Sleep Disorders -- December 14, 2009 -- Dr. Aaron Milstone - | Nashville News, Weather & Sports

Sleep Disorders -- December 14, 2009 -- Dr. Aaron Milstone


Sleep Disorders
December 14, 2009
Dr. Aaron Milstone

According to the National Institutes of Health, more than 70 million Americans suffer from sleep disorders – serious but often overlooked ailments that can lead to high blood pressure, stroke and heart attack. The average person needs seven and a half hours of good quality sleep a night, although some may require only five hours and others may need as much as nine. Good quality sleep means a person experiences a repeating cycle of the five stages of sleep – stages one through four and REM (Rapid Eye Movement) sleep – throughout the night. Usually, those with poor quality sleep spend too much time in stages one and two.

Studies show driving while fatigued is as dangerous as driving after drinking. The National Sleep Foundation reports that being awake for 18 hours is comparable to having a blood alcohol concentration of .08 percent.

Frequent diagnoses for sleep disorders include obstructive sleep apnea, insomnia, restless leg syndrome, periodic limb movement disorder and narcolepsy. Treatment can include diet modification, sleep aids, surgery, medication or behavioral therapy.

 If you are aware of one or more of these symptoms, you may have a sleep disorder.


Do you:


  • Snore loudly?


  • Wake up gasping for breath?


  • Wake up with a headache?


  • Find yourself tired and irritable?


  • Get up frequently to use the restroom?


  • Have trouble concentrating during the day?


  • Fall asleep while driving?


  • Kick and jerk while sleeping?


  • Have painful or crawling sensations in your legs while sitting quietly or lying in bed?


  • Have vivid, frightening or violent dreams?


  • Have difficulty staying awake while reading or watching TV?


  • Have trouble falling asleep consistently?


  • Have high blood pressure?



Sleep Apnea

One of the more concerning sleep disorders is obstructive sleep apnea, a condition where a person stops breathing for anywhere from 10 seconds to a minute. A person suffering form the condition may stop breathing hundreds of times during the night. The NIH estimates 12 million Americans suffer from sleep apnea, which if untreated can lead to high blood pressure, stroke and in extreme cases, heart attacks. Loud snoring, gasping while sleeping and waking often can be signs of the disorder, which may prohibit people from experiencing quality sleep. When a patient suffers from sleep apnea, oxygen levels drop when they stop breathing, causing the heart to work harder. When the patient begins breathing again, the heart slows down.


Risk Factors for Sleep Apnea


  • Some studies have shown that a family history of sleep apnea increases the risk two to four times.


  • Being overweight is a risk factor for obstructive sleep apnea, as is having a large neck. However, not all with sleep apnea are obese.


  • Sleep apnea is more likely to occur in men than in women.


  • Abnormalities of the structure of the upper airway contribute to sleep apnea.


  • Sleep apnea may be more common among African-Americans, Pacific Islanders and Mexicans.


  • Smoking and alcohol use increase the risk of sleep apnea.


Treatments for Sleep Apnea


  • There are a variety of treatments for sleep apnea. The most appropriate treatment depends on an individual's medical history and the severity of the disorder.


  • Treatment regimens include lifestyle changes such as avoiding alcohol, using oral appliances and surgery.


  • Nasal continuous positive airway pressure (CPAP) is the most common treatment for sleep apnea. The CPAP machine pushes air through the airway at a pressure high enough to keep the airway open during sleep.


-American Sleep Apnea Association




Everyone has an occasional night of bad sleep. For most people insomnia lasts only a few days and goes away without treatment. But stress or depression can cause a higher level of insomnia that may last for several weeks. This kind of insomnia may not go away on its own.


If you have insomnia, you are not alone. It is a common sleep disorder. About 30 percent of adults have symptoms of insomnia. Less than 10 percent of adults are likely to have chronic insomnia. It is more common among elderly people and women. Some medical conditions cause insomnia, or it may be a side effect of a medication.


Insomnia is characterized as four things:


  1. Difficulty falling asleep


  1. Difficulty staying asleep


  1. Waking up too early


  1. Poor quality sleep


Symptoms of Insomnia:


  • Feeling tired and grumpy during the day


  • Having trouble concentrating at work


  • Falling asleep during the day


  • Low energy


  • Lack of motivation


  • Attention, concentration or memory problems


  • Poor performance at school or work


  • Extreme mood changes


  • Daytime sleepiness


  • Making errors at work or while driving


  • Tension headaches or stomach aches


  • Frustration or worry about your sleep

- "Sleep Disorders." 2005. American Academy for Sleep Medicine

Restless Leg Syndrome

Restless leg syndrome (RLS) is a strong urge to move your legs. This urge is very hard to resist. It often comes with other uneasy feelings deep inside the legs. You can have a very hard time trying to explain how this feels. The sensation might feel like burning, prickling, itching or tingling. It can even be more extreme and feel painful. These feelings, along with the urge to move, are made worse by rest. Lying or sitting still can be very hard. Temporary relief is found when you walk or move the legs. This relief tends to come right away.

The urge to move the legs grows worse at night and eases in the morning. RLS makes it very hard for you to rest or go to sleep. People with severe RLS may get less than five hours of sleep each night. This total sleep time is lower than with almost any other sleep disorder. Milder RLS will not disturb your sleep as much. People with RLS feel very tired and have less energy during the day. They also are more likely to suffer from depression or anxiety.

How do I know if I have it?


  1. Do you have an urge to move your legs or uncomfortable sensations in your legs?


  1. Is this urge worse when you are at rest?


  1. Do your legs seem to feel better when you walk, stretch or make other movements?


  1. Are these feelings worse, or occur only in the evening or at night?


Periodic Leg Movements


Periodic leg movements are episodes of simple, repetitive muscle movements. You are unable to control them. While they don't usually keep you from falling asleep, they severely disrupt sleep during the night, causing fatigue during the day. They do not involve a change in the body position, stretching a muscle or a cramp. Instead, the movements tend to involve the tightening or flexing of a muscle. They occur most often in the lower legs. They can occur at two different times:


  1. Periodic leg movements while you sleep (PLMS)


  1. Periodic leg movements while you are awake (PLMW)


PLMS is considerably more common. When the movements occur often through the night, they can disrupt your sleep many times. Normally, you are unaware of the movements or of waking up. A typical movement is for the big toe to extend. Often the ankle, knee or hip also will bend slightly. Though less common, the movement also may occur in your upper arms. The degree to which these movements occur can change from night to night, but usually happen during non-Rapid Eye Movement sleep in the first half of the night. When these movements are very severe, they also may happen while you are awake (PLMW). PLMS occurs in both children and adults, but chances increase with age, making it very common in the elderly. It occurs in up to 34 percent of people over age 60. Studies have not yet shown how common it is in other age groups. No difference in rate has been noticed in males and females, and family pattern has not been studied in detail.


How do I know if I have PLMS?


  1. Has someone else told you that your body makes unusual, repetitive movements while you sleep?


  1. Do these tend to occur in your lower legs?


  1. Do you feel like you are never well-rested, even after a full night of sleep?


  1. Are you often very tired during the day?


This disorder may be a factor in causing you to have any of the following:


  • Bad memory


  • Depression


  • Short attention span


  • Fatigue


The National Sleep Foundation offers the following tips for getting enough sleep:


  • Don't expect to fall asleep immediately after hearing or watching disturbing news. Stop watching or listening to news programs at least an hour before trying to go to sleep.
  • Engage in a relaxing, non-alerting activity at bedtime such as reading or listening to music. For some people, soaking in a warm bath or hot tub can be helpful. Avoid activities that are mentally or physically stimulating.
  • Do not eat or drink too much before bedtime. Alcohol is not a sleep aid; don't use it to try to help you sleep.
  • Only get into bed when you're tired. If you don't fall asleep within 15 minutes, get out of bed, go to another room and engage in a relaxing activity such as reading. Return to your bed when you're sleepy.
  • Create a sleep-promoting environment that is quiet, dark, cool and comfortable.


During the day:


  • Consume less or no caffeine. Excess caffeine has the potential to disturb sleep at night. If you feel tired during the day, substitute a short nap of about 15-20 minutes for caffeine. Naps can relieve acute sleepiness and restore alertness, but for people suffering from insomnia, daytime naps should be avoided.
  • Avoid alcohol and nicotine, especially close to bedtime.
  • Exercise, but not within three hours before bedtime.





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