Sleep Disorders Sleep Apnea

Sleep is defined as the reversible state in which the person’s voluntary actions are temporarily suspended but the involuntary functions such as circulation and respiration are carried out normally. During sleeping condition the person adopts a specific posture as well as immobility and his response to external stimuli is also decreased.

The state of sleep can be divided into NREM means NonRapid Eye Movement and REM means Rapid Eye Movement. The former type is divided into four stages on the basis of electroencephalographic criteria. After 60-90 minutes of sleep onset in a normal adult first REM starts and there are about four or five cycles of NREM -REM which have the duration period of 90-110 minutes. A person mostly dreams during the REM sleep. The sleep pattern of humans is controlled by a circadian rhythm. Approximate sleep for an average adult is 7-8 hours but elderly people have frequent awakenings.

A medical disorder of the pattern of sleep of a person or animal is called sleep disorder. Some sleep disorders are too serious that they start interfering with the patient’s normal physical, mental and emotional functions. Polysomnography is the test recommended for any sleep disorder.

Many issues are responsible for disruptions in sleep e.g. from teeth grinding to night terrors. Mainly sleep disorders are of two types which are insomnia and hypersomnia. Insomnia is a disorder in which the person suffers from difficulty in sleeping with no obvious cause while hypersomnia is a disorder in which the sufferer sleeps excessively.

Sleep disorders are classified into dyssom-nias, para-somnias and disorders associated with medical, psychiatric, and neurological illnesses. Dyssom-nias may be of three types which are intrinsic, extrinsic or circadian rhythm disorders. The examples of intrinsic sleep disorders are Obstructive sleep apnea syndrome, Narcolepsy, Psychophysiological and idiopathic insomnia and restless legs syndrome. Inadequate sleep hygiene, insufficient sleep syndrome, hypotonic stimulant and alcohol dependent sleep disorders are included in extrinsic sleep disorders while disorders included in circadian rhythm disorders are jet lag and shift -work sleep disorders.

Abnormal movements or behavior interfering in the sleep characterizes Parasomnias. Behaviors responsible for such disorders are sleep walking, sleep terrors, sleep talking, nightmares, sleep paralysis, teeth grinding and bed wetting.

The major sleep complaints are excessive daytime sleepiness, sleeplessness and abnormal movements and behaviors during sleep. A person suffering from insomnia finds difficulty in initiating or maintaining sleep, repeated awakenings or early morning awakenings in addition to daytime fatigue and impairment of performance. Hypersomnia patients complain of excessive daytime sleepiness and circadian-rhythm sleep disorders are associated with either insomnia or hypersomnia. The cause of insomnia may be psychiatric or psy-chophysiologic disorder like depression, anxiety, or stress. Medical disorders can also be its cause but early morning awakening is characteristic of depression.

There are two types of sleep apnea which are central apnea and obstructive apnea. In central apnea the airflow both at the mouth and nose as well as the effort by the diaphragm also decreases while in obstructive apnea the airflow ceases but the effort of diaphragm continues. Obstructive sleep apnea syndrome is common in middle-aged and elderly obese men. Sleep apnea has all characteristic symptoms of sleep disorders. It is insomniac as the difficulty in breathing while sleeping is very threatfull and it does not allow the patient to sleep. Sleep apnea sufferers are usually overweight which makes breathing more difficult as the airway closes normally causing snoring at sleep onset.

The individuals of age between 15 and 25 suffer from narcoleptic sleep attacks. Narcolepsy means an irresistible desire to sleep and the narcoleptic attacks last for 15-30 minutes. Other symptoms of narcolepsy are fearful dreams or feeling of loss of power at sleep onset or offset and it cannot be cured. Another symptom of narcolepsy is the occurrence of frightening dream hallucinations at sleep onset and upon awakening.

Sleep terror is sometimes referred to as pavor nocturnus. In this disorder the child wake up screaming and crying. Sleep terror disorder is most common in children four to 12 years old and is usually outgrown in adolescence. It affects about 3 percent of children. In children, more males than females have the disorder.

Sleepwalking disorder which is also called somnambulism when a child becomes able to walk. It occurs during stage three and stage four NREM sleep during the first part of the night.The disorder is most common in children eight to 12 years old. The most common age group to experience sleepwalking is children under 10.

Restless legs syndrome is a middle age disorder and the intense disagreeable feelings in the legs at rest and repose with compulsion to move the legs to get relief is the characteristic of this syndrome. The individuals suffering from this syndrome also have periodic limb movement while sleeping.

An overnight polysomnography is done to diagnose the sleep disorder and it involves recording of brain waves, muscle activities, eye movements, heart activity, airflow at the nose and mouth, respiratory effort, and oxygen saturation. The patients of excessive daytime sleepiness, narcolepsy, parasomnias, restless legs-period limb movements, and nocturnal seizures are recommended Polysomnography. Another test for sleep disorders is multiple sleep latency test, it is for documenting pathologic sleepiness and diagnosing narcolepsy.

In the United States, 20 to 25 percent of children have some kind of sleep problem. The percentage of nightmare sleep disorders is 30% and that of insomnia is 23%.

Treatment of obstructive sleep apnea syndrome is to avoid sedatives or alcohol consumption, weight loss, and use of continuous positive airway pressure which will open the upper airway passage. Narcolepsy is treated by stimulants and short naps. Cataplexy can be cured with tricyclics. Sleep hygiene and behavioral modification are the best treatment of insomnia. The Minnesota Multiphasic Personality Inventory (MMPI), the Millon Clinical Multiaxial Inventory (MCMI), the Beck Depression Inventory, and the Zung Depression Scale are the tests most commonly used in evaluating this symptom. Parasomniatics don’t require any specific treatment but psychotherapy is helpful in some cases. Circadian-rhythm are cured by bright light and chronotherapy.

Insomnia is the chronic inability to fall asleep or remain asleep for an adequate length of time. It is the condition of extreme sleeplessness. It can also be described as the abnormal wakefulness or inability to sleep. Insomnia is found in males and females of all age groups, although it seems to be more common in females especially after menopause and in the elderly.

Causes of insomnia may include Use of psychoactive drugs or stimulants, including certain medications, herbs, caffeine, nicotine, cocaine, amphetamines, methylphenidate, MDMA and modafinil. Use of fluoroquinolone antibiotic drugs, see fluoroquinolone toxicity, associated with more severe and chronic types of insomnia. Restless Legs Syndrome, which can cause sleep onset insomnia due to the discomforting sensations felt and the need to move the legs or other body parts to relieve these sensations. Periodic limb movement disorder (PLMD) which occurs during sleep and can cause arousals which the sleeper is unaware of. An injury or condition that causes pain can preclude an individual from finding a comfortable position in which to fall asleep, and can in addition cause awakening. Hormone shifts such as those that precede menstruation and those during menopause. Life events such as fear, stress, anxiety, emotional or mental tension, work problems, financial stress, birth of a child and bereavement. Mental disorders such as bipolar disorder, clinical depression, generalized anxiety disorder, post traumatic stress disorder, schizophrenia, or obsessive compulsive disorder. Disturbances of the circadian rhythm, such as shift work and jet lag, can cause an inability to sleep at some times of the day and excessive sleepiness at other times of the day. Chronic circadian rhythm disorders are characterized by similar symptoms. Certain neurological disorders, brain lesions, or a history of traumatic brain injury. Medical conditions such as hyperthyroidism and rheumatoid arthritis. Abuse of over-the counter or prescription sleep aids can produce rebound insomnia. Poor sleep hygiene, e.g., noise. Parasomnias which include such disruptive sleep events as nightmares, sleepwalking, night terrors, violent behavior while sleeping, and REM behavior disorder, in which the physical body moves in response to events within dreams. A rare genetic condition can cause a prion-based, permanent and eventually fatal form of insomnia called fatal familial insomnia. Physical exercise. Exercise-induced insomnia is common in athletes, causing prolonged sleep onset latency.

Remedies for mild insomnia are to improve sleeping conditions, take warm bathsm, increased use of milk and systematic relaxation. Severe or chronic insomnia may necessitate the temporary use of barbiturates or tranquilizers, but such drugs are often addictive and may be decreasingly effective as the body builds up tolerance. Other methods of treatment include psychotherapy and hypnosis.They are to develop a regular sleeping schedule. Avoid daytime naps and stimulating activities just before bedtime, avoid stimulating drugs, such as caffeine and nicotine, particularly before going to bed, exercise during the day but not in the late evening, avoid alcohol- it is a leading cause of poor sleep, minimize light and noise when trying to sleep, maintain a comfortable bedroom temperature, avoid heavy meals before bedtime. If hungry, eat a light carbohydrate snack, take medications that may be stimulating, or those that may cause you to wake up to urinate long before bedtime and increase exposure to sunlight in the morning, and avoid it later in the afternoon (5-6 PM). By lowering the caffeine intake, healthy eating, and exercise can often help you to get a good nights rest and be a treatment of insomnia.

Insomnia can be classified as transient, acute, or chronic.
Transient insomnia lasts for less than a week. It can be caused by another disorder, by changes in the sleep environment, by the timing of sleep, severe depression, or by stress. Its consequences – sleepiness and impaired psychomotor performance – are similar to those of sleep deprivation.

Acute insomnia is the inability to consistently sleep well for a period of less than a month.

Chronic insomnia lasts for longer than a month. It can be caused by another disorder, or it can be a primary disorder. Its effects can vary according to its causes. They might include muscular fatigue, hallucinations, and mental fatigue; but people with chronic insomnia often show increased alertness. Some people that live with this disorder see things as if they are happening in slow motion, wherein moving objects seem to blend together.

Sleep-onset insomnia is difficulty falling asleep at the beginning of the night, often a symptom of anxiety disorders or the delayed sleep phase disorder.Nocturnal awakenings are characterized by difficulty returning to sleep after awakening in the middle of the night or waking too early in the morning: middle-of-the-night insomnia and terminal insomnia. The former may be a symptom of pain disorders or medical illness; the latter is often a characteristic of clinical depression.

Symptoms of insomnia may include difficulty falling asleep at night, wake up during the night, waking up too not feeling well rested after a night’s sleep, feeling very tired during the day or even sleepiness, become irritated easily, feel depressed or experience anxiety, social life is going down, Difficulty to concentrate and focus, which in turn can lead to a lower performance on the job or at school, Difficulty with memory, coordination slipping, more errors or cause (traffic) accidents because of slower reaction time, Tension headaches, Symptoms of different problems in your digestive tract, start worrying more and more about sleep.

Many times one of the first signs of insomnia will be restlessness. Not being able to get comfortable in your bed for an hour or so could also be a sign. If you wake up from a good sleep for any reason and then are unable to fall back asleep this could also be an indicator. One of the more serious signs that you may have is waking up too early and not being able to go back to sleep.

If you feel like you haven’t had any sleep when you rise the next morning this could be an early stage of insomnia and could display itself as sleep apnea. The more this condition continues so will your symptoms, both physically and mentally. You will notice that you are more irritable and not as well focused during the day.

If you continue to have insomnia for an extended period of time you will start to experience health problems that manifest itself with physical and mental problems. Insomnia side effects can be easy to miss in the beginning and you may not know you have a problem for some time. The signs of insomnia will not always show themselves the same way in all people.

Patients with insomnia are evaluated with the help of a medical history and a sleep history. The sleep history may be obtained from a sleep diary filled out by the patient or by an interview with the patient’s bed partner concerning the quantity and quality of the patient’s sleep. Specialized sleep studies may be recommended, but only if there is suspicion that the patient may have a primary sleep disorder such as sleep apnea or narcolepsy.

Treatment for chronic insomnia consists of following steps. First, diagnosing and treating underlying medical or psychological problems. Identifying behaviors that may worsen insomnia and see how to stop them. Possibly using sleeping pills, although the long-term use of sleeping pills for chronic insomnia is controversial. A patient taking any sleeping pill should be under the supervision of a physician to closely evaluate effectiveness and minimize side effects. In general, these drugs are prescribed at the lowest dose and for the shortest duration needed to relieve the sleep-related symptoms. For some of these medicines, the dose must be gradually lowered as the medicine is discontinued because, if stopped abruptly, it can cause insomnia to occur again for a night or two. Trying behavioral techniques to improve sleep, such as relaxation therapy, sleep restriction therapy, and reconditioning.

Relaxation therapy consists of techniques that help reduce or eliminate anxiety and body tension.

Sleep restriction is a technique that starts with a person only being allowed to get a few hours sleep a night; over time the hours of sleep are increased until a more normal night’s sleep is achieved. This technique is designed to limit the hours that one spends in bed unable to sleep and helps re-associate the bedroom with sleeping, instead of the frustration of insomnia.

Stimulus control therapy attempts teach the patient to use the bedroom is only for activities related to sleep. For most people this means not using their beds for any activities other than sleep and sex.

The goal of cognitive therapy is provide reassurance to patients that sleeping less than 8 hours a night is not necessarily unhealthy and does not always lead to major consequences on the following day.

Insomnia is mostly caused by some other factors and these factors may be any medical condition or any substance which interferes with a person’s sleep.

Some common causes of insomnia are stress and anxiety which further increases upto depression level. The causes of insomnia are described one by one as under:

The first and main cause of insomnia is stress. The mind remains active at night due to the concerns about school, work, family or health and thus it make sleeping difficult. Various stressful incidents of life like a job loss, divorce or the death or illness of any loved one can lead to insomnia.

The second common cause of insomnia is anxiety and these anxieties may be of daily routine as well as some serious anxieties cam disturb the sleep.

Stress and anxiety can lead to depression and it further results in insomnia. If a person is depressed either he will sleep too much or face trouble falling asleep. This usually happens because of chemical imbalances in the brain or due to the worries that may keep the person from relaxing enough for sleeping. Other mental disorders are also accompanied with insomnia.

There are certain prescribed drugs like antidepressants, heart and blood pressure medications, allergy medications, stimulants and corticosteroids which can interfere with th e sleep pattern. Some pain medication combinations, decongestants and weight -loss medicines have caffeine and some other stimulants so they can also disturb the sleep. Initially, Antihistamines make a person groggy but they increase the urinary problems and because of which a person has to get up more during night.

Caffeine containing drinks, coffee and tea are famous as stimulants and drinking a single cup of coffee in late afternoon can make difficult for you to sleep at night. Tobacco products contain nicotine which is also one of the stimulants and it can also cause insomnia. Alcohol is used as a sedative and it can be helpful in falling asleep but it does not let the person go into deep phase of sleep due to which the person awake in the middle of night.

Chronic pain, breathing problems or need to urinate after some time can also be the cause of insomnia. Diseases like arthritis, cancer, congestive heart failure, diabetes, lungs disease, gastroesophageal reflux disease, overactive thyroid, stroke, parkinson’s disease and Alzheimer’s disease can be the cause of insomnia. Better medical condition may help in treating with insomnia.

Travelling or diffirent work shift can alter the sleep pattern and this can cause insomnia as this disrupt the body’s circadian rhythms. Circadian rhythms are our internal clocks and they guide us in our sleep-wake cycle, metabolism and body temperature.

Poor sleep hygienes such as irregular sleep schedule, stimulating activities before going to bed, uncomfortable sleep environment, using the bed for things other than sleep and sex are the cause of insomnia. Sleep hygeine is required for sound sleep and the habits that promote good sleep are known as sleep hygeine.

Some people induce learned insomnia by thinking that they will not be able to sleep and try too hard to sleep. This type of people sleep well when they don’t try to sleep.

Eating too much before going to bed make you feel physically uncomfortable which results in difficulty in sleeping. A light snack before going to bed is ok because those who eat too much before sleeping may feel heartburn, backflow of acid and food to the esophagus from the stomach. This feeling keep you from sleeping.

Chances of insomnia increases with increasing age. The more you get older the more chances of sleep disorders. With the process of aging the sleep becomes restless. There are four stages of sleep and as a person age he starts spending more time in 1st and 2nd stage while less time in 3 and 4 stage. Stage 1 is called transitional sleep, stage 2 is called light sleep and the stage 3 is called deep or delta sleep which is the most restful sleep. As that person spends more time in 1 and 2 stage he has a light sleep and has more chances of wakening. With the advancing age our internal clock also advances which means that we start to get tired in early evening and wake up early in the morning.

Activities help in promoting a good night sleep but with the age the activities are decreased and the person becomes physically and socially less active. Daily nap also disturbs the sleep pattern of the person.

Older people develop certain types of diseases which intrupt their sleep. A very common example of this is the development of noncancerous benign prostatic hyperplasia which results in the need of urination after frequent periods which badly disturbs the sleep. In females after the menopause hot flashes which ic a big hurdle in the way of good sleep.

Sleep apnea and restless leg syndrome are also responsible for insomnia and these problems become more common with age. In sleep apnea the breathing is stopped periodically which causes the person to wake and in restless leg syndrome an irresistable desire to move the legs is arised due to an unpleasant sensation in them.

The chances of insomnia are high in older people than youngs because more prescribed drugs are used by the olds which elevates the chances of insomnia due to medication causes.

Insomnia is a also a sleep disorder of children and young people as their internal clocks are delayed and they want to go to bed late and to get up late in the morning.