Sleep Apnea – Individuals with sleep apnea stop breathing periodically while they are sleeping. These episodes can last up to 90 seconds and often occur repeatedly throughout the night. Sleep apnea can be characterized by choking sensations or a feeling of gasping or waking breathless.
Most often sleep apnea is associated with an obstruction or closure of the upper airway (known as Obstructive Sleep Apnea or OSA). These breathing pauses are almost always associated with snoring that occurs between apnea episodes
Apnea causes frequent interruptions of sleep, which leads to excessive daytime sleepiness and is often associated with morning headaches. Apneas result from a decrease in oxygen levels in the bloodstream which can eventually lead to high blood pressure, stroke, heart apnea arrhythmias, and heart attack. Apnea can also be caused by not having the proper signals sent from the brain to respiratory muscles (Central Sleep Apnea).
Apnea often goes undetected by the patient. The bed partner most often recognizes the following symptoms:
- Loud, irregular snoring; gasping for breath; snorting.
- Pauses in breathing lasting 10-90 seconds.
- Leg movements, jerks, or generally restless sleep.
Treatment for sleep apnea is tailored to the individual based on medical history, physical exam, and severity of the apnea. It may include weight loss, dental devices, or a continuous positive airway pressure (CPAP) device.
Insomnia – Insomnia is the inability to fall asleep or to stay asleep. Insomnia can be short term, lasting only days or weeks; or chronic, lasting for months to years. Insomnia is usually the symptom of another problem. Short-term insomnia typically has an easily identifiable cause; while chronic insomnia is most often due to medical, psychological, or possibly neurological problems.
Treatment for insomnia requires a complete medical exam and detailed sleep history. Behavioral changes, such as improved sleep hygiene, managing stress, and in some cases, medication, are necessary.
Narcolepsy – Narcolepsy is an inherited, chronic, neurological disorder characterized by excessive and often uncontrollable daytime sleepiness. Narcolepsy is often associated with features such as:
- Automatic Behavior – Familiar, routine, or boring tasks are performed without conscious thinking or awareness.
- Uncontrolled Sleep Attacks – Falling asleep at any time or in any situation.
- Cataplexy – Muscle weakness or complete loss of muscle tone usually initiated by extreme emotions, stress, and fatigue.
- Sleep Paralysis – The inability to move when going to sleep or awakening.
- Hypnagogic Hallucinations – Vivid, intense, dream-like states generally occurring between wakefulness and sleep.
Diagnosis and assessment of narcolepsy requires a complete medical history and a sleep study. Treatment goals for narcolepsy are to control the symptoms through the use of medication, behavior modification, and educational support.
Nocturnal Myoclonus – Periodic limb movements (PLM) during sleep tend to occur at regular intervals throughout the night causing frequent arousals and awakenings.
Causes of PLM are unclear, but people with sleep disorders may have a greater incidence.
The treatment for periodic limb movements is directly related to the treatment of the underlying cause. Treatment is often accomplished with medications, vitamin and mineral supplements, exercise, and sleep hygiene.
Parasomnia – Parasomnias are sleep disorders that intrude into or interrupt sleep. Common parasomnias are:
- Sleepwalking – Is most common in children and decreases in frequency with age; although it may persist into adulthood. Sleepwalking may range from simply getting up and walking around the bedroom to prolonged walks throughout the house and outside. The only danger is that of the sleepwalker falling or becoming injured outside.
- Sleep Talking – Harmless episodes of isolated words or even comprehensive speech. It is often temporary and may be brought on by stress. Sleep talking may be associated with other sleep disorders such as sleep apnea and sleep terrors.
- Nightmares – Relatively common, nightmares are frightening dreams that often cause an awakening from dream (REM) sleep, usually with good recall of the dream. Nightmares are quite common in childhood. Adult nightmares are thought to be brought on by emotional stress or traumatic events.
- Sleep Terrors – Characterized by sudden arousals and often are accompanied by a loud scream or vocalization, confusion, and an attempt to try to “escape” from or “fight” the surroundings. This physical activity can result in harm to the sleeper or bed partner. Sleep terrors are more common in children than adults and have been noted to run in families.
- Sleep Eating – May be a manifestation of other sleep disorders such as sleep apnea and nocturnal myoclonus. Concerns for the sleep eater are more of safety, with potential choking or injury with food preparation. Sleep eating is overwhelmingly common in women and usually begins in the mid to late twenties.
Childhood Sleep Disorders – The same type of sleep disorders that occur in adults, such as sleep apnea, insomnia, narcolepsy, and parasomnias, also occur in children.
In children, the parasomnias are of particular interest. Parasomnias such as nightmares, night terrors, sleepwalking, and bed wetting are all unusual sleep behaviors that may affect children and adolescents.
Excessive daytime sleepiness (EDS) is a serious problem for children. Recognition is especially important in children as EDS impacts learning and mood. EDS may cause the child to appear inattentive, hyperactive, or exhibit impulsive behaviors, all of which tend to result in learning and behavior problems.
Sleep Problems and ADHD – There may be a link between attention deficit disorders (ADHD) and sleep problems. Children often express sleepiness by being inattentive and “hyper”. Research has found that children who were frequent snorers had high ADHD scores.
Determining the cause of a child’s inability to sleep, or EDS, as it relates to sleeping disorders is generally made by the physician, parents, and child, who complete a thorough medical history to determine the best interventions. |
