Sleep disturbances and health problems: sleep matters

In this issue of the Journal, two papers highlight the importance of sleep. The first reiterates the role of obstructive sleep apnoea in patients with hypertension and how continuous positive airway pressure (CPAP) therapy can improve blood pressure.1 The second, a qualitative study with patients and clinicians, restates the need for practitioners to be more aware of patients' concerns and the impact of the sleep problem on their lives.2 Sleep has been associated with health problems for a long time. Classically, sleep disturbances, particularly early morning awakening and an inability to get off to sleep, have been associated with anxiety and depression. The consequences of inadequate sleep have been associated with lack of concentration, daytime sleepiness, and impaired performance. Transport authorities have long recognised this through restrictions on heavy vehicle drivers and airline pilots. Closer to home, European Working Time Directives have restricted the amount of on-call allowed, leading to a radical shift in NHS work patterns. However, there can be confusion as to what constitutes a sleep problem. One approach is to consider two entities: first, sleep-disordered breathing including obstructive sleep apnoea, hyperventilation syndrome, upper airways resistance syndrome, and night-time Cheyne-Stokes breathing; and secondly, …