Sleep Disorders

Obstructive Sleep Apnea [OSA]:

The most serious sleep disorder, discovered only recently. It is believed to affect 1 of every 200 Americans -- 70 to 90 of them men, mostly middle-aged and usually overweight. However, the condition can and does afflict both men and women at any age.

People with this disorder may actually stop breathing during sleep, even hundreds of times without being aware of the problem. These periods of apnea last from 10 to 90 seconds. During an apnea attack, oxygen levels become seriously low and carbon dioxide levels increase, straining the cardiac and respiratory systems. In severe cases, the apnea victim may actually spend more time not breathing and be at risk for death.

Symptoms:

• Loud, habitual snoring
• Pauses in breathing during sleep
• Daytime sleepiness
• Irritability/personality changes
• Obesity
• Choking/gasping/snorting during sleep
• Hypertension
• Non-refreshing sleep/inability to wake up
• Memory and concentration problems
• Morning headaches
• Upper airway abnormalities
• Frequent napping
• Nocturnal angina/arrhythmia
• Frequent awakenings
• Daytime fatigue
• Sexual problems

Diagnosis for sleep apnea should be made by pertinent history, physical examination, oximetry and polysomnography. Most people benefit from appropriate evaluation, treatment and follow-up.

In this form of apnea, commonly referred to as "Central Apnea", both oral breathing and throat and abdominal breathing efforts are simultaneously interrupted. Common causes include central nervous system disorders and restriction related mixed apnea.

The most common form of sleep apnea, caused by an obstruction in the upper airway whereby air stops flowing through the nose and mouth, but throat and abdominal breathing efforts are uninterrupted. The snoring that results is produced by vibrations in the soft tissue and uvula at the back of the throat as the air passes between the tongue and tissue, causing the individual to emit a vigorous snoring grunt while gasping for air, arousing them from sleep, then immediately back to sleep -- only to repeat the cycle time after time.

A symptom of sleep apnea, but considered a disorder with varying multiple causes and consequences, ranging from physical abnormalities to psychological indicators. Stress is the most common cause in psychological cases. The problem is that in 70 to 90 percent of stress-related EDS, stress is a byproduct, not the cause. For this reason, stress must be ruled out as the cause of sleep disorders by polysomnography.

EDS is the most common cause of work-related accidents.

According to the American Narcolepsy Association, 1 out of every 100 Americans is affected with this disorder, yet between 50 and 80 percent of them remain undiagnosed.

People with narcolepsy suffer from sleep apnea, although apnea is not a core feature of the disorder.

During a narcoleptic attack, the person may find it physically impossible to stay awake and sleeps for periods ranging from a few seconds to half an hour. An attack can occur while watching TV, reading, or listening to a lecture. More surprisingly, the sudden attacks of sleep can also strike while walking, carrying on a conversation, or even while riding a bicycle.

Despite modern medical knowledge about narcolepsy, people who have such attacks typically do not seek medical attention for some time -- an average of 5-7 years. Usually, symptoms begin mildly, but over time the frequency and severity increase.

The most common symptoms or complaints are:
     A "drug-like" induced sleep attack
     Severe fatigue coming in waves or cycles.

Besides the presence of excessive daytime sleepiness (mirroring narcolepsy), which is usually the first symptom noted, the person suffering may experience a sudden weakness (almost paralytic) of the muscles throughout the body causing inability to move or fight off sleep.

A cataplectic attack is usually triggered by such emotions as laughter, anger, elation or surprise. It may be experienced as partial muscle weakness lasting a few seconds, or as an almost complete loss of muscle control lasting for several minutes. During this period, the sufferer may be in a state of near total physical collapse, unable to move or speak, although conscious and at least partially aware of activity in the immediate environment. This form of narcolepsy with cataplexy is sometimes misdiagnosed as epilepsy, but epilepsy is often accompanied by loss of bladder and bowel control and tongue biting; cataplexy is not. More often, symptoms of narcolepsy with cataplexy are attributed to laziness or psychiatric disorders. Home and job usually suffer as these symptoms go untreated. A sufferer may drive to a destination and not be aware of how they arrived there. Typically, undiagnosed drivers with narcolepsy and cataplexy may not survive long enough to be diagnosed, or to be counted among the sufferers, yet narcolepsy is a major traffic safety problem with a low cost and easy solution: diagnosis and treatment are available and allow near normal quality of life.

In those who have RLS, discomfort in the legs and feet peaks during the evening and night. They may feel an urge to move their legs and/or feet to get temporary relief. As a result, most people who have the condition have excessive rhythmic or cyclic leg movements during sleep. This often delayss the onset of sleep and causes brief but frequent awakenings during sleep. RLS is a common problem among middle-aged and older adults. In severe cases, sufferers awake in the morning feeling as though they have run a race, including leg cramps and pulled muscles.

30 percent of those with RLS have relatives with the same condition.

Similar to restless leg syndrome, except it occurs in extremities other than legs. The inability to keep arms and hands still, resulting in a flexation or jerk of arms or hands. The nerve endings in arms and hands sometimes send pain signals or just a signal to move the extremity, delaying sleep onset.

During sleep, these movements intensify, causing periodic, momentary arousals. The results of frequent arousals lead to fatigue and non-recuperative sleep patterns.

There are many possible causes for PLMD. The strongest associations include kidney failure, some nerve disorders, vitamin deficiencies, pregnancy, iron deficiency, and some medications (such as antidepressants).

Many treatments exist to eliminate PLMD.

A disorder of disassociation of muscle atonia during REM sleep. The disruption of sleep continuity is abrupt and severe. Recognized by abrupt emotional vocalizations, swearing or even injurious and violent behaviors. As in someone acting out dreams, seeming to be awake but fighting, swinging, or hitting anything or anyone close enough to reach.

Affects predominantly men 45 years or older, and is associated to neurodegenerative diseases. The frequency of injury to self occurs in one-third of cases and increases to two-thirds in injury to others. 50 percent of those diagnosed have some history of traumatic stress disorder.

Treatment is available once diagnosed.

Typically occur in the first third of the night during deep, non-REM sleep. During these arousals, the sufferer will exhibit complex behavior but poor or no recollection of events and/or confusion on waking. It is here vivid dreams occur, leaving one only to remember dreaming but no remembrance of what was dreamt. The sufferer may also talk in his or her sleep, speaking with clarity about concise issues or seem to ramble in unrecognizable fashion. These vivid episodes can lead to sleep walking, night terrors, and are all associated with a difficulty or inability to terminate the episode, often awakening confused, not knowing where they are or if the episode was real or dreamt. All slow wave disorders are significant in that many lead to injury to self or others. Easily treatable once diagnosed.

Common in those who use medications for pain, depression, cardiac arrhythmia, or socially. Alcohol may have the same effect. Onset of confusion arousal can occur at any time with or without medication; however, continued or habitual confusion arousal is far from normal and can be dangerous. The sufferer often awakes feelings as if in a cloud and can fall or trip, as most have no idea where they are, often walking into danger (i.e. running into walls, breaking windows, or violence if feeling threatened).

The invasion of REM sleep into wakefulness leads the sufferer to not know they are awake and think they may still be dreaming.

Far more common in children, although it may persist into adulthood. Sleep walking occurs when in non-REM sleep the sufferer may arise from sleep physically to act out a dream or need, all the while never truly waking. Sleep walkers carry out extraordinary activities, from house cleaning and cooking, to driving a car; all of which can be dangerous. One thing common to all sleep walkers is complete lack of remembrance of the episode. A sleep walker caught walking is exceptionally difficult to wake and will almost always awake with extreme confusion.

Unlike REM Behavior disorders in that no acting out occurs, only the waking up terrified with no recollection of why or what terrified them. More traumatic in children due to confusion and difficulty in reassurance that they are okay.

Many recurring night terrors in adults lead to insomnia due to fear of falling asleep. This phenomenon leads to several severe illnesses as sleep deprivation takes its toll.

Symptoms other than the obvious fear include night sweats, screaming out of arousal, and severe confusion and inability to assure.

Defined as daily functions of physiological or behavioral functions, including sleep-wake states generally tied to the 24 hour daily dark-light cycles, but sometimes at a measurably different period when light-dark and other time cues are removed, as in jet lag when our body is ready for sleep-wake and the time has changed measurably.

Night shift workers are especially susceptible to this disorder. Most sufferers consider themselves to be "night owls", when in reality a sleep disorder exists.

Typically, people sleep at night, but with the advent of 24-hour TV, cities, and jobs, the close interaction between our sleep system and our alertness rhythm (which is driven by our internal clock) are altered dramatically.

This "clock" is the small part of the brain called the suprachiasmatic nucleus of the hypothalamus. Light resets this clock and can be moved forward or backwards. Abnormalities related to this clock are called circadian rhythms.

Symptoms are due to environment.

As the frequent traveler crisscrosses the globe shifting time zones, the natural body clock loses its ability to adjust. Aside from the fatigue, confusion and tiredness the sufferer feels, severe problems are just beginning.

Sleep-wake patterns allow for recuperation and regeneration physically and mentally as darkness falls and sleep is achieved. When this pattern is disturbed, physical regeneration and mental recuperation cease. Health continues to decline slowly as fatigue sets in. One can look down or up this page and see other disorders that already are, or soon will be, a part of the sufferer's increasing problems. From EDS (Excessive Daytime Sleepiness) to Slow Wave Arousals, problems continue to mount until the sleep-wake patterns and light-dark patterns are corrected.

In this 24-hour-a-day society we live in, the amount of people working night shift, or "graveyard shift", continues to grow. With that growth, sufferers of circadian rhythm disorders increase, as does health care costs.

The severity of the disturbance between wake-sleep and light-dark patterns leaves those who work these shifts in physical crisis. As the body clock continues to be ignored, the ability to reset it disappears. With it. one's health also begins to deteriorate. Fatigue becomes more common. High blood pressure, inability to recuperate, and confusion all increase -- all leading towards cardiac problems and other severe health risks.

Characterized by disruptions in sleep-wake timing with frequent, irregular daytime napping and poorly consolidated or abbreviated nighttime sleep.

The sufferer here typically has poor sleep hygiene -- constant or frequent changes in bedtime or wake-up time, along with changes in sleep times (i.e. 5 hours of sleep one night and 10 hours another). This pattern eventually leads to insomnia. The inability to achieve sleep onset once in bed, tossing and turning, and the frustration all lead to broken sleep. Sleep stages break down and quality sleep becomes nonexistent.

The singular most important aspect of quality sleep is "wake time", not hours per night nor bedtime. It is wake time that starts or resets the sleep-wake pattern. Continued disregard for this pattern leads to poor health, depression, family discord, sexual problems, and work performance problems, among others.

This sufferer consider themselves a "night owl" or having a nighttime personality. They stay up very late and have difficulty functioning in the mornings after sleeping late, though seldom waking refreshed.

This is very common among teens. As we age, this pattern leads to physical and emotional illnesses. The lack of the recuperative and regenerative powers of sleep are missed, resulting in fatigue, hypertension, emotional duress, irritability, family discord, sexual problems, and poor work performance.

Proper sleep hygiene is step 1 to staving off escalating medical problems.

More common in the elderly. As we age, the onset of sleepiness comes earlier. This sufferer often falls asleep soon after dark, regardless of the clock. Soon after dinner, a comfy couch, and it's "light's out". Often, however, the sleep time cycle shortens and a 3 to 5 a.m. wake-up becomes normal. Attempts to return to sleep are futile. This pattern continues to move earlier and earlier.

Advanced sleep phase is not only associated with the elderly; often, it occurs in synchrony with shorter winter days. Seasonal episodes commonly return to normal. A small percent continues and cause physical and emotional problems.

Light/dark therapy, sleep hygiene and photo therapy are treatments that show good success.

Related almost exclusively to blind persons who loose the light-dark reset button that regulates circadian rhythms. In sighted sufferers, this disorder mirrors irregular sleep-wake pattern, although it is not due to poor sleep hygiene. In this case, the causes can range from central nervous system disorders to neurodegenerative disease. A physical or neurological malfunction of the light-dark sensor is most likely. Extensive retraining is necessary and can be managed.