Sleep Disorders vary in nature and degree.
The three major sleep disorders are dyssomnias, hypersomnia
and parasomnias.
Examples Of Sleep Disorders Include:
Insomnia
Insomnia, the sense of not getting enough sleep to awake
refreshed, affects 20 to 40 percent of all adults in the
course of any year. Although insomnia has myriad causes,
it can roughly be divided into three categories: predisposing,
precipitating and perpetuating.
Predisposing factors are the built-in characteristics
of a person that make him or her vulnerable. Tense or driven
people whose heads are brimming with plans or worries can
easily lose sleep. Others with severe depression often cannot
sleep through the night. In manic disorders, sleeplessness
may be important early sign of impending mania in bipolar
patients. A few have neurologic or other conditions that
affect them mainly at night - restless legs syndrome (for
example) or the involuntary twitching of leg muscles (nocturnal
myoclonus).
Precipitating factors are events in life that trigger
a period of disturbed sleep. Stresses that precipitate insomnia
may include an increase in responsibilities, the loss of
a loved one, hospitalization or acute pain, to name a few.
An abrupt alteration of schedule, resulting from a change
of shift at work or jet lag, can also provoke insomnia.
Perpetuating factors are behaviors that help to maintain
sleeplessness once it has begun. These include irregular
sleep habits and the use of drugs. Abuse of alcohol may
cause or be secondary to the sleep disturbance. Heavy smoking
(more than a pack a day) causes difficulty in falling asleep.
When sleeping pills help, it is mainly with the precipitating
causes of insomnia and only then for a relatively brief
period of time.
Short-term or transient insomnia is seen in people who
have no history of sleep disturbances and who have a fairly
obvious precipitating factor. Taking sleeping pills for
a short period of time (perhaps a few days) may be helpful
in such cases, and there is little controversy about prescribing
them to help people through a crisis. However, chronic insomnia
(defined as three weeks or more of almost nightly sleep
difficulty) is rarely helped by drugs.
Early Awakening
Waking too early may represent a rebound from use of alcohol
at bedtime or even from certain types of sleeping pills.
It is also a symptom of depression. Some people sink into
depression gradually, and feeling blue eventually becomes
a chronic way of living. Others focus on poor sleep, telling
themselves and others, "Life would be much better if
only I could get a decent night's sleep."
Sleep Apnea
The word "apnea" means the absence of breathing.
During sleep, our breathing changes with the stage or depth
of sleep. Some individuals stop breathing for brief intervals,
however, when these episodes of apnea become more frequent
and last longer, they can cause the body's oxygen level
to decrease, which can disrupt sleep. The patient may not
fully awaken, but is aroused from the deep restful stages
of sleep, and thus feels tired the next day.
Sleep apnea should be suspected in individuals who are
noted to have excessive daytime sleepiness and other symptoms
described above, especially if they are known to snore and
have a restless sleep. Commonly, these patients have exhibited
loud snoring for many years, more often are male, and note
that the daytime sleepiness has become a progressive problem
over many months. Less commonly, they may be bothered by
bedwetting or impotence. The sleep problems are often aggravated
by alcohol or sedative medications. They are also more readily
noticed by the patient's family and friends, especially
the bed partner.
Narcolepsy
Narcolepsy is a chronic sleep disorder, characterized by
excessive sleepiness and accompanied by a series of auxiliary
symptoms, typically beginning in adolescence or young adulthood.
It affects both sexes approximately equally. The principal
symptoms are excessive daytime sleepiness (EDS), cataplexy
(loss of muscle tone), hallucinations, sleep paralysis and
disrupted nighttime sleep. Doctors also diagnose narcolepsy
by measuring how quickly the patient falls asleep and how
often rapid eye movements are present at or near the onset
of sleep.
Diagnosis
Your physician will take a complete medical history, perform
a physical exam and may suggest additional tests, including
sleep studies.
Treatment
Treatment varies, depending on the specific sleep disorder,
but may include psychologic strategies as well as medications.
• Good sleeping habits
• Go to bed only when sleepy.
• Sleep only in the bedroom.
• If still awake after 20 minutes, leave the bedroom
and return when sleepy.
• Get up at the same time each morning regardless
of the amount of sleep during the night.
• Discontinue caffeine and nicotine in the evening
(if not completely).
• Establish a daily exercise program.
• Avoid alcohol because it may disrupt continuity
of sleep.
• Learn and practice relaxation techniques.
