Patients with sleep disorders tend to fall into one of four groups.
- Disorders of Initiating and Maintaining Sleep (Insomnia)
- Disorders of Excessive Sleepiness (e.g., sleep apnea, narcolepsy)
- Sleep Related Behaviors (e.g., sleepwalking, night terrors)
- Circadian Rhythm Disorders (e.g., shift work)
- Commonly Occurring Sleep Disorders
Sleep Apnea is one of the most common disorders seen by physicians. It is a disorder of breathing that occurs during sleep. Obstructive sleep apnea is typically characterized by snoring, and a complaint of fatigue or excessive daytime sleepiness. A bed partner may report repeated pauses in breathing during sleep, and patients may complain of gasping or choking episodes during sleep. It is more common in overweight men, but can be seen in a variety of individuals.
Sleep Apnea is diagnosed by the use of a sleep test, known as a Polysomnogram. During a Polysomnogram, a patient will have small wires attached to their body while they sleep to determine if they have this disorder. If present, treatment options can include the use of nasal CPAP (Continuous Positive Airway Pressure), upper airway surgery, dental devices, weight loss, or positional treatments.
Narcolepsy is a genetically inherited illness characterized by excessive daytime sleepiness. It may be accompanied by complaints of sudden episodes of weakness, often triggered by emotion (laughter, anger, etc.) called Cataplexy. Narcolepsy can also be accompanied by waking up paralyzed for seconds (sleep paralysis), and vivid dream-like hallucinations upon falling asleep (hypnogogic hallucinations).
Narcolepsy can also be diagnosed by overnight sleep testing (Polysomnogram), followed by a daytime test called a Multiple Sleep Latency Test. The Multiple Sleep Latency Test is a series of daytime naps occurring every two hours to measure how quickly one falls asleep during the day. Narcolepsy is a treatable condition, which may include medication, and adjustments to sleep behavior.
Restless Leg Syndrome
Restless Leg Syndrome is characterized by:
- An uncomfortable sensation in the limbs (legs, and occasionally arms) associated with an irresistible urge to move the limbs
- Typically occurs in the evening or night time
- Occurs during periods of rest or inactivity
- Is partially or totally relieved temporarily by moving or stretching the affected limb(s)
Restless Leg Syndrome may be inherited in some individuals. It may occur during pregnancy or, in patients with anemia or iron deficiency. It may be due to side effects of certain medications, or occur with certain Neurologic disorders as well. Restless Leg Syndrome is often aggravated by the effects of caffeine, nicotine, or alcohol, but can be treated with medication in many patients.
Insomnia should be viewed as a symptom generally, rather than a disease. Evaluation of insomnia requires a careful sleep history and physical examination. Insomnia can occur as a result of many things, including but not limited to the following:
- Painful Medical Conditions
- Shift Changes
- Restless Leg Syndrome
Treatment of insomnia may require changes in sleep behavior, treatment of underlying medical conditions, and at times, medication. Sleep testing (Polysomnography) is only occasionally required to diagnose the cause of insomnia.