- It has been estimated that two out of three adult males snore some or all of the time during nocturnal sleep and almost that number of women following menopause also experience snoring. Of one hundred people who snore approximately one third will not have sleep apnea, one third will have mild to moderate sleep apnea and one third will have severe sleep apnea. All people who have sleep apnea snore but not all snorers have sleep apnea. Snoring is a sign that the airway is not fully open, and the distinctive sound of snoring comes from efforts to force air through a narrowed passageway in the throat.
- The “typical” patient with sleep apnea is an overweight middle-aged male who habitually exhibits loud snoring throughout the night. The problem with these patients is that they can’t breath properly in a recumbent position because their upper airway either collapses under it’s own weight or the tongue and uvula (the small tissue that hangs on the soft palate in the back of the throat) close over the back of the throat causing air to be blocked. The person literally chokes himself or herself at the level of the upper airway.
Periodic Limb Movements of Sleep (PLMS)
- Periodic Limb Movements of Sleep (PLMS) is another disorder that affects the limbs during sleep. It frequently interferes with the person’s ability to get a full night of restful sleep. It has previously been called nocturnal myoclonus. Movements appear after sleep onset that can be seen and recorded in one or more limbs either individually or can occur on a unilateral or bilateral basis. They occur in runs of muscle contractions and can be strong enough to cause the limb to move and in rare cases to cause a flinging or jerking movement that can wake the patient or can disturb their bed partner. Generally speaking people with RLS have some degree of PLMS but patients with PLMS do not necessarily have RLS.
- Insomnia is defined as a condition manifested by difficulty falling asleep and/or staying asleep. It needs to last for more than three (3) weeks at a time and is associated with negative daytime consequences of the disturbed nocturnal sleep. These daytime symptoms include fatigue, lethargy, impaired thought processes, mood disturbance and non-specific physical complaints including headache, gastrointestinal disturbance or multiple aches and pains. For the most part, insomnia is a symptom of an underlying medical and/or psychological problem; it is not a diagnosis by itself. Treatment is always more effective when the underlying problem is addressed rather than just treating the sleep complaints. An extremely useful regimen is for the person to maintain good sleep habits (see Guidelines for Better Sleep). Treatment can include behavioral therapy aimed at promoting mental relaxation as well as muscle tension release at bedtime. Therapy can be aimed at controlling the patient’s physical as well as their emotional environment that they are contending with at the time of sleep onset, or in special cases the patient can be treated by restricting the number of hours that they spend in bed (time spent waiting to fall asleep as well as time spent asleep) and as the person’s sleep improves the time in bed is increased. In some cases judicious use of sleeping medications are employed. This occurs when a temporary aid is needed to allow the person to get their sleep back on track. In most cases sleep will re-establish itself and in the long run regular use of sleeping pills will do more harm than good.
REM Sleep-Related Disturbances
- Dream related abnormal sleep states include Recurring Nightmares, Sleep Paralysis, and REM Sleep Behavior Disorder (RBD). Nightmares and isolated sleep paralysis are common occurrences and do not constitute an abnormality unless they occur several times a week and disturb the patient’s sleep however RBD is a serious disorder that involves patients acting out their dreams and can include punching, kicking, leaping and running from their bed. The disorder is more common in middle aged and elderly males and there is a high statistical association with a large number of neurologic conditions such as Parkinson’s, Disease, Alzheimer’s Dementia, strike, and Multiple Sclerosis. RBD is due to the body’s inability to turn off the voluntary muscles during dream sleep which then manifests itself as the person “acting out” their dream mentation.
- Narcolepsy is one of the most under diagnosed illnesses that medicine of the twenty first century deals with. It is estimated that only one quarter of those actually suffering from this disorder have been properly diagnosed and treated. This leaves approximately 120,000 sleepy people who have been misdiagnosed and improperly treated or undiagnosed completely. For these people, the impact on their lives is considerable and at times completely disabling or fatal (auto accidents account for the majority of the fatalities). With the advent of modern sleep monitoring techniques and recent developments in genetics this number should drop significantly. Although no cure for narcolepsy has been found, recent advances in medications allow most people to lead normal or nearly normal lives. Narcolepsy can be defined as uncontrollable attacks of REM (Rapid Eye Movement) Sleep also called dream or paradoxical sleep during what is considered daytime or “normal” waking hours. Between these episodes the person feels sleepy on a continual basis unrelated to the amount or type of nighttime sleep.
- Parasomnias are unpleasant feelings or behaviors that take place during the night when non-dream or non-REM sleep is taking place. This usually happens within the first two hours of sleep onset and includes Confusional arousals where there is an abrupt partial awakening from sleep manifested by disorientation, slow speech confusion and amnesia for the event upon full awakening. Sleepwalking and sleeptalking are other examples of parasomnias. More disturbing is the parasomnia known as sleep terrors which are more frightening than dreams or nightmares and include crying out, feelings of extreme anxiety and impending doom. These disorders are common during childhood and generally disappear during the teenage years. They rarely require treatment but sometimes medication is used if the parasomnia causes the person to place themselves in harm’s way.
Circadian Rhythm Disturbances
- Some people have their internal biologic clocks out of alignment with the usual 24 hour cycle of light and dark. These people cannot fall asleep until very late in the night or into the early morning hours and then have difficulty waking up for school or work in the morning and would tend to stay asleep until late morning or early afternoon. Others go to sleep early in the evening and then wake up in the early morning well before daybreak unable to fall back asleep. These sleep problems fall under the category of circadian rhythm disturbances. They are treated using such measures as exposure to bright light at certain times of the day or night depending on the specific complaint and in some cases are used in conjunction with medications that help control the body’s internal clock. People who work Night Shifts and/or Rotating Shifts as well as people who travel across two (2) or more time zones (Time Zone Change) are especially prone to circadian rhythm disturbances.