Common Adult Sleep Problems/Disorders
Below is information, including symptoms, causes and possible treatment options, on some of the more common sleep-related problems and disorders in adults.
Poor Sleep Habits
Poor sleep habits (referred to as sleep hygiene) are one of the most common problems today. We stay up too late and get up too early. We interrupt our sleep with drugs, chemicals, work, and we overstimulate ourselves with late-night activities such as television. Click here for more information on sleep hygiene, which may provide useful tips on attaining a better night's sleep.
Insomnia is the inability to sleep or inability to sleep well at night. Many different medical and mental health issues cause insomnia. Insomnia may be situational, lasting a few days to weeks, or chronic, lasting for more than one month.
About nine to 12% of the American population report chronic insomnia. In severe cases, patients experience fatigue, sleepiness, difficulty concentrating and difficulty with thinking. Many sufferers feel they no longer have any joy in life. Insomnia may be due to breathing problems at night like sleep apnea, medical illness like heart failure, a side effect of medications, or a symptom of severe anxiety or depression.
While periods of short-term insomnia are well treated with medication, long-term insomnia may not respond to medications. Which means suggesting sleeping pills to patients with chronic insomnia is not an effective treatment method.
An evaluation by the patient's physician or a sleep specialist often helps get to the bottom of the problem. Many patients respond well to what is called "cognitive behavioral therapy." This simply means "education about sleep," and a few simple tips that may help patients sleep. In this form of therapy, incorrect ideas about sleep are corrected. Also, relaxation and behavioral techniques may be used to help patients fall asleep. This, combined with treatment of any underlying disorders is often the best way to treat the devastating symptoms of insomnia. Click here for more information on insomnia treatments.
Sleep apnea is a common and potentially serious sleep disorder. It is the most common reason that patients are referred to sleep centers around the country.
The word apnea means "not breathing." Patients with the usual form of sleep apnea actually close off their airway at night. This airway closure occurs either behind the tongue or behind the nose. Patients continue to make efforts to breathe. Then after 10 to 120 seconds, the brain, realizing it is not getting any oxygen, "wakes up." The brain then tells the upper airway to open to let in some air.
This is associated with loud snoring, often described as snorting or gasping. Patients may take a few breaths of air, the brain goes to sleep again and the cycle may repeat itself several hundred times a night. Although extremely disruptive to their bed partner, patients are often not aware they are doing this.
Sleep apnea is a dangerous condition, it is common, relative easy to diagnose, and treatable. Patients with sleep apnea are at a high risk for heart disease, heart attacks, strokes and high blood pressure. Also, since the sleep is poor quality, patients are often finding themselves sleepy during the day. Sleepiness is associated with the inability to concentrate, remember or think. There is also an increased risk of falling asleep while doing dangerous tasks, such as driving or operating heavy machinery.
Medical treatment involves losing weight if the person is overweight, avoiding alcohol and drugs such as sleeping pills, which increase the risk of apneas, and sometimes sleeping semi-upright. But in most cases, additional treatment is required.
In some instances, we use Continuous Positive Airway Pressure (CPAP) to treat patients. For this treatment, a mask is fit over the nose and/or mouth. The mask is pressurized slightly to hold the airway open and allow the patient to sleep normally. Newer technology has made the masks relatively comfortable to use.
Some patients may be candidates for surgery on the upper airway. In the typical upper airway surgery, the uvula (the punching bag-like object in the back of the throat) and some of the surrounding soft tissue is removed to enlarge the air passage. In other cases, a dental device designed to slightly move the lower jaw down and outwards may be worn at night.
In a few instances when sleep apnea is considered to be immediately life threatening, treatment is begun with an emergent tracheostomy. The decision about which form of treatment to use should be made by the patient and his/her physician on the basis of the sleep studies and other clinical data.
Narcolepsy is a chronic sleep disorder that often begins during adolescence and is characterized by excessive daytime sleepiness with the occurrence of sleep attacks. Narcolepsy can run in families, but can also occur in the absence of any family history.
There are several other characteristic symptoms that may or may not be present, including cataplexy, sleep paralysis and hypnogogic hallucinations.
Cataplexy is the sudden loss of muscle tone, commonly associated with strong emotions. It may be a subtle sensation of weakness or a complete loss of strength that can cause a fall to the ground.
Sleep paralysis is a sensation of not being able to move after waking up, usually for a few seconds.
Hypnogogic hallucinations are very vivid and sometimes violent or bizarre sensations, almost dreamlike, that occur on waking or falling asleep.
The treatment of narcolepsy and its associated symptoms often requires a combination of behavioral modification and drug therapy. Many patients with narcolepsy will be helped by naps scheduled at specific times during the day. Stimulant medication may be taken to reduce daytime sleepiness. Other medications, such as certain anti-depressants, are used to treat cataplexy. A new promising treatment for cataplexy using a drug called sodium oxybate has recently become available. The care for each patient must be individualized and discussed on a one-on-one basis with his/her physician.
Restless Legs Syndrome (RLS) and Periodic Limb Movement Disorder
RLS is more common than previously believed, affecting five to 10% of adults and it seems to increase with age. Restless legs syndrome is characterized by an intolerable, internal itching sensation occurring in the lower extremities that causes an almost irresistible urge to move the legs. The sensation is commonly described as a "creepy-crawly" sensation and is typically relieved by moving the legs. When movement stops, however, the sensations frequently return. These symptoms are more common in the late afternoon or evening hours. In some patients, this problem persists into the nighttime and may prevent patients from sleeping well. Iron deficiency and pregnancy are associated with this disease. In many patients, RLS is extremely disruptive.
Almost all patients with RLS have a problem called periodic limb movement disorder. This disorder involves leg and sometimes arm movements occurring at regular intervals during the night. These movements may interrupt sleep, leading to poor quality sleep. Periodic limb movement disorder can also occur on its own, often reported by the bed partner.
Fortunately, in most people, restless legs syndrome and periodic limb movement disorder are relatively easily treated. Treatment usually includes aerobic and leg stretching exercises. Leg stretching or even yoga exercises can be done before bedtime to lessen the symptoms of mild cases. Iron replacement therapy can also be used if it's discovered a patient is iron deficient. Drugs used to treat Parkinson's disease are also very good at treating most cases. These include the drug pramipexole (Mirapex®) and ropinirole (Requip®). Valium-type medications, such as clonazepam (Klonopin®) or analgesic medications related to morphine and opium, can also be considered. In the most severe of cases, anti-seizure medications may be effective.
Sleepwalking, also called somnambulism, is when a person walks or performs other physical activities during sleep. Sleepwalking is common in children -- it effects up to 15% of children -- but can occur at any age. In children, it can be attributed to sleep deprivation or anxiety. In adults, it is more commonly a result of other medical disorders, medication use, or anxiety or depressive disorders.
An afflicted person may simply sit up in bed with their eyes open, appearing to be awake, or they may perform a complex task. These types of episodes can last from seconds to minutes. Contrary to popular belief, it is safe to wake a sleepwalker. They just may be confused and disoriented when you do so.
There aren't many treatment options for sleepwalking, aside from avoiding any known triggers or treating any existing anxiety or depression. In severe cases, short-term use of sedatives is a possibility. But ideally, it's best to just keep the person in as safe of an environment as possible. We often encourage families to make sure windows are closed and to take any and all other safety measures.
Sleep Disorders and Medical Illnesses
Many medical illnesses cause a person to have sleep problems. Chronic lung disease may lower oxygen levels at night and disturb sleep. Asthma may cause wheezing or shortness of breath during sleep, usually in the early morning hours. Heart failure may lead to abnormal breathing at night, which effects sleep much in the way as sleep apnea. Patients with Parkinson's or other neurological diseases may also develop disturbed sleep.
Sleep Disorders and Mental Illnesses
Many people with a mental illness, like depression, anxiety, post-traumatic stress syndrome or panic attacks, develop serious sleep problems. Insomnia is a common symptom of these problems. But patients can improve by leaps and bounds if evaluated and treated by a knowledgeable health care provider.
For more information or to arrange for a sleep study, please call 410-787-4768.