Sleep Disorders

Definition :
Sleep disorders involve any difficulties related to sleeping, including difficulty falling or staying asleep, falling asleep at inappropriate times, excessive total sleep time, or abnormal behaviors associated with sleep.

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Sleep disorders are a group of conditions characterized by disturbance in the amount, quality, or timing of a person’s sleep. They also include emotional and other problems that may be related to sleep. There are about seventy different sleep disorders. Short-term, temporary changes in a person’s sleep pattern are not included in sleep disorders.

Description:

Sleep disorders are divided into two major categories. One category consists of disorders in which a person has trouble falling asleep or staying asleep. This category also includes disorders in which a person may fall asleep at inappropriate times. Conditions of these kinds are called dyssomnias. A second category of sleep disorders includes those in which people experience physical events while they are sleeping. Nightmares and sleepwalking are examples of these disorders. Conditions of this type are called parasomnias.

The following are some examples of each type of sleep disorder:

Dyssomnias

  • Insomnia. Insomnia (see insomnia entry) is perhaps the most common of all sleep disorders. About 35 percent of all adults in the United States experience insomnia during any given year. People with insomnia have trouble falling asleep. Often people with this disorder worry or become anxious about not being able to sleep, which can make the problem even worse. Insomnia may begin at any time in a person’s life. It tends to be most common in young adulthood and middle age.
  • Hypersomnia. Hypersomnia is a condition in which a person is excessively sleepy during normal waking hours. The person may often fall asleep for lengthy periods during the day, even if he or she has had a good night’s sleep. In some cases, patients have difficulty waking up in the morning. They may seem confused or angry when they awaken. About 5 to 10 percent of people who seek help for sleep disorders have hypersomnia. The condition is most common in young adults between the ages of fifteen to thirty.
  • Narcolepsy. Narcolepsy is characterized by sleep attacks over which patients have no control. They may fall asleep suddenly with no warning. The sleep attack may last a few minutes or a few hours. The number of attacks patients experience can vary. People with narcolepsy usually feel refreshed after awakening from a sleep attack but they may become sleepy again a few hours later and experience another attack.

Three other conditions are often associated with narcolepsy: cataplexy, hallucinations, and sleep paralysis. Cataplexy is the sudden collapse of a person’s muscles. The person may become completely limp and fall to the ground. A person may also experience hallucinations. Hallucinations are sounds and sights that a person experiences that do not exist in the real world. Sleep paralysis occurs when a person is just falling asleep or just waking up. The person may want to move, but is unable to do so for a few moments.

  • Sleep apnea. Sleep apnea (pronounced AP-nee-uh) is a condition in which a person actually stops breathing for ten seconds or more. The most common symptom of sleep apnea is very loud snoring. Patients with this condition alternate between periods of snoring or gasping and periods of silence.
  • Circadian rhythm sleep disorders. The term circadian (pronounced sir-CAYD-ee-uhn) rhythm refers to the usual cycle of activities, such as waking and sleeping that is common to any form of life. Most people are accustomed to falling asleep after it gets dark out and waking up when it gets light. In certain conditions, this pattern can be disrupted. A person may fall asleep as the sun comes up and wake up as the sun goes down. An example of a circadian sleep disorder is jet lag. People who fly suddenly across many time zones may have their sleep patterns disrupted. It may take a few days before those patterns return to normal.

Sleep Disorders: Words to Know

Apnea:
A temporary pause in one’s breathing pattern. Sleep apnea consists of repeated episodes of temporary pauses in breathing during sleep.
Brainstem:
Portion of the brain that connects the spinal cord to the forebrain and the cerebrum.
Cataplexy:
A sudden loss of muscular control that may cause a person to collapse.
Circadian rhythm:
Any body pattern that follows a twenty-four-hour cycle, such as waking and sleeping.
Insomnia:
Difficulty in falling asleep or in remaining asleep.
Jet lag:
A temporary disruption of the body’s sleep/wake rhythm caused by high-speed air travel through different time zones.
Narcolepsy:
A sleep disorder characterized by sudden sleep attacks during the day and often accompanied by other symptoms, such as cataplexy, temporary paralysis, and hallucinations.
Polysomnograph:
An instrument used to measure a patient’s body processes during sleep.
Restless leg syndrome:
A condition in which a patient experiences aching or other unpleasant sensations in the calves of the legs.
Sedative:
A substance that calms a person. Sedatives can also cause a person to feel drowsy.
Stimulant:
A substance that makes a person feel more energetic or awake. A stimulant may increase organ activity in the body.
Somnambulism:
Also called sleepwalking, it refers to a range of activities a patient performs while sleeping, from walking to carrying on a conversation.

Parasomnias

  • Nightmare disorder. Nightmare disorder is a condition in which a person is awakened from sleep by frightening dreams. Upon awakening, the person is usually fully awake. About 10 to 50 percent of children between the ages of three and five have nightmares. The condition is most likely to occur in children and adults who are under severe stress.
  • Sleep terror disorder. Sleep terror disorder occurs when a patient awakens suddenly crying or screaming. The patient may display other symptoms, such as sweating and shaking. Upon awakening, the patient may be confused or disoriented for several minutes. He or she may not remember the dream that caused the event. Sleep may return in a matter of minutes. Sleep terror disorder is common in children four to twelve years of age. The condition tends to disappear as one grows older. Less than one percent of adults have the disorder.
  • Sleepwalking disorder. Sleepwalking disorder is also called somnambulism (pronounced suhm-NAHM-byoo-LIHZ-uhm). The condition is characterized by a variety of behaviors, of which walking is only one. Sleepwalkers may also eat, use the bathroom, unlock doors, and carry on conversations. If awakened, sleepwalkers may be disoriented. They may have no memory of their sleepwalking experience. About 10 to 30 percent of children have at least one sleepwalking experience. The occurrence among adults is much lower, amounting to about 1 to 5 percent of all adults.

A few sleep disorders are related to some physical or mental disorder. The three conditions that fall into his category include:

  • Sleep disorders related to mental disorders. Many types of mental illness can cause sleep disorders. People who have severe mental illness, for example, may develop chronic (long-lasting) insomnia.
  • Sleep disorders due to physical conditions. Physical illnesses such as Parkinson’s disease (see Parkinson’s disease entry), encephalitis (see encephalitis entry), brain disease, and hyperthyroidism may cause sleep disorders.
  • Substance-induced sleep disorders. The use of certain types of drugs can lead to sleep disorders. The most common of these drugs are alcohol and caffeine. Certain types of medications can also cause sleep disorders. Antihistamines, steroids, and medicines used to treat asthma are examples.

Causes:

More than 100 different disorders of sleeping and waking have been identified. They can be grouped in four main categories:

  • Problems with falling and staying asleep
  • Problems with staying awake
  • Problems with adhering to a regular sleep schedule
  • Sleep-disruptive behaviors

In many cases, the cause of a sleep disorder is not known. In other cases, researchers know at least part of the reason the disorder occurs. Some examples include:

  • Insomnia. Insomnia may be caused by emotional experiences or concerns such as marital problems, problems at work, feelings of guilt, or concerns about health. A person may become so distraught that sleep is impossible. Insomnia often becomes worse when patients worry about the condition. In such cases, the worry itself becomes another cause for the disorder.
  • Hypersomnia. One possible cause of hypersomnia is restless legs syndrome. Restless legs syndrome is the name given to cramps and twitches a person may experience in the calves of the legs during sleep. These sensations may keep a person awake and lead to sleep episodes during the day.
  • Narcolepsy. The cause of narcolepsy is currently not known.
  • Sleep apnea. The most common cause of sleep apnea is blockage of the airways. The condition occurs most commonly in people who are over-weight. The snoring and gasping that are typical of apnea are caused by the person’s trying to catch his or her breath. Less commonly, sleep apnea is caused by damage to the brainstem.
  • Circadian rhythm sleep disorders. Circadian rhythm sleep disorders are caused when people are forced to adjust to new dark/light patterns. An example is a worker whose assignment is changed from the day shift to the night shift. The worker must learn how to sleep when it’s light out and to work when it’s dark out.

The causes of most parasomnias are not well understood. In some cases, severe stress may be responsible for the condition. In other cases, it is not clear what the cause for the disorder is.

Symptoms:

The symptoms of most sleep disorders are obvious from the descriptions above. A person with insomnia, for example, tends to be very tired during the day. A person with nightmare disorder displays the disturbed behavior typical of a person who has been awakened from sleep by a bad dream.

 

  • Awakening in the night
  • Difficulty falling asleep
  • Excessive daytime drowsiness
  • Loud snoring
  • Episodes of stopped breathing
  • Sleep attacks during the day
  • Daytime fatigue
  • Depressed mood
  • Anxiety
  • Difficulty concentrating
  • Apathy
  • Irritability
  • Loss of memory (or complaints of decreased memory)
  • Lower leg movements during sleep

The symptoms may vary with the particular disorder.
Diagnosis:
A beginning point in diagnosing sleep disorders is an interview with the patient and his or her family. From this interview may come a list of symptoms that suggests one or another form of sleep disorder. For example, very loud snoring may be an indication that the patient has sleep apnea. Sleepwalking is, itself, enough of a symptom to permit diagnosis of the condition.

Doctors use a number of other tools to diagnose the exact type of sleep disorder a patient has experienced. Some of these tools include:

*Sleep logs. Patients are asked to record everything about their sleep experiences they can remember. The log might include symptoms, time of appearance, severity, and frequency. Events in the person’s life may also be recorded as possible clues to the cause of the disorder.

*Psychological testing. Some sleep disorders are caused by emotional problems in a person’s life. Those problems may be identified by means of certain tests. Examples of these tests are the Minnesota Multiphasic Personality Inventory (MMPI), the Beck Depression Inventory, and the Zung Depression Scale.

*Laboratory tests. Techniques have now been developed to observe and record a patient’s behavior during sleep. The most common device used is called a polysomnograph. this device measures a person’s breathing, heart rate, brain waves, and other physical functions during sleep. Various types of sleep disorder can be identified based on these measurements.
Exams and Tests :

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*Polysomnography (recording brain activity, muscle activity and breathing during sleep)

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The most common device to use to test for sleeping disorders is called a polysomnograph. This device measures a person’s breathing, heart rate, brain waves, and other physical functions during sleep. (Photograph by Russell D. Curtis. Reproduced by permission of the National Audubon Society Collection/Photo Researchers, Inc.)

*Multiple sleep latency test — a daytime test that uses polysomnography during multiple brief nap periods

Treatment:
The choice of treatment for a sleep disorder depends on the cause of the disorder, if it is known. For example, some people develop insomnia because they have become depressed. The solution to this problem is not to treat the insomnia, but to treat the depression (see depression entry). The patient may be given antidepressants or counseling to improve his or her emotional outlook. If this treatment is successful, the insomnia usually disappears on its own.

In many cases, however, the sleep disorder itself may be treated directly. The five forms of treatment that can be used are medications, psychotherapy, sleep education, lifestyle changes, and surgery.

Medications:
One might expect that insomnia should be treated with a sedative (a substance that helps a person relax and fall asleep). But sedatives provide only temporary relief from insomnia. They do not cure the underlying cause for the disorder. In addition, some sedatives may be habit-forming or may interact with other drugs to cause serious medical problems.

Stimulants (substances that cause a person to feel more energetic or awake) are often effective in treating narcolepsy. The drug known as clonazepam is used to treat restless legs syndrome. Benzodiazepines are used for children with sleep terror disorder or sleepwalking because they help the child sleep more soundly.

Psychotherapy

Psychotherapy is used when sleep disorders are caused by emotional problems. Patients are helped to understand the nature of their problems and to find ways to solve or to live with those problems. To the extent this treatment is successful, the patient’s sleep disorders may be relieved.

Sleep Education

Researchers now know a great deal about the sleep process. By learning about that process, and changing their behavior patterns, patients may overcome some forms of sleep disorder. Some general guidelines that can help people sleep better include the following:

  • Wait until you are sleepy before going to bed.
  • Avoid using the bedroom for work, reading, or watching television.
  • Get up at the same time every morning, no matter how much or how little you have slept.
  • Get at least some physical exercise every day.
  • Avoid smoking and avoid drinking liquids that contain caffeine.
  • Limit fluid intake after dinner.
  • Learn to meditate or practice relaxation techniques.
  • Do not stay in bed if you can’t fall asleep. Get up and listen to relaxing music or read.

Lifestyle Changes

Some types of sleep disorders can be relieved by changing one’s lifestyle. For example, people with sleep apnea should stop smoking if they smoke, avoid alcohol and drugs, and lose weight to improve the function of their airways. People who experience circadian rhythm sleep disorders should try to adjust their travel or work patterns to allow time to adjust to new day/night patterns. Children with nightmare disorder should not watch frightening movies or television programs.

Surgery

Surgery is the treatment of last resort for sleep apnea, perhaps the only type of sleep disorder that is life-threatening. Combined with other factors, such as obesity, it can cause death. In such cases, surgery may be required to open up the patient’s airways and make breathing easier.

Alternative Treatment

Stress may be responsible for a number of forms of sleep disorder. Alternative treatments that teach people how to reduce stress in their lives can be very helpful. These treatments may include acupuncture, meditation, breathing exercises, yoga, and hypnotherapy. Homeopathic practitioners recommend a variety of substances to treat insomnia caused by various factors. They suggest Nux vomica for insomnia caused by alcohol or drugs, Ignatia for insomnia caused by grief, Arsenicum for insomnia caused by fear or anxiety, and Passiflora for insomnia related to mental stress.

Practitioners of Chinese medicine also have a range of herbs for the treatment of sleep disorder. The substance recommended depends on the particular type of disorder. For example, the magnetic mineral known as magnetite is recommended for insomnia caused by fear or anxiety.

Dietary changes may also help relieve some sleep disorders. Patients should avoid any food that contains caffeine or other stimulants. Such foods include coffee, tea, cola drinks, and chocolate. Some botanical remedies that may help a person relax and get a good night’s sleep include valerian, passionflower, and skullcap.

Prognosis:
Prognosis depends on the specific type of sleep disorder. In most cases, children outgrow sleep disorders such as nightmares and sleep terror disorder. Other conditions tend to be chronic. Narcolepsy, for example, is a life-long condition. Relatively few forms of sleep disorder represent life-threatening medical conditions. Sleep apnea is one of the few examples.

Possible Complications:
A complication is dependence upon sedatives or other medications prescribed for sleep disorders.

Prevention:
Maintaining regular sleep habits and a quiet sleep environment may prevent some sleep disorders.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:
http://www.nlm.nih.gov/medlineplus/ency/article/000800.htm
http://www.faqs.org/health/Sick-V4/Sleep-Disorders.html

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