Current trends in the treatment of sleep disorders

Abstract

The mental and physical consequences of poor sleep have been intensively investigated in recent years, and many studies have shown its risks for conditions such as hypertension, metabolic disturbance, and psychiatric problems such as depression. Insomnia has traditionally been regarded as a symptom, but in recent years, it has become internationally recognized as an independent "insomnia disorder" with a bidirectional relationship with mental and physical conditions. As for its management, cognitive behavioral therapy for insomnia has gained support from rapidly accumulating evidence and is on the way to widespread use as a first-line treatment, while pharmacotherapy is shifting from benzodiazepine receptor agonists to new class hypnotics such as orexin receptor antagonists. Restless legs syndrome, obstructive sleep apnea, and circadian rhythm sleep-wake disorders have been elucidated to have a close relationship with psychiatric disorders such as depression. In occupational health, it is important to provide appropriate sleep assessment, treatment, and instructions for workers in relation to daytime sleepiness, poor performance, occupational accidents, difficulty in waking up in the morning, and absence from/return to work due to psychiatric disorders. It is also essential to have a circadian perspective when dealing with sleep problems, and understanding a person's chronotype (i.e., morningness or eveningness), the so-called "social jet lag", and the harmful effects of media use before bedtime would make it easier to provide health instructions, especially for young workers. Developmental disorders such as autism spectrum disorder and attention-deficit hyperactivity disorder have received more attention in recent years in terms of adaptation in the workplace, and they also have a strong association with sleep problems. Restoring the regularity of sleep-wake rhythm is particularly important in the recovery of mood disorders, and sleep assessment and coping described so far should be integrated with rehabilitation.