WHEN TO CALL THE SLEEP DOCTOR!

If you are having trouble sleeping, you have company. In a 1995 national survey, the Gallup Organization reported that 49% of adults say that they have problems with their sleep. On any given night, millions of us have insomnia! Many sleep disorders go unreported because the individuals were not awake when symptoms appeared. These people are chronically exhausted but do not know why and are regarded as lazy! Sometimes the symptoms of sleep disorders can be quite bizarre and sufferers may not understand their own actions. They may fear the revelation of underlying psychiatric illness and avoid getting help!

 

$$$ The Cost of Poor Sleep $$$

When we battle at night, our sleep is nonfreshing and nonrestorative.

Daytime drowsiness

Decreased productivity

Increased accident rates

Reduction in health and quality of life

The total annual economic costs attributable to insomnia, including decreased productivity at work and health and property costs related to accidents, are estimated to be in the range of $30 to $35 billion.!

Bizarre Real-Life Sleep Stories

The sleeping woman who awoke to find herself in a grocery store aisle wheeling a cart filled with 56 boxes of cornflakes!

The woman who drew a map of the United States on her bedroom wall and then filled in the capitals of every state-all in her sleep!

The air traffic controller whose only way to keep from falling asleep on the job was to stand while working!

The man in the back of a moving trailer who sleep walked out the door and was killed on the highway!

The woman who gained over forty pounds eating chocolates while she slept!

The sleeping woman who drove to the airport, bought a plane ticket, and flew halfway to CA before waking up!
These anecdotes may appear humorous but people with sleep disorders really do suffer. Imagine being on the road with someone driving in his sleep or sharing a bed with someone who kicks and punches. Think of that ninety-year old California man who strangled his wife to death because she kept him awake at night with her persistent cough!

 

BEWARE!!! Many physicians consider the outcomes of sleep deprivation and fatigue due to sleep disorders as normal functioning in today's hectic society!

SLEEP DISORDERS

 

Dyssomnias
The dyssomnias are disorders of sleep that produce difficulty in initiating or maintaining sleep, or produce excessive sleepiness. They include the following:

 

Insomnia: If you have trouble falling asleep, or if you wake up a number of times during the night, or if you wake up earlier than you would like, or if you always feel as though you need nap during the day, or if you fall asleep while watching TV, you may have insomnia. One in every two Americans suffer from it. You experience an insufficient amount of sleep not feel rested after having slept. This often impairs social and occupational functioning, and can be accompanied by feelings of restlessness, irritability, anxiety, daytime fatigue and tiredness.

Obstructive Sleep Apnea: Are you a loud snorer who disturbs your bed partner? Do you fell tired when you wake up? Have you been known to hold your breath, choke, or gasp during sleep? If so, you may have sleep apnea. Sleep apnea occurs because of a sleep-induced failure of the throat muscles to hold the airway open against the suction created by efforts to breathe. It is characterized by repetitive episodes of upper airway obstruction that occur during sleep, causing cessation of breathing for thirty to ninety seconds at a time, up to 600 times each night. Alternating with these long pauses in breathing are loud snores or brief gasps and often whole-body movements. The snoring is so loud that it will disturb the sleep of a bed partner.

Obstructive sleep apnea is most common in middle-aged men. Overweight people are at higher risk, and men are 8 times more likely than women to develop it. In the United States, at least 1 out of every 200 people suffer from obstructive sleep apnea, but 95% don't even know it.

Narcolepsy: Are you always tired, no matter how much sleep you've had? Do you ever collapse after hearing a funny joke, or after becoming very angry? Do you have any relatives who are always sleepy? If you answer "yes" to these questions, you might have narcolepsy. Narcolepsy is characterized by excessive daytime sleepiness, cataplexy, sleep paralysis and hypnagogic hallucinations. Narcolepsy is thought to be an attack of REM sleep during the day.

Restless Legs Syndrome: Do your legs ache, tingle or itch just before you fall asleep? Does your bed partner complain of being kicked during the night? If so, you need to consult with your physician. Restless legs syndrome is a sleep disorder "characterized by disagreeable leg sensations, usually prior to sleep onset, that cause an almost irresistible urge to move the legs." The sensations may be pain, discomfort, itching, pulling, tingling, or prickling. If the patient moves his legs, there is partial or complete relief of the sensation. Yet, the symptoms return upon cessation of the leg movements. Having restless legs syndrome often leads to periodic involuntary limb movements both during sleep and during the day. It is often accompanied by intense anxiety or depression.

Periodic Limb Movement Disorder: Does your bedpartner say that your legs jerk during the night? Is your sleep unrefreshing? Periodic limb movement disorder is "characterized by periodic episodes of repetitive and highly stereotyped limb movements that occur during sleep. The movements typically occur in the patient's legs, and consist of an extension of the big toe in combination with partial flexion of the ankle, knee, and sometimes hips." This often results in partial aerosols from sleep. However, as with sleep apnea, the person remains unaware of the many nocturnal disruptions, and does not know why he or she is so tired during the day. The limb movements often disrupt the sleep of the bed partner

Hypersomnia:

Are you sleeping almost all day? Eating excessively? Hypersomnia implies too much sleep, either in the form of prolonged nocturnal sleep or excessive daytime sleepiness. There are three varieties of the disorder:

Recurrent Hypersomnia: Recurrent hypersomnia, including Kleine-Levin syndrome, involves periodic episodes of hypersomnia lasting up to several weeks. The excessive sleepiness may or may not be accompanied by binge eating and hypersexuality.
 Idiopathic (i.e.. of unknown cause) Hypersomnia: Idiopathic hypersomnia is similar to narcolepsy, but does not include cataplexy. Excessive daytime sleepiness and sleep onset at inappropriate times are characteristic of this disorder.
 Posttraumatic:Post-traumatic hypersomnia occurs as a result of head injury and is usually seen with other symptoms of head trauma such as headaches, difficulty concentrating, and memory impairment. Posttraumatic hypersomnia typically begins immediately after the trauma, but in some instances, onset can be delayed for 6-18 months.
"Healthy" Hypersomnia: Some people just sleep a lot. "Long sleepers" have what is known as "healthy" hypersomnia. They simply need more sleep to feel well rested than the average person their age does (typically more than 10 hours a day). "Healthy" hypersomnia is only a real problem if your sleeping pattern conflicts with your daily schedule.

Just as there are "long sleepers" who need more sleep than is considered normal, there are also "short sleepers" who average less than five hours of sleep each night, but still remain fully rested. Most people aren't so lucky. Both long and short sleepers make up a very small percentage of the population, and there is nothing you can do to make yourself need more or less sleep. The level of sleep you require to feel fully rested is determined by your genes.

Delayed/Advanced Sleep Phase Syndrome: Do you find it difficult to fall asleep until well after midnight, yet are able to sleep a normal length of time if you don't have to get up for work? Or, do you fall asleep too early in the evening and wake up too early in the morning? If so, your biological clock may be out of synch with your preferred sleep-wake schedule.

Someone with delayed sleep phase syndrome has sleep-onset and wake times that are later than desired, but little or no difficulty maintaining sleep once it has begun. Advanced sleep phase syndrome is just the opposite of delayed sleep phase syndrome. Sufferers of advanced sleep phase syndrome fall asleep too early in the evening and wake up too early in the morning, often before dawn. As is the case of delayed sleep phase syndrome, advanced sleep phase syndrome becomes a problem when it conflicts with work and social schedules.

Parasomnias: The parasomnias are a group of disorders that are not associated with the processes of sleep per se, but rather are physical abnormalities that occur for the most part during sleep. They include the following:

 

REM Sleep Disorder: Do you physically act out your dreams? Injure yourself and/or your bed partner? Fly out of bed and have frightening dreams? People with REM sleep behavior disorder actually attempt to act out their dreams. They kick, punch, leap, and run from bed -- often injuring themselves and/or their bed partners. One case in England resulted in a man shooting his new bride to death while he was dreaming of being pursued by gangsters.

We usually can't act out our dreams. During REM sleep a part of our brain keeps us from moving our arms and legs, although we can still breathe and move our eyes. REM sleep, in essence, is characterized by a highly active, dreaming, brain in a "paralyzed" body. When the normal movement inhibiting mechanism fails, some people, usually men over age sixty, may develop REM sleep behavior disorder, and are able to act out their dreams. The risk of developing REM Sleep Behavior Disorder increases with age, and men are more likely than women to develop it.

Sleep Terror: Do you wake up terrified in the middle of the night, and not know why? Sleep terror is a sudden arousal from slow wave sleep with a piercing scream or cry, accompanied by profuse sweating, and intense fear. It's not a dream or nightmare, but rather like having a panic attack in your sleep. Sleep terror is especially frightening, because unlike nightmares, it occurs without dream recall. People experiencing sleep terror do not know how they became so frightened.

Sleepwalking (Somnambulism): Do you walk in your sleep? Sleepwalking (somnambulsim), is initiated in slow wave sleep,and can range from sitting-up in bed, to walking, and even to frantic attempts to "escape." Sleepwalkers do not appear to be sleeping, but they are deeply asleep. Their eyes are typically wide open, with dilated pupils. Sleeptalking can also be observed during sleepwalking episodes. The episodes may or may not be associated with sleep terror.

People who are sleepwalking are not acting out their dreams, but manage to do some pretty incredible things. Some sleepwalkers have gone on shopping sprees, others have traveled long distances on airplanes before waking up. One woman made herself a meal of buttered cigarettes and cat food sandwiches. Some midnight snack!

Tooth-grinding (Bruxism): Eighty-five to 90% of us occasionally grind or clench our teeth during our sleep. A smaller portion, about 5%, do it chronically. Tooth-grinding (Bruxism) occurs in about half of all normal infants and is part of the teething process. Frequent tooth-grinding in adults, often caused by stress, can lead to dental damage and injury, and facial pain associated with temporomandibular joint (TMJ) disorders. It's also unpleasant for the bed partner to hear the sounds made by friction of the teeth.

Bed-wetting (Sleep Enuresis): Persistent bedwetting, sleep enuresis, is considered a disorder after the age of five. It occurs in all sleep stages, and daytime bladder control can be normal. While the prevalence of bedwetting in childhood decreases with age, about 3% of adolescents between the ages of 12 and 18 continue to wet their beds. Bedwetting has a hereditary component. Approximately 77% of children whose parents both wet their beds as children are bed-wetters themselves. A congenitally small bladder, bladder infections, allergies, obstructive sleep apnea, metabolic or endocrinologic disorders, may be predisposing factors. Contrary to popular belief, bedwetting is almost never emotionally or psychologically caused; less than 1% of bedwetting has an emotional source.

Sudden Infant Death Syndrome: Sudden Infant Death Syndrome (SIDS) is arguably the most tragic of the sleep disorders. Occurring in one or two of every thousand live births, SIDS is characterized by the unexpected sudden death during assumed sleep, of otherwise apparently healthy infants. It has not been unequivocally demonstrated whether the primary cause of death is respiratory or cardiac failure. Risk of SIDS is highest between 10 and 12 weeks of age. While unfortunately there is no definite way to predict the possible onset of the disorder, there are some babies at particular risk:
- Infants born with low birth weight are five to ten times as likely to die of SIDS.
- Twins and triplets, even at normal birth weight, are twice as likely to die of SIDS, and after one twin dies, the surviving twin also has an increased chance of dying from SIDS.
- Babies whose previous siblings died of SIDS are two to four times as likely to die of it.
- Six percent of infants with Infant Sleep Apnea die of SIDS.
- Black and Eskimo infants are four to six times as likely to die of SIDS.
- SIDS is more common in lower socioeconomic groups.

It is advisable that all infants be placed so they sleep on their back, not their side or stomach. This will make it less likely that breathing will be obstructed.


When to Call the Sleep Doctor

It's important to remember that sleep disorders are not rare, and that they can be very serious. If, after reading this, you think that you, or someone you know, may be suffering from a sleep disorder, contact a physician who has been trained in sleep medicine. Or consult the list of sleep disorder clinics located in Part 12 of the Main Menu for a place where you can find professional help.

 

 

Return to Main Menu