IS POOR SLEEP TOO VAGUE A CONCEPT FOR RATIONAL TREATMENT

Poor sleep is a common complaint, accounting for 4 - 5% of all general practitioner consultations. Disorders of initiating sleep are overrat ed by patients compared with disorders of maintaining sleep, despite t he greater effect of the latter on daytime performance. There is frequ ently a discrepancy between subjective observations and objective meas urements of sleep. General practitioners should pay attention to sleep disorders lasting more than three weeks and should bear in mind that poor sleep is a symptom, the underlying cause of which needs to be det ermined. Good coordination of endogenous biorhythms and external life and working circumstances can positively influence sleeping patterns. Sleep onset latency determines the amount of deep sleep and, thus, the duration and stability of core sleep. General practitioners usually p rescribe a single type of benzodiazepine drug with a half-life of 5 - 10 h for sleep disorders. Such drugs cause the patient to fall asleep quickly, to have a considerable period of uninterrupted sleep with lit tle waking and to wake in the morning with a subjective feeling of hav ing slept well. A number of less desirable changes can occur, however, that may produce, for example, anxiety dreams, increased snoring and sleep apnoea periods at night, and weakness of muscles during the day. The third generation of hypnotic agents produce less undesirable chan ges than the second generation. Zolpidem (an imidazoypridine), one suc h agent, seems to provide an effective treatment for insomnia without inducing undesirable side-effects.