Sleep Disorders

Sleep Apnea
What is sleep apnea?

Sleep apnea is a serious sleep problem. If you have it, you stop breathing for more than 10 seconds at a time many times while you sleep. Another term for this problem is obstructive sleep apnea.

Sleep apnea affects between 2 and 10% of people. It is more common in men than in women. It is also more common in people who are overweight, but there are many people with normal weight who have sleep apnea.

How does it occur?

During normal sleep, throat muscles relax. In some people the airway can get blocked when this happens. The blockage slows or stops the movement of air, and the amount of oxygen in your blood drops. The drop in oxygen causes the brain to send a signal for you to wake up so that you can start breathing again. This cycle of not breathing and then waking up to breathe again may happen as often as 50 or more times an hour. Generally you will not remember waking up but the many arousals will make you sleepy the next day.

Being overweight may cause a narrowing of your airway. Other possible causes of sleep apnea are:

Tobacco smoking
Drinking a lot of alcohol
Lung disease
An abnormal sleep pattern because of an irregular work schedule or rotating shift work

Some people inherit a tendency to have sleep apnea.

What are the symptoms?

If you have sleep apnea, your body gets less oxygen when you sleep and you don’t sleep well. Common symptoms of sleep apnea are:

Loud snoring interrupted with pauses in breathing followed by loud gasps
Not feeling rested when you wake up in the morning
Morning headaches
Tiredness or sleepiness during the day
Trouble concentrating
Anxiety, irritability, or depression
A strong desire to take afternoon naps
Sleepiness while driving

Many people who snore do not have sleep apnea, but nearly everyone who has sleep apnea snores. If you snore and feel you do not usually get a good night’s rest, you should ask your healthcare provider if you might have sleep apnea.

How is it diagnosed?

Your healthcare provider may:

Ask you about your health history and your family’s health history.
Examine you, especially your throat and nasal passages.
Do a sleep study at a sleep disorders clinic or sleep lab. Your heart rate, brain waves, chest movement, and blood oxygen levels will be measured while you sleep. The study will help determine if the movement of air slows during sleep or if your air movement stops completely during sleep. It will also show how often this happens during sleep.

How is it treated?

It is very important to treat sleep apnea. Untreated sleep apnea can have very serious long-term effects on your health. It may increase your risk of high blood pressure, heart attacks, and sudden death. Effective treatment of sleep apnea may result in normal blood pressure, relief of fatigue, and weight loss.

The most common treatment is use of a machine that sends pressurized air into your nose and throat at night. This treatment is called continuous positive airway pressure (CPAP). It will help you breathe better while you sleep. How much pressure you need from the machine is determined by the sleep study. You may get the pressurized air through a mask or through tubes that fit snugly in the nose, or some other way may be used to get the air into your airways. Your sleep specialist will help you find the way that works best for you and will carefully supervise your use of the breathing machine. Minor adjustments may need to be made so that it works right for you.

If you have pressure on your throat because of excess fatty tissue in your throat, your healthcare provider may suggest a weight-loss program. It may be hard for you to lose weight because you are extremely tired and lack energy to exercise. Use of the breathing machine may help you rest well enough to begin changes in your diet and to increase your physical activity so you can lose weight.

Surgery may be an option if you cannot use the breathing machine regularly and properly. A surgical treatment might include improving the air passage in the nose, removing the tonsils, or moving the back of the tongue forward.

For mild sleep apnea, a dental device that moves the lower jaw forward may help. A minor surgical procedure to place an implant that stiffens the palate can also help.

How long will the effects last?

If your sleep apnea is caused by a reversible problem, such as being overweight, or if it can be treated with surgery, your sleep apnea can be cured. For most people, however, sleep apnea will always be a problem and the CPAP machine will need to be used regularly to get good quality sleep and to prevent the serious complications of sleep apnea.

How can I take care of myself?

If you think you may have sleep apnea, see your healthcare provider.
If you are being treated for sleep apnea, make sure you go to all your follow-up appointments with your provider. If you lose or gain a lot of weight or have new symptoms, talk to your provider to see if you need to change your treatment.

How can I help prevent sleep apnea?

Proper weight control, exercise (according to your healthcare provider’s recommendations), good sleeping habits, not smoking, and avoiding excessive alcohol use will help you have general good health and may help prevent sleep apnea.

For more information, call or write:

American Academy of Sleep Medicine
Phone: (708) 492-0930
Web site: http://www.aasmnet.org
Professional society representing practitioners of sleep medicine and sleep research

Written by Katherine Dinsdale.
Published by RelayHealth.
Last modified: 2009-08-13
Last reviewed: 2009-05-27

This content is reviewed periodically and is subject to change as new health information becomes available. The information is intended to inform and educate and is not a replacement for medical evaluation, advice, diagnosis or treatment by a healthcare professional.

Insomnia
What is insomnia?

Having insomnia means you often have trouble falling or staying asleep or going back to sleep if you awaken. Insomnia can be either a short-term or a long-term problem.

Insomnia affects 1 in 3 adults every year in the United States.

How does it occur?

Causes of insomnia include:

Stress such as a big deadline at work, a financial problem, or a sick family member
Being overweight
Depression, anxiety, or other mental health problems
Medical problems such as sleep apnea or hyperthyroidism
Restless leg syndrome (muscles in your lower legs twitch or tense up during sleep).
Use of caffeine or other stimulants
Use of alcohol, other depressants, or sedatives, which can relax you but lead to shallow sleep that starts and stops, especially if you use these drugs for a long time
Medicines, such as those used to treat asthma
Pain and other discomfort caused by an illness such as arthritis
Shortness of breath caused by chronic obstructive pulmonary disease (COPD) or heart failure
Poor sleep habits, including going to bed at different times or in a noisy environment, or eating or working in bed before sleeping
Changes in sleep patterns because of different work hours or travel (jet lag)

Insomnia may be temporary (called situational insomnia) or ongoing (chronic insomnia).

Situational insomnia occurs with a stressful event. It is often caused by noise, pain, worry, or family, work, financial, or school problems. It lasts 3 weeks or less. This kind of insomnia generally goes away when the stressful event is over or resolved.

Chronic insomnia can be caused by irregular sleep-wake patterns resulting from shift work, drug dependency (including long-term use of sleeping pills or alcohol), stress, illness, or mental health problems such as anxiety or depression. It lasts longer than 3 weeks and requires treatment of the underlying problem.

What are the symptoms?

Symptoms include:

Trouble falling asleep (taking longer than 45 minutes)
Awakening often in the night
Waking up early in the morning and being unable to go back to sleep
Not feeling rested in the morning or feeling tired during the day
Restlessness or anxiety as bedtime approaches

How is it diagnosed?

Your healthcare provider will ask you about:

Your sleep patterns
Use of caffeine, alcohol, medicine, and other drugs
Eating and exercise habits
Your mental and physical condition
Your medical and mental health history, and your family’s history
Your job and travel patterns

Your healthcare provider may also ask your spouse, bed partner, or other family members about your sleep habits. After talking with you, your healthcare provider may give you a physical exam. A blood sample may be taken for lab tests.

Your healthcare provider may ask you to take notes each morning about:

How long you were in bed
How much time you think you actually slept
How many times and what times you woke up
What time you got up in the morning
Your thoughts about the quality of your sleep
Recent stresses

Your healthcare provider may suggest that you sleep overnight in a sleep center. At the sleep center you may have a continuous, all-night recording of your breathing, eye movements, muscle tone, blood oxygen levels, heart rate and rhythm, and brain waves.

How is it treated?

If a medical problem is causing your insomnia, your provider will treat you for it. If drug or alcohol abuse is the cause of your insomnia, you will need to stop using these substances. If you have chronic insomnia, it must be treated with management of the underlying problem.

In some cases of temporary insomnia, your healthcare provider may prescribe medicine to help you sleep until the stressful event is over or resolved. Counseling may also help you deal with psychological problems or reduce stress that may cause or contribute to your insomnia.

Some sleeping medicine can be addictive. Your healthcare provider will work with you to choose the right medicine for short-term or long-term use.

Your healthcare provider may recommend relaxation techniques, changes in diet, cutting out caffeine, and a healthy lifestyle that includes exercise. Your provider also will probably discuss good sleep habits and a regular sleep routine.

How long will the effects last?

Often insomnia lasts for just a few nights. If you cannot sleep almost every night for 2 weeks, tell your healthcare provider. Insomnia that lasts this long usually continues until the cause is identified and treated.

How can I take care of myself?

Tell your healthcare provider if the treatment plan doesn’t help.
Tell your provider if you have side effects from medicine prescribed for the insomnia.
Follow your provider’s instructions for follow-up visits.

How can I help prevent insomnia?

Practice good sleep hygiene:

Establish a regular bedtime and wake-up time and stick to them even on weekends
Avoid taking naps
Exercise regularly during the day. Avoid exercising in the evening
Keep light levels very low after sunset and keep the bedroom very dark
Keep the bedroom at a cool temperature
Use the bed only for sleep and sex, not for reading, using the computer, or watching television
Go to bed when you are drowsy and get up when you are wide awake
Avoid caffeine, other stimulants, cigarettes, and alcohol. Do not drink alcohol within 6 hours of bedtime. If you smoke, try to quit smoking entirely. Cutting back on smoking without quitting may lead to nicotine withdrawal in the middle of the night that awakens you
Eat lightly at the evening meal and avoid snacks after supper
Lose weight if you are overweight
Learn to use relaxation exercises
Meditate for 20 minutes before you go to bed
Read something light or entertaining just before you go to bed, to get your mind off the day’s troubles
Consider having white noise in the background, such as a fan blowing
Try not to focus on falling asleep. For example, don’t keep checking the clock and worry about why you are not asleep yet. If you are awake for more than 30 minutes, leave the bed and do not go back to bed until you feel ready to sleep
Try to reduce stress in your life by changing the things that cause stress
Keep a “to do” journal. Before you go to bed, write down all the things you are worrying about. Then write down what you can do tomorrow. Mark the other things as things to do later in the week. This will help clear your mind of worry
Arrange your medicine schedule with your provider so that you take any drugs that might make you sleepy in the evening and drugs that may interfere with sleep during the day
Avoid daily use of sleep medicines. You may become dependent on them or build up your tolerance to them so that they no longer work as well. Most sleeping pills should not be used for more than 2 weeks in a row

Developed by Phyllis G. Cooper, RN, MN, and RelayHealth.
Published by RelayHealth.
Last modified: 2008-11-05
Last reviewed: 2008-10-17

Restless Legs Syndrome (RLS)
What is restless legs syndrome (RLS)?

Restless legs syndrome (RLS) is a cause of insomnia (trouble sleeping) for many people. Restless legs syndrome is aching, twitching, tingling, burning, or prickling feelings in the lower leg muscles when you lie in bed or sometimes when you are sitting. The discomfort may be relieved only by getting up and standing or walking.

How does it occur?

The exact cause of RLS is not known. It tends to run in families. It is more common after middle age and occurs more often in women than in men. Many people with RLS can remember having what they called growing pains in their legs during childhood. It may be that a nerve malfunction is involved. RLS has also been linked with alcohol dependence, smoking, too much caffeine (usually from drinking coffee), rheumatoid arthritis, anemia, and diabetes. Use of some medicines may make symptoms worse.

What are the symptoms?

Symptoms may include:

Aching, twitching, tingling, burning, prickling in the lower legs when you are lying down or sitting
Relief from the symptoms when you stand up or walk around.

Leg cramps and occasional, sudden jerking of legs or arms are not symptoms of restless legs syndrome. A day of heavy exercise can lead to or tight cramp in your calf (sometimes called a charley horse). Stretching and jiggling the calf muscle helps the cramp ease off and usually you can go back to sleep without having a relapse. Many people also have an occasional night jerk where their arm, leg, or half their body twitches once as they are falling asleep. This may wake you up, but it is not serious. Almost always you can go back to sleep without a second occurrence.

During sleep it is not unusual to have uncontrolled movements of your arms or legs. This is called periodic limb movements of sleep, or PLMS. Usually, you are not aware of these movements and you sleep through them. By themselves, they usually are not bothersome to the sleeper, although they may disturb a bed partner. People can have RLS or PLMS or both. Treatment of PLMS alone usually is not needed.

How is it diagnosed?

The diagnosis of RLS is based on your medical history. Your healthcare provider will examine you and may order blood tests or other tests to check for an underlying medical problem, such as anemia, rheumatoid arthritis, or diabetes.

How is it treated?

Your healthcare provider can prescribe medicine to relieve the symptoms and allow you to sleep. Pramipexole and ropinirole are recommended as the first drugs to try. These drugs act like levodopa (Sinemet), which is another drug that sometimes helps. Low-dose narcotic medicines or benzodiazepines (such as Valium) may also help.

For many people who have RLS, it is a great relief just to learn that there are other RLS sufferers like themselves and that they are not alone. If the nondrug treatments described below work well enough, then not taking a drug for RLS is generally wise.

How can I take care of myself?

Follow your healthcare provider’s advice for relief of your RLS symptoms.
Stretch or massage the leg muscles before going to sleep.
Practice relaxation methods.
Wear long socks to bed.
Use a covered hot water bottle or cold most cloths on painful areas before you go to sleep.
Take a warm bath before bedtime.
Avoid or cut back on caffeine (coffee, tea, cocoa, cola).
Avoid or cut back on alcohol.
Improve your general health: Eat a healthy diet. Exercise regularly.

For more information about restless legs syndrome, visit the Restless Legs Syndrome Foundation Web site: http://www.rls.org.

Developed by Ann Carter, MD, for RelayHealth
Published by RelayHealth.
Last modified: 2009-08-13
Last reviewed: 2008-02-11

Narcolepsy
What is narcolepsy?

Narcolepsy is a rare disorder, affecting about 120,000 people in the United States . It causes sufferers to uncontrollably fall asleep, even in the most unlikely situations, such as in the middle of a meal or conversation. In some people with narcolepsy, the condition can also cause a sudden loss of muscle control and weakness, known as cataplexy, which is usually triggered by emotions such as amusement, anger, or excitement.

What are the symptoms?

Narcolepsy is characterized by chronic, excessive attacks of drowsiness during the day, sudden extreme muscle weakness (cataplexy), hallucinations, paralysis while sleeping, and disrupted sleep during the night. Attacks of drowsiness may persist only a few minutes or last for hours, and may vary in frequency from a few incidents to several during a single day. Although the exact cause of narcolepsy is not known, many researchers suspect that genetic factors play a role in the development of the disorder.

How is it treated?

Clinical trials showed Xyrem can reduce the number of these cataplectic attacks when taken at bedtime and again 2 1/2 to 4 hours after falling asleep.

St. Paul Lung Clinic

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