Sleep Disorder Awareness
What is a Sleep Disorder?
There are more than 85 recognized sleep disorders, the most recognizable of which may be (1) insomnia, (2) sleep apnea, (3) narcolepsy, and (4)restless leg syndrome. These and others may manifest themselves in various ways.
Up to about one-third of the population have symptoms of insomnia. Those with insomnia typically experience:
Many of us experience temporary insomnia from a few days to a few weeks. This kind of insomnia usually results from normal events in our lives such as:
When stressful situations resolve, when you recover from illness, when the pain goes away, when sleep hygiene improves -- then sleep usually improves.
Circadian rhythm disruptions like shift work and jet lag may contribute to insomnia because the times you fall asleep and wake up are temporarily shifted. Proper sleep hygiene, particularly the amount of and timing of light, can help re-set your circadian rhythm and improve the symptoms of insomnia from these causes.
II. SLEEP APNEA
You actually stop breathing, for 10, then 20, then 30 seconds. Then, you begin to gasp for air, as if it were your last breath. This cycle repeats itself over and over, all night long. For your part, you may be totally unaware of all of that, as the alarm clock rings. You may wake with a dry mouth, a headache, and feeling hungover. You may also be sleepy during the day, have significant memory loss, concentration, attention, mood and other related problems. This rather horrifying scenario is typical for a disorder called sleep apnea There are two types of sleep apnea, obstructive (OSA) and central (CSA).
In OSA the throat collapses during sleep, preventing the flow of air to your lungs. As your oxygen levels decrease, your brain gets an alert message to "wake up and breath." These apnea episodes may occur 20 to 60 to 100 or more times per hour.
CSA is far less common, occurring in less than 10% of cases. Here, the brain fails to send a signal to breath. This can occur in various heart and neurological disorders.
Present in about 7% of the population, the prevalence of sleep apnea is on par with diabetes and asthma. It is also a primary risk factor for high blood pressure. Fortunately, with the proper diagnosis, it can be treated quite effectively.
How is Sleep Apnea treated?
There are three categories of treatment for obstructive sleep apnea:
Physical or mechanical therapies only work at the time they are properly used. Apnea episodes return when they are not utilized.
Non-specific therapy addresses the behavioral aspects that may be an important part of a treatment program.
Falling asleep spontaneously may indicate the syndrome of narcolepsy. Excessive daytime sleepiness is typically the first symptom. It's the overwhelming need to sleep when you prefer to be awake. Narcolepsy is associated with cataplexy, a sudden weakness or paralysis often initiated by laughter or other intense feelings, sleep paralysis, an often frightening situation, where one is half awake yet cannot move, and hypnagogic hallucinations, intensely vivid and scary dreams occurring at the onset or end of sleep. One may also experience automatic behavior, in which one performs routine or boring tasks without full memory later.
How is Narcolepsy Treated?
There are both behavioral treatments and medications for this situation, which can make life livable again.
General behavioral measures include:
Medications typically involve stimulants in attempt to increase the level of alertness and antidepressants to control the associated conditions noted above. The effects of stimulant medications vary widely and their dosing and timing must be individualized.
IV. RESTLESS LEG SYNDROME (RLS)
Particularly around bedtime, many people (about 15% of the population) experience "pins and needles feelings," an "internal itch," or a "creeping, crawling sensation" in their legs, with a subsequent irresistible urge to relieve this discomfort by vigorously moving their legs. This movement totally relieves the discomfort. These symptoms are classic for restless leg syndrome.
RLS makes if difficult to fall asleep and may also awaken you out of sleep, forcing you to walk around to relieve the discomfort. Though not considered medically serious, symptoms of RLS can range from bothersome to having a severe impact on you and your bed partner's lives.
Most people with RLS also have periodic limb movement disorder (PLMD), repetitive movements of the toe, foot, and sometimes knee and hip during sleep. They are often recognized as brief muscle twitches, jerking movements, or an upward flexing of the feet. As with sleep apnea, sufferers may be unaware that RLS and PLMD disturb sleep and produce symptoms similar to those noted above. Once again, it is often the bed partner that brings this to light, as movements awaken him or her throughout the night. It is important to note that RLS and PLMD are associated with several other medical conditions, including iron-deficiency anemia. So one should, as always, seek proper medical attention.
How is Restless Leg Syndrome Treated?
RLS generally responds well to medication, but since it may occur sporadically with spontaneous remissions, the continuous use of medications is generally recommended for symptoms occurring at least three nights per week. Sleep experts use three types or classes of medications for RLS and PLMD:
As one would expect, all of these medications are available by prescription only and should be taken only while under a doctor's care.
Seeing a sleep specialist is essential for proper diagnosis and treatment. Many sleep disorders are secondary to a variety of medical and mental-health disorders, pain, and even the treatments for these disorders. Medical conditions like diabetes, congestive heart failure, emphysema, stroke, and others may have nighttime symptoms that disturb sleep. Depressive illnesses and anxiety disorders are associated with sleep disturbances, as is the pain from conditions like arthritis, cancer, and acid reflux, to name a few.
Recognizing and distinguishing among sleep problems, primary sleep disorders, and those secondary to or associated with medical conditions is critical to proper diagnosis and treatment. It is equally important, however, to realize that they often interact in a complex manner, with each impacting the other. For example, poor sleep can affect your mood, and your mood can affect the quality of your sleep. Poor sleep can contribute to obesity, and obesity can cause sleep disorders. Exactly how all these factors interact is not completely known, but we can target each aspect individually and achieve vastly improved interventions and treatments.
The magnitude of the impact of sleep disorders on our individual and public health, safety, and performance is truly enormous. Fortunately, increasing awareness is leading to more effective treatment, less suffering, and happier, more productive lives.
What are the consequences of Sleep Deprivation?
Sleep deprivation induces significant reductions in performance and alertness. Reducing your nighttime sleep by as little as one and a half hours for just one night could result in a reduction of daytime alertness by as much as 32%.
The good news for many of the disorders that cause sleep deprivation is that after risk assessment, education, and treatment, memory and cognitive deficits improve and the number of injuries decreases.
In the long term, the clinical consequences of untreated sleep disorders are large indeed. They are associated with numerous, serious medical illnesses, including:
Studies show an increased mortality risk for those reporting less than either six or seven hours per night. One study found that reduced sleep time is a greater mortality risk than smoking, high blood pressure, and heart disease. Sleep disturbance is also one of the leading predictors of institutionalization in the elderly, and severe insomnia triples the mortality risk in elderly men.
Remarkably, sleep loss may also be a contributing factor to obesity. John Winkelman, MD, PhD, medical director of the Sleep Health Center at Brigham and Women's Hospital and assistant professor of psychiatry at Harvard Medical School sums up this finding up nicely: "What most people do not realize is that better sleep habits may be instrumental to the success of any weight management plan." And Michael Thorpy, MD, director of the Sleep-Wake Disorders Center at Montefiore Medical Center in New York adds, "Any American making a resolution to lose weight ... should probably consider a parallel commitment for getting more sleep."
It is also important to realize the huge scope and prevalence of these disorders; more than 85 sleep disorders are recognized by the American Sleep Disorders Association, affecting more than 70 million Americans. Up to one-third of Americans have symptoms of insomnia; however, less than 10% of those are identified by primary care physicians. Sleep-related breathing disorders represent a spectrum of abnormalities that range from simple snoring to sleep apnea (repeated episodes of cessation of breathing during sleep). As highly prevalent as they are, most cases remain undiagnosed and untreated.
Who suffers from Sleep Disorders?
More than two-thirds of older adults suffer from sleep problems, such as insomnia, and losing sleep can only make matters worse for their health, according to researchers. A new poll shows that poor health, not old age, is a major factor behind many of the sleep disorders among people over 55. In fact, not getting enough sleep may merely compound the aches and pains of getting older.
Researchers say the 2003 Sleep in America poll, released today by the National Sleep Foundation (NSF), shows for the first time that health problems such as diabetes and arthritis are more likely to be responsible for poor sleep among older people in the U.S. than old age.
The poll found that insomnia is the most commonly reported sleep disorder, and nearly half of the 1,506 surveyed said they frequently suffer from at least one symptom of insomnia. But only one in eight says sleep disorders have ever been addressed by a doctor.
"In spite of the emerging science linking sleep and health, only a small fraction of the many reported sleep complaints of older adults are actually diagnosed and treated," says NSF President James K. Walsh, PhD, in a news release.
Walsh says the poll shows that doctors need to talk to their patients about sleep, listen to the problems they describe, and treat those problems as part of any medical condition.
Researchers also found a strong link between the number of diagnosed medical conditions reported by the participants and the quality of their sleep. Only about half of those with no reported medical conditions said they suffered from sleep disorders, compared with 80% of those with four or more medical conditions.
Sleep disorders were reported by:
Loss of sleep was also associated with other physical problems common among older adults, including frequent pain, excess weight, and lack of mobility.
Compared with younger people, the poll found older adults get slightly more sleep on weeknights (7.0 vs. 6.7 hours/night). But younger adults get more sleep on weekends than their older counterparts, averaging about a half hour more sleep on Saturday and Sunday.