SLEEPING DISORDERS

SAIMA IBRAHIM
(feedback@pgeconomist.com)

Dec 20 - 26, 2010

Getting a good night's sleep is essential for feeling refreshed and alert during the day. Lack of sleep might make you feel foggy and unable to concentrate, or just a lesser version of your normal self. Sleep problems will eventually disrupt your work, family, and personal relationships.

A sleep disorder is a medical disorder of the sleep patterns of a person or animal. Some sleep disorders are serious enough to interfere with normal physical, mental, and emotional functioning. A test commonly ordered for some sleep disorders is the polysomnography.

CLASSIFICATIONS

* Bruxism (Tooth-grinding): Involuntarily grinding or clenching of the teeth while sleeping.

* Bedwetting or sleep enuresis.
* Circadian rhythm sleep disorders
* Delayed sleep phase syndrome
* Advanced sleep phase syndrome
* Non-24-hour sleep-wake syndrome

* Hypopnea syndrome: Abnormally shallow breathing or slow respiratory rate while sleeping.

* Cataplexy: A sudden weakness in the motor muscles that can result in collapse to the floor.

* Dyssomnias: A broad category of sleep disorders characterised by either hypersomnolence or insomnia. The three major subcategories include intrinsic (i.e., arising from within the body), extrinsic (secondary to environmental conditions or various pathologic conditions), and disturbances of circadian rhythm.

* Delayed sleep phase syndrome (DSPS): inability to awaken and fall asleep at socially acceptable times but no problem with sleep maintenance, a disorder of circadian rhythms. (Other such disorders are advanced sleep phase syndrome (ASPS), non-24-hour sleep-wake syndrome (Non-24), and irregular sleep wake rhythm, all much less common than DSPS, as well as the transient jet lag and shift work sleep disorder.)

* Hypersomnia
* Recurrent hypersomnia - including Kleine-Levin syndrome
* Posttraumatic hypersomnia
* "Healthy" hypersomnia

* Insomnia: Chronic difficulties in falling asleep and/or maintaining sleep when no other cause is found for these symptoms.

* Medical or Psychiatric Conditions that may produce sleep disorders
* Psychosis (such as Schizophrenia)
* Mood disorders
* Depression
* Anxiety
* Panic
* Alcoholism

* Nocturia: A frequent need to get up and go to the bathroom to urinate at night. It differs from Enuresis, or bed-wetting, in which the person does not arouse from sleep, but the bladder nevertheless empties.

* Narcolepsy: Excessive daytime sleepiness (EDS) often culminating in falling asleep spontaneously but unwillingly at inappropriate times.

* Obstructive sleep apnea: Obstruction of the airway during sleep, causing lack of sufficient deep sleep; often accompanied by snoring. Other forms of sleep apnea are less common.

* Restless legs syndrome (RLS): An irresistible urge to move legs. RLS sufferers often also have PLMD.

* Periodic limb movement disorder (PLMD): Sudden involuntary movement of arms and/or legs during sleep, for example kicking the legs. Also known as nocturnal myoclonus. See also Hypnic jerk, which is not a disorder.

* Parasomnias - A category of sleep disorders that involve abnormal and unnatural movements, behaviors, emotions, perceptions, and dreams in connection with sleep. Parasomnias is disruptive sleep-related events involving inappropriate actions during sleep; sleep walking and night-terrors are examples.

* REM sleep behaviour disorder

* Rapid eye movement behavior disorder (RBD): Acting out violent or dramatic dreams while in REM sleep.

* Sleep terror: Pavor nocturnus, sleep terror disorder: abrupt awakening from sleep with behavior consistent with terror.

* Sleepwalking or somnambulism: Engaging in activities that are normally associated with wakefulness (such as eating or dressing), which may include walking, without the conscious knowledge of the subject.

* Sleep paralysis: is characterised by temporary paralysis of the body shortly before or after sleep. Sleep paralysis may be accompanied by visual, auditory or tactile hallucinations. Not a disorder unless severe. Often seen as part of Narcolepsy.

* Sleepwalking or somnambulism: Engaging in activities that are normally associated with wakefulness (such as eating or dressing), which may include walking, without the conscious knowledge of the subject.

* Sleep talking (or somniloquy)
* Sleep sex (or sexsomnia)
* Exploding head syndrome - Waking up in the night hearing loud noises.
* Sleeping sickness - a parasitic disease which can be transmitted by the Tsetse fly.

* Snoring - Not a disorder in and of itself, but it can be a symptom of deeper problems.

General Treatment: Treatments for sleep disorders can be grouped into four categories:

* behavioral/ psychotherapeutic treatments
* rehabilitation/management
* medications
* other somatic treatments

None of these general approaches is sufficient for all patients with sleep disorders. Rather, the choice of a specific treatment depends on the patient's diagnosis, medical and psychiatric history, and preferences, as well as the expertise of the treating clinician. Often, behavioral/ psychotherapeutic and pharmacological approaches are not incompatible and can effectively be combined to maximise therapeutic benefits.

Medications and somatic treatments may provide the most rapid symptomatic relief from some sleep disturbances. Some disorders, such as narcolepsy, are best treated pharmacologically. Others, such as chronic and primary insomnia, may be more amenable to behavioral interventions, with more durable results. Effective treatment begins with careful diagnosis using sleep diaries and perhaps sleeps studies. Modifications in sleep hygiene may resolve the problem, but medical treatment is often warranted. Special equipment may be required for treatment of several disorders such as obstructive apnea, the circadian rhythm disorders, and bruxism. In these cases, when severe, an acceptance of living with the disorder, however well managed, is often necessary.

INSOMNIA: Insomnia is the inability to sleep or inability to sleep well at night. Many different medical and mental health problems cause insomnia. Insomnia may be situational, lasting a few days to weeks, or chronic, lasting for more than 1 month. Almost everyone will be affected by insomnia at some point during life. Insomnia - a short term or chronic inability to get high quality sleep - is a common sleep problem and can be caused by a variety of things including stress, a change in time zones, a side effect of medications, an altered sleep schedule or poor bedtime habits, or it might be related to an urgent situation at work, or a difficult family issue. Whatever the cause of your insomnia, being mindful of your sleep habits and learning to relax will help you sleep better and feel better.

Treatment: The great news is that insomnia doesn't have to be a permanent problem. In many cases, self help techniques, including improved sleep hygiene, relaxation, and cognitive behavioral therapy (CBT), can alleviate insomnia and promote better health as well as better sleep. Short-lasting insomnia periods are well treated with medication, chronic or long-lasting insomnia may not respond well to medications. Thus, throwing sleeping pills at many patients with chronic insomnia is not an effective way to treat the problem. Medications should be a last resort for insomnia - they do not provide lasting treatment and have numerous possible side effects.

SLEEP APNEA SLEEP DISORDERS

Sleep apnea is a common sleep disorder that can be potentially very serious, and even life-threatening. The word apnea means "not breathing." In sleep apnea, your breathing stops or gets very shallow while you are sleeping. Each pause in breathing typically lasts 10 to 20 seconds or more, and the pauses can occur 20 to 30 times or more an hour. Patients with the usual form of sleep apnea actually close off their airway at night. This airway closure occurs either behind the tongue or behind the nose. Patients continue to make efforts to breathe. Then after 10 to 20 seconds, the brain, realising it is not getting any oxygen, actually "wakes up." The brain then tells the upper airway to open to let some air in thus during the episodes of apnea, the sleeper wakes up to breathe again, disrupting sleep. Patients may take a few breaths of air, the brain goes to sleep again and the cycle may repeat itself several hundred times a night.

SYMPTOMS OF SLEEP APNEA INCLUDE:

* Frequent gaps in breathing during sleep (apnea)

* Gasping or choking for air to restart breathing, often causing sleeper or partner to wake

* Loud snoring

* Feeling un refreshed after a night's sleep and excessive daytime tiredness

The most common type of sleep apnea is obstructive sleep apnea. Causes of sleep apnea are generally physical in nature, including excess weight or tissue (sometimes from being overweight or obese), large tonsils or adenoids, nasal congestion or blockage or a unique shaped head, neck or chin.

Sleep apnea is dangerous, common, relative easy to diagnose, and treatable. Patients with sleep apnea are at great risk for heart disease, heart attacks, strokes, and high blood pressure. In addition, since the sleep is poor quality (remember the brain keeps waking up), patients are often sleepy during the day. Sleepiness is associated with inability to concentrate, remember, or think. There is also increased risk in falling asleep while doing vital tasks such as driving or using heavy machinery.

Treatment: In some cases Continuous Positive Airway Pressure CPAP is to treat sleep apnea patients, it is a mechanical device worn while sleeping which provides continuous air pressure to keep the airway open, for this treatment a mask is fit over the nose or over the nose and mouth. The mask is pressurised slightly to hold the airway open and allow the patient to sleep normally. Newer technology has made the masks relatively comfortable to use. It is the most recommended treatment for moderate to severe sleep apnea. CPAP can take some getting used to, but provide effective relief when used correctly.

Self help treatments, like losing weight, avoidance of drugs, which increase the risk of apneas such as sleeping pills, alcohol and sedative medicines, and sometimes sleeping semi-upright, elevating the head of the bed or sleeping on your side, can also be effective remedies for mild to moderate sleep apnea. Dental appliances and surgery are also treatment options. However, in most cases additional treatment is warranted. Some patients may be candidates for surgery on the upper airway. In the usual upper airway surgery the uvula (that punching bag in the back of the throat) and some of the surrounding soft tissue is removed to enlarge the air passage. In other cases, a dental device designed to move the lower jaw down and outwards slightly may be worn at night. In a few cases, treatment is begun with an emergent tracheotomy when sleep apnea is considered to be immediately life-threatening. The decision about which form of treatment to use should be decided by the patient and his/her physician on the basis of the sleep studies and rest of the clinical data.

SNORING: Snoring, which is sometimes confused with sleep apnea, can be a significant obstacle to quality sleep both for yourself and your partner. Snoring is caused by a narrowing of your airway, either from poor sleep posture, excess weight or physical abnormalities of your throat. A narrow airway gets in the way of smooth breathing and creates the sound of snoring. The snoring noise doesn't necessarily that the airway is obstructed, as it is in sleep apnea. Snoring may accompany sleep apnea, but not always.

Treatment: There are many self-help remedies and cures for snoring. If you are a mild snorer, sleeping on your side, elevating the head of your bed, or losing weight may stop the snoring. Don't give up trying to find a solution for your snoring it will make you and your partner sleep better.

NARCOLEPSY: Narcolepsy is a chronic sleep disorder that commonly begins during adolescence and is characterised by excessive daytime sleepiness with the occurrence of sleep attacks. It is a neurological disorder that causes extreme sleepiness and may even make a person fall asleep suddenly and without warning. Specific causes of narcolepsy are not known but people with narcolepsy are lacking hypocretin, a brain chemical which regulates sleep and wakefulness. The "sleep attacks" experienced by people with narcolepsy occur even after getting enough sleep at night, and make it difficult for people to live normal lives. Falling asleep during activities like walking, driving, or working can have dangerous results.

SYMPTOMS OF NARCOLEPSY INCLUDE:

* Intermittent, uncontrollable episodes of falling asleep during the daytime
* Excessive daytime sleepiness
* Sudden, short-lived loss of muscle control during emotional situations (cataplexy)

Treatment: The treatment of narcolepsy and its associated symptoms commonly requires a combination of behavioral modification and drug therapy. Many patients with narcolepsy will do well with naps scheduled at specific times during the day. Stimulant medication may be used to alleviate symptoms of daytime sleepiness.

RESTLESS LEGS SYNDROME (RLS) AND PERIODIC LIMB MOVEMENT DISORDER (PLMD): Restless legs syndrome (RLS) is characterised by an intolerable, internal itching sensation occurring in the lower extremities that causes an almost irresistible urge to move the legs. The sensation is commonly described as a "creepy" or "crawly" sensation and is typically relieved by movement of the legs or walking around. This disorder causes an almost irresistible urge to move the legs (or arms). The urge to move occurs when resting or lying down and is usually due to uncomfortable, tingly, or creeping sensations in the legs or affected limbs.

In some patients, this problem persists into the nighttime and may prevent patients from getting a restful night's sleep. Pregnancy and iron deficiency are associated with an increased frequency of this disease. In many patients, RLS is extremely distressing.

PLMD is a related condition involving involuntary, rhythmic limb movements, either while asleep or when awake. Most people who have Restless Legs Syndrome also have PLMD. Alternative therapies, lifestyle changes, and even nutritional supplements have proven helpful for RLS and PLMD sufferers.

Almost all patients with restless legs syndrome have a problem called period limb movement disorder. In this, there are rhythmic limb movements, either while asleep or when awake. These movements may fragment sleep, leading to poor quality, non-refreshing sleep. Periodic limb movement disorder can also occur as an isolated problem, often reported by the bed partner.

Treatment: Treatment commonly includes the incorporation of both aerobic and leg stretching exercises. Leg stretching or even yoga exercises can be done prior to bedtime to alleviate symptoms and may be all that is needed in mild cases. Iron replacement therapy is used if patients are iron deficient. Drugs used to treat Parkinson's disease are very effective in treating most cases.

SLEEPWALKING/SOMNAMBULISM: Sleepwalking, also referred to as somnambulism, is characterised by walking or other physical activities during sleep. Sleepwalking is common in children -- up to 15 percent of children have had this problem -- but can occur at any age. In children, it can be associated with sleep deprivation or anxiety. In adults, it is more commonly associated with other medical disorders, medication use, or anxiety or depressive disorders. Clinically, the person may simply sit up with their eyes open, appearing to be awake, or they may engage in a complex task. Episodes can last from seconds to minutes.

Treatment: There is no specific treatment except to avoid triggers if known, or treat anxiety or depression. If severe, short-term use of sedatives may be considered. Otherwise, it is best to keep the person safe and out of harm's way.

LEARNING MORE ABOUT YOUR SLEEP PROBLEM OR DISORDER

Self-diagnosis: To determine if you have a sleep disorder, first pay attention to your sleep habits and daily routine. Keeping a record of your sleep patterns will help you and your doctor find the cause of your sleep problems. A sleep diary, compiled by you and your sleep partner help your doctor or sleep specialist, if you choose to see one. A sleep diary should record all sleep-related information, including:

* time you went to bed and woke up (total sleep hours)

* quality of your sleep - times that you were awake and activity (e.g., stayed in bed with eyes closed, or got up, had a glass of milk, and meditated)

* types and amount of food, liquids, caffeine, or alcohol you consumed before bed, and times of consumption

* feelings and moods before bed happiness, sadness, stress, anxiety

* drugs or medications taken, amounts taken, and times of consumption

SEEING A DOCTOR

You can address many common sleep problems through lifestyle changes and improved sleep hygiene, but see your doctor or a sleep specialist if your sleep does not improve. What can you expect when you go to see a doctor about your sleep problem? Doctors will consider many things before making a diagnosis including:

* description of symptoms
* age and gender
* psychological and medical history
* sleep diary and sleep questionnaire
* possible medical conditions
* medical tests
* sleep center data

Your doctor will probably suggest behavioral and environmental changes as first steps of your treatment. Regardless of your sleep problem, a consistent sleep routine and improved sleep habits will translate into better sleep over the long term.