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Am Fam Physician. 1999;59(4):762-771

See article on page 937.

Just as “problem drinking” is a useful term that defines excessive drinking by its repercussions rather than by a specific amount, so is the term “problem sleepiness” meant to refer to sleepiness that causes adverse effects for the person involved. The specific quantity or quality of sleep that is needed by a given person to avoid problem sleepiness will vary somewhat. When sleepiness reaches a certain point, however, it leads to predictable and recognizable problems for all individuals. The article on recognizing problem sleepiness in this issue of American Family Physician presents a brief overview of sleep disorders and their presentations in primary care populations.1
It is not surprising that sleep disorders have recently garnered more attention in the lay press and the medical literature. The benefits and demands of modern society have loosened the tight grip that cycles of light and dark used to have on our daily routines. We awaken to alarm clocks rather than by our natural circadian rhythm and remain awake long after our fellow diurnal mammals have turned in for the night. While few of us would wish to give up the modern conveniences of our 24-hour society, the sleep deficits that many of us consistently carry do exact a toll.
The ill effects of problem sleepiness are seldom dramatic and, therefore, often go unrecognized. The insidious damage that is done to a person's emotional and physical health from problem sleepiness is frequently attributed to other causes when both physicians and their patients fail to detect the underlying sleep deprivation.
Physicians themselves are some of the worst culprits for constructing lifestyles that incorporate habitual sleep deprivation. We even seem to take a peculiar pride on occasion in our disregard for the adverse effects of chronic sleepiness. It is not surprising then, that we may miss these same effects when they present in our patients. While the related article1 in this issue is primarily intended to help us to diagnose our patients, no doubt a few readers will start by diagnosing their own occult sleep disorder.
The article1 is the product of a working group convened by the National Heart, Lung, and Blood Institute and the National Center for Sleep Disorders Research that included both sleep specialists and primary care physicians. Whenever possible, the document supports its assertions with references to pertinent research. The reader should be cautioned, however, that the document is not an explicitly developed evidence-based guideline but rather a consensus of expert opinion.
Much of sleep medicine research is still somewhat preliminary, and there is a paucity of large, randomized studies to draw from when looking for evidentiary support of specific expert opinions. Indeed, some authors have remarked recently that the public health risks of certain sleep disorders may have been overstated and have decried the large numbers of uncontrolled trials in the supporting research.2
Sleep disorders are often seen in a fairly unhealthy and elderly cohort with many comorbid conditions. While problem sleepiness may be just as endemic (even epidemic) as obesity in our modern society, it is not as easily recognized or quantified. The present limitations of sleep research and expert opinion will of course lead one to view the article with a critical eye; that notwithstanding, the working group has constructed a concise document relevant to a family physician reader with considerable good information on problem sleepiness that is not likely to be encountered elsewhere in the primary care literature.

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