- Sleep Disorders
Sleep is something many people take for granted. But it is something we all need to daily. A sleep disorder can constitute a serious disruption in our lives. Some sleep disorders are insidious enough that you may not even know you have a problem. You are tired and you don’t know why. A disorder such as Obstructive Sleep Apnea (OSA), for example, can keep you from obtaining a sound sleep for many nights without you being aware of what is causing your lack of rest.
Obstructive sleep apnea is a common and serious sleep disorder that causes you to stop breathing during sleep. The airway repeatedly becomes blocked, limiting the amount of air that reaches your lungs. When this happens, you may snore loudly or making choking noises as you try to breathe. Your brain and body becomes oxygen deprived and you may wake up. This may happen a few times a night, or in more severe cases, several hundred times a night.
In many cases, an apnea, or temporary pause in breathing, is caused by the tissue in the back of the throat collapsing. The muscles of the upper airway relax when you fall asleep. If you sleep on your back, gravity can cause the tongue to fall back. This narrows the airway, which reduces the amount of air that can reach your lungs. The narrowed airway causes snoring by making the tissue in back of the throat vibrate as you breathe.
Sleep apnea can make you wake up in the morning feeling tired or unrefreshed even though you have had a full night of sleep. During the day, you may feel fatigued, have difficulty concentrating or you may even unintentionally fall asleep. This is because your body is waking up numerous times throughout the night, even though you might not be conscious of each awakening.
The lack of oxygen your body receives can have negative long-term consequences for your health. This includes:
- High blood pressure
- Heart disease
- Pre-diabetes and diabetes
Narcolepsy is a lifelong sleep disorder that makes you feel overwhelmingly tired, and in severe cases, have sudden uncontrollable sleep attacks. Narcolepsy can impact nearly every aspect of your life. It is dangerous because you can have excessive sleepiness or a sleep attack at any time of the day, in the middle of any activity including eating, walking or driving. Operating a vehicle with untreated narcolepsy can be very dangerous and some states even have laws against it.
Many people with narcolepsy do not know they have the sleep disorder. About one in 2,000 people have some form of narcolepsy. Narcolepsy may run in some families, but most cases are not genetic. The disorder is extremely rare in children. The cause of narcolepsy is still unknown, but recent research suggests that many people with narcolepsy with cataplexy have low levels of the neurotransmitter hypocretin, a chemical that regulates arousal, wakefulness and appetite.
There are two types of narcolepsy:
Narcolepsy with cataplexy – This type of narcolepsy involves a combination of excessive daytime sleepiness and cataplexy. Cataplexy is when you have attacks that cause a sudden loss of muscle tone while you are awake. It may lead to slurred speech and buckling knees, or in more severe cases complete paralysis. These events are usually triggered by strong emotions such as joy, surprise, laughter or anger.
Narcolepsy without cataplexy – This type of narcolepsy occurs when you have continuous excessive sleepiness but no cataplexy. You may take a nap for a couple of hours and wake up feeling refreshed. But after a short time, you feel tired again.
When you add up the hours of total sleep time, people with narcolepsy don’t necessarily sleep any more than people who don’t have the sleep disorder. This is especially true when you consider that many people with narcolepsy often have difficulty sleeping through the night because of unwanted awakenings.
Some people assume that because they are consistently tired during the day, that they may have narcolepsy. Other sleep disorders that cause daytime sleepiness are often mistaken for narcolepsy. These include sleep apnea, circadian rhythm sleep disorders and restless legs syndrome. Medical conditions, mental health disorders and use of certain medications or substances can also cause symptoms similar to narcolepsy.
Insomnia is the most common sleep complaint. It occurs when you have trouble falling asleep or staying asleep even though you had the opportunity to get a full night of sleep. The causes, symptoms and severity of insomnia vary from person to person. Insomnia may include:
- Difficulty falling asleep
- Difficulty staying asleep throughout the night
- Waking up too early in the morning
Insomnia involves both a sleep disturbance and daytime symptoms. The effects of insomnia can impact nearly every aspect of your life. Studies show that insomnia negatively affects work performance, impairs decision-making and can damage relationships. In most cases, people with insomnia report a worse overall quality of life.
Everyone has the occasional night of poor sleep. In many cases this is due to staying up too late or waking up too early. This does not mean you have insomnia, it means you didn’t get enough sleep.
As many as 30 to 35 percent of adults complain of insomnia. It is more common in groups such as older adults, women, people under stress and people with certain medical and mental health problems such as depression.
There are two types of insomnia based on the regularity and duration of the sleep disturbance and daytime symptoms:
Short-term insomnia: This type of brief insomnia lasts for up to three months. It occurs in 15 to 20 percent of people.
Chronic insomnia: This type of insomnia occurs at least three times per week and lasts for at least three months. About 10 percent of people have chronic insomnia.
A board certified sleep medicine physician can diagnose chronic insomnia. The sleep team at an accredited sleep center can provide ongoing care.
Restless Leg Syndrome:
Restless legs syndrome is a neurological sleep disorder that make you have an overwhelming urge to move your legs. Restless legs syndrome makes it difficult to get comfortable enough to fall asleep. The symptoms are usually worse at night. The sensation is difficult for some people to describe. You may lie down and begin to feel burning or itching inside your legs. If you move your legs or get up and walk around, these symptoms may go away. The discomfort may return when you try again to go to sleep.
In some restless legs syndrome cases, you may have trouble sitting still for long periods of time. Long car rides or airplane travel may be difficult.
Many people wait years to seek treatment because they do not view it as a serious concern. If left untreated, you may notice that your symptoms become more frequent and severe.
Restless legs syndrome may cause you to get fewer hours of sleep each night. Many people with severe cases get less than five hours of sleep per night. Milder cases do not disturb your sleep as much, though the sleep may be of poorer quality.
The accumulated sleep loss from restless legs syndrome can make you excessively sleepy during the daytime, cause you to be irritable and make concentration difficult. This may have a major impact on your professional and personal life. People with restless legs syndrome are more likely to have depression or anxiety.
Restless legs syndrome is almost always manageable through medication and a number of lifestyle changes.
Most people develop restless legs syndrome after age 45. Women are nearly twice as likely as men to develop the disorder. If you have a family member with restless legs syndrome, you are more likely to develop the symptoms before you are 45 years old. More than half of people with restless legs syndrome have a pattern of it in their family, as the risk is about three to six times greater.
Periodic Limb Movements:
Periodic limb movements are when you have episodes of simple, repetitive muscle movements. You are unable to control them. They usually do not keep you from falling asleep. Instead, they severely disrupt your sleep during the night. This can cause you to be very tired during the day. They do not involve a change in body position, stretching a muscle, or a cramp. Instead, the movements tend to involve the tightening or flexing of a muscle. They occur most often in the lower legs. They can occur at two different times:
- Periodic limb movements while you sleep (PLMS)
- Periodic limb movements while you are awake (PLMW)
PLMS are much more common. When they occur often through the night, they can disrupt your sleep many times. Normally, you are unaware of the movements or of waking up. A typical movement is for the big toe to extend. Often the ankle, knee or hip will also bend slightly. Though it is less common, this can also happen in your upper arms. The degree to which these movements occur can change from night to night. They usually happen during non-Rapid Eye Movement (NREM) sleep in the first half of the night. When these movements are very severe, then they may also happen while you are awake (PLMW).
An episode will normally last from a few minutes to an hour. Within that time, movements tend to occur every 20 to 40 seconds. They may affect only one of the legs. More often, they will affect both legs. PLMS are quite common. For most people, the movements do not disturb their sleep in a severe way. This means that it is not a sleep disorder. The sleep of the bed partner tends to be affected more often than that of the patient. The movements reach the level of a disorder, periodic limb movement disorder (PLMD), when they disrupt the patient’s sleep and daily life.
This disorder may be a factor in causing you to have any of the following:
- Bad memory
- Short attention span
Obstructive Sleep Apnea (OSA) where breathing is disrupted: Airway obstruction causing unconscious gasping for air, resulting in a lack of needed deep sleep.
Snoring, which becomes rough enough or loud enough to awaken the subject, or limit needed deep sleep.
Unexpected movement-related problems:
Rapid Eye Movement Behavior Disorder (RBD) or REM Sleep Disorder (RSD), where the individual physically acts out a dream sequence with possibly violent movements, endangering anyone sleeping next to them.
Restless Legs Syndrome (RLS) and Periodic Limb Movement Disorder (PLMD), where sudden involuntary movements disrupt sleep.
Circadian body rhythm disruptions:
Nocturia: Frequent need to go to the bathroom overnight.
Situation-based issues such as jet lag, or Shift-Work Sleep Disorder (SWSD).