Sleep disturbance is very common in the fibromyalgia syndrome. The most prominent complaints in these patients consist of non-restorative sleep which is associated with non-specific polysomnographic abnormalities of sleep fragmentation, increased awakenings, decreased sleep efficiency, and also alpha-NREM sleep which, however, is not specific to this condition. PLMS has been documented in many patients. Treatment of this condition, which is unsatisfactory, combines tricyclic antidepressants with short-term intermittent treatment with Zolpidem, an exercise programme, education, and reassurance.
Sleep disturbances are not uncommon in haematological disorders. Paroxysmal nocturnal haemoqlobinuria may disturb sleep as a result of increased levels of plasma haemoglobin in the middle of the night and the early hours of the morning. Obstructive sleep apnoea and reduced oxygen saturation during sleep, causing sleep disturbance, have been described in patients with sickle cell disease.
Almost half of patients with AIDS develop neurological manifestations which include HIV encephalopathy causing dementia, seizures, focal or diffuse central nervous system dysfunction, and sleep disturbances as well as myelopathy, peripheral neuropathy, and polyradiculopathy. Sleep disturbances have been reported in many AIDS patients as part of the manifestation of AIDS encephalopathy. Sleep apnoea with sleep fragmentation and excessive daytime sleepiness in addition to sleep initiation and maintenance difficulties has been reported but no large study has been carried out. Sleep dysfunction has also been reported in seropositive patients without the full AIDS syndrome.
The neurological manifestations of African sleeping sickness (trypanosomiasis) are characterized by delusions, hallucinations, personality changes, and reversal of sleep-wake rhythm. The patient remains somnolent in the daytime and progresses gradually into the stage of stupor or coma. Disruption of the circadian sleep-wake rhythm is the most prominent finding in polysomnography. Circadian disruption of plasma cortisol, prolactin, and sleep-wake rhythms are noted in the most advanced stages, and these findings suggest selective changes in the suprachiasmatic nucleus. The diagnosis of trypanosomiasis is based on history and confirmation of the organism in the blood, bone marrow, cerebrospinal fluid, lymph-node aspirates, or a scraping from the chancre.
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