sleep disorders

The importance of a good night’s sleep

Sleep is an important ingredient in our daily lives, essential for renewing our mental and physical health each day. Yet over 75 sleep disorders have been identified which interrupt or disturb our sleep and can have substantial effects on our waking life. Common sleep disorders are listed below.

The first step in treating any sleep disorder is diagnosis—determining what type of problem is affecting an individual’s sleep. An overnight sleep study is often necessary to record and evaluate the brain's activity and body systems during sleep in order to develop an accurate diagnosis and treatment recommendations.

Common symptoms of sleep disorders are excessive daytime sleepiness, loud snoring, repeated awakening during sleep, or excessive movement before or during sleep.

The Epworth Sleepiness Scale is a common first step in evaluating whether you may have a sleep disorder.

Common sleep disorders

Apnea

• Obstructive sleep apnea syndrome (OSAS) is a pattern of obstructed breathing that can disturb sleep dozens to hundreds of times each night. Often these disturbances are not remembered. If you have OSAS, the oxygen levels in your body may drop during sleep and you probably don’t sleep soundly, resulting in daytime sleepiness. OSAS can also put you at risk for high blood pressure, heart failure, heart attack or stroke. OSAS can be life threatening.
• The most common symptoms are snoring, snorting or gasping during sleep, waking up repeatedly at night, excessive daytime sleepiness, and morning headaches.
• Sleep apnea is commonly treated with a therapy called CPAP.
• Learn more about sleep apnea

Narcolepsy

• Narcolepsy is overwhelming sleepiness at inappropriate times. The most common symptoms are daytime sleepiness, cataplexy (a sudden loss of muscle strength), sleep paralysis, or hypnagogic hallucinations (vivid dreamlike experiences that occur when a person is drowsy).
• Learn more about narcolepsy

Leg movement disorders

There are two common leg movement disorders that interrupt a person's ability to sleep at night, which then can affect daytime function.

• Restless Leg Syndrome (RLS) Individuals with RLS report unpleasant sensations in their legs when sitting or lying still, especially at bedtime, which are relieved by stretching or moving the legs. The need to move to eliminate the RLS sensations can prevent a person from falling asleep.
• Periodic Limb Movement Disorder (PLMD) also known as nocturnal myoclonus. While RLS movements are voluntary, PLMD is involuntary periodic movement which most often occurs when a person is asleep.
• Learn more about leg movement disorder

Insomnia

• Insomnia is the inability to fall asleep or stay asleep. Those who suffer from insomnia often experience daytime symptoms of sleepiness and have trouble concentrating. Insomnia can range from short-term to chronic, and there are many causes and a wide variety of treatment approaches.
• Learn more about insomnia

Parasomnias

• The term parasomnia refers to a broad range of disruptive sleep-related events such as sleep walking, sleep terrors, and confusional arousals. Most occur when a person is between sleep and awake states—awake enough to act out complex behaviors, but still asleep enough to fail to control or remember these acts.

Shift Work Sleep Challenges

• Many people who work at times other than standard daytime hours have trouble falling asleep during the day and being alert on the job at night. This is primarily because the body’s circadian rhythm is tuned to nighttime sleeping. A variety of strategies are available to help a person adjust to non-standard sleep patterns.

The Epworth Sleepiness Scale

What is the Epworth Sleepiness Scale?

The Epworth Sleepiness Scale is an evaluation method used by sleep medicine specialists to determine your level of daytime sleepiness. The scale is subjective, which means it is influenced by how honestly you answer the questions. Oftentimes, truck drivers, train engineers, law enforcement personnel, and others in similar jobs are reluctant to admit to problems with daytime sleepiness.

How can I use the Epworth Sleepiness Scale?

Review the scale that is used on the evaluation form. Then read each situation and rate your likelihood of dozing based on the scale provided. Once you have done this for each situation, add the numbers.

It may be helpful to have your spouse or a close family member also complete an Epworth Sleepiness Scale Evaluation Form based on what they think your likelihood of dozing off in these situations might be.

As a general rule, sleep specialists consider a score of ten or greater to be significant and worth further investigation. Often, simply increasing the amount of time that you sleep will help. Most people need 7 to 10 hours of sleep each night, but in our busy world we often short ourselves. If increasing your sleep time by an hour or two doesn’t improve your feelings of alertness, you may want to visit with your doctor about this.

Daytime sleepiness and feelings of fatigue have many causes. Sleep disorders, such as sleep apnea (a sleep disorder where a person stops breathing periodically during sleep), are sometimes at the root of a person’s daytime sleepiness complaints. If you have questions about this scale or sleep disorders, please feel free to contact us.

Links to other resources

National Sleep Foundation: www.sleepfoundation.org

American Academy of Sleep Medicine: www.aasmnet.org

The American Insomnia Association: www.AmericanInsomniaAssociation.org

Narcolepsy Network: www.narcolepsynetwork.org

American Sleep Apnea Association: www.sleepapnea.org

Restless Legs Syndrome Foundation: www.rls.org

www.Sleepnet.com:  A general site for sleep disorders questions and patient forum.

www.apneanet.org:  A forum for sleep apnea patients.

Sleep Apnea

Apnea is a Greek word that means “without breath.” Sleep apnea is a pause in breathing during sleep that lasts ten seconds or longer. A person suffering from sleep apnea may experience hundreds of these events during a single night of sleep.

The most common type of apnea is called Obstructive Sleep Apnea Syndrome or OSAS. With OSAS a person is making an effort to breathe during sleep, but something between the nose and mouth and the lungs is obstructing or blocking the airway. This is caused by the relaxation of the muscles and tissues of the airway during sleep and may be worsened by excess weight, smoking, or the use of sedating medications or alcohol.

OSAS is believed to affect nearly five million Americans. The most common symptoms of OSAS are:

Excessive daytime sleepiness – Untreated sleep apnea often leads to problems with feeling sleepy after a full night in bed, difficulty staying awake during daytime activities, and an overall lack of energy. This sleepiness is a result of the poor quality of sleep that a person with untreated OSAS experiences as apnea disrupts the normal cycle of sleep and prevents a person from achieving restful sleep. Imagine each apnea as a firm poke in your side while you’re sleeping. Now imagine a hundred pokes in your side during the night. Not every apnea will awaken you, but even the ones that don’t awaken you will often keep you from getting deep, restful sleep.

You can evaluate your daytime sleepiness using the Epworth Sleepiness Scale.

Snoring, gasping and choking during sleep – Although snoring is a common symptom of sleep apnea, approximately 20 percent of people diagnosed with OSAS do not snore. If you have sleep apnea, your bed partner may tell you that you snore, stop breathing for brief periods of time, or make “breakthrough snorts” or loud gasps at the end of an apnea event. One or a combination of these symptoms may be signs of sleep apnea.

Other symptoms of OSAS may include:

• Hypertension (high blood pressure)
• Morning headaches
• Depression
• Difficulty staying asleep or frequent nighttime awakenings
• Frequent nighttime urination
• Low sex drive/impotence

OSAS can be diagnosed during an overnight sleep study. If you think you or a loved one has sleep apnea, you should let your doctor know. There are a variety of treatment options available for sleep apnea. Your doctor may decide to refer you to a sleep medicine specialist or a sleep disorders center for further evaluation, testing, and treatment.

American Sleep Apnea Association: www.sleepapnea.org

www.Sleepnet.com: A general site for sleep disorders questions and patient forum.

www.apneanet.org: A forum for sleep apnea patients.

Narcolepsy

Narcolepsy is uncommon, but may often go undiagnosed. We do not know the exact cause of narcolepsy, but the symptoms of narcolepsy can often be treated with medication and behavioral treatments. The four most common symptoms of narcolepsy:

Excessive Daytime Sleepiness

People with narcolepsy often suffer from excessive sleepiness or “sleep attacks” that come at inappropriate times. These feelings of sleepiness can even occur in situations where a person is actively engaged (while driving, eating a meal, or having a conversation).

Cataplectic attacks are usually triggered by a strong emotion such as anger, surprise, or laughter. Cataplexy is a sudden loss of muscle control and usually very brief. A person having an episode of cataplexy may appear to have fallen asleep or collapsed, but is usually aware of what is happening. For some, the feeling may only be a brief feeling of weakness in the knees.

Sleep Paralysis

Sleep paralysis is a brief loss of muscle control that happens when a person is falling asleep or waking up. The person may be aware of the surroundings, but feels unable to move.

Hypnagogic Hallucinations

If you or someone you know has one or more of these symptoms, it is important to visit with your healthcare provider. Your healthcare provider can make sure that these symptoms aren’t caused by another medical problem. Your next step may be to visit a sleep disorders center or visit with a sleep medicine specialist.

Narcolepsy Network: www.narcolepsynetwork.org

Leg Movement Disorders

Restless Legs Syndrome and Periodic Limb Movement Disorder are among the most common sleep disorders. These sleep disorders are associated with undesirable movements during sleep. It is estimated that five to ten percent of people will experience Restless Legs Syndrome in their lifetime, and almost half of people over the age of 65 have Periodic Limb Movement Disorder.

Restless Legs Syndrome

Restless Legs Syndrome (RLS) is usually described as “creeping” or “crawling” sensations in the legs that often start in the evening and continue into bedtime. People with RLS often complain that their legs are jumpy and can only be relieved by moving them or walking about the room. This restlessness can interfere with a person’s ability to fall asleep. In most cases, if a person suffers from RLS they likely will have Periodic Limb Movement Disorder as well.

Periodic Limb Movement Disorder (PLMD) is a sleep problem that can affect both the legs and arms (but most commonly the legs). It is characterized by short bursts of muscle activity in the limbs during sleep that appear as twitching or jerking in the legs and/or arms. People with PLMD usually do not notice these movements during the sleep but may report restless sleep, poor sleep quality, and/or excessive daytime sleepiness.

RLS and PLMD can be caused by a variety of medical problems including: iron deficiency or anemia, poor circulation in the limbs, kidney disorders, and other vitamin and mineral deficiencies. If you have the symptoms of RLS or PLMD and find that your sleep is disturbed or you are having problems with excessive daytime sleepiness, it may be useful to speak with your physician or visit a sleep medicine specialist about your complaints. In some cases, an overnight sleep study may be necessary to properly diagnose your sleep disorder.

PLMD and RLS can be treated with home remedies such as vitamin supplements and exercise. If these remedies are unsuccessful, there are prescription medications that can be used to treat the symptoms of these sleep disorders.

Find out more at:

Restless Legs Syndrome Foundation: www.rls.org

Insomnia

Insomnia is an inability to fall asleep or stay asleep. It is the most common sleep complaint and it can be divided into three forms:

Transient Insomnia

Transient insomnia is a difficulty falling to sleep or staying asleep that lasts a few days or less and is usually associated with some type of short-term stress or excitement. Children may have transient insomnia on the eve of a holiday or vacation. Adults may have transient insomnia on the night before an important business meeting or a presentation. This form of insomnia is short-lived and resolves once the triggering event has passed.

With short-term insomnia, the difficulties with sleeping last longer, perhaps several weeks or months. Short-term insomnia is usually associated with a stressful situation, but generally this situation is much more serious than the type of triggers present in transient insomnia. The birth of a child, a divorce, a death in the family, or any life-changing event can lead to a bout of short-term insomnia. Once a person adjusts to the situation, this period of insomnia will usually pass.

Chronic Insomnia

Chronic insomnia is a long-lasting problem with falling to sleep or staying asleep. This problem may start with a bout of transient or short-term insomnia and then take on a life of its own and last months or years. Chronic insomnia can be caused by a variety of factors, including persistent stress, depression, or anxiety.

If you suffer from insomnia that has lasted for more than a few months, you should let your family doctor know. Your family doctor may decide to refer you to a sleep medicine specialist or a sleep disorders center for further evaluation, testing, and treatment.

Find out more at:
The American Insomnia Association: www.AmericanInsomniaAssociation.org