
diphenhydramine.
Insomnia may be treated by the above drugs, by
analgesics,
antidepressants, major tranquillisers (
neuroleptics) and miscellaneous other compounds. For the majority of patients, however, the most suitable group seems to be the
benzodiazepines. The
benzodiazepines are much safer than their predecessors, in both acute and chronic usage.(ABSTRACT TRUNCATED AT 250 WORDS)