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Sleep Disorders

Narcolepsy
Narcoleptics experience daytime sleepiness despite the fact they may be getting sufficient sleep at night. This sleepiness increases to such a point that the person cannot resist the urge to sleep, regardless of what they are doing - driving, in a meeting, or eating for example. The narcoleptic may be asleep for seconds, minutes, or more rarely an hour or more.

Narcolepsy is relatively rare, thought to affect 1 in 2000 Americans. However, many narcoleptics are undiagnosed so the rate may be higher. Most narcoleptics are diagnosed between the ages of 10 and 25, but symptoms can become apparent at any age.

Symptoms of Narcolepsy
Excessive daytime sleepiness is usually the first symptom experienced by narcoleptics. This sleepiness may evolve over time until it becomes debilitating. Sufferers describe an inability to concentrate, extreme tiredness, poor mood, and irritability even after a good night's sleep.

Eventually this tiredness causes the person to suddenly fall asleep, whatever their activity. The duration of the sleep is typically short and the sufferer usually feels refreshed for an hour or more. Automatic behavior syndrome, where the person appears awake but functions without conscious thought, is also common. Just like falling asleep, this has obvious safety consequences.

Cataplexy is experienced by about 70% of narcoleptics, and for about 10% of sufferers is the first symptom to be noticed. Cataplexy is a sudden weakness in the muscles. This could be confined to just muscles in the face or jaw, or could affect many of the muscle groups, causing collapse. It is sometimes misdiagnosed as a seizure, delaying proper treatment. Cataplexy is a distinct symptom, not just falling asleep - in fact the person is fully conscious but unable to respond - a distinction from a seizure. Often the cataplexy is triggered by a strong emotional experience - laughter or fear for example.

Sleep paralysis is also experienced by some narcoleptics - this is an inability to move while falling asleep or waking up. This can be frightening as the sufferer may worry that they are permanently paralyzed. Finally, some sufferers have vivid hallucinations as they fall asleep or wake up. Both sleep paralysis and vivid dreaming are part of the normal sleep cycle called REM sleep, but in the case of narcoleptics the experiences are timed differently, effectively occurring when the person is awake.

Causes of Narcolepsy
The causes of narcolepsy are unknown, but it is clear that the parts of the brain responsible for sleep, and especially REM sleep, are not functioning correctly. There are a number of genes that are typically different in narcoleptics, but the presence of these differences does not always mean that the person will suffer from narcolepsy. Equally, the absence of these gene variations does not mean a person will not suffer from narcolepsy.

In rare cases, brain damage may cause the onset of narcolepsy and it is thought that environmental factors may play a role for some.

Treatment for Narcolepsy
Treatment for narcolepsy is symptomatic - in other words the symptoms are treated, rather than the disease itself. Treatment involves reducing daytime sleepiness and decreasing cataplexic attacks.

For daytime sleepiness, amphetamines have been used for a long time, but have undesirable long term effects. Modafinil is also approved for treating daytime sleepiness and does not have the range of side-effects associated with amphetamines. Some antidepressants are successful in reducing cataplexy, but there are typically side-effects.

Behavioral changes are also important - for example improving nighttime sleep as much as possible and timing naps during the day. Support groups exist and can be very important to the mental well-being of sufferers. If you suspect you have narcolepsy, please discuss your symptoms with your doctor or sleep specialist.

Sleep Apnea
Do you know someone who snores?
Excessive snoring may be a signal that something is seriously wrong with breathing during sleep. Snoring is indicative of an airway that is not properly open; indeed, the sounds of snoring come from the body's extra effort to force air through such a narrowed passageway. Snoring can be one of the important signals of a potentially dangerous sleep disorder called Sleep Apnea.

Obstructive Sleep Apnea Syndrome
Sleep Apnea is a medical condition that requires careful attention and proper treatment. This disorder, which can become life threatening, involves the frequent collapsing of the breathing passageway during sleep. This collapsing can cause a partial or complete blockage of the airway. Symptoms of Sleep Apnea include excessive daytime sleepiness, weight gain, sexual dysfunction and depression. If left untreated, Obstructive Sleep Apnea can often lead to high blood pressure, heart failure, heart attack and stroke.

Diagnosis
Snoring and obstructive sleep apnea affect millions of Americans, often with significant impact on social relationships, energy levels, and cardiovascular health. Although every patient can be helped, our goal is to identify the precise source of the problem and to use noninvasive office treatments whenever possible as opposed to surgery.

Through recent advances, sleep specialists are now able to detect and diagnose breathing disorders at earlier, more effective treatable stages. The first step in diagnosis is to conduct a sleep study. A sleep study is used to identify and measure the different stages of sleep, as well as to record and classify various physiological activities and the problems that may be associated with these during sleep. After the study, a Board Certified Physician will review and interpret these records to determine whether the patient suffers from Sleep Apnea, how severe it may be, and how to best proceed with treatment.

Insomnia
Insomnia leaves people feeling tired, irritable, lethargic, and less focused on tasks at hand. This is a particular problem when driving or performing safety-critical tasks at work. Being tired is highly linked with a greater likelihood of a car crash. According to the American Association of Sleep Medicine, 35 million Americans suffer from chronic insomnia.

Symptoms of Insomnia
There are varying degrees of insomnia. Transient (short term) insomnia is often caused by excitement or stress, such as a long anticipated vacation or a highly important business meeting. The end result is usually sleeplessness for a few nights. Intermittent insomnia is characterized by several bouts of sleeping difficulty occurring over several weeks. The most debilitating form of sleeplessness is chronic insomnia, resulting in poor sleep almost nightly for a period of a month or more.

Causes of Insomnia
Insomnia affects people of all ages, however senior citizens, women (especially after menopause) and those with a current depression or anxiety disorder are more likely to suffer from chronic insomnia.

There are several lifestyle-related factors that may produce insomnia. Persistent stress, such as a troubled marriage, a sickly child or a demanding job can be a major cause of insomnia. Quality of sleep can also be impacted by environmental conditions, such as noise levels, extremes in temperature and changes in sleeping locations and time zones.

Some medications can also trigger episodes of sleeplessness. Nicotine and caffeine are stimulants that can prevent the onset of sleep or trigger awakenings throughout the night. Likewise, the ingredients in many popular over-the-counter medications for the flu, weight loss or asthma can lead to poor sleep.

The causes of chronic insomnia are more complex, often involving a variety of underlying mental or physical disorders, such as depression, arthritis, kidney disease, heart failure, asthma, sleep apnea, narcolepsy, restless legs syndrome, Parkinson's disease and hyperthyroidism.

Treatment for Insomnia
Treatment of insomnia starts with cognitive behavior education - coaching people how to get better sleep and putting a plan of sleep therapy in place. Medication (sleeping pills) are commonly prescribed, but there are long-term effects and they should not be regarded as the first solution. There are also new drugs that act differently than the classic 'knock you out' sleeping pills. The natural supplement Melatonin is used by some people. If you believe you suffer from the symptoms of insomnia, you should talk to your physician or sleep specialist.

Sleep Deprivation
Most people need about 8 hours of sleep a night. Sleep deprivation can be short-term, like a college student staying up to cram for an exam, or chronic. Chronic sleep deprivation occurs when you get less sleep than necessary night after night. You end up with a "sleep debt" which has to be repaid at some point. Sleep deprivation has serious consequences on your health and your ability to live a productive life. Chronic sleep deprivation is thought to cause long term changes to the body, which contribute to increased risk for obesity, cardiovascular disease, diabetes and stroke. Sleep deprivation can be dangerous not only to you but others, since it affects motor skills like driving.

Signs of Sleep Deprivation

  • difficulty waking up in the morning
  • memory difficulties
  • inability to learn new tasks
  • increased clumsiness
  • difficulty making decisions
  • falling asleep at inappropriate times
  • feeling especially moody or irritated

Other Sleep Problems
You may also experience sleep problems as a result of:

  • Chronic respiratory problems or lung diseases, which can worsen during sleep, greatly reducing the oxygen levels in the blood.
  • Significant changes in your sleep-wake schedule, such as those due to shift work, or jet lag.Nightmares or night terrors.
  • Nightmares are frightening dreams which can be recalled later. They may occur at any age. In adults, they may be related to psychological factors. Night terrors, on the other hand, cannot be recalled in the morning and are most common in young children.

 

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