Sleeping Disorders

Sleeping Disorders

Individuals with sleep disorders complain of the inability to get adequate quality or quantity of sleep or excessive daytime sleepiness. A detailed history regarding the onset of the symptoms, course, duration, relieving factors, precipitants the effects on daytime functioning and social implications gives the practitioners a direction on the type of sleep disorder an individual might be suffering from. Ideally, there are a number of sleep disorders including Insomnia, Sleep Apnea, Narcolepsy, Sleepwalking and Night Terrors which this discussion intends to cover.

Isomnia

Among other sleeping disorders, Insomnia is the most common disorder affecting people as either comorbid or primary condition (Mai & Bysee, 2008). In strict terms, insomnia means the inability to sleep. The term is applied to people who have a complaint of un-refreshing sleep or difficulties in initiating or maintaining sleep. As far as the prevalence is concerned, insomnia is generally a widespread complaint. The condition affects individuals of all races and ages. Its prevalence varies depending on the specific cases. In most cases, the condition is perceived to originate from a state of hyper-arousal. The sleeping difficulties are therefore caused by the elevated state of alertness.

The main risk factors for insomnia include female sex, increasing age, shift work, medical and substance use and unemployment and lower socioeconomic status. To some extent, patients with insomnia have daytime effects of the disturbed nighttime sleep including tiredness, fatigue, irritability and inability to concentrate that can affect the ability to perform normal duties or socialize. Other enduring characteristics of insomnia include early morning awakening and non-restorative sleep during the day. According to Mai & Bysee, (2008), the prevalence of insomnia is only approximately ten percent.

Insomnia is mainly diagnosed by clinical evaluation through a detailed sleep history and substance, psychiatric and medical history. This can be administered through self-questionnaires, symptom checklists, home sleep logs, bed partner interviews or psychological screening tests (Mai & Bysee, 2008). Behavioral and psychological interventions are effective and recommended in the treatment of chronic, primary and secondary insomnia. Short-term hypnotic treatment should also be supplemented with cognitive and behavioral therapies with time. In order to initiate the appropriate treatment for insomnia, a physician should determine the exact cause.

Sleep apnea

Unlike the insomnia disorder, sleep apnea is a common disorder that poses breathing (Sharafkhaneh, Giray, Richardson, Young & Hirshkowitz, 2005). In most patients, the poses can last for a number of seconds to minutes. Whereas there are a number of sleep apneas, the commonest type is obstructive sleep apnea. The disorder collapses and blocks the airway during sleep. When normal breathing gets back, it does so with a chocking sound or a snort. The main symptoms of the condition include fatigue, daytime sleepiness, disturbed sleep, irritability, diminished quality of life and memory problems (Sharafkhaneh et al, 2005). The individuals suffering from sleep apnea also tend to snore loudly.

Recently, sleep apnea has been associated with a number of psychiatric conditions including anxiety and depression. If not treated, obstructive sleep apnea can cause depression, high blood pressure and other heart diseases, learning and memory problems, irritability, impotence, weight gain and headaches (Sharafkhaneh, et al, 2005). The most at risk individuals are the male, overweight, children with enlarged tonsils or those with small airways or a family history of the disease.

The diagnoses of sleep apnea are based on family and medical histories, sleep duty results and a physical exam (Sharafkhaneh, et al, 2005). The condition can be treated through behavioral changes, breathing devices, mouthpieces or surgery. Losing weight and avoiding sedatives and alcohol are also important steps of managing sleep apnea. Other recommended changes include the use of nose sprays or allergy medicine, sleeping on the side instead of the back and quitting smoking. A mouthpiece is preferred to adjust the tongue and the lower jaw to help keep the airways open.

Generally, the most common treatment for both severe and moderate sleep apnea is continuous positive airway pressure (Sharafkhaneh, et al, 2005). This prevents the airways from closing by delivering air through a mask at a pressure slightly higher than normal. While this mode of treatment is very effective, it can cause a number of side effects including dry and stuffy nose, headaches or irritated skin. Depending with the cause of the airway blockage, surgery can be done as the last option.

Narcolepsy

Another human sleep disorder which has been associated with cataplexy and excessive daytime sleeping disorder is narcolepsy. Narcolepsy is the likely resultant of a defect in the fundamental mechanism of sleep regulation. According to Wilson & Nutt (1999), the disorder has a prevalence of approximately 0.05% with onset from childhood to middle age with a peak in the second decade. The excessive sleepiness of narcolepsy is characterized by repeated episodes of lapses and naps into the sleep of short duration (usually less than one hour), excessive daytime sleepiness and pathologic hallucinations and rapid eye movements. Cataplexy presents an episode of muscle weakness triggered by emotions especially laughter, humor and other positive emotions, sleep paralysis and hallucinations in drowsiness. Daytime sleepiness is however the most disabling aspects of the condition.

Treatment of narcolepsy is mainly carried out in specialist sleep centers where stimulant drugs are used to treat the daytime sleepiness and the cataplexy is often treated with antidepressants such as selective serotonin reuptake inhibitors. According to Wilson & Nutt, (1999), there is no cure for narcolepsy.

Sleep Walking

            Sleep walking is a partial arousal parasomnia which is defined as a series of complex behaviors that are initiated during slow wave sleep and result in walking while asleep. This occurrence mostly happens in the first third of the night. During the transition from slow wave sleep, individuals may move to full arousal, on to the next sleep cycle or become caught between sleeping and wakefulness in a partial arousal state. In children, the partial arousal condition is manifested by behaviors characterized by sleeping eyes closed, incoherent speech during sleep and literary walking out of bed. Since the disorder originates from slow wave sleep, sleep deprivation may precipitate sleep walking episodes since it increases slow wave sleep (Frank, Spirito, Stark & Stively, 1997). Exacerbations of the disorder also coincide with periods of stress, with alcohol increasing the likelihood of them occurring.

The intensity of sleepwalking ranges from calmly sitting up in bed and then walking to agitated walking, seemingly frantic efforts to escape a threatening situation and unexpected behavior including bed wetting. To some extent, sleep walking may be accompanied by other conditions including sleep talking and sleep terrors. Whereas the causes of sleep walking are unknown, genetic factors are said to be important in the etiology of the condition. The disorder also occurs in Parkinson’s disease, migraine, hyperthyroidism and following the use of olanzapine or quetiapine. Some studies also associate mental disorders and psychotropic medications with adult sleepwalking (Mume, 2009).

The most common treatment of the disease is to have children provided with a safe environment not to intervene during a sleepwalking episode. Treatments may also focus on changing or altering sleep staging or the use of medications that suppress the situation including carbamazapam, clonazepam, imipramine, flurazepam and diazepam (Mume, 2009). On the other hand, effective, safe and non-invasive interventions are needed due the disorder’s potential long-term course, potential harm to the sleepwalking child, and the high level of parental concern and the reluctance of physicians to prescribe medications for young children. Consequently, behavioral interventions targeting changes in the sleep pattern are required to help in the transition from slow wave sleep. This could either be in the form of scheduled awakenings or the introduction of daytime naps.

Night Terrors

            A night terror is a disorder that disrupts sleep in a more dramatic presentation than a nightmare. The episodes appear like sudden reactions of fear that occur during the transition from one sleep phase to another.  In the case of a night terror, the patient sits or jumps up from deep sleep with a loud cry, looks terrified and moves violently. Night terrors are also associated with heartbeats and fast breath, thrash around, sweat and scared and upset episodes (Linton, 2013).

Unlike the nightmares which are remembered by the patient, the night terrors do not leave any mental images to be remembered. The patient only appears to be asleep and uncommunicative and often returns to sleep without being aware of the occurrence. In most cases, the terrors are perceived to be a welling up of anxiety from deep centers in the brain which is normally inhibited by cortical mechanisms (Wilson & Nutt, 1999).

The main cause of night terrors is the over arousal of the central nervous system during sleep. It also occurs in individuals who are undertaking new medications, sick, fatigued, stressed, tired, or those sleeping in a new environment. Recently, paroxetine and benzodiazepines have proved effective forms of treating night terrors (Wilson & Nutt, 1999.

Generally, sleeping disorders occur to people of all ages and status. In order to assist in the diagnosis of sleep disorders, the patient should keep a diary of when they slept and how they felt about their sleep. When the symptoms are fully understood, objective recording of sleep is important to differentiate between disorders occurring in different sleep stages.

 

 

References

Frank, N., Spirito, A., Stark, L. Stively, J. (1997). The Use of Scheduled Awakenings to

Eliminate Childhood Sleepwalking. Journal of Pediatric Psychology, 22(3), 345-353

Linton, S. (2013). A Cognitive Behavioral Exposure Treatment Package for Night Terrors: A

Case Study. The Open Sleep Journal, 6, 8-11

Mai, E. & Buysse, D. (2008). Insomnia: Prevalence, Impact, Pathogenesis, Differential

Diagnosis, and Evaluation. Sleep Medicine Clinics, 3, 167-174.

Mume, C. (2010). Prevalence of Sleepwalking in an Adult Population. Libyan Journal of

            Medicine, 5, 1-4

Sharafkhaneh, A., Giray, N., Richardson, P. Young, T & Hirshkowitz, M. (2005). Association of

Psychiatric Disorders and Sleep Apnea in a Large Cohort. SLEEP, 28 (11), 1405-1411.

Wilson, S. & Nutt, D. (1999). Treatment of Sleep Disorders in Adults. Advances in Psychiatric

            Treatment, 5, 11-18.

 

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