Common Sleep Disorders
Obstructive sleep apnea, commonly known as “sleep apnea,” occurs when the upper airway becomes narrow as the muscles relax excessively during sleep. Patients with sleep apnea, often suffer from daytime sleepiness caused by poor sleep, which is fractured by periodic pauses in breathing and often accompanied by loud snoring.
As the patient’s snoring grows louder, it builds to a crescendo and is followed by silence, which signals that breathing has stopped. Eventually, the patient resumes breathing, often with a noisy grunt or deep guttural breath. The silent periods are called apneas. Patients can have dozens of apneas an hour. Each time, the brain sends a powerful signal to resume breathing. The generation of this signal to resume breathing fractures sleep and interrupts restful restorative sleep, leading to severe tiredness and daytime sleepiness. Sleep apnea is often associated with the need to take naps, which are not very helpful because the patient experiences the same symptoms during the naps.
Untreated, sleep apnea can lead to very serious health risks, including high blood pressure, stroke, heart attack and sudden cardiac death. The fatigue resulting from untreated sleep apnea can also lead to increased motor vehicle accidents.
Sleep apnea can be treated with several advanced modalities, including CPAP therapy, which delivers a stream of compressed air via a hose to a nasal pillow, nose mask or full-face mask, keeping the narrowed airway open so that unobstructed breathing becomes possible. The appropriate amount of air pressure is usually determined by a sleep physician after reviewing the patient’s sleep study. For many patients, improvement may be noticed after a single night's use.
Winthrop also offers participation in a support group for sleep apnea patients, building a community of better educated sleep patients. Patients are strongly encouraged to attend.
Depending on how it is defined, insomnia can mean trouble falling asleep, trouble staying asleep, waking up before the desired time, and the overall feeling of not having had a refreshing sleep (“non-restorative sleep”).
When symptoms persist for more than a month, insomnia is considered a chronic condition in need of a multidisciplinary approach. Patients need to be investigated for underlying primary sleep disorders, which can cause insomnia, such as sleep apnea, restless legs syndrome, shift changes, chronic pain, time-zone changes, medications and co-existing medical conditions.
Insomnia affects from 4-40% of the population. While the disorder affects more women than men of all ages, women frequently under report their complaints. Sleep disorders are often found clustered in families can and sometimes be behavioral because families tend to learn their sleep habits from within the family unit. Untreated insomnia affects health and safety in the workplace, where people deprived of restful sleep can be more conflict prone and cost employers more in absenteeism and health care.
At the Winthrop SDC, insomnia evaluation begins with a detailed clinical interview followed by targeted investigations. Frequently, patients participate in data gathering by keeping a sleep diary or sleep log, which can assist with understanding the patient’s sleep patterns over time. Sometimes mood measurement is also helpful, since many patients with long-standing insomnia also develop or struggle with co-existent depression or anxiety.
The SDC physicians consult with behavioral sleep medicine experts, psychoanalysts and psychologists with expertise in counseling and sleep hygiene instruction, as well as management of anxiety and depression. With this multidisciplinary approach many insomnia patients learn to identify the causes and factors sustaining their insomnia.
Sleep hygiene instruction focuses on providing patients with tips to help them sleep well, including sleeping only when sleepy, getting up and going to bed the same time every day, refraining from exercise at least four hours before bedtime and not using coffee, nicotine and alcohol at least four-to-six hours before bed.
Coupling insight, education and behavioral therapy with medical therapy, patients have the chance to begin sleeping well.
“Parasomnia” refers to disorders that occur during the transition between wakefulness and sleep or between stages of sleep. More common in children, parasomnias are also seen in adults. Common parasomnias include sleep walking and sleep talking, night terrors, and sometimes even very complex behaviors like sleep related eating and sleep related driving.
Restless Legs Syndrome
Also known as Ekbom’s syndrome, restless legs syndrome is characterized by a strange sensation in one or both legs, becoming most troublesome late in the day and sometimes preventing patients from falling asleep. The condition can seriously impair quality of life and often goes undiagnosed for years. Non-pharmacological and pharmacological treatments can be used for treatment.
Narcolepsy, one of the most difficult sleep diagnoses and one of the rarest sleep disorders, is characterized by irresistible daytime sleepiness. Patients sometimes experience abrupt ‘sleep attacks’. Untreated, they are compelled to nap frequently, though these naps are, however, only briefly refreshing. If unaware of the diagnosis, patients can be at serious risk when driving, caring for a child alone, operating heavy machinery or performing work requiring attention, concentration, decision-making and alertness. Nighttime sleep is disrupted with frequent awakenings and an inability to stay asleep for the entire major sleep period.
Narcolepsy patients have difficulty keeping the various compartments of sleep separate. Sleep should be either dreaming sleep or non dreaming sleep, or the individual should be awake. In narcolepsy, blurring these distinct boundaries is common, and patients find themselves experiencing dreams when awake, or feeling unsure if they are awake or asleep. The boundary blurring causes disturbing experiences that can be felt in the body, heard or seen when patients are falling asleep or waking up.
Sometimes they exhibit hypnopompic symptoms, symptoms experienced on the way to waking up. They may sense a foreboding presence in the room, seeing images they believe are apparitions or hallucinations, hearing sounds without being able to pinpoint origin. Another symptom is cataplexy, which is the sudden decline in muscle strength triggered by a strong emotion. Narcolepsy can be present with or without cataplexy, but when cataplexy is recognized, narcolepsy is definitely diagnosed.
Most of the time patients require special sleep studies testing nighttime sleep and daytime napping events before narcolepsy can be confirmed. Confirmation is important because treatment is complex, and management is a life-long commitment.
Sleep experts at Winthrop’s SDC are experienced at identifying narcolepsy and very familiar with its treatment. Narcolepsy patients are often treated with sodium oxybate (Xyrem). They also need to take prescribed stimulants to promote daytime alertness. But treatment of narcolepsy is more than medication; it requires educating the patient, the patient’s family and ideally the patient’s employers. What’s more, the patient should also be directed to local support networks especially the Narcolepsy Network, which has over 100 members in the Long Island area.
REM Sleep Behavior Disorder
Often described to patients as “dream sleep-related behavior disorder”, REM behavior disorder is rare. Patients awaken finding they are engaging in activity that matches a dream they remember having. For example, they dream of diving into a swimming pool and awaken to find themselves diving into a closet. Patients with this condition frequently injure themselves or their bed partner seriously sometimes resulting in fractures or bruises. Occasionally, the behavior can seem aggressive, and the partner wakes up trying to fight the patient off. Patients and their partners are sometimes embarrassed by these behaviors. These patients can benefit from careful evaluations and counseling, as well as behavioral and pharmacological therapy.
Sleep Walking & Sleep Talking
Any movement out of bed during sleep is abnormal. Most people can recognize sleep walking in their child, who may be found wandering around at night, yet evidently asleep. Sometimes this is part of normal development. But it can cause serious injury to children and adults. Sleep walking is one of the parasomnias, which need careful multimodal therapeutic approaches. With sleep walkers it is crucial to keep the environment safe, including the elimination of weapons from the bedroom. Securing doors, windows and balconies is also very important, as is keeping car keys in a safe place and difficult for a sleep-walking person to find.
A very commonly experienced symptom, most children talk in their sleep. When adults talk during sleep or make other noises such as moaning and groaning, evaluation is warranted because these sounds can be signs of underlying conditions.
Very common and familiar, snoring is assumed to be normal, but it is never ‘normal’ and should always prompt a visit to the doctor for evaluation. Snoring is the sound caused by breathing through a narrowed airway, which could be narrowed at the nose, at the back of the throat or behind the tongue. While people often come for medical attention at the request of their sleep-deprived bed partner, snoring may be detrimental to the snorer. Snoring can also be a sign of sleep apnea, a more serious sleep disorder. There are many treatments for snoring, usually offered in conjunction with surgeons who may need to perform surgery to relieve the condition.
Many Americans are sleep deprived, and driven by the prevailing American culture of “sleep machismo” — the culture of valuing work as paramount over all else including sleep. Those who appear to get by on less sleep are seen as more ‘macho’ than those who do not. This belief system can be dangerous because it promotes the view that sleep deficit — which can seriously affect memory, coordination and attention — is a quality to be lauded and emulated. The consequences of sleep deprivation include impulsivity, errors, mood swings, inability to concentrate.