Sleep Problems 101


Sleep Problems
Sleep disorders may seem like a light-hearted issue, but actually they can
wreak havoc on patients' lives.

Sleep problems are common, and they range far beyond just missing out on a good night’s sleep. To the legions of sufferers, even a relatively mild problems can be highly troublesome, and serious problem can have extreme consequenses.

The story is told of a woman who left her home one night, drove to the airport, bought a plane ticket, boarded a cross-country flight, and midway through the trip -- woke up! She had been asleep and unaware of her actions during the entire series of events. It's not known what pulled her out of her slumber, but suspicions point to the smell of airplane food.

We've all heard stories such as this about supposed sleepwalking episodes in which sleepers did uncanny things while sound asleep. They usually elicit a hardy chuckle or a shake of the head. In a way, though, these stories can give a false impression about the seriousness of sleep disorders.

Sleep researchers are divided about whether such extreme episodes are truly sleepwalking or are instead due to other factors, such as psychiatric disorders or amnesia related to medication. But one thing researchers do agree on is that even the less-bizarre sleep disorders can and do wreak havoc on sufferers' lives. For the people who suffer from them, sleep disorders are no laughing matter.

Sure, everyone occasionally misses out on a good night's sleep. But for a substantial portion of our population, an entire night of restful or uninterrupted sleep is something they only daydream about. Many of these people suffer from one of over 80 classified sleep disorders.

Most sleep problems are not diseases in themselves. Insomnia, for example, refers to difficulty in falling asleep, difficulty staying asleep, or waking too early. But insomnia is not a disease in and of itself. It is a symptom that can be caused by a host of lifestyle patterns and medical conditions. Insomnia, therefore, is considered a secondary sleep disorder (although for those plagued by insomnia, the term "secondary" hardly does it justice).

On the other hand, there are diseases, such as sleep apnea, that occur primarily during or in association with sleep. These are considered primary sleep disorders. The primary sleep disorders include:

  • sleep apnea
  • narcolepsy
  • hypersomnolence
  • restless legs syndrome
  • periodic limb movement disorder
  • sleepwalking
  • night terrors
  • REM sleep behavior disorder
  • bruxism (grinding your teeth)

In addition to insomnia, the secondary sleep disorders include circadian rhythm disorders, situations in which your body's sleep-wake cycle is out of sync with the times you need to be awake and the times you need to be asleep.

So how do you know what type of sleep problem you have? A starting point is to review your own sleep habits for the possibility of a sleep disorder. Try answering "yes" or "no" to the following questions.


Yes No
1. When you get in bed at night, do you often have trouble falling asleep?

2. Does it seem like you just can't fall asleep until very late at night?

3. Do you find it very difficult to wake up before 10 a.m.?

4. Do you tend to fall asleep early in the evening and then wake up before the sun comes up?

5. Do you find yourself waking up several times throughout the night?

6. Do you wake up earlier in the morning than you need to and have trouble falling back to sleep?

7. Do you ever wake up in the night screaming, yelling, crying, or in an otherwise terrified state without knowing why?

8. Have you ever just collapsed on the spot the instant after hearing a funny joke, seeing a great sports play, or otherwise being excited?

9. Have you ever been told that you snore loudly and seem to stop breathing temporarily during the night?

10. Have you been told that you walk in your sleep?

11. Have you ever awoken to find yourself out of bed without remembering how you got there?

12. Have you been told that you move a lot in your sleep?

13. Have you ever injured yourself or anyone else while you were sleeping?

14. Do you feel tingly, prickly, itchy, or otherwise uncomfortable feelings in your legs as you start to fall asleep?

If you answered "yes" to any of those questions, you may have a primary or secondary sleep disorder. To get a proper diagnosis and appropriate treatment you need to see a physician, preferably one knowledgeable about sleep disorders. This article will address the primary sleep disorders, starting with sleep apnea on the next page.

For more information on how to get a good night's sleep, see:

This information is solely for informational purposes. IT IS NOT INTENDED TO PROVIDE MEDICAL ADVICE. Neither the Editors of Consumer Guide (R), Publications International, Ltd., the author nor publisher take responsibility for any possible consequences from any treatment, procedure, exercise, dietary modification, action or application of medication which results from reading or following the information contained in this information. The publication of this information does not constitute the practice of medicine, and this information does not replace the advice of your physician or other health care provider. Before undertaking any course of treatment, the reader must seek the advice of their physician or other health care provider.

Sleep Apnea

Sleep apnea is a condition in which breathing is severely restricted during sleep, and it leads to fatigue that can greatly reduce the sufferer's quality of life.

Consider Ken. He chronically complains about being tired. He began having severe fatigue when he was in his early thirties. Up to that time, he had been a successful business owner. Since that time, however, he has lost his business and can't keep a job for more than a month. Of the numerous jobs he has held, nearly all have resulted in him getting fired for "laziness."

Employers see his five to ten mini-naps each day as evidence he doesn't care about his job. His being very overweight and having other health conditions have led several doctors to misdiagnose the reason for his sleepiness. After several years and countless trips to different doctors who gave differing diagnoses, he recently went to a sleep disorders clinic, where they correctly diagnosed his condition as sleep apnea.

Ken is one of an estimated 18 million Americans, mostly overweight, middle-aged men, who suffer from sleep apnea, a potentially life-threatening disorder that causes a person to stop breathing during sleep. The word apnea means "without breath." The most common form of sleep apnea is called obstructive sleep apnea. Here's how it happens.

In a person with obstructive sleep apnea, the throat muscles and tongue relax during sleep, and the tongue and uvula (the small dangling tissue at the back of the throat) sag and block the airway. Excess fatty tissue in the neck aggravates this by reducing the size of the airway, allowing it to collapse or be sucked closed. As a result, breathing ceases or is significantly reduced for at least a few seconds and, in some cases, for as much as a few minutes at a time.

When breathing stops or becomes insufficient, it triggers a signal to the brain to jump-start the breathing again. But to do this, the brain has to awaken the body from deep sleep. The signal that the jump-start has kicked in is usually a loud snort and/or gasp.

This impairment of breathing can occur up to 30 times an hour throughout the night. And each time, the person wakes briefly before falling back asleep. Imagine what you would feel like in the morning if you woke up 200 or more times during the course of one night! A "walking zombie" perhaps? How about if this happened every night? It would be a struggle just to perform basic daily tasks. Not only do people with sleep apnea struggle with constant fatigue, but they are also at greater risk for accidents, high blood pressure, heart attacks, and other health conditions.

Sometimes apnea can be cured with weight loss or reduced by sleeping on one's side. Other treatments include dental devices, surgery, and a special mask worn at night to keep the airways open. If you suspect you have sleep apnea, the starting point for diagnosing it would be to visit a sleep clinic.

If, instead of breifly waking up at night, you briefly fall asleep during the day, you may have narcolepsy. Find out about this disorder on the next page.

Snoring and Sleep Apnea
Just because someone snores doesn't mean they have sleep apnea. While between 30 and 40 percent of adults snore, only 1 percent of those people have sleep apnea. So how do you tell the difference? It's difficult for the untrained eye to see sleep apnea. Even nurses and doctors may not know when they are observing a person with sleep apnea.

Not all people with serious sleep apnea completely quit breathing, either. Typically, though, very loud snoring, snorting, and gasping or otherwise struggling to breathe are signs of sleep apnea. Snoring without apnea is not a health threat to the snorer, but it may be a very real problem for a bed-mate who may be sleep-deprived because of the constant nocturnal buzz saw. Snoring is most likely to occur when the sleeper is lying faceup.

A simple way to solve the problem is to sew a pocket into the back of the snorer's bedclothes. Before going to bed, slip a tennis ball in the pocket. This lump will gently remind the person to stay off their back while sleeping. There are also mouth devices and surgical procedures that can alleviate snoring.

For more information on how to get a good night's sleep, see:

This information is solely for informational purposes. IT IS NOT INTENDED TO PROVIDE MEDICAL ADVICE. Neither the Editors of Consumer Guide (R), Publications International, Ltd., the author nor publisher take responsibility for any possible consequences from any treatment, procedure, exercise, dietary modification, action or application of medication which results from reading or following the information contained in this information. The publication of this information does not constitute the practice of medicine, and this information does not replace the advice of your physician or other health care provider. Before undertaking any course of treatment, the reader must seek the advice of their physician or other health care provider.

Narcolepsy

People with narcolepsy experience sudden and irresistible urges to sleep during the daytime; these sleep episodes last anywhere from a few seconds to 30 minutes, but they are not planned naps. They are more appropriately referred to as sleep "attacks" that can occur repeatedly throughout the day during normal activities such as talking, eating, and even driving. One minute the person is awake and alert, the next they are sound asleep.

You might think these folks are dozing uncontrollably because they are sleep-deprived, but people with narcolepsy may be getting an adequate amount of rest at night. The culprit seems to be the degeneration of certain cells in the brain, which in turn leads to abnormalities in alertness control and REM sleep.

The typical person starts a sleep cycle in non-REM sleep and ends it in REM sleep. Researchers have found that people who have narcolepsy, on the other hand, often begin a cycle with REM sleep.

As if those symptoms weren't enough, another important one that accompanies narcolepsy is cataplexy. This is sudden, partial or complete muscle paralysis brought on by emotions such as joy, anger, or elation. So imagine this embarrassing scenario: You're out on a date. Something humorous is said. You spontaneously respond with hearty laughter, and in the next breath your face is in your soup. Not the way you wanted to finish your meal or the date.

Cataplexy is caused by a REM sleep mechanism that is similar to the partial paralysis that the brain naturally triggers to keep us from acting out our dreams at night. This same mechanism may cause another symptom of narcolepsy called sleep paralysis, in which the person is awake but unable to move or to speak for a few moments.

The paralysis occurs as the person is just falling asleep or waking up. Frightening hallucinations, which are actually dreams or nightmares, can occur during the sleep paralysis, which is yet another sign that the REM sleep mode has not disengaged. When sleep paralysis and hallucinations occur together, it can be extremely distressing.

Narcolepsy usually begins in late childhood or adolescence, and excessive sleepiness is almost always the first symptom. There is a strong genetic link among the quarter of a million Americans coping with this difficult sleep disorder.

Although there is no cure for narcolepsy, symptoms can be lessened by taking brief naps as needed throughout the day. Other treatments include prescription medications such as antidepressants and stimulants. The stimulants are used to combat the severe daytime sleepiness, and the antidepressants are used to control the cataplexy, sleep paralysis, and sleep-related hallucinations.

Sleeping during the day can also be a sign of hypersomnia. Learn about this disorder on the next page.

For more information on how to get a good night's sleep, see:

This information is solely for informational purposes. IT IS NOT INTENDED TO PROVIDE MEDICAL ADVICE. Neither the Editors of Consumer Guide (R), Publications International, Ltd., the author nor publisher take responsibility for any possible consequences from any treatment, procedure, exercise, dietary modification, action or application of medication which results from reading or following the information contained in this information. The publication of this information does not constitute the practice of medicine, and this information does not replace the advice of your physician or other health care provider. Before undertaking any course of treatment, the reader must seek the advice of their physician or other health care provider.

Hypersomnia

Hypersomnia is a sleep disorder in which people sleep too much, either at night or during the day. Some people naturally sleep for longer periods and aren't considered to have a sleep disorder. But others may sleep excessively with some distinguishing traits. There are three types of hypersomnia:

  • Recurrent hypersomnia lasts several weeks and can recur periodically. Some people experience binge eating and hypersexuality with the excessive sleeping. This type is most common among adolescent males.

  • Idiopathic (meaning "of unknown cause") hypersomnia is often mistaken for narcolepsy because the symptoms are similar. The major difference is the absence of cataplexy, sleep paralysis and sleep-related hallucinations.

  • Posttraumatic hypersomnia can occur as a result of a head injury and usually includes headaches and concentration and memory problems. The symptoms usually begin immediately after the injury.

Treatment for hypersomnia can include one or more prescription medications. Since the cause of idiopathic hypersomnia is not known, treatment is limited to managing symptoms. An accurate diagnosis is critical before any treatment can begin.

In another primary sleep disorder, restless leg syndrome, a physical affliction prevents the sufferer from falling asleep. Learn more about RLS on the next page.

For more information on how to get a good night's sleep, see:

This information is solely for informational purposes. IT IS NOT INTENDED TO PROVIDE MEDICAL ADVICE. Neither the Editors of Consumer Guide (R), Publications International, Ltd., the author nor publisher take responsibility for any possible consequences from any treatment, procedure, exercise, dietary modification, action or application of medication which results from reading or following the information contained in this information. The publication of this information does not constitute the practice of medicine, and this information does not replace the advice of your physician or other health care provider. Before undertaking any course of treatment, the reader must seek the advice of their physician or other health care provider.

Restless Legs Syndrome and PLMD

Sufferers of restless legs syndrome (RLS) feel a crawling, burning, itchy, or prickling sensation in their legs when resting for long periods, especially in the evening.

What would you think if someone told you they felt like they had bugs crawling around in their leg muscles when they tried to go to sleep? You might be prompted to look up the phone number of a psychiatrist. But more often than not, this symptom is related to restless legs syndrome (RLS).

Moving the legs seems to help alleviate the discomfort, but to do so results in the person frequently awakening from sleep. And that, of course, leads to fatigue during the daytime.

Of the 12 million Americans with RLS, most are middle-aged adults, although the condition can occur at any age. RLS might also be suspected if similar symptoms appear among these high risk groups:

RLS and PLMD
The symptoms of restless legs syndrome (RLS) and periodic limb movement disorder (PLMD) resemble each other, but with some differences. A creepy crawly sensation in the legs, for example, is a hallmark of RLS but not PLMD. While each is considered a separate disorder, the RLS Foundation estimates that 80 percent of those with RLS also experience PLMD.

  • Children who have "growing pains," or those labeled hyperactive
  • Pregnant women, especially those in their third trimester
  • Persons with a family history of RLS
  • People who have iron deficiency, anemia, diabetes, kidney failure or rheumatoid arthritis

Improvement of RLS may occur with regular exercise and reduced caffeine consumption. Most often, RLS is treated with prescription medication and relaxation techniques.

Periodic Limb Movement Disorder (PLMD)

Does your bed partner ever complain that your legs suddenly jerk during sleep? One possible cause might be that you're dreaming of kicking the winning goal in a World Cup Soccer match, but more likely, you have periodic limb movement disorder (PLMD).

Sure, getting a diagnosis of PLMD is not as exciting as winning the World Cup, but at least your sleeping partner will be able to get a better night's sleep if you address the problem. And you will, too.

The involuntary movements of PLMD can occur every 10 to 60 seconds and usually happen in the first half of the night during NREM sleep. The movements themselves are not harmful, except perhaps to your bed partner. The main disadvantage is frequent waking, which leads to daytime fatigue. About one in three people over age 60 has PLMD. Treatment is the same as for restless legs syndrome.

If your limb movements take you up out of bed and around the house, you’re sleepwalking. Learn about this disorder on the next page.

For more information on how to get a good night's sleep, see:

This information is solely for informational purposes. IT IS NOT INTENDED TO PROVIDE MEDICAL ADVICE. Neither the Editors of Consumer Guide (R), Publications International, Ltd., the author nor publisher take responsibility for any possible consequences from any treatment, procedure, exercise, dietary modification, action or application of medication which results from reading or following the information contained in this information. The publication of this information does not constitute the practice of medicine, and this information does not replace the advice of your physician or other health care provider. Before undertaking any course of treatment, the reader must seek the advice of their physician or other health care provider.

Sleepwalking

For most people, sleepwalking conjures a picture of some Hollywood movie where the sleepwalker, eyes glazed, arms stretched out in front, walks in a rigid, monsterlike fashion, unaware of their actions.

While film dramatizes the actual disorder of sleepwalking, some characteristics apply. For instance, sleepwalkers appear awake (their eyes are open) but are actually in the deepest phase of sleep (stage four). They may be able to navigate around objects and in some cases perform basic tasks such as opening a door. And, sleepwalkers may become combative if they are restrained.

Researchers believe that sleepwalking has a genetic link and results from an incomplete development of the brain in certain individuals. Stress, fever, sleep deprivation, and epilepsy are known triggers for sleepwalking. Approximately four percent of adults have consulted doctors about sleepwalking. Yet it appears to be more common among children. Approximately 10 to 15 percent of children aged 5 to 12 have at least one episode of sleepwalking.

In most cases, sleepwalking ends on its own after adolescence. Treatment for older children and adults may include a variety of medications as well as hypnotherapy. Adults who sleepwalk may be suffering posttraumatic stress disorder or other psychiatric illness that may require treatment with prescription medications, hypnotherapy, stress-management techniques, and psychotherapy.

Like sleepwalking, night terrors also afflict people while they are fully asleep. Learn what this condition is and how it differs from nightmares.

For more information on how to get a good night's sleep, see:

This information is solely for informational purposes. IT IS NOT INTENDED TO PROVIDE MEDICAL ADVICE. Neither the Editors of Consumer Guide (R), Publications International, Ltd., the author nor publisher take responsibility for any possible consequences from any treatment, procedure, exercise, dietary modification, action or application of medication which results from reading or following the information contained in this information. The publication of this information does not constitute the practice of medicine, and this information does not replace the advice of your physician or other health care provider. Before undertaking any course of treatment, the reader must seek the advice of their physician or other health care provider.

Night Terrors

Night terrors (also called sleep terrors) are frightening instances in which a person screams, cries, even jumps from bed, while still fully asleep. These episodes can be very unsettling to the bed partner or others in the living situation and may result in bodily harm to the sleeper or others. The person may not awaken until the episode is over and may remember nothing of the incident.

You may recall that in non-REM sleep, physical movement is not restricted as it is in REM sleep. Since both sleepwalking and night terrors occur during NREM sleep, the person can move about freely while still technically asleep. Night terrors are often confused with nightmares but are not the same (see sidebar below).

Approximately three percent of adults have night terrors, and 15 percent of children and adolescents experience them. Night terrors are believed to occur when there is a disruption in the nervous system, often triggered by stress, sleep deprivation, or sleeping in unfamiliar surroundings.

Some sleep experts believe that sleepwalking and night terrors are two manifestations of the same disorder, with sleepwalking being the mildest form and night terrors the most severe. In children, this disorder usually disappears as they mature. Treatment for adult night terrors may include much the same approaches that are used for adult sleepwalkers -- prescription medication, hypnotherapy, psychotherapy, and stress-management techniques.

While night terrors can disrupt sleep, some people have difficulty falling asleep at all. The next page will introduce you to the wide-ranging condition of insomnia.

Night Terrors vs. Nightmares
Night terrors occur in non-REM sleep, while nightmares (also called dream anxiety attacks) take place in REM. You may recall that dreaming only occurs in REM sleep, and when you are dreaming, your body is physically unable to move.

So if you were having a nightmare, you wouldn't be able to grab that baseball bat stored in your bedroom closet to ward off your imagined attackers. The act of getting out of bed or verbally yelling or crying during sleep is more likely to be a night terror than a nightmare.

For more information on how to get a good night's sleep, see:

This information is solely for informational purposes. IT IS NOT INTENDED TO PROVIDE MEDICAL ADVICE. Neither the Editors of Consumer Guide (R), Publications International, Ltd., the author nor publisher take responsibility for any possible consequences from any treatment, procedure, exercise, dietary modification, action or application of medication which results from reading or following the information contained in this information. The publication of this information does not constitute the practice of medicine, and this information does not replace the advice of your physician or other health care provider. Before undertaking any course of treatment, the reader must seek the advice of their physician or other health care provider.

Insomnia

Although insomnia is classified as a secondary sleep disorder, the fatigue and hardship it causes are on par with primary disorders. Insomnia, a broad term that covers many different forms of sleeping difficulty, has a host of causes and can be related to several other health conditions. Check out Causes of Insomnia for more information about this wide-spread sleep disorder.

Sleep problems can make your waking hours almost unbearable. If you're feeling fatigued, use the information in this article, along with your doctor's advice, to determine what the trouble might be.

For more information on how to get a good night's sleep, see:

ABOUT THE AUTHOR

Virgil D. Wooten, M.D., is the medical director of the TriHealth Sleep Centers at Good Samaritan and Bethesda North hospitals in Cincinnati. He is also a diplomat of the American Board of Sleep Medicine, a fellow of the American Academy of Sleep Medicine, and a consultant, writer, and speaker on sleep-related subjects. Dr. Wooten has more than 25 years of research, clinical and teaching experience.

This information is solely for informational purposes. IT IS NOT INTENDED TO PROVIDE MEDICAL ADVICE. Neither the Editors of Consumer Guide (R), Publications International, Ltd., the author nor publisher take responsibility for any possible consequences from any treatment, procedure, exercise, dietary modification, action or application of medication which results from reading or following the information contained in this information. The publication of this information does not constitute the practice of medicine, and this information does not replace the advice of your physician or other health care provider. Before undertaking any course of treatment, the reader must seek the advice of their physician or other health care provider.