Sleep occupies approximately 8h of each 24-h cycle, but much less attention has been paid to the medical problems during this phase of life than to those that occur during wakefulness.
There are several reasons for this. Patients are often reticent about events which occur during sleep. They regard this as a personal and private time and are more reluctant to talk about problems occurring during sleep than about those occurring during wakefulness. They may be unaware of the existence of a sleep disorder causing their abnormal movements at night, or of obstructive sleep apnoeas, which may only be reported if the partner becomes alarmed.
Sleep related symptoms are often attributed to problems occurring in everyday life. ‘Tiredness’, for example, may be thought to be due to age or overwork, rather than to a sleep disorder.
The consequences of sleep deprivation and sleep disorders are almost certainly increasing in developed societies without a corresponding increase in the awareness of these problems by the general population. More public education about the need for sleep and the main components of good sleep hygiene is required. The effects of shift work should be more widely recognized.
Awareness of these issues should become an important influence on those who make decisions regarding practices at work, in educational establishments, and in relation to social activities. If government policy reflected the importance of sleep problems in everyday life, better provision for, for instance, the sleepy driver would be made on motorways, which pose the greatest risk for sleep-related accidents.
In addition to this under-reporting of sleep problems, medical and other healthcare professionals are generally less aware of sleep disorders and how to assess and manage them than of conditions arising during wakefulness. Medical consultations take place while the patient is awake so that direct observation of a sleep disorder by the doctor is unusual.
A survey of British medical schools has shown that only a few minutes are spent on the study of sleep disorders during the whole of the undergraduate and postgraduate training . An American survey has indicated that the mean number of questions asked in response to the complaint of insomnia is only 2.5. This probably reflects the lack of awareness of the possible causes and effects of this symptom, and how to formulate a management plan for it.
It is important that doctors and other healthcare workers become aware of the impact of sleep disorders and that these become a regular part of their training programme. Clear checklists or protocols might be helpful for general practitioners to assist in identifying significant sleep disorders and providing treatment. The provision of specialist sleep centres should reflect the need for them by society, and within each centre a multidisciplinary approach should be developed.