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The neurobiology, diagnosis and treatment of narcolepsy. Ann Neurol 2003;53:154-66. Schwartz JR and Roth T. Shift work sleep disorder: burden of illness and approaches to management. Drugs. 2006;66:2357-70. Shipp S. The brain circuitry of attention. TICS 2004;8:223-30. Silber MH et al. An algorithm for the management of restless legs syndrome. Mayo Clin Proc. 2004 Jul;79(7):916-22. Erratum in: Mayo Clin Proc 2004;79:1341. htm Stahl SM. Essential psychopharmacology 3rd Ed. New York, NY: Cambridge University Press; in press.

This release of melatonin is indirectly controlled by the SCN through the PVN and via the brainstem. 12 Information about the body’s activity state is conveyed to the SCN through indirect projections from the brainstem arousal nuclei (BAN). There is also local feedback inhibition from other hypothalamic areas, such as the dorsomedial nucleus (DMN). 13 Up to 5% of adults are thought to suffer from shift-work sleep disorder and this can lead not only to reduced work productivity, errors, and vehicular accidents, but also to mood problems such as irritability, malaise, hostility, and depression.

9 There are a number of medications, both prescription and over-the-counter (OTC), that can help improve sleep and thus in turn may reduce excessive sleepiness during waking hours. The classic benzodiazepines bind non-selectively to any of the α-subunit isoforms of GABAA receptors. This means that, along with their sedative effects, they can also be used for anxiety problems, as muscle relaxants, and as hypnotics. Although these are added benefits for some people, they can lead to problems with next day sedation and psychomotor slowness.

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