The US Department of Health and Human Services reports that 40 million people in the United States suffer from sleep problems. Sleep disorders affect a person’s overall quality of life and are related to difficulty falling asleep, staying asleep, the quantity of sleep, quality of sleep, and level of alertness during the day. There are 81 official sleep disorders. The most common sleep disorders are sleep apnea, insomnia, narcolepsy, and restless leg syndrome (RLS). Most sleep disorders can be helped by changing personal habits and behaviors. Nightmares, sleepwalking, headbanging, bedwetting, and teeth grinding are just a few sleep problems called parasomnias. Parasomnias are disorders that disrupt sleep.
Sleep apnea is a disorder of breathing during sleep usually accompanied by loud snoring. People with sleep apnea do not get enough oxygen when they sleep and experience brief moments throughout the night where breathing stops. There are two types of sleep apnea; obstructive sleep apnea and central sleep apnea. Obstructive sleep apnea is the most common type and is caused by an obstruction in the airway during sleep. Central sleep apnea is caused by a delay in the signal from the brain to breath and is difficult to diagnose. In both types of apnea, a person wakes up briefly several times during the night to breathe, usually with no knowledge of doing so. Sleep apnea can be a life-threatening condition if it goes undiagnosed and untreated for a long period of time. The severity of the condition determines how it should be treated.
Mild sleep apnea can be treated with behavioral changes including losing weight and sleeping on your side. However, there are also devices that a person can wear during sleep to help keep the airway open. Moderate to severe sleep apnea is usually treated a machine called the CPAP (continuous positive airway pressure) that blows air into your nose via a nose mask. The continuous air keeps the airway open and unobstructed. A Bi-level PAP(Bi-PAP) machine is used for more severe cases of apnea. The bi-level machine blows air at two different pressures; higher pressure when a person inhales and lower pressure when a person exhales. In cases where CPAP can not help or when a person has a facial deformity that causes sleep apnea, surgical procedures to increase the size of the airway are needed.
Insomnia is another sleep disorder involving difficulty falling asleep, difficulty staying asleep, waking up too early, and sleep state misperception. At times, life events can cause insomnia but it is usually temporary. This is called transient or short-term insomnia. Chronic insomnia involves sleeping poorly most nights for a month or longer. There are usually a number of factors involved including physical and or mental disorders. Depression is the most common cause of chronic insomnia. However, chronic insomnia may also be due to the misuse of caffeine, alcohol and drugs. Chronic insomnia can also be caused by a disruption in the sleep/wake cycle, like shift work and other nighttime activities. Anxiety about sleep and/or chronic stress are other behaviors that can perpetuate insomnia. Medication and behavioral treatment can help with transient, short term and chronic insomnia.
Transient and short term insomnia may not need to be treated because the episodes only last a short period of time. For example, if insomnia is due to a disruption in the sleep cycle, usually a person’s biological clock will readjust to normal on its own. However, short-acting sleeping pills are available for those that experience impaired performance due to day time sleepiness from insomnia. The first step for treating chronic insomnia is diagnosing and treating the underlying medical or psychological problem causing the sleeplessness. This can be followed by identifying and stopping or reducing behaviors that may worsen insomnia. Finally, the use of sleeping pills prescribed at the lowest dose for the shortest duration needed can also be beneficial. Behavioral techniques such as relaxation therapy, sleep restriction therapy and reconditioning are also effective and safe.
Narcolepsy is a chronic sleep condition where a person continues to experience an irresistible need to sleep no matter how much sleep they get. It is mostly a hereditary condition but only prevalent in about 0.3% of the population. Symptoms include, excessive sleepiness, temporary decrease or loss of muscle control (especially when excited), vivid dream-like images when drifting off to sleep or waking up unable to move or talk for a brief time. Symptoms usually begin between the ages of 15 and 30 with a peak in the teenage years. There is no cure for narcolepsy, however, behavior and medical therapy can help control symptoms.
The excessive daytime sleepiness is usually treated with a stimulant drug. Muscle weakness and REM sleep symptoms are treated with antidepressants. The medications reduce symptoms but don’t alleviate them and some medications may have side effects. Maintaining a routine sleep schedule, a good diet, increased exercise and avoiding exciting situations are lifestyle adjustments that can help reduce excessive daytime sleepiness and muscle weakness. With proper medication and support from friends and family, most individuals with narcolepsy enjoy a nearly normal lifestyle.
Restless Legs Syndrome (RLS) is a discomfort or prickly/tingly feeling in the legs relieved by moving or stimulation the leg. The most unusual aspect of this condition is that relaxing or lying down tends to activate the symptoms. Therefore, most people with RLS have trouble falling asleep or staying asleep. When undiagnosed and untreated RLS can cause daytime fatigue and extreme exhaustion. 80% of persons with RLS also experience periodic limb movement disorder (PLMD). PLMD is associated with involuntary leg twitching or jerking movements occurring every 10 to 60 seconds throughout the night. The causes of RLS and PLMD are unknown, however, they can be treated.
Mild to moderate cases of RLS can be treated with lifestyle adjustments including reduction of caffeine intake, alcohol consumption, and tobacco. Taking a hot bath, taking vitamin supplements, using a heating pad and maintaining a regular bedtime routine can also relieve some symptoms of RLS. Dopaminergics, benzodiazepines (central nervous system depressants), opioids, and anticonvulsants are the types of drugs physicians prescribe to treat the disorder since there is no one drug to help everyone with RLS. RLS is a lifelong condition that can be managed but usually gets worse with age.
If you experience lack of sleep, too much sleep, non-breathing spells during sleep, or exhaustion is interfering with your daily life, contact your health care provider for assistance.