Common Sleep Disorders

There are over 100 sleep disorders that have been identified in humans. Some are very common (Obstructive Sleep Apnea) to extremely rare (Fatal Familial Insomnia).

OBSTRUCTIVE SLEEP APNEA (OSA) is a common, potentially life-threatening disorder. The good news is that it is easy to recognize and treat.

There are two types of sleep apnea: central and obstructive. Central sleep apnea, which is less common, occurs when the brain does not send the appropriate signals to the muscles of breathing to start a respiration. Obstructive sleep apnea is very common and occurs when airways collapse and air cannot flow in or out of the individual’s nose or mouth, although attempts to breathe continue. These pauses in breathing may last for a few seconds to a minute or more, and may occur as much as a hundred times per hour.

Because the individual is unable to breathe, blood levels of oxygen decrease and carbon dioxide increase, alerting the brain to resume breathing. This causes a disruption in the sleep cycle, which repeats over and over during sleep, preventing the individual with OSA from getting enough deep, restorative sleep.
Symptoms may include:

loud snoring
pauses in breathing
gasping or choking during sleep
morning headache
excessive daytime sleepiness
sexual dysfunction
irritability
memory loss
poor concentration and decision making

Spouses or bed partners are usually the first to recognize the symptoms of loud snoring, pauses in breathing, and the resultant struggle to breathe.

Co-workers may notice that the individual falls asleep during work hours. Often the individual with OSA is unaware he or she has a problem, and should be encouraged to seek assistance for a sleep disorder evaluation.

The consequences of OSA can be serious and may be life-threatening. They include:

high blood pressure
heart disease, heart attack
stroke
weight gain
depression
chronic headache
excessive daytime sleepiness with the increased incidence of motor vehicle and workplace accidents

The first line treatment for OSA is continuous positive airway pressure (CPAP). CPAP is delivered by a mask from a small machine that sits at the bedside. Pressurized air keeps the airway open, allowing for uninterrupted sleep and the elimination of snoring.

Other treatment options if CPAP fails, include upper airway surgery, nasal/sinus surgery, or oral appliances.

NARCOLEPSY is a neurological disorder that affects the lateral hypothalamus in the brain and the production of orexin, which regulates sleep and wakefulness.

An individual with narcolepsy has continual sleepiness and tends to fall asleep unexpectedly and at inappropriate times.

Symptoms include:

excessive daytime sleepiness
sleep paralysis, which is a brief loss of muscle control while falling asleep or awakening
cataplexy, a sudden loss of muscle tone caused by strong emotions, such as; laughing, getting angry, or being surprised
vivid, lifelike hallucinations while falling asleep or awakening

Narcolepsy is diagnosed by a thorough sleep evaluation and history, followed by a sleep study.

Medications are used to treat narcolepsy which enables the individual to resume a normal lifestyle.

RESTLESS LEGS SYNDROME is a common disorder affecting up to 10% of Americans. It is described as a “crawling” sensation that causes an uncontrollable need to move the legs (at times, arms). Stretching and moving the legs causes temporary relief.

The need to move the legs to decrease the discomfort prevents an individual from falling asleep. If left untreated, the disorder may lead to insomnia.

Symptoms of Restless Legs Syndrome include:

uncomfortable sensations in the foot, calf or upper leg
the discomfort is decreased during movement and resumes when movement stops
occurs usually in the evening and night time hours
night time sleep disruption
daytime sleepiness

On occasion, restless legs syndrome is associated with iron-deficiency, diabetes, renal failure, and pregnancy. It often runs in families.

Restless legs syndrome responds well to medications. Anti-parkinson, opoids and benzodiazepines are the classes of medications most commonly used.

Caffeine, alcohol and certain medications can intensify symptoms.

INSOMNIA is the most common sleep disorder. According to the Gallup poll for the National Sleep Foundation:

Almost half of Americans suffer from sleep difficulties at least 1 out of 5 nights
74% of the sufferers have problems an average of 6 nights per month
26% of the sufferers have problems an average of 16 nights per month
70% of those frequent sufferers (the 26%) never discussed it with a health care provider

Individuals with insomnia have difficulty falling asleep, staying asleep or have unrefreshing sleep.

Causes of insomnia may be medical (respiratory problems, movement disorders and other medical disorders), psychiatric/psychological (anxiety, stress, depression) or environmental.

Individuals with insomnia have overactivity in specific brain structures which inhibit the rapid transition from wake to sleep. The resulting hyperactivity of the brain during sleep results in underactivity of the prefrontal cortex during waking hours. The resulting consequences of fatigue, impaired concentration and memory, irritability, lack of productivity at work and decreased quality of life are the driving forces in causing an individual to seek help.

Treatment is aimed at the underlying disorder causing the insomnia. Establishing good sleep habits is the first step in treating insomnia. Refer to the section on sleep hygiene.

Medications may be used to increase the strength of the inhibitory neurotransmitters in the brain or by turning off the brains alerting clock. Cognitive behavioral therapy (CBT) attempts to resolve hyperarousal with behavioral change. Included are relaxation therapy, sleep restriction therapy and stimulus control.