What is a sleep disorder?
A
sleep disorder interferes with one's ability to sleep normally. For
many people, it is a chronic, nightly problem that can affect daytime
behavior. Activities at work and school and relations with loved ones
can be affected. A sleep disorder can worsen existing medical
conditions, and it can also lead to new medical problems.
What are the most common sleep disorders?
There are over 85 known sleep disorders.
Those most commonly seen include:
3. Insomnia
4. Narcolepsy
6. Parasomnias
7. Periodic Limb Movement Disorder
9. Snoring
Circadian
sleep disorders are disorders of the timing of sleep and wakefulness.
We all have an internal "clock," which controls our rhythm of sleeping
and wakefulness. There are times of the day when we are most alert --
most often mid-morning and early evening. And, there are times when we
are more likely to be sleepy – early to mid-afternoon and late evening.
Our environment impacts this rhythm, and may either complement or
disrupt our internal clock.
Excessive
sleepiness can develop when our sleep rhythm is altered. We may feel
sleepy when we need to remain awake. On the other hand, insomnia is
when we don't feel sleepy when we do want to sleep,
Disorders that are related to changes in the normal sleep-wake pattern:
Advanced Sleep-Phase
is a shift in nighttime sleep to a time earlier than the desired
bedtime. Arising time the next morning is also earlier than desired.
Bedtime often occurs between 6 p.m. and 9 p.m. Arising time often
occurs between 1 a.m. and 3 a.m.
Delayed Sleep-Phase
is when the usual nighttime sleep period occurs later than the desired
bedtime. These "night owls" are unable to sleep until the early morning
hours. They don't arise until late morning to early afternoon.
Irregular Sleep-Wake Pattern
The timing of sleep and wake activities are erratic. Three or
more naps replace the major nighttime sleep. Evening insomnia and
daytime sleepiness are common symptoms.
Jet Lag
After rapid travel across many time zones, our internal clock
remains fixed to our home time zone. It may take a few days for the
internal clock to adjust to the new time zone. For example, the
advanced bedtime after an eastward flight may result in trouble falling
asleep at a "normal time." On the other hand, westward flights result
in a delay in nighttime sleep. It also results in increased awakenings
during the early morning hours. Luckily for the traveler, sleep tends
to improve after two to three days.
Shift Work Sleep Disorder
Large numbers of people in this country perform shift work. Excessive
sleepiness and insomnia may develop when people work outside the 8 a.m.
to 5 p.m. shift. Sleepiness and decreased concentration is common if
one must work at night. A shift work sleep disorder poses a major
hazard in the workplace.
Chronic
lack of sleep is a common cause of excessive sleepiness. It is
important to get enough sleep. Getting enough sleep each night will
help you maintain normal alertness and performance while awake.
A
person may allow plenty of time for sleep, but sleep time can be
interrupted by sleep apnea or periodic limb movements . Excessive
sleepiness occurs with sleep disorders such as narcolepsy, or circadian
rhythm disorders, which is a simple disturbance of the body clock. This
occurs because the timing of wakefulness and sleep is altered. Two
examples are jet lag or shift work.
Medicines
can cause excessive sleepiness. Medicines that sedate as a side-effect
can cause this. The routine use of sedating or opioid pain medicines
may also cause excessive sleepiness. This is more likely to occur if
large doses or long-acting medicines are taken during the night.
Excessive sleepiness may occur if stimulant medicines are quickly
stopped. Speak to your doctor if you are concerned that your medicines
may be causing excessive sleepiness.
Why should I worry about feeling tired during my day?
Excessive
sleepiness becomes a problem when the person cannot stay awake and
alert long enough to complete daily tasks. Sleep occurs during the day.
Excessive sleepiness is different from fatigue or physical tiredness.
Excessive
sleepiness may increase the risk of car, work, or home accidents. It
may also cause poor school or work performance. Memory problems and
changes in behavior can also occur.
Are some types of excessive sleepiness worse than others?
Mild sleepiness occurs during rest, or when little attention is required for the activity. Examples including reading or watching television.
Moderate sleepiness
is present if it occurs during activities that require more attention.
They may be physical or mental. One example is during a group meeting.
Severe sleepiness occurs during physical activities, which require full attention. Examples include talking, eating, or driving.
Insomnia is the failure to fall asleep and/or remain asleep. Sleep is light and easily disturbed. Other common symptoms include:
* fatigue
* irritability
* poor attention
Insomnia can increase the chance of accidents, decrease performance, and impair judgment.
Are some types of insomnia more severe than others?
Mild Insomnia: Poor sleep has little effect on social function or work.
Moderate Insomnia: Poor sleep impacts social and work function.
Severe Insomnia: Poor sleep has a major impact on how a person functions during the day.
Acute Insomnia: Poor sleep lasts only a few days.
Chronic Insomnia: Poor sleep may last for several months or more. It may start in early childhood and be life-long.
What causes insomnia?
There are many reasons for poor sleep. Often there is more than one cause. Causes and types of insomnia may include:
Acute stress
- Acute stress, such as major life events (tragic loss, marriage, a job
change, or an exam) can lead to insomnia. Sleeping in new settings such
as a hotel or hospital room can also lead to insomnia. This type of
sleep disturbance is brief. Sleep tends to return to normal once the
stress is removed or reduced, or when the person learns to cope with it.
Bedtime Behavior in Children
- Children often attempt to delay bedtime. A child may ask for one more
bedtime stories, take several trips to the bathroom, ask for food or
water, or to watch a few more minutes of television. These attempts to
delay the bedtime should be recognized by the caretaker, and then
limited before bedtime. Once this is accomplished, sleep often occurs
naturally and quickly.
However,
several other factors may also affect a child's sleep. These include
fear of the dark, fear of being left alone, or an unreasonably early
bedtime. Some children are unable to sleep unless a special blanket or
pacifier is present.
Environmental Factors
- Loud noise, bad odors, bright lights, and extremes in room
temperature can disturb sleep. A snoring sleep partner or an
uncomfortable bed can also disturb sleep. Concerns about safety in the
house and caring for a family member may also cause poor sleep.
Altitude can affect sleep, and sleep disturbance can develop after a
rapid ascent to a high altitude.
Medical Conditions
- Some medical conditions may cause insomnia. If you have a chronic
illness and you are having sleep disturbances, talk with your doctor.
Medicine-induced Insomnia
- Medications can be a major cause of insomnia. Stopping medicine that
encourages sleep after long-term use can lead to severe insomnia. Some
medicines have a stimulating effect. They cause wakefulness and
alertness. These can cause insomnia, often when taken close to bedtime,
or when the dose is increased. I fyou take any of these medicines and
are having sleep disruptions talk with your doctor. Do not stop any
medicines if you have not consulted with your doctor.
Poor Sleep Hygiene
- Insomnia can begin with habits or activities that do not promote
sleep. Caffeine, alcohol, or smoking too close to bedtime can lead to
poor sleep. Strenuous exercise or stimulating mental activity can as
well. Frequent changes in bedtime or awakening times can disrupt sleep.
Napping during the day can also disrupt sleep. Performing activities in
bed such as doing homework, talking on the telephone, or watching
television are also habits that may cause sleep problems.
Psychophysiologic Insomnia
- Behaviors that disturb sleep can develop and become the major factors
causing Insomnia. For instance, an insomniac may "try too hard" to fall
sleep and, therefore, become tense and even more aroused. This, in
turn, increases anxiety about not being able to sleep. Thus, a vicious
cycle begins.
Excessive
sleepiness occurs when there is a problem with the part of the brain
that causes sleep and wakefulness. Narcolepsy affects 1 of every 2,000
people. Symptoms often begin in young adults, and may be hereditary.
Symptoms may include:
Excessive sleepiness
- This is often the first symptom of narcolepsy. It is often lifelong.
Sleep occurs during moments of inactivity or boredom. Sudden and
unexpected sleep "attacks" can also occur at any time. Brief napping is
common. Each nap lasts 10 to 20 minutes. Sleepiness is reduced after
awakening from a short nap. The sleepiness increases again within the
next two to three hours.
Cataplexy
- Cataplexy is the loss of muscle strength after an intense emotion.
Emotions such as anger, fright, surprise, excitement, or laughter can
cause this. It may occur without any cause and does not trigger loss of
consciousness. Episodes may last from seconds to minutes. The loss of
muscle strength may be mild, such as drooping of the eyelids, sagging
of the jaw, or buckling at the knees. It may also be severe with
complete lack of muscle strength causing the person to collapse.
Sleep paralysis
- This is a brief loss of the ability to move. It occurs either at the
start of sleep or upon awakening. Except for the eye muscles and those
involved with breathing, all muscles are affected. Paralysis often
lasts from one to a few minutes. Hallucinations and a sense of dread
may also occur.
Sleep hallucinations
- Sleep hallucinations may occur at sleep onset or upon wakening. A
person may see shapes, colors, or actual figures; or, one may hear a
sound or music, or feel movement. These feelings are often fearful,
such as being attacked or escaping from danger.
Other symptoms of narcolepsy include disturbed sleep, waking up often, and abnormal behavior.
Sleep
apnea is a condition characterized by brief interruptions of breathing
during sleep. It owes its name to a Greek word, apnea, meaning "want of
breath." Sleep apnea occurs when air cannot flow into or out of the
person's nose or mouth although efforts to breathe continue. In a given
night, the number of involuntary breathing pauses or "apneic events"
may be as high as 20 to 60 or more per hour. These breathing pauses are
almost always accompanied by snoring, although not everyone who snores
has this condition. Sleep apnea can also be characterized by choking
sensations. The frequent interruption of deep, restorative sleep often
leads to excessive daytime sleepiness and may be associated with early
morning headaches. Early recognition and treatment of obstructive sleep
apnea is important because it may be associated with irregular
heartbeat, high blood pressure, heart attack, and stroke.
Types of apnea
There are two types of sleep apnea: central and obstructive. Obstructive Sleep Apnea
(OSA) is the most common type. This is caused as the sleeper's entire
body relaxes during sleep -- including the windpipe or upper airways.
So, air cannot flow into or out of one's nose or mouth, although
efforts to breathe continue. Breathing stops for several seconds to
over a minute, and levels of blood oxygen may drop during these
episodes. Each episode causes one to partially or fully awaken and then
go back to sleep. Central Sleep Apnea occurs when, for some reason, the brain does not send the appropriate signals to continue breathing.
Who develops sleep apnea?
Sleep
apnea tends to affect middle-age people. People with sleep apnea are
often overweight. It is seen more often in men than in women. However,
it can affect children and persons in a normal weight range as well.
Why is it important to find out if you have sleep apnea?
Excessive sleepiness can become so severe it impacts daily activities. You may fall asleep while driving or during meetings, formal gatherings, or church services. Your performance at school or work may decline. Many people with sleep apnea become depressed or irritable. If left untreated, sleep apnea may lead to serious medical problems. These include an irregular heart rate, heart disease, heart attack, high blood pressure, and stroke.
Parasomnias
are physical events that occur during sleep. They may or may not
disrupt sleep. Often, it is the sleep partner who calls these events to
the sleeper's attention.
Confusional Arousals
Confusion and disorientation occur following arousals from sleep.
This often happens in the first part of the night. There is often no
memory of the event. Confusional arousals may be caused by lack of
sleep. They may also be caused by abrupt awakenings from deep sleep.
Leg Cramps
A painful tightening of the muscles of the leg or foot awakens a person
from sleep. Flexing or massaging the leg or foot relieves the
sensation. Nighttime leg cramps are common. It may be more common among
the elderly, during pregnancy, or after intense exercise.
Nightmares
Frightful dreams can quickly awaken the sleeper. Once awake, the person
is fully alert. He or she can clearly remember the dream and is fearful
and anxious. The person is unable to promptly return to sleep.
REM Sleep Behavior Disorder
Body movements occur with dreaming. They may be simple motions.
They may also be highly complex acts such as screaming, punching,
kicking, or running. These movements may result in sleep disruption
and/or injury to the sleeper or sleep partner.
Rhythmic Movement Disorder
Repetitive movements of parts of the body start before falling
asleep. They continue during early light sleep. This is called "head
banging" if it involves motions of the head and neck. Other types
include head rolling, body rolling, or body rocking. This is often seen
in young children. Adolescent and adult cases are rare.
Sleep Starts
Sleep starts consist of abrupt jerks of parts of the body. These may
startle a person out of sleep with a feeling of "falling" or "dreaming."
Sleep Talking Words and sentences can be uttered during sleep. Sometimes, only unclear mumbles are heard.
Sleep Terrors
A person having a sleep terror appears to quickly awaken from sleep
with profound fear. The person bolts upright from bed crying or
yelling, breathing heavily with heart pounding, and with increased
sweating. Unlike nightmares, people have a poor memory of these
episodes and are confused. Sleep terrors occur more often in the first
third of the night. They are more common in children and tend to
resolve by adolescence.
Sleepwalking The sleepwalker is difficult to arouse, may display "bizarre" behavior, and has little memory of the event. Sleepwalking can lead to physical injuries to the sleeping person. Sleepwalking is most often seen in young children. It is less common among adults.
7. Periodic Limb Movement Disorder
Repeated body movements characterize periodic limb movement disorder. These movements may occur in the toes, feet, ankles and/or legs, during sleep. A person may be unaware of these movements during sleep, but a sleep partner may notice them. This disorder is common in older adults and in people with restless legs syndrome.
Restless
legs syndrome occurs when falling asleep. It is an uncomfortable
feeling in the lower legs, and less often in the arms. These feelings
have been described as "creeping," "crawling," or "aching." Moving the
legs or walking relieves these feelings. However, they quickly recur
when leg motion stops. Restless legs syndrome can make it hard for a
person to fall asleep when it occurs at bedtime. It can also cause
frequent awakenings during the night and then make it hard to return to
sleep.
Who gets restless legs syndrome?
Five
to 15% of people have restless legs syndrome. More women are affected
than men. Restless legs syndrome is more common in people with anemia,
kidney problems, and during pregnancy.
Snoring
is as ancient as sleep itself. George Washington, Abraham Lincoln, and
Theodore Roosevelt were all great men and great snorers. Snoring has,
for many years, been regarded simply as a nuisance. It troubled the
sleep partner more than it affected snorer. Most snorers are unaware of
the disturbance they create. Descriptions have varied from a low
humming to loud rumbles. Snoring may not be as harmless as it was once
believed to be.
How is snoring produced?
As we sleep, the roof and walls of our mouth may vibrate as we breathe. The noise created by these vibrations may increase as the size of our throat decreases. The nose and tongue can contribute to this noise as well. The character and volume of snoring can vary across the night as well as on different nights.
