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kathleen
 it's been my experience that "disorders" are much like the proverbial
"monkey wrench" that has been thrown into the "works"
with our bodies, tho - it seems that it all starts out
with a minor infraction to your regular routines...
we skip breakfast because we have found a more lucrative job that
forces one to leave earlier in the day than normal, travel farther than normal, encounter more traffic, that not only forces
more stress upon our morning thought processes, but gives us indigestion because if we do try to
eat, we eat while driving in the car, a greasy sausage mcmuffin instead of some fruit & fiber...
it all begins somewhere or somehow like that - the disorder does...
Sleep Disorders
Provided by A.D.A.M., Inc.
Definition
A
sleep disorder is a disruptive pattern of sleep that may include:
- difficulty falling or staying asleep
- falling asleep at inappropriate times
- excessive total sleep time
- abnormal behaviors associated w/ sleep
Causes, incidence & risk factors
More than 100 different disorders
of sleeping & waking have been identified. They can be grouped w/in 4 main categories:
- problems w/ staying
& falling asleep
- problems w/ staying awake
- problems w/ adhering to a regular sleep schedule
- sleep disruptive behaviors
Problems w/Staying & Falling Asleep
Insomnia
- any combination of difficulty w/ falling
asleep
- Episodes may be transient, short-term (lasting 2 to 3 weeks), or
chronic
- common factors associated w/insomnia
- poor sleeping environment (e.g., noise or too much light)
- certain medical conditions
- other counterproductive sleep habits such as early bedtimes, & excessive time spent awake in bed
Disorders include:
- Psychophysiological (learned insomnia)
- Delayed sleep phase syndrome
- Hypnotic dependent sleep disorder
- Stimulant dependent sleep disorder
Problems w/Staying Awake
Disorders of excessive sleepiness are called hypersomnias.
These include:
- Sleep apnea
- Narcolepsy
- Restless leg syndrome
- Obstructive sleep apnea
- Central sleep apnea
- Idiopathic hypersomnia
- Respiratory muscle weakness associated sleep disorder
Sleep
apnea more commonly affects obese people but it may affect others w/ short necks or a small jaw.
The disorder causes:
- breathing to stop intermittently during sleep resulting
in people being awakened repeatedly such that they have difficulty achieving prolonged deep sleep
- results in excessive
daytime sleepiness
Narcolepsy is
a condition of daytime sleep attacks as well as other features which may include sleep paralysis & hypnagogic hallucinations.
Sleep attacks occur despite adequate sleep at night.
Restless leg syndrome is a condition of periodic lower-leg movements during sleep w/ associated daytime sleepiness,
or complaints of insomnia.
Problems w/Adhereing to a Regular Sleep Schedule
Problems
may also occur with maintaining a consistent sleep & wake schedule as a result of disruptions of normal times of sleeping
& wakefulness.This occurs when traveling between times zones & with shift workers on rotating schedules, particularly
w/ nighttime workers.
These disorders include:
- Sleep state misperception (the person
actually sleeps a different amount than they think they do)
- Shift work sleep disorder
- Natural short sleeper (the person
sleeps less hours than "normal" but suffers no ill effects)
- Chronic time zone change syndrome
- Irregular sleep-wake syndrome
Sleep Disruptive Behaviors
Abnormal
behaviors during sleep are called parasomnias & are fairly common in children.
They include:
- Sleep terror disorder
- Sleep walking
- REM behavior disorder (a type of
psychosis can develop related to lack of REM sleep & lack of dreaming)
Sleep terror disorder is an abrupt awakening from sleep w/ fear, sweating, rapid
heart rate & confusion. Sleep walking is not remembered by the person doing it & affects children 2 to 12 years
old.
In adults,
it may also be caused by an organic
brain syndrome, reactions to drugs, psychopathology & medical conditions.
Symptoms - (need we add "night eating"?)
- Awakening in the night
- Difficulty falling asleep
- Excessive daytime drowsiness
- Loud snoring
- Episodes of stopped breathing
- Sleep attacks during the day
- Daytime fatigue
- Depressed mood
- Anxiety
- Difficulty concentrating
- Apathy
- Irritability
- Loss of memory
(or complaints of decreased
memory)
- Lower leg movements during sleep
Note: The symptoms may vary w/
the particular disorder.
- Multiple sleep latency test
- Polysomnography
Treatment
Insomnia - The treatment is related to the
cause, if it's determined. If there's an obvious physical or psychological cause, it's treated.
Attempts
to control environmental & lifestyle factors such as too much light, noise, caffeine or other stimulants, or erratic hours of wakefulness should be made.Sleeping drugs should be used only when prescribed by a health care provider.
Hypersomnia
- Sleep apnea is treated w/ weight reduction
& the administration of air under pressure thru the nose. Occasionally, surgery or other measures may be needed. Narcolepsy is treated with stimulating medications
during the daytime. Restless leg syndrome is treated by treating the underlying disorder & with opiate or dopaminergic
agonists.
Parasomnias -
Night terrors are treated w/ hypnosis, guided imagery techniques
& benzodiazepines, but safety measures are needed to prevent people from harm during nighttime walking.
Sleep
disorder clinics often are able to help people restore normal sleeping patterns thru various techniques.
Expectations (prognosis)
The
outcome varies w/ the type of disorder; some disorders may resolve spontaneously.
Complications
A complication is dependence upon sedatives or other medications prescribed for sleep disorders.
Calling your health care provider
Call for
an appointment w/ your health care provider if lack of sleep or too much sleep is interfering w/ daily living.
Also
call if breath-holding spells are observed during sleep.
Prevention
Maintaining regular
sleep habits & a quiet sleep environment may prevent some sleep disorders.
Last
Reviewed: 7/30/2001 by Galit Kleiner-Fisman MD, FRCP(C), Department of Neurology, University of
Toronto, Toronto, Ontario, Canada. Review provided by VeriMed Healthcare Network.
What are Arousal Disorders?
Arousal disorders are parasomnia disorders presumed to be due
to an abnormal arousal mechanism. Forced arousal from sleep can induce episodes. The "classical" arousal disorders are sleepwalking(somnambulism),
sleep terrors & confusional arousals. Experts believe the various types of arousal disorders are related & share some
characteristics. These arousals occur when a person is in a mixed state of being both asleep & awake, generally coming
from the deepest stage of nondreaming sleep. This means a person is awake enough to act out complex behaviors but still asleep
& not aware or able to remember these actions.
What are the causes arousal disorders?
These disorders tend to run in families & are more common
in children. Being over tired, having a fever or taking certain medications may make it worse. Because disorders of arousal
are less common in adults, having an evaluation is important. In some cases, these disorders are triggered by other conditions,
such as sleep apnea, heartburn, or periodic limb movement during sleep.
A sleep specialist should evaluate the person's
behaviors & medical history.
How are arousal disorders treated?
If it is a severe case that leads to injury or involves violence,
excessive eating, or disturbs the bedpartner or family, treatment by a sleep specialist may be necessary. Treatment might
involve medical intervention with perscription drugs or behavior modification through hypnosis or relaxation/mental imagery.
Mild brain injuries linked to sleep disorders
Reuters Health
Tuesday,
April 3, 2007
NEW YORK (Reuters Health) - Experiencing a mild traumatic
brain injury may increase the risk of developing a sleep disorder & a good portion of
these appear to be based on disturbances in the body's normal circadian rhythm, according to the results of a new study.
"As many as 40 to 65% of patients with minor traumatic brain
injury complain of insomnia," Dr. L. Ayalon, of the University of California, San Diego & colleagues write in the medical
journal Neurology.
In a small study of patients with minor traumatic brain injury,
who were also suffering from insomnia, Ayalon's team found that about 1/3 of the patients had circadian rhythm sleep disorders.
The researchers examined the physiologic & behavioral characteristics
related to circadian rhythm in 42 patients who sustained mild traumatic brain injuries & were having problems with insomnia.
Circadian rhythm sleep disorders are disturbances in the 24-hour
sleep & wake cycle, which may be related to abnormalities in neurological mechanisms or triggered by changes in an individual's
schedule.
The subjects underwent a variety of tests, including melatonin
& temperature measurements & imaging tests. They were also evaluated overnight in a sleep laboratory & completed
a questionnaire to determine the time of day they felt the most awake, or their "circadian preference."
Fifteen of the 42 patients (36%) were diagnosed with a circadian
rhythm sleep disorder. 8 subjects had a delayed sleep phase syndrome & 7 had an irregular sleep-wake pattern.
All 8 patients with delayed sleep phase syndrome had a 24-hour
regular temperature rhythm, but only 4 patients with irregular sleep-wake patterns displayed a similar daily rhythm.
Patients in the irregular sleep-wake pattern group also had
a smaller range of 24-hour temperature rhythm compared with those in the delayed sleep phase syndrome group.
The authors note that the patients described their wake-sleep
patterns that fit the clinical diagnosis they received. For example, the majority of patients diagnosed with delayed sleep
phase syndrome rated themselves as "definitely an evening type," usually an indication of delayed sleep phase syndrome, Ayalon's
team reports.
Conversely, patients diagnosed with an irregular sleep-wake
pattern tended to classify themselves as "neither evening nor morning type," which "is most compatible with the irregular
sleep-wake pattern, which lacks a clear circadian rhythm of sleep-wake cycle."
SOURCE: Neurology, April 2007.
Disrupted sleep may alter pain perception
Reuters Health
Monday,
April 2, 2007
By Amy Norton
NEW YORK (Reuters Health) - People who continually
have their sleep disrupted, whether by insomnia or a crying newborn, may become more susceptible to pain, preliminary research
suggests.
In a sleep-lab study of 32 healthy young women, researchers
found that those who were subjected to repeated sleep disruptions over 3 nights showed a change in their pain perception.
Their bodies' ability to inhibit pain signals declined &
as a group, the women reported more "spontaneous" pain, such as an aching back or stomach cramps, on the days following their
poor night's sleep.
In contrast, this wasn't the case for study participants who
were allowed to sleep for only a few hours per night but didn't have their sleep disrupted.
Although these women slept for the same total time as those
in the disrupted-sleep group, their pain perception appeared unaffected.
This suggests that repeated awakenings during the night might
have a particular affect on the brain's processing of pain, the study authors report in the journal Sleep.
"It's not just the total sleep loss, it's the fragmentation,"
lead researcher Dr. Michael T. Smith, of Johns Hopkins University in Baltimore, told Reuters Health.
Specifically, he said, sleep disruptions may affect the body's
opioid system, which helps regulate pain perception. In doing so, fragmented sleep might contribute to or worsen the chronic
pain of people with fibromyalgia or lower back problems, i.e.
The findings are based on a week-long sleep study of 32 healthy
women. On the first 2 nights, all participants slept for a normal 8-hour period. They were then assigned to 1 of 3 groups
for the next 3 nights: a "forced awakening" group where participants were repeated roused from sleep each night; a 2nd group
that was kept up late & awakened early & a "control" group that continued to get a good night's sleep.
Throughout the study, the women also had their pain perception
measured. In one test, pressure was applied to their arm muscles until they said they felt pain.
In a 2nd test, pressure was applied to each woman's arm while
her opposite hand was immersed in cold water; normally, this cold-water shock should lessen the pain perceived in the other
arm, as the body's pain-inhibiting systems kick in.
However, Smith's team found, this natural pain inhibition appeared
to be dysfunctional when the study participants were subjected to forced awakenings.
What's more, women in this group reported having more aches
& pains on the days following their sleep-disrupted nights.
Smith said the study's forced-awakening condition was akin to
having middle-of-the-night insomnia - or to being a doctor on call or a parent responding to a newborn's cries.
People who have both chronic pain & trouble staying asleep
should consider seeking therapy for their sleep problem, he suggested. One approach to treating insomnia, Smith noted, is
to restrict the amount of time a patient sleeps; although this means at first sleeping for only a few hours, it's a solid,
uninterrupted few hours.
So this type of therapy, by reducing fragmented sleep, might
be helpful for people with chronic pain, according to Smith. "This study actually supports that approach, particularly for
chronic pain patients," he said.
SOURCE: Sleep, April 1, 2007.
Sleep disruptions may increase heart disease risk
Reuters Health
Tuesday, March
27, 2007
By Michelle Rizzo
NEW YORK (Reuters Health) - Relatively healthy individuals
who experience sleep disruptions at night appear to have an increased risk activity of factors associated with the development
of a blood clot, also referred to as a thrombus.
"There's an extensive literature demonstrating that sleep disruption
is associated with increased coronary artery disease risk, but the possible mechanism for that association has been unclear,"
lead author Dr. Joel E. Dimsdale, of the University of California San Diego, told Reuters Health.
"In previous work, we've found that sleep disruption was associated
with pro-coagulant activity in patients with obstructive sleep apnea & in patients facing major life stress," he continued.
"The current study reports similar findings even in a relatively
healthy population."
Dimsdale & colleagues examined whether sleep disruptions,
verified by polysomnography, were associated with increased levels of prothrombotic factors previously shown to predict the
risk of coronary artery disease.
The findings are published in the medical journal Chest.
A polysomnograph, conducted in a sleep laboratory, involves
the measurement of brain waves to record:
- sleep cycles & stages
- plus monitoring muscle activity
- eye movement
- breathing rate
- blood pressure
- blood oxygen levels
- heart rate
The patient is also directly observed during sleep.
A total of 135 unmedicated subjects, an average of 37 years
old, without a history of sleep disorders underwent full-night polysomnography.
The researchers also recorded blood levels of factors associated
with blood clotting & oxygen saturation. In their analyses, they accounted for the effects of age, gender, ethnicity,
body mass index, blood pressure & smoking history.
The investigators found that a higher score on total arousal
index & longer periods of wakefulness interrupting sleep were associated with higher levels of the von Willebrand Factor
antigen & soluble tissue factor antigen, respectively, both of which are linked with blood coagulation.
An association was also observed between average oxygen saturation
levels of less than 90% & the plasminogen activator inhibitor antigen, also involved in coagulation, although this relationship
wasn't statistically significant.
"Our findings suggest that sleep disruptions, even in a relatively
healthy population, are associated with a prothrombotic state that might contribute to coronary artery disease," the authors
conclude.
SOURCE: Chest, March 2007.
Does Melatonin Help With Sleep Problems?
About 1 out of every 3 people has problems sleeping.
There are many possible causes: stress & worry, breathing
difficulties, illness, menopause, depression, shift work, jet lag & poor sleep habits.
Many people seek relief by taking melatonin pills. Melatonin
is a hormone made by the pineal gland in the brain & it's the main hormone in the body that controls our normal sleep–wake cycle.
Because of this function, you might expect that taking
extra melatonin will help you sleep better. Based on the
research that has been done so far, however, melatonin doesn't appear to help people fall or stay asleep & doesn't prevent sleep disruption from travel or shift work.
So, instead of reaching for the melatonin, here are
some tips from the National Sleep Foundation to help you sleep
better:
• Go to bed & get up at about the same
time every day
• Have a relaxing bedtime routine
• Make your bedroom cool, dark, quiet & comfortable
• Sleep on a comfortable mattress & pillows
• Use your bedroom only for sleep & sex
• Finish eating 2 to 3 hours before bedtime
• Get regular exercise
• Stay away from nicotine (tobacco) & caffeine (coffee, tea, soft drinks, chocolate) close to bedtime
• Don't drink alcohol close to bedtime
If you still have problems sleeping, keep a sleep diary & talk to your doctor.
Use sleeping pills only as a last resort. Although TV ads promise a great sleep with no problems, all sleeping pills carry
some side effects. They shouldn't be taken with some medicines or with alcohol, they can lose their effect after a while &
they carry a risk of dependency.
Sleeping pills are best used for short-term problems; their use should be monitored
by your doctor. Chronic loss of sleep affects your health and can cause other medical problems.
It is important to talk with your doctor if you continue to have trouble falling asleep or staying asleep.
Delayed
Sleep Phase Syndrome & Advanced Sleep Phase Syndrome
What is delayed
sleep phase syndrome (DSPS)?
Delayed sleep phase syndrome (DSPS) is a disorder of sleep timing. People with
DSPS tend to fall asleep at very late times & will subsequently sleep later in the day having difficulty waking up in
time for normal work, school, or social needs.
What causes DSPS?
The exact cause of DSPS isn't known, but the disorder is related to circadian
rhythms, which regulate the internal biological clock & influence functions such as sleep-wake patterns. DSPS can occur
in people who have experienced head trauma or serious illnesses.
In these cases, the body's natural healing process might disrupt
normal circadian rhythm & leave the biological clock unable to reset itself. Many teenagers tend to have delayed sleep
phase but often grow out of it.
What are the symptoms of DSPS?
DSPS is characterized by the inability to fall asleep before early morning
(i.e., midnight to 3 a.m.) & difficulty waking in the morning.
Usually, people who have DSPS can fall asleep when the body
signals that it's time. Sleepiness doesn't usually occur before this delayed period.
If a person tries to force the body into a particular phase,
symptoms such as excessive daytime sleepiness, fatigue & altered eating habits might develop.
How is DSPS treated?
DSPS treatments are meant to adjust a person’s circadian rhythm
& sleep pattern. The goal of treatment is to fit a person’s sleep pattern into a schedule that can allow the person
to meet the demands of a desired lifestyle.
Treatment is meant to allow the person with DSPS to wake up
at a given time feeling refreshed & functional. People receiving treatment gradually adjust to an earlier bedtime with
sleep therapy.
This therapy usually combines proper sleep hygiene practice
& external stimulus therapy such as bright light therapy & chronotherapy.
Chronotherapy is a behavioral technique in which bedtime is
systematically adjusted. Bright-light therapy is designed to reset a person’s circadian rhythm to the desired pattern.
When combined, these therapies might produce significant results in people with DSPS.
Patients can also be treated with one medicine that puts them
to sleep earlier in the evening & another medicine that helps wake them up in the morning, but this form of treatment
is usually used only in extreme cases.
What is advanced sleep phase syndrome
(ASPS)?
Advanced sleep phase syndrome (ASPS)
is a disorder in which a person’s sleep time is early in relation to the time of day. This syndrome results in symptoms
of evening sleepiness, an early sleep onset & an awakening time that is earlier than desired.
What causes ASPS?
The disorder is related to circadian rhythms, which regulate the internal
biological clock & influence functions such as sleep-wake patterns.
People with this sleep disorder haven't been studied extensively,
but familial inheritance of this condition has been reported. This condition is more likely to appear in the elderly.
What are the symptoms of ASPS?
People with advanced sleep phase syndrome have:
In people who have ASPS, daytime school or work activities
aren't affected by sleepiness. However, evening activities are cut short by the need to retire early.
Typical sleep onset times are between 6 & 8 p.m. & no
later than 9 p.m. & wake times between 1 & 3 a.m. & no later than 5 a.m. These sleep-onset & wake times occur
despite a person’s best efforts to delay sleep to later hours.
How is ASPS treated?
Advanced sleep phase syndrome is treated with chronotherapy - a behavioral technique in which bedtime
is systematically delayed - or with bright light therapy. Bright-light therapy is designed to reset a person’s circadian
rhythm to a later hour.
© Copyright 1995-2006 The Cleveland
Clinic Foundation. All rights reserved
What is Hypersomnia?
Hypersomnia is characterized
by recurrent episodes of excessive daytime sleepiness or prolonged nighttime sleep.
Different from feeling tired due to lack of or interrupted sleep
at night, persons with hypersomnia are compelled to nap repeatedly during the day, often at inappropriate times such as at
work, during a meal, or in conversation.
These daytime naps usually provide no relief from symptoms.
Patients often have difficulty waking from a long sleep & may feel disoriented.
Other symptoms may include:
- anxiety
- increased irritation
- decreased energy
- restlessness
- slow thinking
- slow speech
- loss of appetite
- hallucinations
- memory difficulty
Some patients lose the ability
to function in family, social, occupational, or other settings. Hypersomnia may be caused by another sleep disorder (such as narcolepsy or sleep apnea), dysfunction of the autonomic nervous system,
or drug or alcohol abuse.
In some cases it results from
a physical problem, such as a tumor, head trauma, or injury to the central nervous system. Certain medications, or medicine
withdrawal, may also cause hypersomnia.
Medical conditions including:
- multiple sclerosis
- depression
- encephalitis
- epilepsy
- obesity
may contribute to the disorder. Some people appear to have a
genetic predisposition to hypersomnia; in others, there is no known cause. Hypersomnia typically affects adolescents &
young adults.
Is there any treatment?
Treatment is symptomatic in nature. Stimulants, such as:
-
amphetamine
-
methylphenidate
-
modafinil
may be prescribed.
Other drugs used to treat hypersomnia include:
Changes in behavior (i.e., avoiding night work & social activities that delay bed time) & diet may offer
some relief. Patients should avoid alcohol & caffeine.
What is the prognosis?
The prognosis for persons with hypersomnia depends on the cause of the
disorder. While the disorder itself isn't life threatening, it can have serious consequences, such as automobile accidents
caused by falling asleep while driving. The attacks usually continue indefinitely.
What research is being done?
The NINDS supports & conducts research on sleep disorders such as
hypersomnia. The goal of this research is to increase scientific understanding of the condition, find improved methods of
diagnosing & treating it & discover ways to prevent it.
What Is Insomnia?
Insomnia is a condition in
which you have trouble falling or staying asleep. Some people with insomnia may fall asleep easily but wake up too soon. Other
people may have the opposite problem, or they have trouble with both falling asleep & staying asleep. The end result is
poor-quality sleep that doesn’t leave you feeling refreshed when you wake up.
Types of Insomnia
There are two types of insomnia.
The most common type is called secondary insomnia. More than 8 out of 10 people with insomnia are believed to have secondary
insomnia.
Secondary means that the insomnia
is a symptom or a side-effect of some other problem. Some of the problems that can cause secondary insomnia include:
- Certain illnesses, such as some heart & lung diseases
- Pain, anxiety & depression
- Medicines that delay or disrupt sleep as a side-effect
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