Sleep disorders: Facts and Overviews

Sleep Disorders Overview

Sleep disorders include a range of problems from insomnia to narcolepsy and affect millions of Americans. Sleep disorder or somnipathy is a medical disorder of the sleep patterns of a person or animal.

Sleep problems, including snoring, insomnia, sleep apnea, sleep deprivation and restless legs syndrome are common. A good sleep is necessary for optimal health and can affect hormone levels mood and weight.

Some sleep disorders are serious enough to interfere with normal physical, social, mental and emotional functioning. The Polysomnography is a test commonly ordered for some sleep disorders.

Most common sleep disorders include:

• Bruxism: Involuntarily grinding or a clenching of the teeth while sleeping.
• Delayed sleep phase disorder (DSPD): inability to awaken and fall asleep at socially acceptable times but no problem with sleep maintenance, disorder of circadian rhythms. (Some such disorders are advanced sleep phase disorder (ASPD), non-24-hour sleep–wake disorder (non-24), and irregular sleep wake rhythm, much less common than DSPD as well as the transient jet lag and shift work sleep disorder.)
• Hypopnea syndrome: have Abnormally shallow breathing or slow respiratory rate while sleeping.
• Idiopathic hypersomnia: a primary neurologic hypersomnia which shares many similarities with narcolepsy.
• Insomnia disorder: A Chronic difficulty in falling asleep and/or maintaining sleep when no other cause is found for these symptoms.
• Kleine–Levin syndrome
• Narcolepsy: Excessive daytime sleepiness (EDS) often culminating in falling asleep spontaneously but unwillingly at inappropriate times. Often associated with cataplexy, sudden weakness in the motor muscles that can result in collapse to the floor.
• Night terror: Pavor nocturnus, a sleep terror disorder: abrupt awakening from sleep with behavior consistent with terror.
• Nocturia: A frequent need to get up and go to the bathroom to urinate at night. It differs from Enuresis or a bed-wetting in which the person does not arouse from sleep and the bladder nevertheless empties.
• Parasomnias: A Disruptive sleep-related events involving inappropriate actions during sleep; sleep walking and night-terrors are examples.
• Periodic limb movement disorder (PLMD): Sudden involuntary movement of arms and or legs during sleep, example kicking the legs. Also known as nocturnal myoclonus. See also Hypnic jerk which is not a disorder.
• Rapid eye movement sleep behavior disorder (RBD): Acting out violent or dramatic dreams while in REM sleep, sometimes injuring bed partner or self (REM sleep disorder or RSD)
• Restless legs syndrome (RLS): An irresistible urge to move legs.
• Sleep apnea, obstructive sleep apnea: Obstruction of the airway during sleep causing lack of sufficient deep sleep, more often accompanied by snoring. Other forms of sleep apnea are less common. When air is blocked from entering to the lungs, the individual unconsciously gasps for air and sleep is disturbed. Stops of breathing for at least ten seconds and 30 times within seven hours of sleep, classifies as apnea. Some forms of sleep apnea include central sleep apnea and sleep-related hypoventilation.
• Sleep paralysis: is characterized by temporary paralysis of the body shortly before or after sleep. Sleep paralysis can be accompanied by auditory, visual or tactile hallucinations. It’s not a disorder unless severe. Often seen as part of narcolepsy.
• Sleepwalking or somnambulism: Engaging in activities that are normally associated with wakefulness (such as eating or dressing), which may include walking, without the conscious knowledge of the subject.
• Somniphobia: A cause of sleep deprivation. a Somniphobia is a dread fear of falling asleep or going to bed. The signs of illness include anxiety and panic attacks during attempts to sleep and before it.
• Situational circadian rhythm sleep disorder: shift work sleep disorder (SWSD). Jet lag was previously included, but it doesn’t appear in DSM-5 (Diagnostic and Statistical Manual of Mental Disorders).

The amount of sleep a person needs in general:

• Infants require sleep about 14-15 hours a day.
• Teenagers need about 8.5-9.5 hours on average.
• Most adults need at least 7 to 9 hours a night for the best amount of sleep, although some people may need as few as 6 hours or as many as 10 hours of sleep each day.
• Women in first 3 months of pregnancy often need several more hours of sleep than usual.

The Dangers of Sleep Deprivation

Many studies make it clear that sleep deprivation is dangerous. Sleep deprived are people who were tested by using a driving simulator or by performing a hand-eye coordination task perform as badly as or worse than those who are intoxicated.

Sleep deprivation can also magnifies alcohol’s effects on the body, so a fatigued person who drinks will become much more impaired than someone who is well rested.

Driver fatigue is responsible for an estimated about 100,000 motor vehicle accidents and about 1,550 deaths each year, according to the National Highway Traffic Safety Administration. But since drowsiness is the brain’s last step before falling asleep, driving while experiencing drowsy can and often does lead to disaster. The caffeine and other stimulants cannot overcome the effects of severe sleep deprivation.

National Sleep Foundation says you are probably too drowsy to drive safely if you:

• Have trouble keeping your eyes focused
• Can’t stop yawning
• Can not remember driving the last few miles
• Are day dreaming and wandering thoughts
• Have trouble holding your head up
• Are drifting in and out of lanes

Diagnosing insomnia

Insomnia is characterized by an extended period of symptoms including trouble with retaining sleep, fatigue, decreased attentiveness and dysphoria. To diagnose insomnia these symptoms must persist for a minimum of 4 weeks. DSM-IV categorizes insomnias into primary insomnia, insomnia associated with a medical or mental illness and insomnia associated with the consumption or abuse of substances. Individuals with insomnia often worry about the negative health consequences, which can lead to the development of anxiety and depression.

The following tests are used to diagnose insomnia as well as several other sleep disorders.

• Sleep diary: Tracking sleep patterns may help a doctor reach a diagnosis.
• Epworth Sleepiness Scale: a validated questionnaire that is used to assess daytime sleepiness
• Polysomnogram: a test measuring brain and muscle activity including breathing during sleep
• Multiple Sleep Latency Test: a test for daytime sleepiness, usually administered the day after overnight polysomnography
• Actigraphy: a test to assess sleep-wake patterns, usually for a week or more. Actigraphs are wrist-worn devices, about the size of a wristwatch, that measure movement.
• Mental health exam: Because insomnia may be a symptom of depression, anxiety, or another mental health disorder, a mental status exam, mental health history, and basic mental evaluations may be part of the assessment for a person complaining of insomnia.