Sleep Disorders and Sleep Deprivation: An Unmet Public

Sleep Disorders and Sleep Deprivation: An Unmet Public Health Problem
http://www.nap.edu/catalog/11617.html
106 SLEEP DISORDERS AND SLEEP DEPRIVATION
sure to membranes, tubing, and cellular mechanical trauma) and backflow
of endotoxins through the membrane (Panichi et al., 2000). Interleukin-1,
tumor necrosis factor-α, and interleukin-6 are the major proinflammatory
cytokines that may be involved (Pertosa et al., 2000). These substances
have both somnogenic and pyrogenic properties and have been linked to a
number of postdialytic symptoms (Konsman et al., 2002), including daytime
sleepiness and sleep disturbances (Raison and Miller, 2001; Capuron
et al., 2002). Dialysis-associated changes in melatonin levels and pattern of
secretion and alterations in body temperature rhythm may also play a role
in disrupting circadian systems (Vaziri et al., 1993, 1996; Parker et al.,
2000; Parker, 2003).
Treatments for Rheumatologic and Immunologic Disorders
Numerous other classes of medications can alter sleep and waking. Corticosteroids
are a class of medications that are used to treat a variety of medical
conditions including rheumatologic and immunologic disorders, cancer,
and asthma. Sleep disturbances, insomnia, daytime hyperactivity, and mild
hypomania are common side effects (Wolkowitz et al., 1990); a significant
decrease in REM sleep may also occur (Born et al., 1987). Theophylline, a
respiratory stimulant and bronchodilator, is in the same class of medications
as caffeine and can likewise disturb sleep—even in healthy subjects (Kaplan et
al., 1993). Nonsteroidal anti-inflammatory agents may also affect sleep as
they decrease the production of sleep-promoting prostaglandins, suppress
normal surge of melatonin, and alter the daily rhythm of body temperature
(Murphy et al., 1994, 1996). Pseudoephedrine and phenylpropanolamine,
which have many of the same pharmacological properties of ephedrine, also
cause sleep disruption—and many of these preparation are readily available
over the counter (Lake et al., 1990; Bertrand et al., 1996).
Although the medications and treatments listed above are often necessary,
it is essential for patients to be aware of potential side effects relating
to the sleep-wake-related cycle. Unfortunately, patients often neglect to report
such complaints as they think nothing can be done to alleviate the
problems. However, numerous behavioral and pharmacological interventions
are available to treat these iatrogenically induced problems with the
sleep-wake cycle. In addition, administering treatment or medications at
appropriate times of day in relationship to the sleep-wake schedule may
potentially be beneficial and enhance clinical outcomes (Levi, 1994; Bliwise
et al., 2001; Hermida and Smolensky, 2004). Research in this area is greatly
needed.
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