Do you ever go to bed after a hard days’ work, only to find yourself lying awake at night thinking, “Why can’t I sleep even though I’m exhausted?” It’s estimated that about 70 million Americans suffer from chronic sleep problems.
Not only can sleep disorders like these be discouraging, but they can be dangerous. Lack of sleep increases the risk of a heart attack, chronic disease, mental illness, poor quality of life and injury, not to mention increased health care costs and lost work productivity. Unfortunately, despite these dangers, sleep disorders are rarely addressed. That said, thank you for taking the time today to learn more about how you can treat common disorders such as insomnia, sleep apnea, narcolepsy, restless legs syndrome, sleep walking, excessive sleepiness, and shift work disorder. Without further ado, let’s get started.
Insomnia is the most common sleep disorder, affecting about 40% of women and 30% of men. It tends to increase with age, unlike some of the other disorders on our list (like sleepwalking, which starts in childhood and is usually resolved by the teen years). Insomnia isn’t characterized by the amount of sleep an individual gets, but rather their quality of sleep.
The average person needs 7-8 hours a night, although some require less sleep and others require more. Short-term insomnia can be caused by life stress and then be resolved when the stressors subside. However, insomnia that occurs for three nights a week for a month or more is considered chronic insomnia. It can be caused by a number of factors, but is commonly associated with other health problems, such as depression, chronic stress, and pain/discomfort at night. Sometimes there is an underlying sleep disorder that gets in the way such as apnea, narcolepsy or restless legs syndrome (RLS).
Treatment for insomnia varies based on the underlying cause. Secondary insomnia is treated by attending to the underlying sleep disorder or medical condition. In primary insomnia, treatment plans are customized to a patient’s specific needs, and may include referral to a behavioral therapist to discuss sleep hygiene, stimulus control, light therapy, sleep schedule, and muscle relaxation techniques. Medications are prescribed for treating insomnia when appropriate.
2. Sleep Apnea
Sleep apnea is the second most common form of sleep disorder, affecting more than 22 million Americans, making it as common as type 2 diabetes. Untreated, it can cause high blood pressure and other cardiovascular diseases, memory problems, weight gain, impotence and headaches. There are 3 types of sleep apnea: obstructive sleep apnea, central sleep apnea, and mixed sleep apnea. Obstructive sleep apnea (OSA) is caused by a blockage of the airway. This usually occurs when the soft tissue in the rear of the throat collapses and closes during sleep. Central sleep apnea occurs when the airway isn’t blocked but the brain fails to signal the muscles to breathe. Mixed sleep apnea is a combination of the two. When apnea events happen, the brain rouses the sleeper (usually only partially) to signal breathing to resume. As a result, the person’s sleep is fragmented.
Treatment for sleep apnea is tailored to the specific form of sleep apnea the person is experiencing. For those who experience OSA, the use of continuous positive airway pressure (CPAP) devices can be greatly beneficial. Oral appliances can also be of help. There are over 100 oral devices approved by the FDA for treating sleep apnea, and unlike positive airway pressure devices, they are more portable. Those with severe OSA may be prescribed both oral appliances and positive airway pressure devices. Dentists can custom-make these oral appliances for you after a thorough examination of your teeth, mouth, and temporomandibular joint. Hypoglossal neuro-stimulation therapy was designed for those who are unable or unwilling to use CPAP therapy or oral appliances. This implant therapy delivers muscle tone to key tongue muscles, controlling upper airway flow and reducing or eliminating sleep apnea.
For those who suffer from central sleep apnea (or mixed sleep apnea), neuro-stimulation therapy can be helpful. Implantable systems stimulate a nerve in the chest (the phrenic nerve), which sends signals to the muscle that controls breathing (the diaphragm). These signals stimulate breathing in the same way that the brain does. They are placed by a cardiologist during a minimally invasive procedure. The systems are battery powered devices placed under the skin in the upper chest area. There are two small thin wires (leads): the stimulation lead (which delivers the therapy) and the sensing lead (which senses your breathing).
People with Narcolepsy feel extremely tired during the day despite getting adequate amounts of sleep the previous night. This often leads to an irrepressible urge to sleep, culminating in “sleep attacks” that last for a few minutes.
Over time, this can cause sleep-onset and sleep maintenance problems. There are two types of narcolepsy: Narcolepsy type 1 (NT1) and narcolepsy type 2 (NT2). Type 1 often includes cataplexy, which is a sudden loss of muscle tone that causes people to fall or slump over as they fall asleep. In Type 2, sleep attacks occur without the presence of cataplexy. This disorder affects about 1 in 2,000 people in the US and Western Europe. It is most common in Japan, where it affects 1 in 600 people. Narcolepsy is an extremely dangerous sleep disorder, with those who suffer from it experiencing a three-to-fourfold increase in their chances of being in an automobile accident.
Treating narcolepsy involves behavioral approaches and medications, and generally involves a combination of the two therapies. Behavioral approaches to treat narcolepsy include planned naps to heighten alertness during key parts of the day (although this approach does require special work or school accommodations at times), sound sleep hygiene, accident prevention by avoiding long drives in repetitive settings, finding support, eating a healthy diet, quitting smoking, and daily exercise to combat cardiovascular problems that are common in those with narcolepsy.
There are a variety of medications that doctors prescribe for their patients suffering from narcolepsy. Modafinil is usually one of the first ones prescribed, since it helps improve alertness and is usually well tolerated by patients. Other drugs for treating excessive daytime sleepiness include Methylphenidate, Pitolisant, and Solriamfetol. There are other medications for treating different components of narcolepsy, including treatments for disrupted nighttime sleep and treatments for cataplexy.
4. Restless Legs Syndrome
About 7%-10% of the US population may suffer from some form of RLS. This neurological disorder is characterized by a persistent, sometimes overwhelming need to move one’s legs (and occasionally other body parts), usually while resting. This is classified as a sleep disorder because the compulsion to move one’s legs during rest can have a severe impact on the ability to get to and maintain sleep.
There are several risk factors for RLS, including gender (women are twice as likely to experience it), and age (the elderly are more affected by it than children). Symptoms usually worsen if they aren’t treated. There are several conditions associated with RLS, including Parkinson’s, iron deficiency, pregnancy, kidney issues, and diabetes. It can be worsened with alcohol, tobacco, and caffeine use.
If RLS stems from an underlying cause, it can sometimes be resolved by treating that issue. Other treatments of RLS include lifestyle changes and medication. Treating restless leg syndrome with lifestyle changes may include regular exercise, cutting back on alcohol, caffeine, tobacco, leg massage, hot baths and regular sleep. Anti-seizure medications have proven helpful in treating patients who suffer from RLS, in addition to muscle relaxants and sleep medications. Opioids are sometimes prescribed for patients who are experiencing severe pain due to their RLS symptoms.
Sleepwalking (or somnambulism) involves getting up and walking around while in a state of sleep. This is more common in children than adults, and usually occurs early in the night (usually 1-2 hours after falling asleep). Those who sleepwalk, may get out of bed and walk around & not respond or communicate with others, be difficult to wake, not remember the episode in the morning, or have sleep terrors in addition to sleepwalking. Sometimes a person who is sleepwalking will leave the house, engage in unusual activities, or engage in other activities typically associated with the waking period. They may become violent during the period of brief confusion immediately after waking. Occasional cases of sleepwalking aren’t usually cause for concern but a doctor should be consulted if they occur often, lead to dangerous behavior, result in daytime symptoms or extend into the teen years.
Treatment for sleepwalking can include medication adjustments, anticipatory awakenings (waking the person about 15 minutes before he or she usually sleepwalks, and allowing them to stay awake a few minutes before falling asleep again), learning self-hypnosis, therapy/counseling, and medication, in addition to treating sleepwalking by addressing any of the underlying conditions that commonly contribute to the disorder.
6. REM Sleep Behavior Disorder
Rapid eye movement (REM) sleep behavior disorder is a sleep disorder that causes sufferers to physically act out vivid (usually unpleasant) dreams with vocal sounds and sudden, violent arm and leg movements. This is sometimes called dream-enacting behavior. The onset of REM sleep disorder behavior is usually gradual and can get worse with time.
This disorder is associated with other neurological conditions, such as Lewy body dementia, Parkinson’s or multiple system atrophy. It is more common in those who have narcolepsy and males under 50 (although women under 50 are also being diagnosed with this disorder). Taking certain medications (including newer antidepressants), and use or withdrawal from drugs and alcohol, are also contributing factors.
Treatment for this disorder includes physical safeguards (padding the floor/bed, removing dangerous items from the bedroom, barriers, protecting windows, and sleeping in a separate bed until symptoms are controlled) and medications. The medications that are normally prescribed for this disorder include Clonazepam/Klonopin, which is often used to treat anxiety but may cause side effects such as sleepiness, decreased balance and worsening of sleep apnea. Another medication, which may be as effective as clonazepam and is usually well-tolerated with few side effects, is melatonin.
7. Shift Work Sleep Disorder
Shift Work Sleep Disorder (SWSD) is a circadian rhythm sleep disorder characterized by insomnia, excessive sleepiness, or both, but especially affects people whose work hours overlap with the typical sleep period. Since about 20% of the population participates in shift work, the excessive sleepiness associated with SWSD can present a huge problem for workers, their families, and their employers.
Treatment for SWSD is very similar to that of other sleep disorders, and can include prescribed sleep/wake scheduling, bright light treatment, and medications such as melatonin to adapt the circadian system to a nighttime work schedule and medications that promote alertness such as caffeine along with prescription medications such as Modafinil and Armodafinil.
Other Techniques to Help Treat Sleep Disorders
Sleep hygiene practices such as adhering to consistent sleep and wake times, avoiding alcohol and sedatives, avoiding caffeine late in the day (or a few hours before you plan to sleep), limiting the use of electronic devices at night/utilizing blue light glasses, and creating a sleep-friendly environment in your bedroom by purchasing a sleep mask, blackout curtains, or utilizing a white noise machine are all ways to further reduce the possibility of being affected by sleep disorders. Of course, ensuring the room temperature, mattress, and bedding are as comfortable as possible are other great ways to increase your sleep quality.
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