Sleep Disturbance
WHAT IS A SLEEP DISTURBANCE?
We humans spend about a third of our lives sleeping, making it vital. The quality of our sleep impacts the quality of our lives in many ways, so it is important that we sleep well. It is estimated that as many as 70 million people suffer from some type of sleep disturbance. Over 80 types of sleep disturbances have been identified, the most common of which fall into four categories—insomnia; periodic limb movement and restless legs syndrome; sleep apnea; and hypersomnia and parasomnia disorders.
If disturbed sleep is a problem for you, finding its cause and getting proper treatment can have a tremendous positive impact on the quality of your waking life.
WHAT IS INSOMNIA?
Description.
Insomnia is difficulty in falling or staying asleep. People with insomnia suffer from insufficient sleep. About 10 percent of Americans have chronic insomnia, and half suffer significant sleeplessness at some point during their lives. As people grow older, they tend to sleep less. This reduced need may be upsetting but usually does not lead to health problems.
Symptoms.
Difficulty falling asleep or staying asleep.
Causes.
Insomnia may arise as the result of physical illness or emotional problems (e.g., anxiety or depression). It can also arise from the use or abuse of drugs or alcohol or disruption of a person’s normal sleep schedule, such as during periods of travel. Insomnia can also coexist with other sleep disorders, such as sleep apnea or restless legs syndrome.
Treatment.
Treatment for insomnia varies. Depending on the cause of their insomnia, patients may respond to one or more of the following:
- Understanding that insomnia can be caused by emotional issues such as worry, anxiety, or depression and addressing these issues
- Learning that insomnia is caused by a physical illness and addressing the illness
- Learning relaxation and other stress management techniques
- Not napping during the daytime
- Drinking warm milk before bedtime
- Temporarily taking medication for sleeplessness
WHAT ARE PERIODIC LIMB MOVEMENT AND RESTLESS LEGS SYNDROME?
Description.
People who lose sleep from periodic limb movement experience a jerking in their feet or legs. People with restless legs syndrome have a creeping or crawling feeling during sleep, causing them to move their legs.
Symptoms.
Both of these disorders can cause insomnia and other sleep disturbances. The symptoms of these disorders cause people to sleep less, to not feel refreshed upon awakening, and to feel sleepy during waking hours.
Causes.
These disorders are more common among older people.
Treatment.
See your medical doctor for treatment of these disorders.
WHAT IS SLEEP APNEA?
Description.
Sleep apnea comprises a group of sleep disorders. The most serious of these disorders is obstructive sleep apnea (OSA). In OSA, the upper airway becomes blocked while a person sleeps. The blockage can happen for as long as 90 seconds and as many as several hundred times during a single night. People with OSA experience extreme sleepiness during waking hours. It is more common among men than women.
Symptoms.
Sleep apnea symptoms may include any of the following:
- Loud snoring
- Gasping or choking while sleeping
- Stopped breathing while sleeping
- Repeated awakenings
- Difficulty in waking up when one has to
- Headaches upon waking up
- Extreme sleepiness during waking hours; needing to take naps
These symptoms are often accompanied by personality changes, irritability, poor memory, poor concentration, and sexual problems. Patients with OSA also tend to be obese and suffer from hypertension, upper airway abnormalities, and angina. The symptoms of OSA range from mild to severe. It can even be lethal, although deaths are rare.
Causes.
Moderate to severe obesity can cause OSA and other sleep apnea disorders. The narrowing of the upper airway causes an obstruction during sleep.
Treatment.
Treatment may include any of the following:
- When the disorder is related to obesity, weight reduction usually helps relieve symptoms.
- A mask device called continuous positive airway pressure (CPAP) is helpful in many cases. It relieves symptoms quickly and is easy to use.
- Wearing special mouth appliances help many patients. In rare cases, surgery is needed.
WHAT IS HYPERSOMNIA?
Description.
Hypersomnia comprises a group of sleep disorders in which a person sleeps more than normal. Normal sleep varies greatly and may be any amount from four to ten hours. These disorders can be frightening to the patient and may place him/her in danger. They can also get in the way of social and work relationships.
Symptoms.
Hypersomnia can include narcolepsy (where a person falls asleep suddenly), cataplexy (sudden paralysis or loss of muscle tone), sleep paralysis, and hypnagogic phenomena (vivid auditory or visual hallucinations). The symptoms may appear suddenly or arise gradually over several years.
Causes.
Hypersomnia may be caused by any of the following:
- Anemia
- Brain lesions
- Depression
- Drug abuse
- Encephalitis
- Epilepsy
- Hyperglycemia
- Hypoglycemia
- Hypothyroidism
- Influenzia
- Liver failure
- Multiple sclerosis
- Sleep apnea
- Uremia
Treatment.
Many otherwise normal persons have occasional episodes of sleep paralysis or hypnagogic phenomena but are not bothered, do not seek medical assistance, and need no treatment. For other persons, Modafinil or stimulant drugs may help prevent sleepiness. Tricyclic antidepressants and monoamine oxidase inhibitors are useful in treating cataplexy, sleep paralysis, and hypnagogic hallucinations.
WHAT ARE PARASOMNIAS?
Description.
Parasomnias comprise a group of sleep disorders in which a person is aroused from sleep. This group includes nightmares, sleep terrors, sleepwalking, sleep talking, violent behavior during rapid eye movement (REM) sleep, and seizures during sleep. Parasomnias are dangerous because they may result in injury to the sleeper or to others in the house.
Symptoms.
Parasomnias may include any of the following:
- Nightmares.
- Sleep terrors—waking up suddenly and screaming with fear, going back to sleep after about 15 minutes, and having no memory of the incident.
- Sleepwalking.
- Violent behavior during REM sleep. Also called REM movement disorder.
- Seizures—when a person has a seizure during sleep, he/she may cry out, scream, or get out of bed and move around.
Causes.
Sleep talking may be caused by stress or disorders such as sleep apnea or sleep terrors.
Treatment.
Some of these disorders, such as sleepwalking and sleep talking, are generally harmless and usually disappear after childhood. No medical treatment is needed, but parents should protect sleepwalkers from harm by closing windows and doors. Some disorders, such as REM movement disorder, respond to medication. If a sleep disorder occurs for longer than a month, it is a good idea to see your medical doctor. He/she may recommend that you consult a special sleep disorder center. These centers are staffed with professionals who are trained to help people with all kinds of sleep disorders.
GENERAL SUGGESTIONS FOR BETTER SLEEP
- Avoid drinking caffeine-containing beverages during the 6-hour period before you go to sleep.
- Avoid drinking alcohol or using nicotine during the 2-hour period before you go to sleep.
- Exercise on a regular basis but not shortly before you go to sleep.
- Wake up every day at the same time, regardless of when you went to sleep.
WHERE CAN I GO FOR MORE INFORMATION?
National Sleep Foundation (sleepfoundation.org).
Hauri, Peter, and Linde, Shirley. No More Sleepless Nights. New York: John Wiley & Sons, 1996.
Jacobs, Gregg D. Say Goodnight to Insomnia. New York: Owl Books, 1999.
Utley, Marguerite Jones. Narcolepsy: A Funny Disorder That’s No Laughing Matter. Published by the author, 1995.