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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\u2014particularly dopamine agonists\u2014can 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.<\/jats:p>","DOI":"10.1136\/pn-2025-004688","type":"journal-article","created":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T18:20:33Z","timestamp":1768242033000},"page":"208-215","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Sleep neurology: pearls and pitfalls"],"prefix":"10.1136","volume":"26","clinical-trial-number":[{"clinical-trial-number":"nct06470828","registry":"10.18810\/clinical-trials-gov"},{"clinical-trial-number":"nct06358950","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7673-2134","authenticated-orcid":false,"given":"Mohammad Hijaz","family":"Adenan","sequence":"first","affiliation":[{"name":"National Hospital for Neurology and Neurosurgery, London, England, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laura","family":"Perez Carbonell","sequence":"additional","affiliation":[{"name":"Sleep Disorders Centre, Guy's and St Thomas\u2019 Hospitals NHS Trust, London, England, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8799-7226","authenticated-orcid":false,"given":"Guy","family":"Leschziner","sequence":"additional","affiliation":[{"name":"Sleep Disorders Centre, Guy's and St Thomas\u2019 Hospitals NHS Trust, London, England, UK"},{"name":"Department of Neurology, Guy's and St Thomas\u2019 Hospitals NHS Trust, London, England, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2026,1,12]]},"reference":[{"key":"2026051402150809000_26.3.208.1","doi-asserted-by":"publisher","DOI":"10.1053\/smrv.2002.0186"},{"key":"2026051402150809000_26.3.208.2","doi-asserted-by":"crossref","first-page":"767","DOI":"10.1016\/j.neurol.2023.08.008","article-title":"Insomnia in neurological disorders: Prevalence, mechanisms, impact and treatment approaches","volume":"179","author":"de Bergeyck","year":"2023","journal-title":"Rev Neurol (Paris)"},{"key":"2026051402150809000_26.3.208.3","doi-asserted-by":"crossref","DOI":"10.1111\/jsr.12710","article-title":"The impact of stress on sleep: Pathogenic sleep reactivity as a vulnerability to insomnia and circadian disorders","volume":"27","author":"Kalmbach","year":"2018","journal-title":"J Sleep Res"},{"key":"2026051402150809000_26.3.208.4","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(22)01018-2"},{"key":"2026051402150809000_26.3.208.5","doi-asserted-by":"publisher","DOI":"10.1016\/j.jocn.2010.08.014"},{"key":"2026051402150809000_26.3.208.6","doi-asserted-by":"crossref","first-page":"471","DOI":"10.1016\/j.jsmc.2022.06.011","article-title":"Drug-Induced Insomnia and Excessive Sleepiness","volume":"17","author":"Van Gastel","year":"2022","journal-title":"Sleep Med Clin"},{"key":"2026051402150809000_26.3.208.7","doi-asserted-by":"publisher","DOI":"10.1097\/MCP.0000000000001007"},{"key":"2026051402150809000_26.3.208.8","doi-asserted-by":"crossref","first-page":"196","DOI":"10.5664\/jcsm.27772","article-title":"Comorbid insomnia and obstructive sleep apnea: challenges for clinical practice and research","volume":"6","author":"Luyster","year":"2010","journal-title":"J Clin Sleep Med"},{"key":"2026051402150809000_26.3.208.9","doi-asserted-by":"crossref","first-page":"1599","DOI":"10.5664\/jcsm.8020","article-title":"Predicting Nondiagnostic Home Sleep Apnea Tests Using Machine Learning","volume":"15","author":"Stretch","year":"2019","journal-title":"J Clin Sleep Med"},{"key":"2026051402150809000_26.3.208.10","first-page":"513","article-title":"Circadian Rhythm Sleep Disorders","volume":"20","author":"Kim","year":"2013","journal-title":"J Clin Outcomes Manag"},{"key":"2026051402150809000_26.3.208.11","doi-asserted-by":"crossref","DOI":"10.1093\/sleep\/zsaf090.0889","article-title":"0889 Recognizing, Diagnosing, and Treating Circadian Disorders - Lessons from a Circadian Clinic","volume":"48","author":"Grom","year":"2025","journal-title":"Sleep"},{"key":"2026051402150809000_26.3.208.12","doi-asserted-by":"publisher","DOI":"10.1002\/pnp.146"},{"key":"2026051402150809000_26.3.208.13","doi-asserted-by":"crossref","DOI":"10.1186\/1471-2458-13-1163","article-title":"Delayed sleep phase syndrome in adolescents: prevalence and correlates in a large population based study","volume":"13","author":"Sivertsen","year":"2013","journal-title":"BMC Public Health"},{"key":"2026051402150809000_26.3.208.14","doi-asserted-by":"publisher","DOI":"10.1080\/07420528.2016.1217002"},{"key":"2026051402150809000_26.3.208.15","doi-asserted-by":"publisher","DOI":"10.1212\/CON.0000000000000499"},{"key":"2026051402150809000_26.3.208.16","doi-asserted-by":"crossref","unstructured":"Oxford textbook of sleep disorders. 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