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Four Common Sleep
Disorders…
Polysomnographic readout for obstructive Sleep
Apnea | Perhaps the number one sleep
disorder is sleep apnea. Sleep apnea is a breathing disorder where there are
brief interruptions during sleep. Obstructive Sleep Apnea, the most common form,
occurs when air cannot flow into or out of the person’s nose and mouth.
There may be as many as 20-60 involuntary breathing pauses per hour. The
pauses are almost always accompanied by snoring, which allows the individual to
open the closed airway. The individual is usually not aware of these breathing
pauses, but they do interrupt the deep, restorative REM sleep needed for feeling
well-rested.
Individuals with sleep apnea often have high blood pressure and are
overweight. An individual with sleep apnea is excessively sleepy during the day,
and may have chronic morning headaches. Detecting sleep apnea is important
because it may indicate other physical conditions that need attention – an
irregular heartbeat, or the need to examine the patient’s heart and carotid
arteries for any signs of impending heart attack or stroke.
Sleep apnea is more common in men. Sleep apnea appears to run in some
families, indicating a genetic tendency toward sleep apnea.
Bed partners or family members are often the first to suspect something is
wrong because of loud snoring or a struggle to breathe. The patient is unaware
there is a problem, so it is particularly important to encourage the family
member to see a physician.
The most common remedy for sleep apnea is to have it correctly diagnosed in
an accredited sleep lab. The individual is usually fitted with a Continuous
Positive Airway Pressure (CPAP) mask that maintains constant pressure on the
airway, keeping it open throughout the night. Overweight sleep apnea patients
should be encouraged to lose weight. It is also important to determine if the
individual has high blood pressure, and to treat that with medication, along
with CPAP therapy.
Narcolepsy is a chronic neurological disorder that involves the body’s
central nervous system. For those with narcolepsy, the nerves that carry
messages about when to sleep and when to be awake often occur during unwanted
circumstances: while eating, while conversing, while driving.
Recent discoveries show narcoleptics lack a brain chemical – hypocretin –
that stimulates arousal and regulates sleep. Why there is a reduction in the
number of Hert cells that secrete hypocretin is not known.
Narcolepsy affects both men and women, and first symptoms usually appear
between 15 and 30 years of age. Excessive daytime sleepiness is the first
symptom. The urge to sleep is overwhelming and cannot be ignored.
Narcoleptics may experience cataplexy, or a sudden loss of muscle control.
This symptom is usually triggered by an intensive emotion, like anger, laughter,
surprise. Some narcoleptics experience sleep paralysis, and are unable to talk
or move during their brief sleep period. Some narcoleptics will report vivid and
scary dreams when falling asleep.
The diagnosis of narcolepsy begins with a medical history and physical exam.
The individual is asked to sleep overnight in an accredited sleep lap to measure
brain waves and body movements, as well as nerve and muscle function. After the
regular sleep period, the individual goes through a Multiple Sleep Latency Test
(MSLT), which measures the time it takes to fall asleep and move into deep
sleep, while taking several naps over a defined time period.
Treatment for narcolepsy usually includes prescriptions for a stimulant to
improve alertness and an antidepressant to control cataplexy, hallucinations and
sleep paralysis. Narcoleptics are encouraged to follow good sleep hygiene
practices and to schedule one or more naps during the day.
If you have restless legs syndrome (RLS), you’ll recognize these
symptoms:
- You have an urge to move your legs. You feel uncomfortable creeping,
crawling sensations, and the only relief is to move your legs. Some affected
by RLS will try rubbing their legs, trying a different position in bed, or
getting up and walking.
- RLS appears late in the day and at night. The condition worsens while
lying down and is a common “sleep stealer.”
The cause of RLS is unknown, but symptoms tend to worsen with age. There
appears to be some hereditary tendency when first-degree relatives have RLS.
Some cases of RLS have been associated with iron deficiency anemia, stress, diet
and other health problems.
Many RLS patients response to treatment with levadopa medication. Some
researchers have concluded RLS may be related to a dopamine deficiency in the
body.
According to the National Center on Sleep Disorders Research, RLS is a
common, underdiagnosed, but treatable condition. Symptoms can range from
bothersome to almost incapacitating. Most cases of RLS respond to
pharmacological treatment. If you experience the symptoms described, talk with
your family doctor. You may be referred for a sleep study to confirm RLS, or
referred to a sleep specialist.
For most people, dreams are just a mental activity during sleep. Those who
suffer from REM Behavior Disorder act out their dreams. They may physically move
their limbs, talk, shout, scream, or fly out of bed.
Sleep involves three stages: wakefulness, Rapid Eye Movement (REM) sleep and
non-REM sleep. For those with REM Behavior Disorder, the brain’s electrical
activity during REM sleep appears similar to electrical activity during waking.
The characteristics of one stage of leave carry over into the others.
Those with REM Behavior Disorder lack the temporary muscle paralysis that
most individuals experience during REM sleep. This permits them to act out their
dreams while still asleep.
Researchers have found that more than 90% of REM Behavior Disorder patients
are male and usually over the age of 50. Research is ongoing as to the cause of
REM Behavior Disorder. A formal sleep study is needed to confirm this disorder.
In general, benzodiazapine medications control or eliminate the behavior in 90%
of all cases.
Credit: National Sleep Foundation |