Sleep Disorder Guide

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 is the cause of insomnia.

Transient and short-term insomnia generally occur in people who are temporarily experiencing one or more of the following:
• stress
• environmental noise
• extreme temperatures change in the surrounding environment
• sleep/wake schedule problems such as those due to jet lag
• medication side effects

Chronic insomnia is more complex and often results from a combination of factors, including underlying physical or mental disorders. One of the most common causes of chronic insomnia is depression. Other underlying causes include arthritis, kidney disease, heart failure, asthma, sleep apnea, restless legs syndrome, Parkinson’s disease, and hyperthyroidism. However, chronic insomnia may also be due to behavioral factors, including the misuse of caffeine, alcohol, or other substances; disrupted sleep/wake cycles as may occur with shift work or other nighttime activity schedules; and chronic stress.

In addition, the following behaviors have been shown to perpetuate insomnia in some people:
• poor sleep hygiene in general
• expecting to have difficulty sleeping and worrying about it
• ingesting excessive amounts of caffeine
• drinking alcohol before bedtime
• smoking cigarettes before bedtime
• excessive napping in the afternoon or evening
• irregular or continually disrupted sleep/wake schedule

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.The most common symptoms of obstructive sleep apnea (OSA) that you may notice include:

* Excessive daytime sleepiness, which is falling asleep when you normally should not, such as while you are eating, talking, or driving.
* Waking with an unrefreshed feeling after sleep, having problems with memory and concentration, feeling tired, and experiencing personality changes.
* Morning or night headaches. About half of all people with sleep apnea report headaches.2
* Heartburn or a sour taste in the mouth at night.
* Swelling of the legs if you are obese.
* Getting up during the night to urinate (nocturia).
* Sweating and chest pain while you are sleeping.

Symptoms of sleep apnea that others may notice include:

* Episodes of not breathing (apnea), which may occur as few as 5 times an hour (mild apnea) to more than 50 times an hour (severe apnea). How many episodes you have determines how severe your sleep apnea is.
* Loud snoring. Almost all people who have sleep apnea snore, but not all people who snore have sleep apnea.
* Restless tossing and turning during sleep.
* Nighttime choking or gasping spells.

Older adults may normally have periods when they stop breathing during sleep, making it hard to know whether they have sleep apnea. Short lapses in breathing during sleep usually do not cause a large drop in the blood oxygen level.
Symptoms in children

In children, symptoms of sleep apnea depend on how old the child is:

* In children younger than 5, symptoms include snoring, mouth breathing, sweating, restlessness, and waking up a lot.
* In children 5 years and older, symptoms include snoring, bed wetting, doing poorly in school, and not growing as quickly as they should for their age. These children may also have behavior problems and a short attention span.

Children who have sleep apnea nearly always snore. But they may not appear to be excessively sleepy during the day (a key symptom in adults). The only symptom of sleep apnea in some children may be that they do not grow as quickly as they should for their age.

Although rare, in children sleep apnea can cause developmental delays and can cause the right side of the heart to get bigger (cor pulmonale).

Other conditions with symptoms similar to sleep apnea include an underactive thyroid (hypothyroidism) and other sleep disorders, such as suddenly falling asleep (narcolepsy) or an intense urge to move the legs (restless legs syndrome).

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.

Narcolepsy is a chronic disorder affecting the brain where regulation of sleep and wakefulness take place. Narcolepsy can be thought of as an intrusion of dreaming sleep (REM) into the waking state.

The prevalence of narcolepsy has been calculated at about 0.03% of the general population. Its onset can occur at any time throughout life, but its peek onset is during the teen years. Narcolepsy has been found to be hereditary along with some environmental factors.
Symptoms

* Excessive sleepiness.
* Temporary decrease or loss of muscle control, especially when getting excited.
* Vivid dream-like images when drifting off to sleep or waking up.
* Waking up unable to move or talk for a brief time.

Simple Test for Narcolepsy:

* Do you feel like you could sleep for days and still wake up sleepy?
* Do you ever collapse or feel weak when laughing?
* Do you ever collapse or feel weak when angry?
* Are you afraid you may fall asleep while swimming?
* Are you afraid you may fall asleep while taking a bath?
* Did one of your parents or close relatives have the “sleeping sickness”?

Answering yes to any of these questions may be an indication of narcolepsy. You should discuss this with your physician.

Narcolepsy in Depth

Narcolepsy is a disabling disorder of sleep regulation that affects the control of sleep and wakefulness. It may be described as an intrusion of the dream sleep (called REM or rapid eye movement) into the waking state. Symptoms generally begin between the ages of 15 and 30. The four classic symptoms of the disorder are excessive daytime sleepiness; cataplexy (sudden, brief episodes of muscle weakness or paralysis brought on by strong emotions such as laughter, anger, surprise or anticipation); sleep paralysis (paralysis upon falling asleep or waking up); and hypnagogic hallucinations (vivid dreamlike images that occur at sleep onset). Disturbed nighttime sleep, including tossing and turning in bed, leg jerks, nightmares, and frequent awakenings, may also occur. The development, number and severity of symptoms vary widely among individuals with the disorder. There appears to be an important genetic component to the disorder as well.

Excessive sleepiness is usually the first symptom of narcolepsy. Patients with the disorder experience irresistible sleep attacks, throughout the day, which can last for 30 seconds to more than 30 minutes, regardless of the amount or quality of prior nighttime sleep. These attacks result in episodes of sleep at work and social events, while eating, talking and driving, and in other similarly inappropriate occasions. Although narcolepsy is not a rare disorder, it is often misdiagnosed or diagnosed only years after symptoms first appear. Early diagnosis and treatment, however, are important to the physical and mental well-being of the affected individual.

TREATMENT: There is no cure for narcolepsy; however, the symptoms can be controlled with behavioral and medical therapy. The excessive daytime sleepiness may be treated with stimulant drugs, while cataplexy and other REM-sleep symptoms may be treated with antidepressant medications. At best, medications will reduce the symptoms, but will not alleviate them entirely. Also, some medications may have side effects. Basic lifestyle adjustments such as keeping a good sleep schedule, improving diet, increasing exercise and avoiding “exciting” situations may also help to reduce the effects of excessive daytime sleepiness and cataplexy.

PROGNOSIS: Although narcolepsy is a life-long condition, most individuals with the disorder enjoy a near-normal lifestyle with adequate medication and support from teachers, employers, and families. If not properly diagnosed and treated, narcolepsy may have a devastating impact on the life of the affected individual, causing social, psychological, and financial difficulties.

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.

Call Your Doctor If:

• Your sleep does not improve with self-help techniques, such as establishing good sleep hygiene, cutting down on caffeine, exercising, and using relaxation techniques.
• You think your sleep problems may be related to an underlying condition, such as depression or heart failure.
• You snore loudly or make snorting or gasping noises while you sleep — or your partner observes these things while you’re asleep.
• You fall asleep doing normal activities, such as talking or driving.
• You regularly feel unrefreshed on awakening and are constantly fatigued. Sleep disorders are among the many possible causes for fatigue.
• You suspect your medication is causing your sleep problems.