Sleep disorders are a group of syndromes characterised by disturbance in the patient's amount, quality or timing of sleep. It also refers to the changes in behaviours or physiological conditions associated with sleep.
Here, we discuss some of the common disorders:
Jet lag results from rapid long-distance trans-meridian [east-west or west-east] travel, as on a jet plane. The symptoms include headache, fatigue, irregular sleep patterns, insomnia, disorientation, grogginess, irritability, mild depression, constipation or diarrhoea. Gradually adjusting your sleep timings over a few days and ensuring that you sleep the full 7 – 8 hours during that period helps reduce symptoms of jet lag.
Restless leg syndrome [RLS]
People suffering from RLS have an irresistible urge to move their legs. This makes it difficult for them to fall asleep and also interferes with their sleep. RLS is commonly observed in people suffering from anaemia, chronic diseases such as kidney failure, diabetes, Parkinson's disease, and peripheral neuropathy [damage to nerves].
Some pregnant women too experience RLS, especially in their last trimester. Certain medications such as prochlorperasine or metoclopramide, phenytoin or haloperidol, caffeine, alcohol, and tobacco too may aggravate or trigger symptoms in patients who are predisposed to RLS.
Periodic limb movements of sleep [PLMS]
In this case, there are repeated typical movements of the great toe and the foot, which occur every 20 – 40 seconds and disturb sleep. What really causes PLMS is yet unknown. In many cases, patients also suffer from other medical problems such as Parkinson's disease or narcolepsy. Factors that increase the likelihood of PLMS include working in shifts, snoring, drinking excess coffee, stress, and use of hypnotics and sedatives.
Presence of musculoskeletal diseases, heart disease, obstructive sleep apnoea, cataplexy [drop attacks], doing physical activities close to bedtime and a mental disorder are significantly associated with a higher risk of both PLMS and restless legs syndrome.
Sleep walking [somnambulism]
People affected by this disorder carry out automatic activities in their sleep that range from simple to complex. They may even walk out of their house while remaining partially awake. This generally occurs in children and adolescents. So, if you have children at home, be cautious.
Sleep talking [somniloquy]
This refers to talking in sleep, which can be quite loud and can vary from being simple sounds to long speeches. It can even occur many times in a sleep cycle. People have no control over what they say and can say things they would otherwise not say when conscious. They often don't remember doing so, and are quite shocked when informed of the things they said while sleeping.
People affected by sexsomnia engage in sex while sleeping, though they have no memory of their actions once they wake up. The sexual activities such individuals engage in could be anything from harmless, humorous actions to a criminal act like rape. Sexsomnia is a variant of sleep walking and can be diagnosed by sleep studies.
These occur in adults in the REM [rapid eye movement] sleep. The person is abruptly awakened from sleep and is able to describe the dream in detail.
It is the complaint of inadequate sleep. It could be difficulty in falling asleep, frequent awakenings, early morning awakenings, persistent sleepiness and fatigue. It could be transient or chronic.
Transient insomnia is often temporary and could be due to stress or external events. Chronic insomnia—one that has been ongoing for over three weeks—needs detailed evaluation and assessment of associated medical and psychiatric diseases. Drugs like caffeine, alcohol and nicotine are some of the known causes.
Excessive daytime sleepiness [EDS]
EDS could be the result of sleep apnoea, sleep deprivation, medication, narcolepsy, or circadian rhythm disturbances due to jet lag and or shift duty works. Individuals affected by EDS feel so drowsy all day that it often interferes with their daytime activities.
It is the inability to sustain one's wakefulness voluntarily. It is associated with cataplexy in which the patient suddenly slouches or drops unconscious. Narcolepsy is associated with sleep paralysis [inability to perform voluntary movements] or sleep hallucinations. This ailment often starts at a younger age. Persons affected with narcolepsy should refrain from driving, flying and working with machinery.
Obstructive sleep apnoea [OSA]
In OSA, the patients' upper airways which are narrow, get further narrowed during sleep, causing snoring. On deeper breathing, the passage narrows further, leading to louder snoring. This continues till the breathing stops completely. The person makes a visible, laboured effort to breathe despite closed airways, which leads to a low oxygen intake and low oxygenation in blood.
The low level of oxygen stimulates the brain to wake up and the patient gets up in order to resume normal breathing. This happens continuously in sleep, resulting in fragmented, interrupted sleep and recurrent hypoxia [low oxygen supply] to the body.
It leads to high surge of several hormones and chemicals, which elevates blood pressure [this is difficult to control by medicines]. In severe cases, OSA can lead to uncontrolled diabetes, cause nocturnal angina [angina that occurs at night], sudden cardiac arrest, cardiac failure, paralytic attacks and even vascular injuries. This cascade of events also triggers obesity and causes personality changes, depression and sexual dysfunction.
In central sleep apnoea, the breathing efforts of an individual are absent leading to apnoea [reduced or stopped breathing]. It can be associated with OSA. Cardiac failure, high altitude and narcotic drug abuse can also cause sleep apnoea in some people.
The fragmented sleep at night leads to daytime sleepiness and cognitive impairment like deterioration in intellectual function, forgetfulness, motor vehicle accidents, accidents at home while working with fire or cooking.
In children, sleep apnoea leads to scholastic impairment, crankiness, irritability, nocturnal enuresis [bedwetting], frequent upper respiratory infections and weight gain.
Confirmatory tests of this disorder can be done at home or in the hospital. Sometimes a CT or an MRI or even sleep endoscopy may be required to diagnose upper airway obstruction.
Treating the problem
- Weight reduction remains the mainstay solution to almost all sleep disorders.
- Anti-snoring devices should not be used. They give a false sense of security since they do not actively address the problem.
- The gold standard for treatment in case of OSA is the Continuous Positive Airway Pressure [CPAP] machine. It delivers air under set pressure through a nasal or oro-nasal mask to prevent airways from collapsing. CPAP is effective, but some people may have difficulty using it.
- Surgical option like uvulopalatoplasty is also available. In children, sometime simple tonsillectomy and adenoidectomy can relieve sleep apnoea. In individuals with mild OSA, who have difficulty in using CPAP machine, oral appliances can be used.
- Simple things such as going to sleep at the same time every day, keeping the bed clean and the bedroom atmosphere pleasant contributes to a good night's sleep.
- Avoiding hot discussions, unpleasant viewing, heavy meals and a heavy workout before sleeping are factors promote pleasant sleep.
If you have been having trouble sleeping, get professional help as soon as possible, because a good sleep is a prelude to the beginning of a good day to follow your dream.... to be able to dream in fact.
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