EDITOR’S PREFACE

Awakening to Sleep
This issue of Continuum is devoted to the recognition of the
importance of sleep in neurologic health and to the diagnosis and
management of our patients with disorders of sleep, whether or not
occurring in association with other neurologic disorders. To
accomplish this important task, I am so pleased that Dr Charlene
Gamaldo accepted my request to be the guest editor for this issue, and I am so
appreciative of Dr Gamaldo for organizing a thoughtful and inclusive set of topics
and enlisting such renowned experts to guide us.

The issue begins with two articles that serve as
important and detailed introductions to the articles
that follow. First, Dr Logan Schneider details the
underlying neurobiological aspects of sleep and the
current thinking about the role and neuroprotective
benefits of sleep, a physiologic state in which we
spend a good portion of our lives. Next, Dr Raman K.
Malhotra provides a thorough introduction to the
clinical approach with regard to history,
examination, and subsequent assessment of patients
with disorders of sleepiness and sleeplessness.
The next articles address the specific disorders
that present as sleepiness. First, Dr Lynn Marie Trotti
reviews the current concepts regarding the
pathophysiology, diagnosis, and management of the
central disorders of hypersomnolence, including
narcolepsy type 1 and narcolepsy type 2, idiopathic
hypersomnia, and Kleine-Levin syndrome.
Dr Douglas B. Kirsch then reviews the diagnosis and
management of obstructive sleep apnea, a common
cause of hypersomnia and whose management can
have significant secondary health benefits.
Next, the issue turns to the parasomnias, events
occurring in association with sleep. First, Dr Michael
J. Howell reviews the phenomenology, diagnosis,
management, and prognostic significance (ie, with
regard to an underlying synucleinopathy) of rapid
eye movement (REM) sleep behavior disorder. In the
next article, Dr Michael H. Silber describes the
clinical features and current approaches to the
management of the variety of parasomnias that occur
in non-REM sleep. Drs Celia Garcia-Malo, Sofia
Romero Peralta, and Diego Garcia-Borreguero then
discuss the clinical diagnosis and management of
restless legs syndrome and other movement
disorders related to sleep.
In the next article, Drs Phyllis C. Zee and Sabra M.
Abbott review the physiology of the circadian
rhythm and describe the clinical features and
management of each of the circadian rhythm
sleep-wake disorders. Drs Maria Nichole Perez and
Rachel Marie E. Salas then provide their review of
insomnia, including a variety of alternative
nonpharmacologic management options to expand
our armamentarium.
Dr Sara E. Benjamin reviews the relationship
between sleep and classic (non–primary-sleep-
related) neurologic diseases and the role that
treatment of an associated sleep disorder can have on
mitigating the patient’s neurologic disease burden. In
the final review article of the issue, Dr Amy Licis
provides an encyclopedic review of the clinical
features, diagnosis, and management of the many
sleep-wake disorders that can present in childhood.
In the Medicolegal Issues article, Dr Joseph S. Kass
and Ms Rachel V. Rose provide an unusual but
illustrative case as a springboard to discuss the
concept of criminal culpability for acts committed
during a possible episode of REM sleep behavior
disorder, describing medicolegal principles that can

846 AUGUST 2020

Copyright © American Academy of Neurology. Unauthorized reproduction of this article is prohibited.

be extrapolated to other possible nonvolitional
violent events. In the Practice Issues article, Dr Jason
C. Ong and Dr Gamaldo provide us with very
practical information to counsel our patients on
optimizing behavioral sleep strategies that we can
bring to our clinical practices.
After reading the issue and taking the Postreading
Self-Assessment and CME Test written by Drs D.
Joanne Lynn and James W. M. Owens Jr, you may
earn up to 20 AMA PRA Category 1 CreditsTM toward
self-assessment CME or, for Canadian participants, a
maximum of 20 hours toward the Self-Assessment
Program (Section 3) of the Maintenance of
Certification Program of the Royal College of
Physicians and Surgeons of Canada. Additional credit
can be obtained by listening to Continuum Audio
interviews associated with this and other Continuum
issues, available to all subscribers, and completing
I would like to voice my deep
appreciation to Dr Gamaldo for her
expert guest editorship of this issue,
including her organization of such a
thoughtful and complete set of
topics in sleep neurology, her
recruitment of such expert authors,
and her untiring devotion to the
issue throughout the process…
CONTINUUMJOURNAL.COM
Copyright © American Academy of Neurology. Unauthorized reproduction of this article is prohibited.
tests on the Continuum Audio web platform or
mobile app. Continuum Audio is also accredited by the
Royal College of Physicians and Surgeons of Canada.
We also invite all readers to try the new
Continuum mobile phone experience available at
continpub.com/ConBeta. Using this exciting and
intuitively built new mobile phone application,
subscribers are able to search, access, and read full
Continuum articles in an easy-to-view format,
including all text, tables, and figures, wherever they
are and whenever they want. This new mobile phone
format is in a beta phase, during which we are relying
on our subscribers to provide feedback to help us
make improvements before it officially launches.
Please let us know what you think using the feedback
link on the home screen of the beta.
I would like to voice my deep appreciation to
Dr Gamaldo for her expert guest editorship of this
issue, including her organization of such a thoughtful
and complete set of topics in sleep neurology, her
recruitment of such expert authors, and her untiring
devotion to the issue throughout the process, all to
inform us about the most current understanding of
the critical role that sleep plays in cognitive
functioning and overall neurologic health and
provide us with the tools we need to recognize,
diagnose, manage, and counsel our patients with
disorders of sleep.
—STEVEN L. LEWIS, MD, FAAN
EDITOR-IN-CHIEF
© 2020 American Academy of Neurology.
847