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Common Sleep DisordersSleep Apnea
SymptomsThe hallmark symptom of the disorder is excessive daytime sleepiness. Additional symptoms of sleep apnea include restless sleep, loud snoring (with periods of silence followed by gasps), falling asleep during the day, morning headaches, trouble concentrating, irritability, forgetfulness, mood or behavior changes, weight gain, increased heart rate, anxiety, depression, increased frequency of urination, bedwetting, esophageal reflux and heavy sweating at night. Obstructive Sleep Apnea is more likely to occur in men than in women, and in people who are overweight or obese. All other factors being equal, people with larger neck measurements are also more likely to suffer from this condition. Obstructive Sleep Apnea occurs more frequently in people with Down Syndrome than in the general population. A little over 50% of all people with Down Syndrome suffer from sleep apnea (de Miguel-Díez, et al 2003), and some advocate routine testing of this group (Shott, et al 2006) DiagnosisThe typical patient with obstructive sleep apnea is an overweight middle-aged male with a neck size of more than 17 inches. However, the condition is also common in women and not all sufferers are overweight. Almost everybody who has obstructive sleep apnea is a snorer, often a very heavy snorer. Pauses in breathing during sleep are commonly noticed by a bed partner but this history is often lacking and up to five "events" per hour are considered normal. One of the more consistent symptoms is "nonrestorative sleep," meaning that the patient wakes in the morning feeling unrefreshed no matter how much he slept during the night. Excessive daytime sleepiness is common in sleep apnea of any severity, but some patients complain of fatigue rather than sleepiness and others notice neither. Other symptoms include hypertension, anxiety/depression, trouble concentrating, and nocturnal awakenings. The most accurate diagnostic tool, polysomnography, can establish the diagnosis and assist in identifying the type of sleep apnea present. This test is usually done overnight in specialized sleep laboratories, either freestanding or in a hospital. Portable sleep recording systems that can perform unattended polysomnography in the patient's home or hospital bed are used in certain circumstances, but in-laboratory testing with a technician present remains the gold standard and is required by many insurers, (eg. Medicare of the United States) before they will pay for treatment of the condition. Screening devices, measuring fewer parameters than traditional polysomnography, are sometimes used to determine if patients are likely to test positive for obstructive sleep apnea. The value of such devices is the subject of debate and study among sleep medicine professionals. Some feel that such devices can reduce costs and conserve resources, while others feel that the devices are unnecessary: a positive result leads to polysomnography anyway, while a negative result cannot be trusted if the patient still complains of symptoms. Back to top ^Chronic InsomniaThe inability to fall or to remain asleep. Insomnia may last from 2 to 3 days to more than a month. This disorder can be triggered by daily stress, depression, poor bedtime habits, hormonal shifts during menstruation and menopause, psychological trauma, and medical problems, such as arthritis, asthma, and gastroesophageal reflux. Common causes of insomniaA person can have primary or secondary insomnia. Primary insomnia is sleeplessness that is not attributable to a medical or environmental cause. Secondary insomnia means that a person is having sleep problems because of something else, such as a health condition, an example of which would be generalized anxiety disorder. Some of the most common causes of insomnia are:
A common misperception is that the amount of sleep one requires decreases as he or she ages. The ability to sleep for long periods, rather than the need for sleep, appears to be lost as people get older. Some elderly insomniacs toss and turn in bed and occasionally fall off the bed at night, diminishing the amount of sleep they receive. In addition, a rare genetic condition can cause a prion-based, permanent and eventually fatal form of insomnia called Fatal Familial Insomnia. Back to top ^NarcolepsyThe main characteristic of narcolepsy is overwhelming excessive daytime sleepiness (EDS), even after adequate nighttime sleep. A person with narcolepsy is likely to become drowsy or to fall asleep, often at inappropriate times and places. Daytime naps may occur with or without warning and may be irresistible. These naps can occur several times a day. They are typically refreshing, but only for up to a couple hours. Drowsiness may persist for prolonged periods of time. In addition, night-time sleep may be fragmented with frequent wakenings. Symptoms of narcolepsyFour other classic symptoms of narcolepsy, which may not occur in all patients, are:
Daytime sleepiness, sleep paralysis, and hypnagogic hallucinations also occur in people who do not have narcolepsy, more frequently in people who are suffering from extreme lack of sleep. Cataplexy is generally considered to be unique to narcolepsy. In most cases, the first symptom of narcolepsy to appear is excessive and overwhelming daytime sleepiness. The other symptoms may begin alone or in combination months or years after the onset of the daytime naps. There are wide variations in the development, severity, and order of appearance of cataplexy, sleep paralysis, and hypnagogic hallucinations in individuals. Only about 20 to 25 percent of people with narcolepsy experience all four symptoms. The excessive daytime sleepiness generally persists throughout life, but sleep paralysis and hypnagogic hallucinations may not. The symptoms of narcolepsy, especially the excessive daytime sleepiness and cataplexy, often become severe enough to cause serious problems in a person's social, personal, and professional lives and severely limit activities. Back to top ^Restless Leg SyndromeRLS (also commonly referred to as Jimmy Legs) may be described as uncontrollable urges to move the limbs in order to stop uncomfortable, painful or odd sensations in the body, most commonly in the legs. Moving the affected body part eliminates the sensation, providing temporary relief. The sensations and need to move may return immediately after ceasing movement, or at a later time. RLS may start at any age, including early childhood, and is a progressive disease for a certain percentage of sufferers, although it has been known for the symptoms to disappear permanently in some sufferers. SymptomsThe International Restless Legs Syndrome Study Group (IRLSSG) identified four criteria that must be present for an RLS diagnosis.
The sensations are unusual and unlike other common sensations, and those with RLS have a hard time describing them. People use words such as: uncomfortable, electrical, creeping, painful, itching, pins and needles, pulling, creepy-crawly, ants inside the legs, and many others. The sensation and the urge can occur in any body part; the most cited location is legs, followed by arms. Some people have little or no sensation, yet still have a strong urge to move.
Movement will usually bring immediate – however often temporary – relief. Walking is most common, however doing stretches, yoga, biking, or other physical activity may relieve the symptoms. Constant and fast up-and-down movement of the leg, coined "sewing machine legs" by at least one RLS sufferer, is often done to keep the sensations at bay without having to walk. Sometimes a specific type of movement will help a person more than another.
Any type of inactivity involving sitting or lying – reading a book, a plane ride, watching TV or a movie, taking a nap - can trigger the sensations and urge to move. This depends on several factors: the severity of the person’s RLS, the degree of restfulness, the duration of the inactivity, etc.
While some people only experience RLS at bedtime and others experience it all day and all night, all sufferers notice that the RLS is worst in the evening and the least noticeable sometime in the early to mid morning. CausesRLS is either primary or secondary. Primary RLS is considered idiopathic, or with no known cause. However, there is a high incidence of familial cases, suggesting a genetic tendency in primary RLS. Primary RLS starts before age 40 or 45 (can occur as early as the first year of life). In primary RLS, the onset is often slow. The RLS may disappear for months, or even years, however it always returns. It is often progressive and gets worse as the person ages. Secondary RLS often had a sudden onset and may be daily from the very beginning. It often occurs after the age of 40, however it can occur earlier. It is most associated with specific medical conditions or the use of certain drugs. The conditions include: pregnancy, iron deficiency, folate deficiency, uremia, diabetes, thyroid problems, peripheral neuropathy, and certain auto-immune disorders such as Sjogren's, Celiac Disease, and rheumatoid arthritis. Treatment of the underlying condition often eliminates the RLS. Both primary and secondary RLS can be worsened by surgery of any kind, however back surgery or injury is often associated with causing RLS. Certain medications may worsen RLS in those who already have it, or cause it secondarily. These include: anti-nausea drugs, certain antihistamines (often in over-the-counter cold medications), drugs used to treat depression (both older tricyclics and newer SSRIs), antipsychotic drugs, and certain medications used to control seizures. Train drivers in South Africa operate a vigilance control by clicking a pedal with their right foot every thirty seconds. If it doesn't happen, a stimulus is emitted followed soon by emergency braking, it can contribute to restless legs syndrome which can keep the driver clicking the pedal while sleeping. Back to top ^Periodic Limb MovementPeriodic Limb Movement Disorder (PLMD), also called nocturnal myoclonus, is a sleep disorder where the patient moves involuntarily during sleep. It can range from a small amount in the ankles and toes to wild flailing of all four limbs. These movements, which are more common in the legs than arms, occur for between 0.5 and 10 seconds, recurring at intervals of 5 to 90 seconds. A formal diagnosis of PLMD requires three periods during the night, lasting from a few minutes to an hour or more, each containing at least 30 movements followed by partial arousal or awakening. PLMD is a cause of insomnia and daytime sleepiness. The incidence of this disorder increases with age. It is estimated to occur in 5% of people age 30 to 50 and in 44% of people over the age of 65. As many as 12.2% of patients suffering from insomnia and 3.5% of patients suffering from excessive daytime sleepiness may experience PLMD. It is related to restless leg syndrome (RLS) in that 80% of people with RLS also have PLMD. However, most people with PLMD do not experience RLS. |
Sleep Apnea a serious condition in which airflow is reduced or blocked during sleep. The sleeping person awakens in order to breathe, often unknowingly, hundreds of times during the night. Total collapse of the airway causes snoring, snorting or gasping. Potential consequences of sleep apnea include high blood pressure, heart disease, heart attack, stroke, impotence, and memory loss. Potential symptoms of apnea include snoring, excessive daytime sleepiness, irritability and morning headaches.
