Sleep neurology: pearls and pitfalls

Sleep disorders are among the most frequent and disabling conditions encountered in neurological practice. Chronic insomnia alone affects approximately 10% of adults, while other sleep disorders, including obstructive sleep apnoea, restless legs syndrome, circadian rhythm disturbances, parasomnias and narcolepsy, are often under-recognised and misdiagnosed. Over-reliance on investigations and inappropriate use of pharmacotherapy represents recurring pitfalls. Cognitive behavioural therapy for insomnia remains the gold-standard first-line therapy, yet access is limited and medications are frequently started prematurely. Advances in therapeutics, including dual orexin receptor antagonists for insomnia and orexin-based therapies for narcolepsy, offer new opportunities but require careful integration into practice. Management of restless legs syndrome remains an area where inappropriate use of medications—particularly dopamine agonists—can worsen outcomes. This review highlights common diagnostic and therapeutic pitfalls across the spectrum of sleep disorders, integrates emerging evidence and provides practical strategies for neurologists to optimise care.