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Sleep Health -- September 17, 2012 -- Dr. Kelly Carden

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SAINT THOMAS HEALTH'S MEDICAL MONDAYS
Monday, September 17, 2012
TOPIC: SLEEP HEALTH | NARCOLEPSY AWARENESS
Kelly Carden, MD: Sleep Specialist
BAPTIST HOSPITAL

News notes provided by webmd.com

 

Wake Up Nashville | Dream Big Event

Bringing greater awareness towards Narcolepsy and Emerging Treatments

Marathon Music Works

Friday, September 21, 2012 | 7-10p

615.891.1781

https://www.wakeupnarcolepsy.org

 

 

Sleep Myths

How much do you know about sleep disorders? Review these statements and learn which are true and which are not.

Health problems have no relation to the amount and quality of a person's sleep.

False: More and more scientific studies are showing correlations between poor quality sleep and/or insufficient sleep with a variety of diseases, including high blood pressure, diabetes, and depression. For example, insufficient sleep can impair the body's ability to use insulin, which can lead to the development of more severe diabetes. Patients with poorly controlled diabetes and sleep apnea have improvement of blood sugar control when treated for sleep apnea. This is also found in patients with high blood pressure and sleep apnea. When the sleep apnea is treated, the blood pressure also improves. In addition, too little sleep may decrease growth hormone secretion, which has been linked to obesity.

Older people need less sleep.

False: The average adult needs a total sleep time of seven to nine hours per day. While sleep patterns usually change as we age, the amount of sleep we generally need does not. Older people may sleep less at night due, in part, to frequent night waking, but their need for sleep is no less than that of younger adults.

Snoring can be harmful.

True: Aside from bothering other people, snoring is not harmful. However, it can be a sign of sleep apnea, a sleep disorder that is associated with significant medical problems such as cardiovascular disease and diabetes. Sleep apnea is characterized by episodes of reduced or no airflow throughout the night. People with sleep apnea may remember waking up frequently during the night gasping for breath.

You can "cheat" on the amount of sleep you get.

False: Sleep experts say that most adults need between seven and nine hours of sleep each night for optimal health. Getting fewer hours of sleep will eventually need to be replenished with additional sleep in the next few nights. Our body does not seem to get used to less sleep than it needs.

Teens need more sleep than adults.

True: Teens need at least 8.5 to 9.25 hours of sleep each night, compared to an average of seven to nine hours each night for most adults. The internal biological clocks of teenagers can keep them awake later in the evening and can interfere with waking up in the morning.

Insomnia is characterized only by difficulty falling asleep.

False: One or more of the following four symptoms are usually associated with insomnia:

  • Difficulty falling asleep.
  • Waking up too early and not being able to get back to sleep.
  • Frequent awakenings.
  • Waking up feeling unrefreshed.

Daytime sleepiness means a person is not getting enough sleep.

False: While excessive daytime sleepiness often occurs if you don't get enough sleep, it can also occur even after a good night's sleep. Such sleepiness can be a sign of an underlying medical condition or sleep disorder such as narcolepsy or sleep apnea.

Your brain rests during sleep.

False: The body rests during sleep, not the brain. The brain remains active, gets recharged, and still controls many body functions including breathing during sleep.

If you wake up in the middle of the night and can't fall back to sleep you should get out of bed and do something.

True: If you wake up in the night and can't fall back to sleep within about 15-20 minutes, get out of bed and do something relaxing. Do not sit in bed and watch the clock. Experts recommend going into another room to read or listen to music. Return to bed only when you feel tired.

Getting too little sleep may impact weight.

True: How much a person sleeps at night can impact their weight. This is because the amount of sleep a person gets can affect certain hormones, specifically the hormones leptin and ghrelin, that affect appetite. Leptin and ghrelin work in a kind of "checks and balances" system to control feelings of hunger and fullness. Ghrelin, which is produced in the gastrointestinal tract, stimulates appetite, while leptin, produced in fat cells, sends a signal to the brain when you are full. When you don't get enough sleep, it drives leptin levels down, which means you don't feel as satisfied after you eat, and increases ghrelin levels, stimulating your appetite so you want more food. The two combined can set the stage for overeating, which in turn may lead to weight gain.

 

Are You Getting Enough Sleep?


The amount of sleep a person needs depends on many factors, including age. For example, in general:

  • Infants require about 16 hours a day
  • Teenagers need about 9 hours on average
  • Most adults need 7 to 8 hours a night for the best amount of sleep, although some people may need as few as 5 hours or as many as 10 hours of sleep each day
  • Women in the first 3 months of pregnancy often need several more hours of sleep than usual

However, experts say that if you feel drowsy during the day, even during boring activities, you haven't had enough sleep.

Sleep Deprivation Debits

The amount of sleep a person needs also increases if he or she has been deprived of sleep in previous days. Getting too little sleep creates a "sleep debt," which is much like being overdrawn at a bank. Eventually, your body will demand that the debt be repaid. We don't seem to adapt to getting less sleep than we need, while we may get used to a sleep-depriving schedule, our judgment, reaction time, and other functions are still impaired.

Consequences of Too Little Sleep

Too little sleep may cause:

  • Memory problems
  • Depression
  • A weakening of your immune system, increasing your chance of becoming sick
  • Increase in perception of pain

 

The Dangers of Sleep Deprivation

Many studies make it clear that sleep deprivation is dangerous. Sleep-deprived people who are tested by using a driving simulator or by performing a hand-eye coordination task perform as badly as or worse than those who are intoxicated.

Sleep deprivation also magnifies alcohol's effects on the body, so a fatigued person who drinks will become much more impaired than someone who is well rested.

Driver fatigue is responsible for an estimated 56,000 motor vehicle accidents and 1,500 deaths each year, according to the National Highway Traffic Safety Administration. Since drowsiness is the brain's last step before falling asleep, driving while drowsy can -- and often does -- lead to disaster. Caffeine and other stimulants cannot overcome the effects of severe sleep deprivation.

The National Sleep Foundation says that if you: 

  • have trouble keeping your eyes focused
  • can't stop yawning
  • can't remember driving the last few miles you are probably too drowsy to drive safely.

 

 

What is Narcolepsy | an OVERVIEW

Narcolepsy is a neurological disorder that affects the control of sleep and wakefulness. People with narcolepsy experience excessive daytime sleepiness and intermittent, uncontrollable episodes of falling asleep during the daytime. These sudden sleep attacks may occur during any type of activity at any time of the day.

In a typical sleep cycle, we initially enter the early stages of sleep followed by deeper sleep stages and ultimately (after about 90 minutes) rapid eye movement (REM) sleep. For people suffering from narcolepsy, REM sleep occurs almost immediately in the sleep cycle, as well as periodically during the waking hours. It is in REM sleep that we can experience dreams and muscle paralysis -- which explains some of the symptoms of narcolepsy.

Narcolepsy usually begins between the ages of 15 and 25, but it can become apparent at any age. In many cases, narcolepsy is undiagnosed and, therefore, untreated.

What Causes Narcolepsy?

The cause of narcolepsy is not known; however, scientists have made progress toward identifying genes strongly associated with the disorder. These genes control the production of chemicals in the brain that may signal sleep and awake cycles. Some experts think narcolepsy may be due to a deficiency in the production of a chemical called hypocretin by the brain. In addition, researchers have discovered abnormalities in various parts of the brain involved in regulating REM sleep. These abnormalities apparently contribute to symptom development. According to experts, it is likely narcolepsy involves multiple factors that interact to cause neurological dysfunction and REM sleep disturbances.

What Are the Symptoms of Narcolepsy?

Symptoms of narcolepsy include:

  • Excessive daytime sleepiness (EDS): In general, EDS interferes with normal activities on a daily basis, whether or not a person with narcolepsy has sufficient sleep at night. People with EDS report mental cloudiness, a lack of energy and concentration, memory lapses, a depressed mood, and/or extreme exhaustion.
  • Cataplexy: This symptom consists of a sudden loss of muscle tone that leads to feelings of weakness and a loss of voluntary muscle control. It can cause symptoms ranging from slurred speech to total body collapse, depending on the muscles involved, and is often triggered by intense emotions such as surprise, laughter, or anger.
  • Hallucinations: Usually, these delusional experiences are vivid and frequently frightening. The content is primarily visual, but any of the other senses can be involved. These are called hypnagogic hallucinations when accompanying sleep onset and hypnopompic hallucinations when they occur during awakening.
  • Sleep paralysis: This symptom involves the temporary inability to move or speak while falling asleep or waking up. These episodes are generally brief, lasting a few seconds to several minutes. After episodes end, people rapidly recover their full capacity to move and speak.

How Is Narcolepsy Diagnosed?

A physical exam and exhaustive medical history are essential for proper diagnosis of narcolepsy. However, none of the major symptoms is exclusive to narcolepsy. Several specialized tests, which can be performed in a sleep disorders clinic or sleep lab, usually are required before a diagnosis can be established. Two tests that are considered essential in confirming a diagnosis of narcolepsy are the polysomnogram (PSG) and the multiple sleep latency test (MSLT).

The PSG is an overnight test that takes continuous multiple measurements while a patient is asleep to document abnormalities in the sleep cycle. A PSG can help reveal whether REM sleep occurs at abnormal times in the sleep cycle and can eliminate the possibility that an individual's symptoms result from another condition.

The MSLT is performed during the day to measure a person's tendency to fall asleep and to determine whether isolated elements of REM sleep intrude at inappropriate times during the waking hours. As part of the test, an individual is asked to take four or five short naps usually scheduled two hours apart.

How Is Narcolepsy Treated?

Although there is no cure for narcolepsy, the most disabling symptoms of the disorder (EDS and symptoms of abnormal REM sleep, such as cataplexy) can be controlled in most people with drug treatment. Sleepiness is treated with amphetamine-like stimulants, while the symptoms of abnormal REM sleep are treated with antidepressant drugs.

There has recently been a new medication approved for those who suffer from narcolepsy with cataplexy. This drug, called Xyrem, helps people with narcolepsy get a better night's sleep, allowing them to be less sleepy during the day. Patients with narcolepsy can be substantially helped -- but not cured -- by medical treatment.

Lifestyle adjustments such as avoiding caffeine, alcohol, nicotine, and heavy meals, regulating sleep schedules, scheduling daytime naps (10-15 minutes in length), and establishing a normal exercise and meal schedule may also help to reduce symptoms.

Common Symptoms of Recognized Sleep Disorders

Insomnia

Insomnia is itself often a symptom of other problems. Typical patterns of insomnia include the inability to fall asleep or stay asleep at night, waking up earlier than usual, and daytime fatigue. Most people with insomnia don't fall asleep in inappropriate situations, like driving. If this does occur, it may signal that a medical disorder (such as sleep apnea) is the cause of insomnia.

Sleep Apnea

Excessive daytime sleepiness is the primary symptom. Some people will deny sleepiness but feel fatigued. Other symptoms are snoring, snorting, and gasping sounds when you sleep -- often first noticed by a sleeping partner. Restless or unrefreshing sleep is also typical, as are headaches in the morning.

Narcolepsy

Excessive sleepiness during the day, alleviated by naps, is a symptom of narcolepsy. Dreaming during naps and experiencing dream-like hallucinations as you fall asleep are also warning signs. Loss of muscle control (called cataplexy) that occurs with emotion, such as laughing or anger, and the inability to move as you're going to sleep or waking up (called sleep paralysis) are also symptoms.

Restless Leg Syndrome

The primary warning sign is the irresistible urge to move your legs shortly after you get into bed, in the middle of the night after awakening, or even when wide awake during the day. It usually feels better if you get up to walk around or rub your leg. "Creepy-crawly" or twitching feeling in your calves, feet, thighs, or arms are symptoms of restless leg syndrome -- the sensations of discomfort can be quite varied. Kicking or twitching leg movements during sleep, and sometimes while awake, may be warning signs.

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