When asleep, the brain generates electrophysiologic patterns far more complex than when awake. The chronologic architecture of nighttime and daytime electroencephalography compares in complexity as a cathedral to a cottage. And yet, little is known about sleep disorders beyond a few syndromes. Insomnia, hypersomnia, and sleep apnea sum up most of what we know. Psychiatrists and family physicians usually deal with insomnia, neurologists most often manage narcolepsy, and sleep apnea remains a divided realm among internists, otolaryngologists, and others. The contributors to this controversy disagree more in approach than in conclusions. Dr Culebras emphasizes brain mechanisms and Dr Mitler surveys those who actually look after patients with sleep disorders.
The potential for assessing the damaged brain by polysomnography in head injury1 and in stroke2 has not been fully explored. Moreover, recent evidence that dream sleep promotes desirable reversed learning3 and that prostaglandin D2 may be a natural soporific4 makes sleep medicine a promising field.
Vladimir H. Comment. Arch Neurol. 1985;42(6):602. doi:10.1001/archneur.1985.04060060108020
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