A sleep disorder (somnipathy) is a medical disorder of the sleep patterns of a person or animal. Some sleep
disorders are serious enough to interfere with normal physical, mental and
emotional functioning. A test commonly ordered for some sleep disorders is the
polysomnogram.
The most common sleep disorders include:
- Primary insomnia: Chronic
difficulty in falling asleep and/or maintaining sleep when no other cause is
found for these symptoms.
- Bruxism: Involuntarily grinding or
clenching of the teeth while sleeping
- Delayed sleep phase syndrome
(DSPS): inability to awaken and fall asleep at socially acceptable times but no
problem with sleep maintenance, a disorder of circadian rhythms. Other such disorders are advanced sleep phase syndrome
(ASPS) and Non-24-hour sleep-wake syndrome
(Non-24), both much less common than DSPS.
- Hypopnea syndrome: Abnormally
shallow breathing or slow respiratory rate while sleeping
- Narcolepsy: Excessive daytime sleepiness (EDS)
often culminating in falling asleep spontaneously but unwillingly at
inappropriate times.
- Cataplexy, a sudden weakness
in the motor muscles that can result in collapse to the floor.
- Night terror, Pavor
nocturnus, sleep terror disorder: abrupt awakening from sleep with behavior
consistent with terror
- Parasomnias: Disruptive
sleep-related events involving inappropriate actions during sleep stages - sleep
walking and night-terrors are examples.
- Periodic limb movement disorder
(PLMD): Sudden involuntary movement of arms and/or legs during sleep, for
example kicking the legs. Also known as nocturnal
myoclonus. See also Hypnic
jerk, which is not a disorder.
- Rapid eye movement behavior
disorder (RBD): Acting out violent or dramatic dreams while in REM sleep
- Restless legs syndrome (RLS): An
irresistible urge to move legs. RLS sufferers often also have PLMD.
- Situational circadian rhythm sleep
disorders: shift work sleep disorder (SWSD) and
jet lag
- Obstructive sleep apnea: Obstruction of
the airway during sleep, causing lack of sufficient deep sleep; often
accompanied by snoring. Other forms of sleep apnea are less common.
- Sleep paralysis
is characterized by temporary paralysis of the body shortly before or after sleep.
Sleep paralysis may be accompanied by visual, auditory or tactile hallucinations. Not a disorder unless severe.
Often seen as part of Narcolepsy.
- Sleepwalking or
somnambulism: Engaging in activities that are normally associated with
wakefulness (such as eating or dressing), which may include walking, without the conscious knowledge
of the subject.
- Nocturia: A frequent need to get
up and go to the bathroom to urinate at night. It differs from Enuresis, or bed-wetting, in which the person does not
arouse from sleep, but the bladder nevertheless empties.
Broad classifications of sleep disorders
Common causes of sleep disorders
Changes in life style, such as shift work change (SWC), can contribute to
sleep disorders.
Other problems that can affect sleep:
Treatments for sleep disorders generally can be grouped into four
categories:
None of these general approaches is sufficient for all patients with sleep
disorders. Rather, the choice of a specific treatment depends on the patient's
diagnosis, medical and psychiatric history, and preferences, as well as the
expertise of the treating clinician. Often, behavioral/psychotherapeutic and
pharmacological approaches are not incompatible and can effectively be combined
to maximize therapeutic benefits. Management of sleep disturbances that are
secondary to mental, medical, or substance abuse disorders should focus on the
underlying conditions.
Medications and somatic treatments may provide the most rapid symptomatic
relief from some sleep disturbances. Some disorders, such as narcolepsy, are
best treated pharmacologically. Others, such as chronic and primary insomnia,
may be more amenable to behavioral interventions, with more durable results.
Chronic sleep disorders in childhood, which affect some 70% of children with
developmental or psychological disorders, are under-reported and under-treated.
Sleep-phase disruption is also common among adolescents, whose school schedules
are often incompatible with their natural circadian rhythm. Effective treatment
begins with careful diagnosis using sleep diaries and perhaps sleep studies.
Modifications in sleep hygiene may resolve the problem, but medical treatment is
often warranted.
Special equipment may be required for treatment of several disorders such as
obstructive apnea, the circadian rhythm disorders and bruxism. In these cases,
when severe, an acceptance of living with the disorder, however well managed, is
often necessary.
Due to rapidly increasing knowledge about sleep in the 20th century,
including the discovery of REM sleep and sleep apnea, the medical importance of
sleep was recognized. The medical community began paying more attention than
previously to primary sleep disorders, such as sleep apnea, as well as the role
and quality of sleep in other conditions. By the 1970s in the USA, clinics and
laboratories devoted to the study of sleep and sleep disorders had been founded,
and a need for standards arose.
Sleep Medicine is now a recognized subspecialty within internal medicine,
family medicine, pediatrics, otolaryngology, psychiatry and neurology in the United States. Certification in
Sleep Medicine shows that the specialist:
"has demonstrated expertise in the diagnosis and management of clinical
conditions that occur during sleep, that disturb sleep, or that are affected by
disturbances in the wake-sleep cycle. This specialist is skilled in the analysis
and interpretation of comprehensive polysomnography, and well-versed in emerging
research and management of a sleep laboratory."
Competence in sleep medicine requires an understanding of a plethora of very
diverse disorders, many of which present with similar symptoms such as excessive daytime sleepiness, which,
in the absence of volitional sleep deprivation, "is almost inevitably
caused by an identifiable and treatable sleep disorder", such as sleep apnea, narcolepsy, idiopathic central
nervous system (CNS) hypersomnia, Kleine-Levin syndrome, menstrual-related
hypersomnia, idiopathic
recurrent stupor, or circadian rhythm
disturbances.
Another common
complaint is insomnia, a set of symptoms which can have a great many different
causes, physical and mental. Management in the varying situations differs
greatly and cannot be undertaken without a correct diagnosis.
Sleep dentistry (bruxism, snoring
and sleep apnea), while not recognized as one of the nine dental specialties, qualifies for board-certification
by the American
Board of Dental Sleep Medicine (ABDSM). The resulting Diplomate status is
recognized by the American Academy of Sleep
Medicine (AASM), and these dentists are organized in the Academy
of Dental Sleep Medicine (USA).
The qualified
dentists collaborate with sleep physicians at accredited sleep centers and can
provide oral appliance therapy and upper airway surgery to treat or manage
sleep-related breathing disorders.
In the UK, knowledge of sleep medicine and possibilities for diagnosis and
treatment seem to lag. Guardian.co.uk quotes the director of the Imperial College
Healthcare Sleep Centre: "One problem is that there has been relatively
little training in sleep medicine in this country – certainly there is no
structured training for sleep physicians." The Imperial
College Healthcare site shows attention to
obstructive sleep apnoea syndrome (OSA) and very few other sleep disorders.
Copyright(C) 2007
- 2015. All rights reserved.
|