Clinical neurology of insomnia in neurodegenerative and other disorders of neurological function.

Complaints of insomnia are prevalent in neurodegenerative and neurological disorders. Neurologists therefore must be aware of the underlying causes, pathophysiologic mechanisms, and potential interventions when encountering a patient with underlying neurological disorders who is also complaining of poor sleep and insomnia. This article describes the underlying pathophysiology, diagnostic approaches, and potential interventions for insomnia in the neurological patient. Clinicians need to recognize that insomnia in older patients with underlying neurological disorders is not only unique, but also complex, demanding comprehensive and careful evaluation and management. Treatment of insomnia should start by addressing nonpharmacologic options, including improvements in sleep hygiene, improving sunlight exposure during the day, and searching for underlying reversible causes, such as sleep apnea, restless legs syndrome, periodic leg movements, and circadian rhythm disturbances, all of which can precipitate insomnia when left untreated. Some patients may benefit from targeted and carefully tailored pharmacologic treatment. Successful amelioration of insomnia can ultimately be a very rewarding experience for the patient, family members, and the practitioner.