Parasomnias are disorders in which the normal "architecture" of sleep is distorted or disrupted. For example, sleepwalking may occur during a stage of deep sleep called delta sleep. And agitated or violent behavior may be exhibited by people with abnormal REM (rapid eye movement) sleep, a stage normally associated with dreaming.
What should you do if you have a persistent sleep problem? A thorough exam by your general practitioner or family physician is the best place to begin. Doctors often are able to diagnose the problem simply by taking a careful history. In a few cases, an overnight test called a polysomnogram will be needed. This is a painless procedure that measures breathing, brain-wave activity and muscle movements.
Treatment of sleep disorders depends on the specific diagnosis. For primary insomnia, it's crucial to improve "sleep hygiene": Keep regular sleep hours; get out of bed when you can't sleep; avoid caffeine or alcohol in the evening; and use the bed only for sleep and sex -- not business activities! Treatment of obstructive sleep apnea may involve weight loss, use of special breathing equipment at bedtime or minor surgery to correct obstruction of the upper airway. Narcolepsy sufferers must take medication.
For some patients with severe, chronic insomnia, medication that induces sleep is useful. However, it's usually best to limit this to a few weeks, because some of these medications (such as Dalmane or Halcion) can be habit-forming. While herbal sleep remedies, melatonin and other over-the-counter agents are popular, research on their safety and effectiveness is limited, and their purity varies widely from brand to brand.
When an underlying psychiatric disorder is the cause of a sleep disorder, both medication and psychotherapy may be required.