Sleep Disorders

Science has described more than 70 sleep disorders, most of which can be managed effectively once they are correctly diagnosed.  Sleep disorders account for an estimated $16 billion in medical costs each year, while the indirect costs due to lost productivity and other factors are much greater.  The most common sleep disorders include insomnia, Circadian rhythm disorders, sleep apnea, narcolepsy, restless leg syndrome and sleepwalking.  If you’re suffering from sleepiness its possible that you are suffering from one or more of the conditions below.

Insomnia

Insomnia, which is Latin for “no sleep,” is the inability to fall asleep or remain asleep adequately.  Insomnia is often practically defined as a positive response to either of two questions: “Do you experience difficulty sleeping?” or “Do you have difficulty falling or staying asleep?”

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Insomnia is the most common sleep complaint among Americans. It can be either acute; lasting one to several nights, or chronic; lasting months to years. When insomnia persists for longer than a month, it is considered chronic.

Insomnia is most often thought of as both a sign and a symptom that can accompany several sleep, medical, and emotional disorders. Half of all those who have experienced insomnia blame the problem on stress and worry. Insomnia is characterized by a persistent difficulty falling asleep and/or staying asleep or sleep of poor quality.

If you have difficulty sleeping, it is essential to determine whether an underlying disease or condition is causing the problem. Insomnia can be caused by pain, digestive problems or another sleep disorder. Insomnia may also be the result of emotional or cognitive disorders such as anxiety and depression. If insomnia is indeed caused by an underlying condition, often times, it will make this condition worse.

If your sleep trouble is confined to difficulty falling asleep, or waking too early, the time you are choosing to go to sleep may not be synchronized with your biological clock (see circadian rhythm disorders below).

Another cause of insomnia is poor sleep hygiene. Sleep hygiene, as defined by the national sleep foundation is define as a variety of different practices that are necessary to have normal, quality nighttime sleep and full daytime alertness. See how we help insomnia.

Circadian rhythm disorders

Circadian rhythms are regular changes in mental and physical characteristics that occur in the course of a day (circadian is Latin for “around a day”).  Also called Non-24 Hour Sleep Wake Disorder (N24HSWD), a Circadian rhythm disorder affects the normal 24-hour synchronization of your body’s natural internal clock.

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Circadian rhythms are controlled by the body’s biological “clock.” This clock, called the suprachiasmatic nucleus or SCN, is actually a pair of pinhead-sized brain structures that together contain about 20,000 neurons. The SCN also governs functions that are synchronized with the sleep/wake cycle, including body temperature, hormone secretion, urine production, and changes in blood pressure. In fact, virtually every physiological, hormonal, biochemical, and behavioral measure taken over time shows a strong circadian rhythm. Our biological cycles normally follow the 24-hour cycle of the sun and are greatly affected by the type, amount and timing of the light we are exposed to.

Sleep disorders and difficulties caused by the miss-timing of the body clock include:

• Delayed Sleep Phase Disorder (Sleep onset insomnia) is a sleep disorder in which your sleep patter is delayed by two or more hours.
• Advanced Sleep Phase Disorder (Early morning awakening insomnia) is a condition in which patients have a natural tendency to go to sleep and wake up at times considered early than what is normal.
• Irregular and free-running circadian rhythm is characterized by chaotic or drifting later timing of sleep patterns. Most totally blind people have circadian rhythms that are “free-running” (i.e., that are not synchronized to environmental timing cues.
• Jet-Lag – When travelers pass from one time zone to another, they suffer from disrupted circadian rhythms, an uncomfortable feeling known as jet lag. For instance, if you travel from California to New York, you “lose” 3 hours according to your body’s clock. It usually takes several days for your body’s cycles to adjust to the new time.
• Shift Work Disorder – Symptoms much like jet lag are common in people who work nights or who perform shift work. Because these people’s work schedules are at odds with powerful sleep-regulating cues like sunlight, they often become uncontrollably drowsy during work, and they may suffer insomnia or other problems when they try to sleep.

Sleep apnea

Sleep apnea is a common disorder in which you have one or more pauses in breathing or shallow breaths while you sleep.  Breathing pauses can last from a few seconds to minutes.  They may occur 30 times or more an hour.  Typically, normal breathing then starts again, sometimes with a loud snort or choking sound.

Sleep apnea usually is a chronic (ongoing) condition that disrupts your sleep.  When your breathing pauses or becomes shallow, you’ll often move out of deep sleep and into light sleep.  As a result, the quality of your sleep is poor, which makes you tired during the day.  Sleep apnea is a leading cause of excessive daytime sleepiness and often may be accompanied by another sleep disorder.

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Most people who have sleep apnea don’t know they have it because it only occurs during sleep. A family member or bed partner might be the first to notice signs of sleep apnea. There are different types of sleep apnea;

• Obstructive sleep apnea is the most common type of sleep apnea. In this condition, the airway collapses or becomes blocked during sleep. This causes shallow breathing or breathing pauses. Obstructive sleep apnea is more common in people who are overweight, but it can affect anyone. For example, small children who have enlarged tonsil tissues in their throats may have obstructive sleep apnea.
• Central sleep apnea is a less common type of sleep apnea. This disorder occurs if the area of the brain that controls breathing doesn’t send the correct signals to the diaphragm. As a result, no effort to breathe is made for brief periods. Snoring typically doesn’t happen with central sleep apnea. Central sleep apnea can affect anyone. However, it’s more common in people who have certain medical conditions or use certain medicines.
• Complex Sleep Apnea, in rare cases, central sleep apnea can occur with obstructive sleep apnea.

Narcolepsy

Narcolepsy is a disorder that causes periods of extreme daytime sleepiness.  The disorder also may cause muscle weakness.

Most people who have narcolepsy have trouble sleeping at night.  Some people who have this disorder fall asleep suddenly, even if they’re in the middle of talking, eating, or another activity.

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Narcolepsy also can cause:

• Cataplexy -This condition causes a sudden loss of muscle tone while you’re awake. Muscle weakness can affect certain parts of your body or your whole body. For example, if cataplexy affects your hand, you may drop what you’re holding. Strong emotions often trigger this weakness. It may last seconds or minutes.
• Hallucinations -These vivid dreams occur while falling asleep or waking up.
• Sleep paralysis – This condition prevents you from moving or speaking while waking up and sometimes while falling asleep. Sleep paralysis usually goes away within a few minutes.

The two main phases of sleep are nonrapid eye movement (NREM) and rapid eye movement (REM). Most people are in the NREM phase when they first fall asleep. After about 90 minutes of sleep, most people go from NREM to REM sleep. Dreaming occurs during the REM phase of sleep. During REM, your muscles normally become limp. This prevents you from acting out your dreams. For more information about the stages of sleep click here.

People who have narcolepsy often fall into REM sleep quickly and wake up directly from it. As a result, they may have vivid dreams while falling asleep and waking up. This may also account for the aforementioned cataplexy, hallucinations and sleep paralysis.

Hypocretin, a chemical in the brain, helps promote wakefulness. Most people who have narcolepsy have low levels of this chemical. What causes these low levels isn’t well understood. However, researchers have postulated that certain factors may work together to cause a lack of hypocretin. These factors may include heredity, infections, functional brain deficits, and autoimmune disorders.

Restless Leg Syndrome

Restless legs syndrome (RLS) is a neurological disorder characterized by throbbing, pulling, creeping, or other unpleasant sensations in the legs.  This results in an uncontrollable, and sometimes overwhelming, urge to move them.  Symptoms occur primarily at night when a person is relaxing or at rest and can increase in severity during the night.  Moving the legs relieves the discomfort.  Often called paresthesias (abnormal sensations), or dysesthesias (unpleasant abnormal sensations), the sensations range in severity from uncomfortable to irritating to painful.

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One type of RLS usually starts early in life (before 45 years of age) and tends to run in families. It may even start in childhood. Once this type of RLS starts, it usually lasts for the rest of your life. Over time, symptoms slowly get worse and occur more often. If you have a mild case, you may have long periods with no symptoms.

Another type of RLS usually starts later in life (after 45 years of age). It generally doesn’t run in families. This type of RLS tends to have a more abrupt onset. The symptoms usually don’t get worse over time.

Some diseases, conditions, and medicines may trigger RLS. For example, the disorder has been linked to kidney failure, Parkinson’s disease, diabetes, rheumatoid arthritis, pregnancy, and iron deficiency. When a disease, condition, or medicine causes RLS, the symptoms usually start suddenly.

Medical conditions or medicines often cause or worsen the type of RLS that starts later in life.

Sleepwalking

Sleepwalking is a disorder that originates during deep sleep and results in walking or performing other complex behaviors while asleep.  It is much more common in children than adults and is more likely to occur if a person is sleep deprived.

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A sleepwalker typically remains in the deep sleep stage of sleep throughout the episode, therefor he may be difficult to awaken and will probably not remember the sleepwalking incident. Read more about the stages of sleep here.

The prevalence of sleepwalking is highest for children between the ages of three and seven, and occurs more often in children with obstructive sleep apnea. Sleepwalking often occurs with other sleep disorders such as sleep terrors and bed-wetting.

Other symptoms of sleepwalking include:

• Sleep-talking
• Inappropriate behavior such as urinating in closets (more common in children)
• Screaming (when sleepwalking occurs in conjunction with sleep terrors)
• Violent attacks on the person trying to awaken the sleepwalker

Bed-wetting

Bed-wetting, known as nighttime incontinence or nocturnal enuresis, is defined as the involuntary urination during sleep.  It fairly common in fact, it is estimated that seven million children in the United States wet their beds on a regular basis.  The age at which children develop bladder control is variable and bed-wetting most often is a result of immaturity or developmental delay.  Bed-wetting has been linked with behavioral issues and poor self-esteem.

There are both primary and secondary forms of bed-wetting.  With primary bed-wetting, the child has never had nighttime control over urination.  The secondary form is less common and refers to bed-wetting that occurs after the child has been dry during sleep for 6 or more months.

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Primary nocturnal enuresis (PNE)

Primary nocturnal enuresis (PNE) is the most common form of bed-wetting. Medical guidelines vary on when a child is old enough to stay dry. Common medical definitions allow doctors to diagnose PNE beginning at between 4 to 5 years old.

Some researchers, however, recommend a different starting age range. This guidance says that bedwetting can be considered a clinical problem if the child regularly wets the bed after turning 7 years old.

Secondary nocturnal enuresis

Secondary enuresis occurs after an individual goes through an extended period of dryness at night (roughly six months or more) and then reverts to nighttime wetting. Secondary enuresis can be caused by emotional stress or a medical condition, such as a bladder infection or a hormonal imbalance.

Genetic relationship

Bedwetting has a strong genetic component. Children whose parents were not bedwetters have only a 15% incidence of bedwetting. When one or both parents were bedwetters, the rates jump to 44% and 77% respectively.

Causes

Other causes include:

• Immaturity • Developmental delay • Physical abnormalities
• Genetics • Caffeine consumption • Psychological, emotional
• Alcohol consumption • Hormonal imbalance • Other Sleep Disorders

Night Terrors

Night terrors (sleep terrors) are a sleep disorder in which a person quickly wakes from sleep in a terrified state.

Night terrors are most common in males, although they also can occur in females. The prevalence of sleep terror episodes has been estimated at 1%-6% among children and at less than 1% of adults. Sleep terrors begin between ages 3 and 12 years and then usually dissipate during adolescence. In adults, they most commonly occur between the ages of 20 to 30.  Night terrors may run in families and occur in adults, especially when there is emotional tension or the use of alcohol.

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Night terrors are most common during the first third of the night, often between midnight and 2 a.m.

  • The universal feature of night terrors is inconsolability
  • The individual often screams and is very frightened and confused. He may thrash around violently and often is not aware of his surroundings, so caution should be taken.
  • You may be unable to talk to, comfort, or fully wake up a person who is having a night terror.
  • The person may be sweating, breathing very fast (hyperventilating), have a fast heart rate, and widened (dilated) pupils.
  • The spell may last 10 – 20 minutes, then the person goes back to sleep.

Most are unable to explain what happened the next morning. They often have no memory of the event when they wake up the next day.

Children with night terrors may also sleep walk.

In contrast, nightmares are more common in the early morning. They may occur after someone watches frightening movies or TV shows, or has an emotional experience. A person may remember the details of a dream when he or she wakes up, and will not be disoriented after the episode.