Sleep Disorders

Sleep Apnea

Sleep apnea is a serious, potentially life-threatening condition that is far more common than generally understood. Sleep apnea is a breathing disorder where brief pauses of breathing during sleep are observed. In Greek apnea means “without breath”. There are two types of sleep apnea: central and obstructive. Central sleep apnea is less common and occurs when the brain fails to send the appropriate signal to the breathing muscles to initiate breathing. Obstructive sleep apnea is far more common and occurs when air cannot flow into or out of the person’s nose or mouth although efforts to breathe continue. Sleep apnea can also be characterized by choking sensations. The frequent interruptions of sleep often lead to excessive daytime sleepiness, excessive daytime fatigue and may be associated with early morning headaches. Sleep apnea may be associated with irregular heartbeat, high blood pressure, heart attack, and stroke therefore early recognition and treatment of sleep apnea is very important.

Sleep apnea is more common in men but can occur in all age groups and both sexes.

Four percent of middle-aged men and 2 percent of middle-aged women have been documented to have sleep apnea. People who develop sleep apnea are most likely to be the ones who snore loudly, are overweight, have high blood pressure, have some physical abnormality in the nose, throat, or other parts of the upper airway. Sleep apnea seems to run in some families, suggesting a possible genetic basis.

Excess amount of tissue in the airway can cause it to be narrowed in obese people. The tongue, the uvula and the throat muscles can relax and cause the airway to become blocked. The person continues the effort to breathe but air cannot flow easily into or out of the nose or mouth due to the blockage. This results in heavy snoring, breathing pauses and frequent arousals from sleep. Alcohol consumption, sleeping pills or muscle relaxant medications can increases the frequency and duration of apneas.

The apneas cause one’s Oxygen levels in blood to drop and Carbon Dioxide levels to increase which in turn arouse the brain from sleep and normal breathing resumes with a loud snort. Frequent arousals from sleep prevent the person from getting enough deep sleep and cause daytime fatigue or daytime sleepiness. The daytime symptoms may include symptoms related to depression, irritability, sexual dysfunction, learning and memory difficulties, difficulty concentrating at work, falling asleep while at work, on the phone, or driving. Up to 50 percent of sleep apnea patients have high blood pressure. It has recently been shown that sleep apnea contributes to high blood pressure and increased risk for heart attack and stroke.

Apneas are usually witnessed by bed partners or family members. Patient’s co workers may notice patient falling asleep at inappropriate times such as meetings or while talking. The patient often does not know he or she has a problem.

Nocturnal Symptoms:

Snoring
Gasping or chocking in sleep
Witnessed pauses in breathing (usually by bed partner or family member)
Frequent trips to the bathroom
Blocked nose
Acid reflux
Leg cramps
Sexual dysfunction

Daytime Symptoms:

Morning headaches
Feeling unrefreshed upon awakening
Waking up with dry mouth
Daytime sleepiness (impaired work performance, decreased quality of life, increased rate of automobile and work accidents.)
Concentration problems
Likely to fall asleep in non-stimulating situations
Memory loss
Daytime fatigue
Learning difficulties
Excess weight / obesity
High blood pressure
Irritable mood / crankiness

Insomnia

Insomnia means having problems falling asleep or staying asleep. It may also be associated with awakenings during the night or waking up too early the next morning. Short term stress can cause difficulty sleeping but can get better in less than a month. Chronic insomnia may develop if someone worries about not sleeping well.

Insomnia can be caused by stress, depression, anxiety, poor sleeping habits, changes in your sleep habits or surroundings, pain, breathing problems, restless leg syndrome, and many other health problems. Use of stimulants such as caffeine or tobacco, alcohol, drugs or certain medications can cause insomnia as well.

You may have difficulty falling asleep, wake up and have difficulty falling asleep again or wake up earlier than planned. A detailed medical assessment along with some blood tests and or sleep study may help the treating physician diagnose insomnia. A sleep diary may help the doctor make the diagnosis.

The cause of the insomnia has to be treated. If a medical problem or emotional problem is causing the insomnia, then that has to be treated. Some life style changes such as going to bed at the same time each night, getting up at the same time each day, avoiding caffeine or alcohol for several hours before bedtime, getting regular exercise or avoiding daytime naps may help.

Medications can be used for short term but they can be habit forming and don’t work as well over time as behavioral changes. Counseling may help. Talk to your doctor about your sleep problems and any other health issues you may have.

Insomnia is very common and can affect people at any stage in life but is generally more common in women and older people. Sleep patterns also change with ageing as many older adults sleep less. Sleep quantity and sleep quality can be affected by health problems and medicines as well. If you have trouble getting to sleep or are not sleeping well, discuss it with your doctor at your next checkup.

Restless Leg Syndrome (RLS)

Restless legs syndrome is a condition when a person feels an intense and irresistible urge to move his / her legs in the evening or when trying to sleep. RLS causes an uncomfortable sensation in the legs that may be described as tingling, pins and needles or crawling sensation. Moving the legs may provide temporary relief. Restless legs syndrome disrupt sleep and can lead to daytime fatigue and daytime sleepiness. The cause of restless legs syndrome is unknown. It can be genetic. Conditions such as iron deficiency, kidney failure, pregnancy, rheumatoid arthritis, diabetes or Parkinson’s disease may be associated with it. A doctor’s evaluation, blood tests and a polysomnography help in diagnosing this disorder. Regular exercise, stretching, avoiding smoking and caffeine may relieve mild symptoms but medication may be needed when the symptoms are more severe and affect sleep.

Periodic Leg Movements (PLMD)

Periodic limb movement disorder (PLMD) is a sleep disorder characterized by periodic movements of the limbs during sleep. The movements typically involve the legs, but upper extremity movements may also be involved. Limb movements occur throughout the night and may be different in severity from one night to another. They can last anywhere from a few minutes to several hours during the night. The causes of PLMD are unknown. Iron deficiency, kidney failure, pregnancy, arthritis, Parkinson’s disease and narcolepsy may cause frequent periodic limb movements in sleep. They may be caused by medications such as antidepressants. Leg movements can cause micro arousals from sleep thus disrupt sleep and result in daytime fatigue and sleepiness. The patient usually is not aware of the leg movements but a bed partner may witness them. Some blood test and a polysomnography can help making the diagnosis. Medical treatment with medications is needed to treat the PLMd. Stimulants such as coffee, chocolate, tea or soft drinks may worsen the PLMD and therefore should be avoided.

Narcolepsy

Narcolepsy is a central system disorder that affects the control of sleep and wakefulness. People with narcolepsy experience excessive daytime sleepiness and intermittent, uncontrollable episodes of falling asleep during the daytime and these sleep attacks may occur during any type of activity suddenly. In a normal sleep cycle REM sleep occurs at about 90 minutes from sleep onset. Narcolepsy sufferers can experience REM sleep almost immediately at sleep onset. REM sleep is associated with muscle paralysis and this can explain the narcolepsy symptoms. Narcolepsy can begin at any age but generally it is predominantly diagnosed between the ages of 15-25. There is no one specific known cause of narcolepsy. The reasons may be having specific genes that affect the sleep awake cycle or maybe due to a deficiency in the production of a chemical called hypocretin by the brain. There may be abnormalities in certain parts of the brain which regulate REM sleep. Symptoms for narcolepsy include excessive daytime sleepiness, cataplexy (sudden brief loss of muscle control), hypnagogic hallucinations (vivid dreamlike experience that occurs when a person is drowsy), automatic behavior (routine tasks performed by a person who is not consciously controlling the activity), sleep paralysis (brief loss of muscle control that occurs when a person is falling asleep or waking up) and disturbed nighttime sleep. A detailed medical exam and a battery of tests are required to diagnose narcolepsy. An overnight sleep study (Polysomnogram) and an MSLT (Multiple Sleep Latency Tests) are essential in making the diagnosis. There is no cure for narcolepsy but medical treatment along with life style changes are necessary. The treatment may include stimulant medications and or antidepressives. Life style changes such as avoiding caffeine, alcohol and nicotine. Regular sleep as well as nap schedule may be helpful.

Snoring

Snoring is a common condition where the flow of air is partially obstructed. It occurs when an individual breathes in through a partially obstructed airway which in turn causes vibrations of the soft palate and the uvula. It can affect all people at any age but it affects men and overweight people more often. Snoring has a tendency to worsen with age. 45%-50% of adults snore occasionally, while 25%-30% snore regularly. Snoring is usually a nuisance for the bed partner and can cause serious relationship problems. Snoring may be caused by blocked nose, poor muscle tone in the upper airway, large tonsils, long soft palate and or uvula. Snoring can cause serious health problems if not treated. Sleep apnea maybe associated with snoring.

Hypersomnia

Hypersomnia means excessive sleepiness. A person suffering from hypersomnia can fall asleep anytime and has difficulty staying awake during the day. Hypersomnia may be caused by other sleep disorders such as sleep apnea , narcolepsy or periodic leg movement disorder. Sleep deprivation, illicit drug use, alcohol abuse, head trauma, depression and medications may cause excessive sleepiness. A detailed medical exam, some blood tests, polysomnogram can be helpful in making the diagnosis. Hypersomnia can be treated with stimulant and or antidepressant medications.

Circadian Rhythm Disorders

The term circadian comes from Latin and means around the day. Circadian rhythm disorders are disruptions in a person’s circadian rhythm. There are patterns of brain wave activity and biological activities around the 24 hours clock. Circadian rhythm disorders may factors such as shift work, medications, travel (jet lag), pregnancy and stress. The treatment for circadian rhythm disorders is based on the kind of disorder. Therapy for CRD may consist of bright light therapy, chronotherapy and proper sleep hygiene.

Parasomnias

Parasomnias are sleep-related disorders that can occur during arousals from REM sleep or from non-REM sleep. They may include somnambulism (sleep walking), nightmares, night terrors, sleepwalking and somnoliquay (sleep talking) Sleepwalking occurs in deep sleep but the person appears to be awake. There is no recollection of the sleep walking event in the morning. This disorder is most commonly seen in children aged eight to twelve and is reduced with aging. Sleepwalking appears to run in families. Sleepwalking can be dangerous because the person is unaware of his or her surroundings and can bump into objects or fall down. Nightmares cause awakening from sleep with feelings of fear, terror, and anxiety causing difficulty returning to sleep. Nightmares can be caused by many factors including illness, anxiety, medication reaction, the loss of a loved one, and or stress. Night terrors cause abrupt awakening from sleep in a terrified state. The person may appear to be awake but is difficult to fully awaken. The person is confused, unable to communicate and non-responsive to questions. The person goes back to sleep after a few minutes and does not remember the events in the morning. Sleep talking can be caused by fever, emotional stress or other sleep disorders. It is harmless although can be disturbing to sleep partners or other family members. The talk can be brief or long and the the sleep talker has no recollection of his / her actions.