General measures

Managing sleep disorders calls for a holistic approach.  Good sleep hygiene should perhaps be the starting point.  A healthy lifestyle that includes appropriate attention to diet, exercise and exposure to natural light facilitates good sleep.  Smoking, alcohol and recreational drug use can have serious impact on sleep and avoiding these can improve sleep.

Sleep is affected by a number of medical and mental health problems and addressing these will improve sleep.  Further many medications affect sleep adversely. If your problems started after you started taking a new medication it is important to have the therapy reviewed.

Wherever possible treatment of individual sleep problem is aimed to remove the cause of the disease.  When this is not possible the aim will be to control the symptoms.  This is particularly so in conditions such as narcolepsy where no curative treatment is available.

Finally, if symptoms cannot be adequately controlled with treatment, then learning to adapt to the new state is important.  This may not be easy as many sleep disorders affect one’s ability to continue to drive, work and earn.

Outline of drug treatment for common sleep problems

Narcolepsy:

Unfortunately we do not have a curative treatment for narcolepsy.   Apart from the general measures noted above, the mainstay of treatment is wake promoting drugs. This coupled with scheduled naps can make a huge difference.

Restless Legs Syndrome:

Treatment includes Dopamine agonists and drugs such as gabapentin and pregabalin.  In intractable cases, morphine type drugs can be used.

Iron therapy

This is of particular importance in the treatment of Restless Legs Syndrome.  Patients who have RLS have brain iron deficiency even when the blood iron levels are perfectly within the normal range and adequate for bone marrow function. This is due to a derangement of  absorption of iron from the blood in to the brain in patients with RLS.  A good percentage of patients will have near complete relief of RLS symptoms with iron therapy  alone. It is often difficult to achieve adequate blood level of iron through dietary means and oral iron therapy.  As a result, patients with RLS often require intravenous iron.

REM Sleep Behaviour Disorder (RBD)

RBD can be controlled in the majority of patients with drug treatment.  Currently the favoured treatment is melatonin.  Clonazepam is another effective drug.