Sleep Disorders

Sleep disorders include Insomnia, Sleep Apnea, Restless Legs Syndrome, and Narcolepsy. Sleep, and lack of sleep, affects our daily functioning and our physical and mental health in many ways that medicine and psychology are just beginning to understand.

Until the 1950s, most people thought of sleep as a passive, dormant part of our daily lives. We now know that our brains are very active during sleep. Moreover, sleep affects our daily functioning and our physical and mental health in many ways that we are just beginning to understand.

During sleep, we usually pass through five phases of sleep: stages 1, 2, 3, 4, and REM (rapid eye movement) sleep. These stages progress in a cycle from stage one to REM sleep, then the cycle starts over again with stage one. We spend almost 50 percent of our total sleep time in stage two sleep, about 20 percent in REM sleep, and the remaining 30 percent in the other stages. Infants, by contrast, spend about half of their sleep time in REM sleep.

The amount of sleep each person needs depends on many factors, including age. Infants generally require about 16 hours a day, while teenagers need about 9 hours on average. For most adults, 7 to 8 hours a night appears to be the best amount of sleep, although some people may need as few as 5 hours or as many as 10 hours of sleep each day.

People tend to sleep more lightly and for shorter time spans as they get older, although they generally need about the same amount of sleep as they needed in early adulthood. About half of all people over 65 have frequent sleeping problems

Almost everyone has nights when you can not fall asleep or when your sleep is fitful.  However, in the U.S. sleep deprivation and fatigue are major health issues.  Over 40 million Americans each year suffer from chronic, long-term sleep disorders and over 20 million more experience occasional sleep problems. Estimates are that between 25%-50% of Americans have difficulty with sleep.

These disorders and the resulting sleep deprivation interfere with work, driving, and social activities. They also account for an estimated $16 billion in medical costs each year, while the indirect costs due to lost productivity and other factors are probably much greater. Doctors have described more than 70 sleep disorders, most of which can be managed effectively once they are correctly diagnosed. The most common sleep disorders include insomnia, sleep apnea, restless legs syndrome, and narcolepsy.

The types of insomnia are: 1) difficulty falling asleep; 2) no problem falling asleep but difficulty staying asleep (many awakenings); 3) waking up too early; and 4) Sleep State Misperception. In Sleep State Misperception a person will sleep most of the night and believe they didn't sleep at all. Sleep State Misperception can cause anxiety which increases the symptoms.

Another approach to classifying insomnia list three basic types of Insomnia: 1) Transient insomnia - lasting for a few nights; 2) Short-term insomnia - two or four weeks of poor sleep; and 3) Chronic insomnia - poor sleep that happens most nights and last a month or longer.

Almost everyone occasionally suffers from short-term insomnia. This problem can result from stress, jet lag, diet, or many other factors. Insomnia almost always affects job performance and well-being the next day. About 60 million Americans a year have insomnia frequently or for extended periods of time, which leads to even more serious sleep deficits. Insomnia tends to increase with age and affects about 40 percent of women and 30 percent of men. It is often the major disabling symptom of an underlying medical disorder.

For short-term insomnia, doctors may prescribe sleeping pills. Most sleeping pills stop working after several weeks of nightly use, however, and long-term use can actually interfere with good sleep. Mild insomnia often can be prevented or cured by practicing good sleep habits

Transient and short-term insomnia generally occur in people who are temporarily experiencing one or more of the following:
• stress
• environmental noise
• extreme temperatures change in the surrounding environment
• sleep/wake schedule problems such as those due to jet lag
• medication side effects

Chronic insomnia is more complex and often results from a combination of factors, including underlying physical or mental disorders. One of the most common causes of chronic insomnia is depression. Other underlying causes include arthritis, kidney disease, heart failure, asthma, sleep apnea, restless legs syndrome, Parkinson's disease, and hyperthyroidism. However, chronic insomnia may also be due to behavioral factors, including the misuse of caffeine, alcohol abuse, or other drug abuse; disrupted sleep/wake cycles as may occur with shift work or other nighttime activity schedules; and chronic stress.

Insomnia can affect not only your energy level and mood, but also your mental and physical health.  It leads to diminished mental alertness and concentration. 

The following behaviors have been shown to cause and/or perpetuate insomnia:
* poor sleep habits
* expecting to have difficulty sleeping and worrying about it
* ingesting excessive amounts of a stimulant such as caffeine
* drinking alcohol before bedtime
* smoking cigarettes before bedtime (nicotine is a stimulant)
* excessive napping in the afternoon or evening
* irregular or continually disrupted sleep/wake schedule
* medications, herbs and caffeine
* anxiety and worry about falling asleep
* physical problems such as pain
* stress and anxiety
* lack of exercise
* long-term use of sleep medications
* eating too much too late in the evening
* aging often results in changing sleep patterns and insomnia
* depression

Treatment of Insomnia

Transient and short-term insomnia may not require treatment since episodes last only a few days at a time. Treatment for chronic insomnia consists of diagnosing and treating any underlying medical conditions and psychological problems.

Psychotherapy and behavioral therapy techniques such as relaxation therapy, sleep restriction therapy, and reconditioning may help.

Relaxation Therapy can reduce or eliminate anxiety and body tension. As a result, the person's mind is able to stop "racing," the muscles can relax, and restful sleep can occur.

Sleep Restriction can be helpful. Some people suffering from insomnia spend too much time in bed unsuccessfully trying to sleep. They may benefit from a sleep restriction program that at first allows only a few hours of sleep during the night. Gradually the time is increased until a more normal night's sleep is achieved.

Reconditioning involves helping some people with insomnia. For most people, this means not using their beds for any activities other than sleep and sex (some experts even say using the bed for sex call cause performance anxiety which could lead to insomnia). As part of the reconditioning process, the person is usually advised to go to bed only when sleepy. If unable to fall asleep, the person is told to get up, stay up until sleepy, and then return to bed. Throughout this process, the person should avoid naps and wake up and go to bed at the same time each day. Eventually the person's body will be conditioned to associate the bed and bedtime with sleep.

Medications include prescription sleeping pills although doctors generally don't recommend relying on prescription sleeping pills for more than a few days because they may cause side effects, and developing your ability to sleep without the help of medication is the goal. The antidepressant trazodone (Desyrel) also may help with insomnia. Over-the-counter sleep aids contain antihistamines that can induce drowsiness. They may help with occasional sleepless nights, but they, too, often lose their effectiveness the more you take them.

Sleep apnea is a disorder of interrupted breathing during sleep. It usually occurs in association with fat buildup or loss of muscle tone with aging. These changes allow the windpipe to collapse during breathing when muscles relax during sleep.  This problem, called obstructive sleep apnea, is usually associated with loud snoring (though not everyone who snores has this disorder). An estimated 18 million Americans have sleep apnea. However, few of them have had the problem diagnosed.

During an episode of obstructive apnea, the person's effort to inhale air creates suction that collapses the windpipe. This blocks the air flow for 10 seconds to a minute while the sleeping person struggles to breathe. When the person's blood oxygen level falls, the brain responds by awakening the person enough to tighten the upper airway muscles and open the windpipe. The person may snort or gasp, then resume snoring. This cycle may be repeated hundreds of times a night. The frequent awakenings that sleep apnea patients experience leave them continually sleepy and may lead to personality changes such as irritability or depression. Sleep apnea also deprives the person of oxygen, which can lead to morning headaches, a loss of interest in sex, or a decline in mental functioning. It also is linked to high blood pressure, irregular heartbeats, and an increased risk of heart attacks and stroke.

Treatment of Sleep Apnea

Patients with the typical features of sleep apnea, such as loud snoring, obesity, and excessive daytime sleepiness, should be referred to a specialized sleep center that can perform a test called polysomnography. This test records the patient's brain waves, heartbeat, and breathing during an entire night. If sleep apnea is diagnosed, several treatments are available. Mild sleep apnea frequently can be overcome through weight loss or by preventing the person from sleeping on his or her back. Other people may need special devices or surgery to correct the obstruction. The most common treatment is a device that pushes air through the airway. This device is called a CPAP.

Restless legs syndrome (RLS), a familial disorder causing unpleasant crawling, prickling, or tingling sensations in the legs and feet and an urge to move them for relief, is emerging as one of the most common sleep disorders, especially among older people. This disorder, which affects as many as 12 million Americans, leads to constant leg movement during the day and insomnia at night. Severe RLS is most common in elderly people, though symptoms may develop at any age. In some cases, it may be linked to other conditions such as anemia, pregnancy, or diabetes.

Many restless legs syndrome (RLS) patients also have a disorder known as periodic limb movement disorder or PLMD, which causes repetitive jerking movements of the limbs, especially the legs. These movements occur every 20 to 40 seconds and cause repeated awakening and severely fragmented sleep.

Treatment of Restless Legs Syndrome

Restless legs syndrome (RLS) and periodic limb movement disorder (PLMD) often can be relieved by drugs that affect the neurotransmitter dopamine, suggesting that dopamine abnormalities underlie these disorders' symptoms. Learning how these disorders occur may lead to better therapies in the future.

Narcolepsy affects an estimated 250,000 Americans. People with narcolepsy have frequent "sleep attacks" at various times of the day, even if they have had a normal amount of night-time sleep. These attacks last from several seconds to more than 30 minutes. People with narcolepsy also may experience cataplexy (loss of muscle control during emotional situations), hallucinations, temporary paralysis when they awaken, and disrupted night-time sleep. The disorder (or at least a predisposition to it) is usually hereditary, but it occasionally is linked to brain damage from a head injury or neurological disease.

Treatment of Narcolepsy

Once narcolepsy is diagnosed, stimulants, antidepressants, or other drugs can help control the symptoms and prevent the embarrassing and dangerous effects of falling asleep at improper times. Naps at certain times of the day also may reduce the excessive daytime sleepiness.

For more information about insomnia and other sleep disorders, please click on the linked websites listed below.

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