Common Sleep Disorders

 

Daytime Sleepiness & Narcolepsy

Narcolepsy is a disorder of inappropriate sleep. People with this condition often develop symptoms while in their teens and early 20's. Narcolepsy is rare, with only 1 in 2,000 people affected. 

The single most common sign of narcolepsy is uncontrollable sleep attacks that occur at any time, often with little warning. Some people are aware of an impending attack and can take a brief nap, which helps.

Other associated symptoms include:

Cataplexy: Sudden episodes of muscle weakness during strong emotional situations. Cataplexy may be mild with brief weakness in the legs, or difficulty speaking, to severe, with full collapse and falling. People with these are awake and aware of surroundings.

Sleep Paralysis: Being awake, but not able to move for several moments upon awakening or falling asleep. This can be seen when someone is sleep deprived, so it must be seen with other symptoms of narcolepsy.

Hypnagogic Hallucinations: Vivid, dreamlike images that occur while falling asleep, waking up, or during naps. These are often misdiagnosed or confused with hallucinations accompanying various forms of mental illness.

To diagnose Narcolepsy, an overnight sleep study or polysomnogram is performed to monitor the quality of sleep and to rule out the presence of other more common disorders such as Sleep Apnea and Periodic Limb Movement Disorder. The overnight test is followed by a MSLT or Multiple Sleep Latency Test to evaluate daytime sleepiness and look for specific sleep patterns. The MSLT is simply a series of short naps every 2 hours throughout the day.

While there is no cure, Narcolepsy can be managed with medications.  Strict adherence to good sleep habits and brief scheduled naps throughout the day are helpful when used in conjunction with medications.

Some people can have excessive sleepiness without receiving the diagnosis of Narcolepsy. These patients may have a combination of other sleep disorders that when added together result in such poor sleep that daytime alertness is compromised. A careful evaluation with a sleep specialist followed by a sleep study, and a follow-up office visit is crucial in dealing with these complex situations. 

 

Insomnia 

Insomnia is described as the inability to fall asleep or stay asleep. According to the National Sleep Foundation, 9% of the people in the U.S. have persistent insomnia, and 27% of people have experienced at least several weeks of insomnia at some point in their lives.

Insomnia is a symptom, not a primary disease, and is usually the result of stress, anxiety, depression, or poor sleep habits that have developed over a long period of time. Treating the underlying cause is the key to effective resolution of the problem. An actual medical condition causing the difficulty is found in only 15% of individuals with chronic, long-term insomnia.

The most effective and long-lasting therapies for insomnia involve breaking bad sleep habits and re-learning the process of falling asleep. Along with stress reduction, you need to follow good sleep hygiene practices.  

If you have Insomnia:

  • Keep track of when you go to bed, get up, consume coffee and alcohol, exercise and other habits you suspect may affect your sleep. Keeping a sleep log for a week or two often identifies trouble.
  • Don't nap, unless you've found naps don't interfere with nighttime sleep.
  • Don't use your bed or bedroom as an office or place to watch television. Reserve your bed for sleep.
  • If you are a bedtime "worrier," find another time of the day to write down both the problems and possible solutions.
  • If you can't sleep, don't stay in bed fretting. After 10 or 15 minutes, go to another room and read or watch TV until sleepy.
  • Spend less time in bed. If your doctor has determined that no physical disorder plays a role in your insomnia, consider sleep restriction: This anti insomnia treatment is based on the finding that many insomniacs spend excessive amounts of time in bed, trying to make up for lost sleep.

 

Restless Legs and Periodic Limb Movements 

Periodic Limb Movements (PLMS) are characterized by hundreds of repeated kicking or jerking movements of the legs or arms during sleep. Each movement may result in a brief awakening, fragmenting sleep and leading to difficulty staying asleep. Severe repeated awakenings can result in significant daytime sleepiness.
 

Restless Leg Syndrome is a related condition, characterized by bothersome sensations of the legs and feet while at rest. People commonly describe "creepy crawly" or "ants in the pants" feelings, that are only relieved by walking around. PLMS are more common in the elderly, with up to 30% of those between 50 and 65 years of age, and 50% of people over age 65 having symptoms. Restless Legs can affect 10 to15% of the population. Restless Legs Syndrome appears to be inherited in approximately 30% of patients.

While the cause of Restless Legs is not known, but there are certain circumstances or conditions that seem to be related, including nerve problems, poor circulation, iron deficiency anemia, kidney disorders, alcoholism, and vitamin and mineral deficiencies. Symptoms are often aggravated by caffeine, temperature extremes, fatigue and smoking. Individuals requiring kidney dialysis are often affected as well. The same related conditions seem to associate with Periodic Limb Movement Disorder.

Treatment involves various prescribed medications that inhibit the brain arousal or awakenings due to the movements, or medications that seem to decrease the intensity of the movements. A sleep study is not usually required to evaluate this condition. However, it may be detected during a recording performed for another diagnosis.

 

Sleep Apnea & Snoring

Sleep apnea and snoring are a related and common disorder that can lead to serious health problems such as high blood pressure, heart disease, stroke, and may cause a significantly greater mortality rate if untreated. Snoring can be irritating, and may be a sign of sleep apnea, a more serious disorder where one actually stops breathing during sleep. Sleep apnea affects up to 20% of middle-aged men and 10% of all age groups. 

Snoring is caused by a restriction of the air passages in the nose and/or throat. The blockages usually result from an enlarged soft palate, elongated uvula, enlarged tonsils, nasal obstruction or the tongue falling backwards while sleeping.

Further relaxation of the muscles in the airway while sleeping can produce partial or complete blockage of airflow, resulting in a condition called Obstructive Sleep Apnea (OSA). Typically, patients with OSA stop breathing hundreds of times each night for periods of 10 to 120 seconds at a time.

In addition to disrupted sleep, the repeated events lead to drops in oxygen level, hypertension, daytime sleepiness, and, if severe and left untreated, serious risk of cardiac events. Interrupted snoring, gasping and choking are common signs of OSA.  

OSA is also seen in children. In fact, the American Academy of Pediatrics recently reported that all children with chronic snoring should be evaluated for sleep apnea. Over 30% of children with previous diagnosis of Attention Deficit Hyperactivity Disorder have been shown to have sleep apnea. Children with disturbed sleep from any cause often become "hyper" in contrast to adults. Treatment for children often involves surgery to remove the tonsils and adenoids.

 

Unusual Sleep Behaviors

Unusual sleep behaviors are called parasomnias. These are usually not treated until they become bothersome or dangerous to the patient.

Some parasomnias such as sleep talking, night-terrors, nightmares (bad dreams) or sleep walking are common, especially in childhood. They tend to be worse when the patient is having stress, anxiety or is sleep deprived. When the parasomnias persist into adulthood and occur multiple times per week, it is advised to seek professional consultation.

Tooth grinding (bruxing) is a common parasomnia that does not require sleep evaluation. Bruxing can cause significant damage to the teeth if left untreated. See your dentist to discuss the use of a night guard to protect the teeth.

Some parasomnias are dangerous, such as sleep walking down stairs, into the street, or out onto a balcony, etc. Nighttime epileptic seizures are also considered parasomnias, and should be evaluated. There is even a disorder where people act out their dreams during sleep, called Rapid Eye Movement (REM) Sleep Behavior Disorder.

Some patients who have experienced some type of severe emotional upset or abuse can have such severe nightmares and night-terrors that they are literally terrified to fall asleep. Careful evaluation by a sleep specialist in conjunction with the use of guided imagery techniques to "re-direct" the dreaming has been shown to work over time.

The first step in evaluation is to see a sleep specialist, then an overnight sleep study if required. Once diagnosed, the specific disorder can usually be managed by medications.

Call the JMC Sleep Center at 561-744-4478 for more information.