Sleep Disorders

The following is a description of some common sleep disorders, as well as methods for detecting and treating them.

Sleep Apnea

Heavy snoring can signal health problems, one of which is sleep apnea. People with sleep apnea stop breathing repeatedly throughout the night, sometimes hundreds of times. The person's sleep is repeatedly interrupted, but he often does not recall awakening.

Sleep apnea is usually caused by an obstruction or narrowing of air passages. The disorder can cause excessive daytime sleepiness, fatigue, personality changes, morning headaches, hypertension, impotence, irregular heart rhythm and even death. Because it occurs during sleep, this condition can go undetected by the patient. Often a spouse will notice the warning signs, which include:

• Pauses in breathing that can last to 90 seconds
• Loud, snoring, snorting or gasping for breath
• Restless sleep or sudden body movements when breathing resumes
• Excessive sweating during sleep

Treatment for sleep apnea varies according to the symptoms and severity of the problem. Selected patients benefit from types of oral mouthpieces, or surgical and radiofrequency techniques which reduce tissue in the airway. Machines which deliver air through the nose may be prescribed in many instances.

Narcolepsy

Narcolepsy is a neurological disorder which causes irresistible sleep attacks. While the disorder affects each person differently, it is often marked by sudden attacks of sleep, excessive daytime sleepiness, muscular weakness, hallucinations and attacks of rapid eye movement (REM).

Sometimes narcolepsy patients exhibit automatic behavior, performing tasks without consciously thinking and then being unable to recall details of having done the task.

Because these attacks can happen anywhere and at anytime, they can be very dangerous. Narcolepsy is diagnosed using a combination of the patient's history, and the findings from both a nighttime sleep study and a series of nap studies conducted for the following day.

Narcolepsy is usually treated with carefully administered stimulants to prevent the sleep attacks, along with educational support.

Insomnia

Most adults have experienced insomnia or sleeplessness at one time or another in their lives. An estimated 30 to 50 percent of the general population are affected by insomnia, and 10 percent have chronic insomnia.
Insomnia is a symptom, not a stand-alone diagnosis or a disease. By definition, insomnia is "difficulty initiating or maintaining sleep, or both" and it may be due to inadequate quality or quantity of sleep. Insomnia is not defined by a specific number of hours of sleep that one gets, since individuals vary widely in their sleep needs and practices. Although most of us know what insomnia is and how we feel and perform after one or more sleepless nights, few seek medical advice. Many people remain unaware of the behavioral and medical options available to treat insomnia.

Insomnia is generally classified based on the duration of the problem. Not everyone agrees on one definition, but generally:

• symptoms lasting less than one week are classified as transient insomnia,
• symptoms between one to three weeks are classified as short-term insomnia, and
• those longer than three weeks are classified as chronic insomnia.

Insomnia affects all age groups. Among adults, insomnia affects women more often than men. The incidence tends to increase with age. It is typically more common in people in lower socioeconomic groups, chronic alcoholics and mental health patients. Stress most commonly triggers short-term or acute insomnia. If you do not address your insomnia, however, it may develop into chronic insomnia.

Restless Leg Syndrome

Restless leg syndrome is a sleep disorder characterized by leg discomfort during sleep, which is only relieved by frequent movements of the legs.

The disorder consists of sensations in the lower legs that make the person uncomfortable unless the legs are moved. The sensations usually occur shortly after going to bed but may also occur during the daytime. The abnormal sensations occasionally occur in the upper leg, the feet, or the arms, in addition to the lower leg.

There is an irresistible urge to walk or move the legs to relieve the discomfort, resulting in periodic episodes of leg movements during early sleep stages. Symptoms, which may last for 1 hour or longer and may be worse during stress or emotionally upsetting periods, can include:

• Abnormal sensation in the legs (occasionally, feet, thighs, arms)
• Creeping sensations or discomfort (not pain, not cramps) relieved by movement of the legs may occur during the day and may be worse when lying down
• Irresistible urge to move the legs
• Persistent leg movements during sleep hours
• Sleeping difficulty

Shift Work Sleep Disorders

SWSD is a sleep disorder that affects people who frequently rotate shifts or work at night. Schedules of these people go against the body’s natural Circadian rhythm, and individuals have difficulty adjusting to the different sleep and wake schedules. SWSD consists of a constant or recurrent pattern of sleep interruption that results in insomnia or excessive sleepiness. This disorder is common in people who work non-traditional hours, usually between 10 p.m. and 6 a.m.

The most common symptoms of SWSD are insomnia and excessive sleepiness. Other symptoms of SWSD include:

• Lack of energy
• Difficulty concentrating
• Headaches

If you are a shift worker and experience any of these symptoms, you should talk to your doctor.

Consequences of SWSD include:

• Increased accidents
• Increased work-related errors
• Increased sick leave
• Increased irritability, mood problems, etc.

Shift workers must be willing to make sleep a priority. People who work shifts other than a 9:00 a.m. to 5:00 p.m. routine might have to prepare for sleep even though it might be daylight outside. Prepare your body and mind for sleep. Minimize exposure to light on your way home from work if you are on the night shift to keep morning sunlight from activating your internal "daytime clock." Follow bedtime rituals and try to keep a regular sleep schedule - even on weekends. Go to sleep as soon as possible after work. It is important to get at least 7 to 8 hours of sleep every day.

At home, ask family and friends to help create a quiet and peaceful setting during your sleep time. Have family members wear headphones to listen to music or watch TV. Encourage people in the household to avoid vacuuming, dish washing, and other noisy activities during your sleep time. Put a "Do Not Disturb" sign on the front door so that delivery people and friends will not knock or ring the doorbell.

Some general guidelines for decreasing the effects of SWSD

• Decrease the number of night shifts worked in a row. Shift workers working the night shift sleep less than day workers and become progressively more sleep-deprived over several days. You are more likely to recover from sleep deprivation if you can limit your number of third shifts to five or less, with days off in between. If you work a 12-hour shift, you should limit work to four shifts in a row. After a string of night shifts, you should have more than 48 hours off, if possible.
• Avoid extended work hours. Avoid working prolonged shifts and putting in excessive overtime. Make sure you have time to sleep and participate in family and social activities.
• Avoid long commutes, which can take time away from sleeping.
• Avoid frequently rotating shifts. It is more difficult to deal with rotating shifts than it is to work the same shift for a longer period of time.
• Get enough sleep on your days off. Practice good sleep hygiene by planning and arranging a sleep schedule and by avoiding caffeine, alcohol, and nicotine. Do not start a night shift with sleep deprivation.
• Caffeine and prescription wake promoting drug such as modafinil (Provigil®) have some role in promoting wakefulness during work hours. But the best strategy is to get adequate sleep.