What are sleep disorders?
What is Sleep Apnea?
Sleep Apnea is a serious, potentially life-threatening condition that is far more common than generally understood. There are two types of sleep apnea: central and obstructive.
Obstructive Sleep Apnea (OSA) is the most common and severe. The muscles at the back of the throat relax to the point of obstructing the upper airway. Breathing can actually stop for 10 seconds or more causing mini-awakenings (usually not remembered) several hundred times a night as the sleeper chokes or gasps for air. Loud snoring is common. Though, not everyone who snores has this condition.
Obstructive Sleep Apnea occurs in men and women of all ages, but is more common in men. An estimated 18 million Americans have sleep apnea. See our sleep disorders checklist on our Patient Information page for symptoms. Those most likely to have sleep apnea include those who snore loudly and are overweight, or those with high blood pressure, or those with a physical abnormality in the nose, throat, or other parts of the upper airway.
Central Sleep Apnea is less common and results from a failure of the brain to send proper breathing signals to the muscles of the diaphram and muscles around the lungs.
What Are the Causes of Sleep Apnea?
During sleep, all muscles in the body profoundly relax. The muscles in the throat and the tongue are no exception. OSA can occur during sleep when these muscles become slack and partially block the opening of the upper airway. Obesity, a narrow airway, or certain phycial abnormalities in the nose and throat are likely to severely exaggerate or even cause OSA. Unknown to the person, this results in heavy snoring, periods of no breathing, and frequent arousals (causing abrupt changes from deep sleep to light sleep). Alcohol and sleeping medications often make symptoms of OSA worse.
How is Sleep Apnea Treated?
The specific therapy for sleep apnea is tailored to the individual patient based on medical history, physical examination, and the results of polysomnography. Oxygen is sometimes used in patients with pulmonary disease or central apnea caused by heart failure.
CPAP Therapy - Nasal continuous positive airway pressure (CPAP) is the gold standard treatment for sleep apnea. In CPAP therapy, the patient wears a mask over the nose during sleep, and pressure from the CPAP inflates the upper airways to prevent them from collapsing and to allow breathing to continue. CPAP therapy has the advantage of causing no surgical changes to the airway and it may be adjusted over time as symptoms of apnea increase or decrease, especially with weight loss. Apnea episodes return when CPAP is stopped or it is used improperly.
Surgery - Most surgeries are performed by Otolaryngologists (Ear, Nose and Throat specialists). Surgery is often chosen by individuals who are intolerant of CPAP therapy. More common procedures include removal of adenoids and tonsils (especially in children) and correction of structural deformities.
Other Therapies - Behavioral changes that result in weight loss can be effective in treating OSA. Also, apnea sufferers should know that alcohol, pain medications and certain sleeping pills can aggrivate apnea by further relaxing airway muscles and worsening apnea. In patients with mild sleep apnea, sometimes avoiding sleeping on the back can alleviate symptoms.
What is Periodic Limb Movement is Sleep (PLMS)?
Periodic limb movements in sleep are characterized by uncontrollable movements of legs and even arms during sleep. These movements are often felt as twitches, jerks, or kicks. They tend to cluster into episodes lasting for minutes or even hours.
Symptoms of PLMS - Individuals with PLMS may experience twitches, jerks, or kicks. They may also have Restless Legs Syndrome (RLS), an irritation or uncomfortable sensation in the calves or thighs when awake, during sleep onset or during awakenings in the night. However, many people with PLMS may not be aware of the symptoms because they are asleep. In fact, bed partners often notice PLMS symptoms more than the one suffering from symptoms. Men and women both experience PLMS with equal frequency, but those over age 65 are much more likely to have the disorder.
Effects of PLMS - PLMS is implicated as a contributing factor in chronic insomnia and/or daytime fatigue because they may cause awakenings during the night. PLMS can decrease the quality of sleep because leg twitches and kicks are often accompanied by arousals from deeper sleep and may be followed by apneas.
What is the Treatment for PLMS?
While not medically serious, PLMS can negatively effect sleep quality. PLMS responds to several medications. Providers usually only treat PLMS in individuals that also have restless legs (RLS), insomnia or daytime fatigue.
What is Narcolepsy?
Narcolepsy is a chronic (long-lasting) disorder that involves your body's central nervous system. For individuals with narcolepsy, the messages about when to sleep are disrupted. Recent research indicates that such a lack of chemical in the brain called hypocretin, which stimulates arousal, may be a cause of narcolepsy. As a result, these people can feel extreme fatigue or fall asleep at times that are not appropriate like while driving, at work, or while tending their children. While relatively rare (1 in 2000 people have it), narcolepsy can be devestating to its sufferers. While narcolepsy effects men and women in equal numbers, its symptoms usually only begin after puberty, usually between age 15 and 30, and persist for the remainder of life.
Symptoms of Narcolepsy - In addition to excessive daytime sleepiness as described above, key symptoms include:
Cataplexy - a sudden loss of muscle control ranging from slight weakness to total collapse. It is commonly triggered by intense emotion.
Sleep paralysis - being unable to talk or move for a brief period when falling asleep or waking up.
Hypnagogic hallucinations - vivid and often scary dreams and sounds reported when falling asleep.
Automatic behavior - familiar, routine or boring tasks performed without full awareness or later memory of them.
How is Narcolepsy Diagnosed?
A diagnosis includes a screening by the patient’s physician and by OmniSleep for symptoms. Because other sleep disorders like apnea and PLMS can also cause excessive sleepiness, an overnight sleep study is used to rule out other sleep disorder. If no other sleep disorders are diagnosed by a PSG study, the sleep lab will perform a Multiple Sleep Latency Test (MSLT), which measures the time it takes to fall asleep and to go into deep sleep while taking several naps over a period of time.
How is Narcolepsy Treated?
Narcolepsy is treated primarily with medications, namely, modafinil (ProvigilTM) or stimulants to increase alertness, and antidepressants to control other symptoms like cataplexy and hypnagogic hallucinations. Striking the best balance between maintaining alertness and minimizing side effects is the goal. Other treatment considerations may include daily napping, getting at least eight hours of sleep per night, avoiding caffeine / nicotine / alcohol after 5pm , improving sleep hygeine, and regular exercise. Individuals with narcolepsy may also benefit from seeking careers and life pursuits that are a good fit for the symptoms of narcolepsy.