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Personalized sleep medicine is an emerging area of research and practice. Sleep disorders are common with appreciable morbidity and economic impact. Recent studies have identified clear inter-individual differences in performance vulnerability to sleep loss. Although clear biomarkers for this vulnerability are not known, new research indicates that genetic influences on sleep and circadian systems may be important. As well, recent work has shown a wide variation in clinical phenotypes and conventional disease severity metrics in sleep apnea. Similar phenotypic variation in insomnia exists. Currently, treatments in sleep disorders are not well individualized with typical “silo” approaches that do not reflect the value of targeting treatment to the individual patient. Development of a personalized medicine agenda in sleep health will depend on better research standardization and international collaboration to better understand phenotype-genotype influences on sleep disorders and their individualized treatments.

These poems present the story of Ruth in the form of a dialogue between Ruth and Boaz on the threshing floor of a barn that could as easily stand in the Polish countryside as on the outskirts of ancient Bethlehem. The first poem allows Boaz indirect authority through Ruth's account of her response to him, but diminishes the authority of Naomi. The second poem is set in an Eastern European landscape, where, along with the biblical characters, the trees, the river, and the wind speak Yiddish. The poem's themes of restlessness, insomnia, indecision, and leave-taking show how the author avoids the certainty of the biblical Ruth, who successfully crosses over from her home in Moab to Naomi's in Bethlehem and from her Gentile origins to her adoptive religion and people. Instead, he focuses on Naomi, the displaced Jew, and Orpah, who returns to her Gentile home.

Sleep disturbances, and insomnia in particular, are extremely common in depression and vice versa. These conditions co-occur more often than each occurs on its own. Insomnia, hypersomnia, and fatigue are also diagnostic criteria for depressive disorders. Longitudinal studies have demonstrated that sleep disturbances often begin before the onset of other depressive symptoms. Insomnia may (adversely) affect the response to treatment of depression and, if residual, predict depressive relapse. Early evidence suggests that persistent insomnia may increase the risk of suicide among people who are depressed. Even if not causally related to depression, better methods for recognizing sleep disturbance in populations might assist in the early detection of depression or in identifying those at high risk of suicide.

There is increasing concern about the apparently high rate of misdiagnosis of various clinical conditions despite the fact that they seem to be well taught in medical training. How much more likely are mistakes in the recognition and diagnosis of sleep disorders, given their neglect in both public and professional training? Because of this neglect, help must often be denied those many people who suffer sleep disturbance and its potentially serious consequences. This chapter illustrates the ways in which the various causes of insomnia, excessive sleepiness, and disturbed behaviour at night (parasomnias) can be misconstrued in people of all ages. It suggests guidelines for the avoidance of such mistakes which, clearly, have important implications for patient care, use of clinical services, and also epidemiological studies of the many sleep disorders now officially acknowledged.

In 1858, free of the university, John Henry Newman expressed his wish to go back to his old studies. In spite of all his accomplishments, he felt too weary and unfulfilled. He thought maybe time alone would vanquish all his doubts about himself and his religion. The disappointments and sufferings of the last decade had taken their toll on Newman. 1859 proved to be one of the most critical and trying years of his life. His “general health” was better but he felt he was “fading out from the world”. Despite suffering from insomnia and strain, Newman left Birmingham by the end of July 1861 for a three-week holiday. He was accompanied by William Neville, whom he received into the Church and who joined the Oratory in 1851. Newman had been advised by a London specialist to rest for several months that eventually turned into years of silence.

This chapter provides a case study to show the desired skills, attitudes, and knowledge required to diagnose and manage sleep disorders in palliative patients. It addresses a number of questions such as: How common are sleep disorders? Why should we pay close attention to the patient's disrupted sleep? How to diagnosis a patient's sleep disorder? What other medical conditions are associated with sleep disorders?

This chapter provides a brief account of the diagnosis and treatment of some of the common symptoms found in terminally ill patients. It discusses the causes and recommended treatment for these symptoms, which include anorexia, weight loss, insomnia, and dyspnoea. The chapter also provides a list of essential drugs often given until the last day of life, including morphine, anticonvulsants, and psychotropic drugs.

In this chapter, Maya Plisetskaya reflects on her life, both personal and professional. Her entire bustling life has been characterized by premieres, struggles and conflicts, hassles, frustrations, impulses, meetings, suitcases, the daily grind. She has suffered from insomnia all her life, having swallowed kilograms of sleeping pills from Nembutal to Luminal, Tazepam, Roginal, and Valium. She was a creature of extremes and a fanatic soccer fan. Throughout her entire life, she adored and idolized Rodion Shchedrin, her husband. With regards to her ballet, she poured warm water into the heels of her ballet slippers (to make the foot sit more firmly) before every class and every performance. She and her fellow dancers bought all their food at Moscow markets and got some goodies from the buffets of the Bolshoi Ballet.

This chapter discusses sleep-disordered breathing in heart failure (HF). The association between HF and sleep disturbance can be divided into two major categories: the symptoms of HF which result in direct disruption of sleep and insomnia; and sleep apnoea syndromes (central sleep apnoea syndrome (CSAS), which is usually a consequence of worsening HF; and obstructive sleep apnoea syndrome, which may be a precursor of cardiac diseases leading to the development of chronic HF). The diagnosis and treatment options for these categories are shown. The prognosis of patients with chronic HF seems to be significantly worse if CSAS is present. Treatment options include continuous positive airway pressure (CPAP) and supplemental oxygen. Adequately powered prospective randomized controlled trials with survival and health status as endpoints are needed to establish whether the correction of sleep-related abnormalities of breathing in patients with HF really does improve outcome.

This chapter explores the function of sleep habits and insomnia in Ford Madox Ford's Parade's End and Siegfried Sassoon's Memoirs of an Infantry Officer, arguing that insomnia is an embodiment of the individual's resistance to military discipline, loss of privacy, and the subjection of one's body to authoritative control. Insomnia, a liminal state between sleeping and waking, pits the body against the mind or mind against the body, and in doing so illustrates the failure of disciplinary mechanisms to completely regulate individual behaviours. Further, the phenomenology of insomnia is in many ways similar to the phenomenology of experience in the First World War, especially given the war's association with exhaustion and fatigue, nocturnal activity, a sense of endlessness, and idiosyncratic temporality, making it an apt device through which to express the anxieties associated with participation in the war.

Sleeping and waking mechanisms operate together as a homogeneous functional unit, the final output of which determines the level of arousal. Thus, disorders of one mechanism inevitably tend to affect others: anxiety is accompanied by insomnia; poor night-time sleep is associated with daytime sleepiness. However, for convenience the disorders are divided here into those which are mainly manifested in the waking state (for example anxiety syndromes) and those whose main characteristic is sleep disturbance (for example insomnia and hypersomnia).

In Chapter 4, “Cognitive Behavioral Therapy: Evidence-Based Practice,” research on the use of CBT with older adults is summarized and evaluated. Fifteen meta-analyses and systematic reviews published between 2000 and 2015 are presented. The most developed area of research on CBT effectiveness with older clients is on depression and anxiety outcomes. A smaller, but still substantial, literature focuses on outcomes of CBT for insomnia. While research on the effectiveness of CBT with older adults is not as encompassing as that for younger populations, it is, nonetheless, substantive and, thus far, more advanced than that of most other psychotherapeutic interventions used with older adults. Research suggests that CBT with older clients is as effective as other psychotherapeutic interventions, with superior results in decreasing the negative outcomes of anxiety. In administration, CBT is a flexible approach that has utility across a variety of settings and contexts.

Sleep is a universal phenomenon that occurs in every species studied so far. A normal sleep period fluctuates in a regular cycle of two basic forms: slow wave sleep (SWS) and rapid eye movement (REM) sleep. The sleep–wake cycle is modulated by diverse brain circuits and neuromodulators as well as by several endogenous and exogenous molecules, including cannabinoids. This chapter describes the effects of certain cannabis-derived and synthetic cannabinoids on sleep. Additionally, it provides an overview of current knowledge about potential uses of natural or synthetic cannabinoids for the treatment of sleep disorders.

Pregnant women experience a greater degree of sleep disturbance than their non-pregnant counterparts. Complaints range from sleep maintenance issues to excessive daytime sleepiness. Emerging evidence suggests that there is variability in sleep patterns and complaints which manifest differently among pregnant women. Moreover, it is well accepted that sleep disturbance can dysregulate normal immune and endocrine processes that are critically important to the health and progression of gestation. A possible consequence of sleep disturbance is an increased risk for adverse pregnancy outcomes. Then again, many endogenous and exogenous factors, including pregnancy-related physiological, hormonal, and anatomic changes, as well as lifestyle changes, can impact the degree and chronicity of sleep disturbance. Alas, there is still much to learn in terms of what women can/should expect with regard to the timing, degree, frequency, and/or severity of a specific pregnancy-related sleep disturbance(s), despite the number of published studies evaluating what sleep during pregnancy encompasses.

Pain and sleeplessness are two of the commonest reasons for primary care appointments. The prevalence of each problem alone is high, and to add to the complexity, pain and insomnia frequently co-occur, with pain interrupting sleep and pain being further aggravated following a poor night’s sleep. Sleep and pain management are increasingly recognized as important to public health. In particular, insomnia and chronic pain are long-term conditions that actively contribute to morbidity, disability, economic burden to society, and suffering to the individual and immediate family. This chapter examines the interrelationship between the two at the population level. Specifically, evidence from population-based studies regarding the co-occurrence and temporal link of pain and sleep is reviewed, with moderators and mediators of the relationship highlighted. Possible directions for future research and treatment development are also outlined.

Although a universal necessity, sleep, as the past powerfully indicates, is not a biological constant. Before the Industrial Revolution, sleep in western households differed in a variety of respects from that of today. Arising chiefly from a dearth of artificial illumination, the predominant form of sleep was segmented, consisting of two intervals of roughly 3 hours apiece bridged by up to an hour or so of wakefulness. Notwithstanding steps taken by families to preserve the tranquillity of their slumber, the quality of pre-industrial sleep was poor, owing to illness, anxiety, and environmental vexations. Large portions of the labouring population almost certainly suffered from sleep deprivation. Despite the prevalence of sleep-onset insomnia, awakening in the middle of the night was thought normal. Not until the turn of the nineteenth century and sleep’s consolidation did physicians view segmented sleep as a disorder requiring medication.

Over 70 described sleep disorders disrupt the sleep of an estimated 50–70 million Americans. The disorders present with a broad array of symptoms but result in the individual not getting the health, cognitive, and restorative benefits of a good night’s sleep. The disorders have been categorized into the following categories: insomnia, sleep-related breathing disorders, central disorders of hypersomnolence, circadian rhythm sleep–wake disorders, parasomnias, and sleep-related movement disorders. This chapter reviews each category and provides details on the symptoms, pathophysiology, and treatment of the most common disorder in each category, including insomnia, obstructive sleep apnoea, narcolepsy, restless legs syndrome, and REM sleep behaviour disorder. The presenting complaint is the key to diagnosis, directing subsequent evaluation.

Drowsiness is often marked by hypnagogia: with eyes closed, you see rapidly changing vivid images, while you are still definitely awake. These images may be related to the ways that readers visualize while reading fiction.

Hundreds of authors have written about insomnia; and some, like Kafka, have said that insomnia is responsible for their being writers. This is no doubt due to the insights of this liminal state—for during insomnia the daylight personality dissolves, and one becomes aware of a restless nocturnal consciousness.