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Sleep Disorders

We sleep for approximately one-third of our lives and the human body is a complex unit, so it is not unusual for us to experience some strange things during these times we are asleep. It is, however, undesired if these events impact the time that we are awake or adversely affect our health and well being.

There is a wide range of sleep disorders that are known to impact our sleep and subsequently our health. They can occur due to underlying medical conditions, our state of health, environmental effects and even hereditary causes.

Some of the main sleep disorders within the population include:

  • Snoring

  • Obstructive Sleep Apnea

  • Central Sleep Apnea

  • Restless Legs Syndrome

  • Narcolepsy

  • Bruxism

  • Insomnia

  • Parasomnias

Snoring

 

Snoring occurs when there is a partial obstruction to the airway, causing the soft tissue at the back of the throat to flap and vibrate as we breathe. It is common for most people to snore at some point in their life; however severe chronic snoring can impact your sleep, health and may often indicate a more serious underlying issue, most commonly Obstructive Sleep Apnea.

 

Obstructive Sleep Apnea

Obstructive Sleep Apnea (OSA) is a serious disorder where breathing is continually interrupted during sleep. While asleep, there is a collapse of the airway at the back of the throat, causing no airflow and a cessation of breathing. The obstruction in the airway may be caused by the muscles in the back of throat relaxing too much, excessive weight and fat around the neck, the tongue falling back in the throat,

or a combination of these.

When the airway collapses, breathing stops for a period of time. The body detects that it is not receiving enough oxygen, which prompts an arousal in sleep, just enough to regain muscle tone and start breathing again. Then, as sleep takes back over, the airway again collapses. Individuals may stop breathing from 3 to 60 seconds at a time, with these events occurring from 5 to 80 times per hour of sleep.

 

Symptoms of OSA include:

  • Snoring

  • Excessive daytime sleepiness

  • Waking up during the night gasping or choking

  • Morning headaches

  • Waking unrefreshed

  • Poor memory and concentration

  • Disturbed or restless sleep

  • Dry mouth or sore throat in the morning

  • Depression, anxiety or mood behaviour changes

 

 Effects of untreated OSA include:

  • High blood pressure

  • Increased risk cardiovascular disease

  • Increased risk of stroke

  • Type II diabetes

  • Obesity

  • Depression

  • Cognitive impairment

  • Impotence

  • Increased risk of motor vehicle accidents

There are numerous options available for the treatment of OSA. The most appropriate treatment depends on a person’s severity of OSA, anatomical features, medical history, degree of symptoms and occupation.

Some of the treatments options include:

Treatment of OSA should always be individualised and recommended by a General Practitioner or specialist Sleep Physician.

 

 

Central Sleep Apnea

 

Central Sleep Apnea (CSA) is a condition where breathing is continually interrupted during sleep. It is different from Obstructive Sleep Apnea (OSA) in that there is typically no physical blockage of the airway, rather the pauses in breathing are caused by a lack of respiratory effort from the brain.

CSA is typically associated with heart failure, where there is slow circulation from the heart having an adverse effect on the normal reflexes. This causes over-breathing, under-breathing and cessation of breathing.

CSA may also be caused by some medication which alters the breathing control centre of the brain, or some neuromuscular disorders which cause a weakness in the respiratory muscles.

CPAP may help with CSA, however, the typical treatment option is Adapto-Servo-Ventilation.

  

Restless Legs Syndrome

Restless Legs Syndrome (RLS) is a neurological condition which causes restlessness and tingling sensations in the legs when relaxed. This can make it very difficult for people suffering from RLS to initiate and maintain sleep.

The main symptom of RLS is an irresistible urge to continually move the legs to attempt to diminish the uncomfortable tingling sensation (and sometimes numbness). Sometimes there are abnormal leg movements associated when trying to keep them still. These symptoms tend to be worse of an evening and when relaxing.

The cause of RLS is not certain, however, evidence points towards numerous medical conditions including kidney disease, iron deficiency, nerve damage, diabetes and pregnancy.

There is a range of medications prescribed for treating RLS. Your GP or Sleep Physician can advise what medication is best suited to your condition.

There are also non-pharmaceutical treatments for the symptoms of RLS which include maintaining good sleep hygiene, reducing alcohol and caffeine intake of an evening, increasing physical activity during the day and decreasing any physical activity before bedtime.

 

Narcolepsy 

Narcolepsy is a sleep disorder which is characterised by extreme excessive daytime sleepiness, sleep paralysis, audio and visual sleep hallucinations and sometimes cataplexy. They also have an abnormally fast transition from wake-to-sleep and sleep-to-REM sleep.

The sleep-wake function in people with narcolepsy does function correctly, leaving them feeling abnormally sleepy during the day, despite regularly achieving adequate sleep of a night time. There are some cases where individuals fall asleep involuntarily at inappropriate times. Others suffer the effects of cataplexy, where there is a dramatic decrease in the muscle at times of high emotion (laughter, crying) and

their body can become limp.

If a person is chronically sleep-deprived (either by a lack of sleep or effects from a pre-existing sleep disorder such as OSA) they may present with some symptoms of narcolepsy. Therefore narcolepsy can only be diagnosed by first ruling out any other sleep disorder and ensuring that adequate sleep is being achieved on a regular basis.

An attended Sleep Study is required to objectively demonstrate no pre-existing sleep disorder. This overnight Sleep Study is then followed by a daytime Sleep Study called a Multiple Sleep Latency Test (MSLT). The MSLT is designed to objectively measure sleepiness through recording the transitions from wake-to-sleep and sleep-to-REM sleep throughout a number of tests during the day.

There is no known cure for narcolepsy, however, some medications and behavioural changes can help improve the symptoms and increase quality of life.

 

Bruxism

Bruxism is a medical term for the clenching and grinding of teeth during sleep

(and can sometimes occur while awake).

Bruxism is classified as a sleep disorder as it may be associated with moderate to severe dental damage, jaw pain, sleep disturbance and subsequent daytime tiredness.

Precise causes of Bruxism are unknown, however, studies have linked it to factors such as stress, anxiety, alcohol consumption, caffeine, sleep apnea and fatigue.

An attended Level-1 sleep study is the best method of diagnosing sleep Bruxism. Once diagnosed, A Dentist can often fit a dental device which will minimise the impact of damage to the teeth. Jaw alignment exercises may also assist in facial pain.

 

Insomnia

Insomnia is a sleep disorder which is characterised by difficulty either falling asleep or maintaining sleep.

 

Types of insomnia:

  • Primary insomnia is where a person is experiencing sleep problems which are not associated with any other medical condition.

  • Secondary insomnia is where a person is experiencing sleep problems which are caused by other factors such as a medical condition, medications or pain.

  • Acute insomnia is short-term and may last from a few days to a few weeks. Acute insomnia is often caused by stress, physical discomfort, environmental factors (noise, light, temperature) or interference in typical sleep habits and cycles (night shift work, jet lag).

  • Chronic insomnia is long-term and may last from a few months to years. Chronic insomnia is often caused by long-term stress, anxiety or depression or long-term pain.

 

Parasomnias

Parasomnia is a term which covers numerous unusual and undesired events that may occur sleep. The most common parasomnias include:

  • Night Terrors are partial arousals from a deep sleep, characterised by sitting up in bed with an expression of fright, panic, screaming and often being inconsolable. Following night terrors, there is often profuse sweating, rapid heart rate, disorientation and confusion. It is not unusual for people experiencing night terror to have no recollection of these events in the morning. 

  • Sleep Walking is initiated during slow-wave sleep and results in walking during sleep. During these sleepwalking episodes, the sleepwalker has decreased awareness and responsiveness to surroundings. They may appear clumsy and inclined to self-inflicted injuries. It is reported that some complex behaviours, such as eating or driving, can occur. Sleepwalking episodes typically last less than 15 minutes. Attempts to wake someone who is sleepwalking may lead to aggressive and violent responses. Sleepwalking episodes usually terminate by the patient returning to bed and resuming sleep, however, some sleepwalkers may also awaken to find themselves in inappropriate places.

  • Confusion Arousals result from incomplete or partial awakening from sleep causing confusion, slow thought process, disorientation to time and place and atypical responses to stimulus. Behaviours from this may include kicking or thrashing in bed and picking up objects that may be near. 

  • REM-sleep Behavior Disorder (RBD) occurs when vivid dreams are acted out while asleep. During REM sleep the body is typically in a state of paralysis. During episodes of RBD, this paralysis is overridden and behaviours associated with the acting of these vivid dreams may include shouting, swearing, grabbing, punching and kicking. RBD It is not a psychiatric disorder. By itself does not cause daytime tiredness, however it is often diagnosed in parallel with other sleep disorders such as sleep apnea, period limb movement disorder and narcolepsy.