SLEEP DISORDERS

sleep disorder

Good night sleep is important for physical, mental and social well-being of a person. Sleeping disorders include inconsistent sleep/wake pattern, difficulty in onset of sleep and staying asleep. Studies across the globe have shown that the prevalence of sleep problems may range between as low as 1.6% to as high as 56%. In a study conducted in South India in 2011, it was estimated that about one fifth of an apparently healthy population suffers from sleep related disorders. The noteworthy observation in this study was a lack of awareness and poor knowledge about sleep disorders and their health related issues in India.  People have low perception about sleep related problems. There are rising incidences of sleep disorders due to 24 X 7 society, involving round the clock activities. Changing life style, work profile, stress, eating habits, and leisure activities influence sleep pattern of a person. There are increasing night time usage of television, smart phones and internet causing reduced sleep duration. In fact some data suggest a decline in sleep duration of 18 min/night over the past 30 years. Complains of short sleep (< 6hours) has significantly increased in full time workers. Moreover, shift workers working in day and night  shifts suffer major health issues due to disturbances in their circadian rhythm (biological clock). Rising population of elderly and higher prevalence of obesity worldwide has further added substantial burden of sleep disorders in the society. Most adults need 7-8 hours of sleep at night.

There are immediate and long term effects of sleep disorders on human health. Immediate effect includes poor work performance, day time sleepiness and fatigue.  Long term effects of sleep disorders is associated with high blood pressure, cardiac disease, diabetes, obesity, osteoporosis, psychiatric illnesses like anxiety and depression,  poor quality of life and premature death. In fact loss of sleep (insomnia) is a core symptom of patients with depression. Sleep disorders can worsen the management and clinical outcome of depression. Sleep problems are associated with higher incidence of accidents and errors.  Sleep deprivation is used as a common form of torture. Rats deprived of sleep die in a month.

Sleep disorders are grouped into following categories:

  1. Insomnia: Insomnia is a common sleep problem for adults characterized by lack of sleep. Patients suffering from insomnia may have difficulty falling asleep or short sleep duration. It can be caused by unhealthy sleep habits, psychiatric or medical conditions, specific substances (alcohol, caffeine, tobacco, heavy meals)  and/or biological factors. Medical conditions that can cause insomnias are acute or chronic pain, asthma, indigestion, excess thyroid function (hyperthyroidism) or allergic diseases. Medications used for the treatment of cold, cough, high blood pressure, diabetes, neurological and psychiatric illnesses are also associated with insomnia.
  2. Excessive sleep with Obstructive Sleep Apnea (OSA):  Patient experience abnormal patterns in breathing while he is asleep. There is a brief and repeated interruption of breath during sleep. Apnea refers to breathing pause that last at least 10 seconds.  Patient with OSA snore loudly in between episodes and can also gasp or choke. There is sleep fragmentation during night and a patient feels excessive daytime sleepiness.
  3. Excessive Sleepiness: Excessive sleepiness is a major complain of patients who visit sleep clinics. In fact 20% of population can be classified as having excessive sleepiness. Excessive sleepiness is a serious symptom that requires further investigation in consultation with the doctor. Common causes are poor sleep habits, OSA and certain medicines.     
  4. Shift Work Disorder: Shift workers like doctors, nurses, health care professionals, drivers, police and factory workers suffer from sleep disorder and have high risk of various physical and mental illnesses. They do not keep regular 9 to 5 schedule of working. These people have to work in a pattern that is out of the sync with the body’s internal clock (circadian rhythm). There is a disruption of a hormone, melatonin that regulates the biological clock and sleep during night. 
  5. Narcolepsy: Narcolepsy is excessive sleepiness during daytime and falling asleep suddenly during the day. It can pose a serious safety risk to the patient during the day like cooking, driving or operating machinery. Narcolepsy has a genetic predisposition and affects both male and females. It can be triggered by an infection during childhood or adolescent. Lack of a chemical, hypocretin in the brain is considered a key feature in this disorder.     
  6. Restless Leg Syndrome (RLS): Person has a tingling or prickly sensation in his leg with  a powerful urge to move them.  
  7. Parasomnia: Parasomnia is an unusual action while falling asleep like waking from sleep and walking, talking, or eating

SYMPTOMS:   

  1. More than 30 minutes on bed to fall asleep
  2. Waking up several times during night and have trouble falling back to sleep.
  3. Daytime sleepiness
  4. Loud snoring or gasping/choking during sleep
  5. Jerks in arms and leg during sleep
  6. Vivid dreams while falling asleep
  7. Cannot move when first wake up.

DIAGNOSIS:

  1. Medical History
  2. Sleep History
  3. Clinical Examination
  4. Sleep Study (Polysomnogram): Sleep studies monitor and record data about the patient during full night of sleep. These data include brain wave changes, eye movement, breathing rate and pattern, heart rate and electrical activity of heart and blood pressure. 

TREATMENT:

  1. Good sleep habits and fixed schedule of going to bed and waking in the morning
  2. Avoid daytime nap
  3. Life style changes like limit caffeine, alcohol and tobacco. 
  4. Exercise daily
  5. Reduce body weight if obese or overweight
  6. Healthy Food habits; avoid heavy meals before bedtime.   
  7. Avoidance of gadgets like TV, Smartphone, laptop, internet before bedtime
  8. Relaxation technique and Meditation
  9. Cognitive Behavioral Therapy (CBT) to reduce anxiety
  10. Get medical treatments for illness causing sleep problems like nasal block, cough or allergies.  
  11. Sleeping pills: Recommended only for a short period after consultation with the doctor.

Changes in sleep pattern are also a part of aging process not necessarily a sleep disorder. Melatonin, a sleep hormone is reduced with advancing age causing irregular sleep pattern in this age group. Maintaining good sleep habits is the key in alleviating this problem. Elderly can be advised to limit their day time nap. Natural melatonin supplements can be given to improve the sleep. If life style changes do not work for your sleep problem, visit your health care professional to discuss your sleep problem. It is important to exclude any serious illness for sleep disorders. Review the medications you are taking to rule out the cause of sleep disturbances. The medications that can help you sleep are safe when prescribed by a physician and taken as directed.