Sleep Disorders

Almost everyone occasionally suffers from insomnia. Insomnia can result from stress, jet lag, diet, or many other factors. It can also affect job performance and well-being the next day.

Each year about 60 million Americans report frequent or extended periods of insomnia. Insomnia tends to increase with age and affects about 40 percent of women and 30 percent of men.

Recurring insomnia can lead to serious sleep deficits and other issues. It is often the major disabling symptom of an underlying medical disorder.

TREATMENT:

Mild insomnia often can be prevented or cured by practicing good sleep habits. For short-term insomnia, doctors may prescribe sleeping pills. Most sleeping pills stop working after several weeks of nightly use, and long-term use of sleeping aids can actually interfere with good sleep.

Researchers are experimenting with light therapy and other ways to alter circadian or sleep cycles to treat more serious cases of insomnia.

It is important to talk openly with your doctor about everything going on in your life and in your body, as insomnia could be caused by both internal issues and external stimuli such as stress.

Sleep apnea causes interrupted breathing during sleep which, if advanced, can not only prevent a good night’s sleep but can be quite dangerous.

It is usually associated with loud snoring, although not everyone who snores has this disorder. An estimated 18 million Americans have sleep apnea. However, few of them have seen a doctor have the problem properly diagnosed and treated.

Basically, sleep apnea can prevent proper oxygen flow to the brain, which could result in daytime sleepiness and other issues.

Obstructive sleep apnea occurs in association with fat buildup or loss of muscle tone with aging which can allow the windpipe to collapse during breathing when muscles relax during sleep. It can also occur if the neurons that control breathing malfunction during sleep.

During an episode of obstructive sleep apnea:

• The person's effort to inhale air creates suction that collapses the windpipe which blocks the airflow for 10 seconds to a minute while the sleeping person struggles to breathe.
• When the person's blood oxygen level falls, the brain responds by awakening the person enough to tighten the upper airway muscles and open the windpipe.
• The person may snort or gasp, then resume snoring.

This cycle may be repeated hundreds of times a night. The frequent awakenings that sleep apnea patients experience leave them continually sleepy and may lead to personality changes such as irritability or depression.

Sleep apnea also deprives the person of oxygen, which can lead to morning headaches, a loss of interest in sex, or a decline in mental functioning.

It also is linked to high blood pressure, irregular heartbeats, and an increased risk of heart attacks and stroke.

In fact, patients with severe, untreated sleep apnea are two to three times more likely to have automobile accidents than the general population.

In some high-risk individuals, sleep apnea may even lead to sudden death from respiratory arrest during sleep.

Diagnosis

Patients experiencing loud snoring, interrupted sleep, and extreme daytime sleepiness should be tested at a specialized sleep center—like Semmes Murphey Clinic—that can perform a polysomnography test which records the patient's brain waves, heartbeat, and breathing during an entire night.

The Semmes Murphey team will assess the patient’s level of sleep apnea and propose treatment options.

Treatment

Mild sleep apnea frequently can be overcome through weight loss or by preventing the person from sleeping on his or her back.

Other people may need special devices or surgery to correct the obstruction.

It is important to note that people with sleep apnea should never take sedatives or sleeping pills, which can prevent them from awakening enough to breathe.

Restless legs syndrome (RLS) causes unpleasant crawling, prickling, or tingling sensations in the legs and feet along with an urge to move them for relief. It is emerging as one of the most common sleep disorders.

This familial disorder, which affects as many as 12 million Americans, leads to constant leg movement during the day and insomnia at night.

Severe RLS is most common in elderly people, though symptoms may develop at any age, but it may be linked to other conditions such as anemia, pregnancy, or diabetes.

Many RLS patients also have a disorder known as periodic limb movement disorder (PLMD) which causes repetitive jerking movements of the limbs, especially the legs. These movements occur every 20 to 40 seconds and cause repeated awakening and severely interrupted sleep. In one study, RLS and PLMD accounted for a third of insomnia seen in patients older than age 60.

Treatment

Currently, RLS and PLMD are most often relieved by prescribed drugs that affect the neurotransmitter dopamine, suggesting that dopamine abnormalities underlie these disorders' symptoms. Learning how these disorders occur may lead to better therapies in the future.

Affecting an estimated 250,000 Americans, narcolepsy causes frequent "sleep attacks" at various times of the day—even though they had a normal amount of night-time sleep. These attacks can last from several seconds to more than 30 minutes.

People with narcolepsy may also experience cataplexy (loss of muscle control during emotional situations), as well as hallucinations, temporary paralysis when they awaken and disrupted night-time sleep. Scientists have linked these symptoms seem to be features of REM sleep that appear during waking, which suggests that narcolepsy is a disorder of sleep regulation.

The disorder, or a predisposition to it, is usually hereditary, but it occasionally is linked to brain damage from a head injury or neurological disease. Symptoms of narcolepsy typically appear during adolescence, though it often takes years to obtain a correct diagnosis.

Treatment

Once narcolepsy is diagnosed, stimulants, antidepressants, or other drugs can help control the symptoms and prevent the embarrassing and dangerous effects of falling asleep at improper times. Naps at certain times of the day also may reduce the excessive daytime sleepiness.

In 1999, a research team identified a gene that, when defective, causes narcolepsy. The defective versions of the gene could be preventing the relay of the messages to the cells that promote wakefulness. This breakthrough brings us closer to a cure for this disabling condition.