Sleep Disorders

Sleep Disorders, Causes, Symptoms, Solutions

By The Fix staff 01/21/15

Sleep problems often develop in conjunction with other health issues

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Sleep Disorders

We all talk about sleep, or the lack thereof. Most of the time, comments revolve around not getting enough of the precious commodity. According to the Centers for Disease Control and Prevention (CDC), as many as 37% of adults report not getting enough sleep.

Almost everyone on the planet has experienced at least one time when wanting to catch 40 winks and not being able to. The situation pushes into disorder territory when the person feels distressed and anxious about not being able to sleep the way they need to and can't improve things no matter how hard they try. Also, a condition becomes a disorder when the person experiences negative consequences at home, at work or school, or during leisure time as a result of insomnia or other sleep disorders.

A surprising number of factors are part of being able to get restful and refreshing sleep. Environment, noise level, time of day, what was eaten or drunk, activity level before sleep time, and traveling to a different time zone are just some of the things that can affect sleep.

Getting to sleep doesn't mean a person is home free, either. Some people get to sleep fine, but have trouble staying asleep or sleeping long enough. Waking in the middle of the night and not being able to get back to sleep, or waking up earlier than planned are also examples of disordered sleep.

What are Sleep and Sleep Disorders

Sleep is something humans can't stockpile. Sleeping 12 hours one night and four hours the next doesn't work, even though the average is eight hours a night over the two-night period. A person must get enough sleep every night/24-hour period in order to feel functional. Getting, or not getting, the amount of sleep that works for an individual (7-9 hours/night for most adults) can have strong effects on personality, ability to concentrate, alertness, emotional stability, and appearance. Needing to nap during the day (if a person is more than five years old), or needing caffeine or supplements to stay awake or keep going throughout the day are two major signs that something in the sleep department is not right.

For some, it's more than a case of getting to bed early enough. Both physical and mental health factors affect the quantity and quality of sleep some people get. These factors are considered serious enough that they have their own section in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V). Sleep-wake disorders are divided into three major categories:

Breathing-Related Sleep Disorders

These particular issues may be more related to physical conditions than the others. Generally speaking, these disorders center around not being able to breathe properly while asleep. There is a growing understanding of how these disorders come about, and this may affect how clinicians choose to treat them. Physical health personnel as well as mental health professionals need to be part of diagnosis and treatment.

  1. Obstructive sleep apnea/hypopnea. Not breathing often enough, or not breathing at all while sleeping can be fatal. Sleep apnea causes restlessness, poor-quality sleep, snoring, headaches, fatigue and irregular heart rhythms.
  2. Central sleep apnea, a problem with a person's central nervous system, doesn't send proper breathing signals to the body during sleep. It is rarer than obstructive sleep apnea.
  3. Sleep-related hypoventilation -  Heart failure is a possible complication when oxygen levels in the blood are chronically too low

Circadian Rhythm Sleep-Wake Disorders

In general, these are problems with falling asleep and waking up.

  1. Advanced sleep phase syndrome – On the surface, this sounds like the person is simply being a night owl, but its problem status is revealed when the individual tries to, and can't, get onto a more conventional and practical sleep-wake cycle.
  2. Hypersomnolence is excessive daytime sleepiness (EDS) and feeling disoriented and sluggish, even after several hours of sleep
  3. Insomnia is being unable to get the right amount of sleep. This is the most common sleep disorder and can occur in combination with physical and mental conditions. This word is used in general terms when an individual is experiencing disruptive sleep. In the context of the DSM-V, it specifically refers to not being able to fall asleep.
  4. Narcolepsy, or falling asleep unexpectedly at inappropriate times, includes a sudden weakness of the muscles of the body -- especially the legs but also the face and neck -- that is brought on by strong emotion, especially laughing; and temporary paralysis of the body just before sleep or upon awakening.

Sleep Behavior Disorders

These conditions seem to have more of a psychological component involved with them.

  1. Non-Rapid Eye-Movement Sleep Behavior Disorder – occurrences of parasomnias, or sleep behaviors that affect the function, quality or timing of sleep. Some examples of parasomnias are sleep walking, sleep talking, sleep eating, nightmares or night terrors, sleep paralysis, or "sleep sex."
  2. Rapid Eye-Movement Sleep Behavior Disorder is defined as physically acting out vivid, often unpleasant dreams with vocal sounds and sudden, often violent arm and leg movements during REM sleep, the stage of sleep where dreaming occurs. In a normal person, there is no body movement during REM sleep.
  3. Restless Legs Syndrome – Sufferers experience a strong need to move their legs around when they lie down, or notice a tingling, aching or itching sensation in their legs that keep them from falling asleep.

Causes

Every one of the sleep conditions listed, but especially insomnia, can be caused by:

  1. Life stressors (e.g., job loss or change, death of a loved one, moving)
  2. Illness
  3. Medications
  4. Emotional or physical discomfort
  5. Environmental factors such as noise, light, or extreme hot or cold temperatures
  6. Lifestyle or schedule changes that interfere with a normal sleep schedule (jet lag or switching from a day to night shift, for example)
  7. Depression
  8. Anxiety
  9. Chronic stress

Some disorders have biochemistry imbalances as part of their causation. All sleep disorders feed the physical and mental discomfort back and forth in vicious cycle, or Catch 22-type feedback loops.

Signs and Symptoms

Things that disrupt sleep can be mental and physical because physical and mental disruptions are heavily intertwined. Separating one from the other is nearly impossible to accomplish.

For example, irritability has more than one cause – depression, anxiety, insufficient sleep. One, or all, could be involved in causing a person to feel irritable.

The most telling sign, though, of a sleep-wake disorder is daytime sleepiness. Every other symptom can be attributed to something else, but feeling sleepy or fatigued has just one cause – not getting the amount of sleep right for that individual. If this is the case, a sleep disorder must be considered.

Tests

Medical tests conducted in the process of figuring out the presence or absence of a sleep disorder are looking for a specific physical condition, like an obstructed airway in Sleep Apnea, or no physical problem at all, like Restless Legs Syndrome.

When medical tests rule out a physical reason for a condition, mental health professionals get involved. They use psychological approaches to identifying and diagnosing the problems. These approaches include:

  1. Sleep studies, which can have physical and psychological components
  2. Self-reports, which may include sleep diaries, sleep logs and sleep journals
  3. Information given by others, especially in cases involving children with suspected sleep-wake disorders, and conditions in which the behaviors happen when the sufferer is asleep
  4. Psychological evaluations and interviews

Diagnosis

Because physical and mental causes of sleep issues are so closely intertwined, teasing out a diagnosis that may have a psychological basis is almost impossible to do. As a result, both the physical and mental aspects of the conditions are acknowledged.

Treatment Options

Behavioral interventions can be implemented by the individual without the need for any kind of professional medical involvement. Often, like with insomnia, improved sleep hygiene, healthier eating, and moderate exercise, improve problem sleeping situations. Sometimes, like with advanced sleep phase syndrome, the person will grow out of it.

Behavioral Interventions

  1. Not drinking alcohol, anything with caffeine or sugar or eating within two hours of going to bed to sleep
  2. Not exercising vigorously within four hours of trying to sleep
  3. Going to bed and getting up at the same times, even on weekends and holidays
  4. Consciously winding down before bedtime
  5. Avoiding stimulating TV, movies or books before bedtime

Medical Interventions

  1. C-PAP (Continuous Positive Air Pressure) machine for sleep apnea
  2. Sleeping medications for insomnia
  3. Surgery for some sleep apneas
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