Sleep Disorders

Types of Sleep Disorders
  • Snoring
  • Sleep Apnea
  • Narcolepsy
  • Restless Legs Syndrome
  • Periodic Limb Movement Disorder
  • Insomnia
  • Parasomnias
Snoring

Snoring is a condition that affects 45% of normal adults and can be a signal that something is seriously wrong with one’s breathing during sleep. Men are generally more likely to snore than pre-menopausal women, however, women who have gone through menopause are just as likely to snore as men. Children generally do not snore unless they have enlarged tonsils or adenoids.

Causes:
  • Poor muscle tone in the throat and the tongue.
  • Alcohol and sleeping pills relax the muscles too much, causing snoring
  • Blocked nasal passages.
  • A long soft palate and uvula narrows the passage from the nose to the throat – They can flutter during relaxed breathing causing snoring
  • Deformities in the nose or nasal septum – Deviated septum refers to a malformation in the wall that separates the nostrils.
Treatments:
  • Exercise regularly.
  • Avoid sleeping pills and antihistamines before bedtime.
  • Avoid alcoholic beverages within 3 hours before bedtime
  • Avoid heavy meals within 3 hours before bedtime
  • Sleep on the side rather than in supine position. To keep from turning you can sew a pocket with a tennis ball in it on the back of your pajamas.
  • If snoring becomes disruptive to the snorer and his/her family, consult a health care professional. The snoring may be a symptom of obstructive sleep apnea.
Sleep Apnea
  • Approximately 30 million Americans are victims of a sleep disorder called sleep apnea.
  • Many millions more are pre-disposed and have a high risk of developing the illness.
  • “Apnea” is a Greek word meaning “without breath”
  • Those with apnea literally stop breathing in their sleep often hundreds of times during the night.
HOW DOES IT OCCUR?
  • During normal sleep, throat muscles relax.
  • If the throat is crowded due to obesity, the airway collapses during sleep. Airflow stops and the blood oxygen level drops, which causes the brain to wake up.
  • If you have sleep apnea, this cycle may repeat hundreds of times during the night while you have no idea it is happening.
WHAT ARE THE COMMON SYMPTOMS?
  • Fatigue and tiredness during the day.
  • Loud snoring.
  • Waking up with choking or gasping.
  • Not feeling rested in the morning or satisfied with a night’s sleep.
  • A strong desire to take a daily afternoon nap.
  • Unexplained accidents or errors.
  • Morning headaches.

OTHER COMMON FEATURES ARE:
  • Obesity
  • Small jaw, thick neck
  • High blood pressure
  • Restless sleep; the repeated struggle to breathe can be associated with a great deal of movement.
  • Depressed mood and/or irritability
  • Reduced sex drive and impotence
  • Snorting, gasping, choking during sleep
HOW SERIOUS IS IT?
  • Sleep apnea is a potentially life-threatening condition.
  • Undiagnosed severe sleep apnea can cause irregular heartbeats, unstable high blood pressure, leg swelling, heart attack, stroke, cardiac arrest during sleep, or a harmful accident.
  • Increased daytime sleepiness poses a serious risk of automobile accidents, impaired functioning in the workplace and in personal relationships.
  • Untreated sleep apnea tends to progressively worsen and can cause partial or complete disability and death.
HOW IS IT DIAGNOSED?
  • An overnight sleep study, called polysomnography, is usually done to diagnose sleep apnea.
  • The sleep study measures your heart rate, brain waves, chest movement, air flow and blood oxygen levels while you sleep.
  • Other sleep disorders that cause unrestful sleep may be detected with a sleep study as well.
  • The test involves no pain and is covered by insurance.
HOW IS SLEEP APNEA TREATED?
  • The most commonly prescribed treatment for sleep apnea is continuous positive airway pressure (CPAP).
  • The CPAP machine delivers air pressure through a small nasal mask that the patient wears while sleeping.
  • The pressure acts as an “air splint” which keeps the throat open eliminating obstructive apneas.
  • Sleep becomes uninterrupted and restorative, and dramatically improves daytime functioning as well as general health.
  • Sleep apnea can also be treated surgically; however, the success rates may vary greatly depending on which procedure is chosen and the experience and skills of the surgeons.
  • Some patients try dental appliances that work by bringing the lower jaw forward to increase the size of the airway.

 

Narcolepsy

Narcolepsy is a relatively uncommon sleep disorder that involves the body’s central nervous system and is characterized by attacks of sleep. Narcolepsy affects about 1 in 2,000 people, both men and women of any age. A person with narcolepsy is likely to fall asleep at inappropriate times and places. Daytime sleep attacks may occur with or without warning and can occur repeatedly in a single day. Nighttime sleep may be fragmented with frequent arousals. While there is not yet a cure, recent technology and pharmacology has allowed those with this sleep disorder to live normal lives.

SYMPTOMS:
  • Excessive daytime sleepiness
  • Sudden loss of muscle control (Cataplexy)
  • Low concentration
  • Vivid dream-like experiences while dozing or falling sleep or waking up (Hypnagogic Hallucinations)
  • Temporary inability to talk or move when falling asleep or waking up (Sleep Paralysis)
  • Occupational/school problems
TREATMENT:
  • Medication including stimulants and anti-depressants
  • Changes in behavior to encourage good night time sleep
  • Scheduling short naps (10 to 15 minutes) two to three times per day to help control excessive daytime sleepiness.

 

Restless Leg Syndrome

Restless legs syndrome is a “creepy, crawly” feeling in the legs when they are still, especially at bedtime. Stretching or moving the legs temporarily relieves these feelings. The constant need to stretch or move the legs to rid of the uncomfortable sensations often prevents the person from falling asleep resulting in daytime sleepiness.

5 to 10% of people experience the pain of RLS at some point in their lives. RLS can occur at any age but is more common in the elderly. Approximately 30% of RLS cases have a hereditary case.

SYMPTOMS:
  • An urge to move the legs, often accompanied by uncomfortable sensations in the legs
  • Worsening of the discomfort when lying down or during other forms of inactivity
  • Experiencing the most discomfort at night and late in the day
TREATMENT:
  • Home remedies such as a hot bath, ice packs, leg message and regular exercise
  • Medication, including pain relievers, Benzodiazepines (such as Valium, Halcion, Restoril and Klonopin) and L-Dopa drugs that enhance a brain chemical known as dopamine
  • In certain cases Vitamin E and supplemental Calcium
Periodic Limb Movement Disorder

Periodic Limb Movement disorder (PLMD) refers to involuntary movements of the legs and arm during sleep. These movements cause arousals and sleep disturbances. PLMD are observed mostly in people over 50 years of age and are rare in people younger than 30. PLMD are more common in people who have kidney disease or narcolepsy. Individuals with PLMD may also experience Restless Legs Syndrome (RLS).

SYMPTOMS:
  • Repetitive movements, most typically in the lower limbs, that occur every 20-40 seconds
  • Brief muscle twitches, jerking movements or an upward flexing of the feet during sleep
TREATMENT:
  • Many people sleep through PLMD and are not bothered by them. In these cases no treatment is needed.
  • Following the guidelines for a good night’s sleep will help people who are disturbed by PLMD
  • Certain drugs are reported to reduce PLMD, however, the effectiveness of these drugs are not proven.
  • Treatment is only necessary when PLMD is accompanied by Restless Legs Syndrome(RLS), insomnia or daytime fatigue
Insomnia

The inability to fall asleep or stay asleep is called insomnia. Insomnia, in its chronic form, can last for weeks, months, or even years. It may be related to worry, anxiety, depression, medical/psychiatric problems, or substance abuse. Insomnia is a symptom and in order to treat it the physicians must find the cause. Most insomnia sufferers sleep better after the appropriate evaluation and treatment.

  • Transient insomnia is the inability to sleep over a period of a few nights. Stress or excitement usually causes this type of insomnia. For example the bride may not sleep well the night before the wedding or an athlete may experience some transient insomnia the night before the big meet.
  • Short-term insomnia is caused by periods of high stress at work, school, or daily life and results in two to three weeks of poor sleep. After the stressful period is over, sleep usually returns to normal.
  • Chronic insomnia is characterized by poor sleep most or every night. Most chronic insomnia is caused by physical ailment such as breathing disorders and muscle activity.
TREATMENT:
  • Sleeping pills, taken for a limited time usually no more than 3 weeks, can help in certain cases in treating short term and chronic insomnia.
  • Good sleep habits.

 

Parasomnia

Parasomnia refers to a variety of disruptive sleep-related events that disrupt one’s sleep and can lead to injury or disturbance of oneself or others in the bed or house. Parasomnias often can be effectively diagnosed and treated. Parasomnias include:

  • Sleepwalking – Sleepwalking seems to be a temporary sleep mechanism malfunction that occurs during deeper stages of sleep and tends to run in families. Sleepwalking affects mostly children and tends to go away after puberty. People who sleepwalk do not remember their nocturnal walk the next day.
  • Sleep talking – Sleep talking is generally harmless and usually temporary, brought on by illness or stress. The sleeper has no memory of sleep talking. Sleep talking can sometimes be associated with sleep apnea or sleep terrors.
  • Sleep terrors – Sleep terrors are more common in children and typically do not continue into adulthood. Sleep terrors are marked by a sudden awakening with physical behaviors associated with intense fear and last about 15 minutes after which the person goes back to sleep.
  • REM sleep behavior disorder – In this type of a disorder the paralysis that occurs normally during REM sleep is incomplete or absent, allowing the sleeper to act out their dreams. This type of disorder is most common in men and can lead to violent behavior or injuries. Medication is usually very effective in treating this disorder.