Diagnosis and treatment of sleep disorders caused by co-morbid disease

Sleep disorders, both insomnia and hypersomnia, are commonly associated wit h various co-morbid conditions, including general medical and neurologic di sorders, psychiatric illnesses, and secondary or symptomatic restless legs syndrome/periodic limb movements in sleep. Diagnosis of the co-morbidity is the first step in treatment, followed by an assessment of the sleep distur bance. This begins with a complete history and physical examination, follow ed by laboratory testing such as polysomnography, multiple sleep latency te sting, and actigraphy. The treatment of sleep disorders caused by co-morbid conditions is discussed under seven categories, including the use of gener al measures (e.g., sleep hygiene, encouraging patients to develop good slee p habits, medication), treatment of the co-morbid condition, treatment of i nsomnia, treatment of excessive daytime somnolence, treatment of parasomnia s, treatment of sleep-wake schedule disorders, and treatment of secondary o r symptomatic restless legs syndrome.