Sleep Disorders

Agnes Padilla, MD, DPBP. FPPA

 Content
• Definition
• Causality
• Types of sleep Disorders
– Diagnosis
– Treatment
 Definition
• Good sleep is necessary for optimal health and
can affect hormone levels, mood and weight.
• Sleep problems, happen when the number of
hours of the person’s regular sleep is disrupted
and the quality of sleep is not good
• refers to conditions that affect sleep quality,
timing, or duration and impact a person’s ability
to properly function while they are awake.
• These disorders can contribute to other medical
problems, and some may also be symptoms for
underlying mental health issues
 Types of sleep Disorders

INSOMNIA
• It is characterized by the recurring difficulty to fall
or remain asleep despite motivation and means
to do so.
• People with insomnia also experience excessive
daytime sleepiness and other cognitive
impairments while they are awake.
• Insomnia is considered a chronic condition when
patients exhibit symptoms at least three times
per week for at least three months.
 Treatment
• Two main objectives:
– improving sleep quality and duration, and
reducing associated daytime impairments.
– A chronic insomnia treatment regimen typically
includes at least one behavioral intervention,
which often takes the form of cognitive behavioral
therapy for insomnia (CBT-i); if therapy and other
behavioral interventions are not effective,
– sleep medication.
 Medications
• benzodiazepines- e.g diazepam, alprazolam,
clonazepam
• Non benzodiazepines-(z drugs) e.g. stilnox
• Melatonin agonist
Types of insomnia
• Sleep-onset insomnia occurs when people
have difficulty falling asleep, even when they
are tired.
• Sleep maintenance insomnia refers to
difficulty staying asleep during the night.
• Mixed insomnia is a hybrid condition
characterized by sleep-onset and sleep
maintenance insomnia symptoms.
CAUSES
Common causes of insomnia include stress, an
irregular sleep schedule, poor sleeping
habits, mental health disorders like anxiety
and depression, physical illnesses and pain,
medications, neurological problems, and
specific sleep disorders. For many people, a
combination of these factors can initiate and
exacerbate insomnia.
 Narcolepsy
• Narcolepsy is a disorder that disrupts sleep-wake
processes. Its primary symptom is excessive daytime
sleepiness (EDS), which occurs because the brain
is unable to properly regulate wakefulness and sleep.
• Normal sleep unfolds through a series of stages, with
rapid eye movement (REM) sleep occurring in the final
stage, usually an hour or more after falling asleep.
• In narcolepsy, REM sleep is irregular and often begins
within minutes after falling asleep, which is much
earlier than normal.
 Diagnosis
• A test called the Epworth Sleepiness Scale
(ESS) is based on the patient’s subjective
sense of their symptoms.
• Polysomnography (PSG), a detailed test in
which sensors monitor brain and body activity,
may be necessary. This kind of sleep study is
done overnight in a specialized clinic.
 Treatment
• The goals of treatment for narcolepsy are
improving patient safety, reducing symptoms, and
enhancing quality of life.
• A combination of medical and behavioral
approaches can significantly decrease but not
eliminate symptoms. Some level of EDS
normally persists despite treatment
• All therapies should be carried out under the
guidance of a doctor who can best tailor a
treatment plan to the patient’s specific situation.
 Sleep Apnea
• Sleep apnea is a condition marked by
abnormal breathing during sleep.
• People with sleep apnea have multiple
extended pauses in breath when they sleep.
• These temporary breathing lapses cause
lower-quality sleep and affect the body’s
supply of oxygen, leading to potentially
serious health consequences.
• Sleep apnea is one of the most common sleep
disorders in the United States. It can
affect children and adults and people of both
sexes, although it is more common in men.
 Types
• Obstructive sleep apnea (OSA): OSA occurs when
the airway at the back of the throat becomes
physically blocked. That obstruction causes
temporary lapses in breath.
• Central sleep apnea (CSA): CSA happens because
there is a problem with the brain’s system for
controlling muscles involved in respiration,
leading to slower and shallower breathing.
• Mixed sleep apnea: When a person has both OSA
and CSA at the same time, it is referred to as
mixed sleep apnea or complex sleep apnea.
 Symptoms
All three types of sleep apnea share certain
common symptoms:
– Disrupted breathing in which a person’s
respiration can become labored or even stop for
up to a minute at a time
– Excessive daytime sleepiness
– Morning headaches
– Irritability
– Limited attention span or difficulty thinking clearly
 Treatment
• Continuous Positive Airway Pressure (CPAP)
• Weight loss
 Restless Leg Syndrome
• Also called Willis Ekbom disease causes
uncomfortable feelings in the legs, such as
itching, prickling, pulling, or crawling. These
sensations create an overwhelming urge to move
the legs.
• Patients may walk, stretch, or shake their legs to
achieve relief. Symptoms tend to be worse when
inactive, including when relaxing or lying down.
As a result, the symptoms of RLS often disrupt
sleep.
 Symptoms
The words and phrases most commonly used
by patients to describe the feelings are:
• “Twitchy”
• “Uncomfortable”
• “Restless”
• “Need to stretch”
• “Urge to move”
• “Legs want to move on their own”
 Triggers
Sitting or resting are common triggers for the
appearance of the symptoms. Additionally, some
substances can make symptoms worse. These include:
• Alcohol
• Caffeine
• Nicotine
• Medications, including certain drugs used to treat
nausea, colds and allergies, and mental health
conditions
• Incidentally, most of these substances when taken in
excess or too close to bedtime can also adversely affect
our sleep architecture.
 Treatment
• Sleep hygiene: Good sleep hygiene means maintaining
a bedroom environment and a daily routine that
supports high-quality sleep. Avoiding alcohol and
caffeine is especially important for RLS patients
because these substances can worsen symptoms.
• Exercise: Because physical inactivity often triggers RLS
symptoms, exercise may be helpful. A research
study8 found that RLS patients showed af 39%
reduction in symptom severity after six weeks of
engaging in an exercise program compared to an 8%
symptom reduction in patients who did not exercise.
• Pneumatic pressure therapy: Pneumatic
compression devices increase blood flow to the
legs by filling with air to squeeze the legs.
Researchers found that the device improved RLS
symptoms, quality-of-life, and fatigue after one
month of daily use compared to a control group.
• Massage and hot baths: Using massage and hot
baths to stimulate the legs is widely
recommended in RLS literature; however, there is
limited scientific evidence supporting the
effectiveness of these methods at this time.
 Other Sleep Disorders for self study:
• Parasomnias
• REM sleep Behavior Disorder
• Excessive sleepiness
• Non-24-hours Sleep Wake Disorder
• Shift Work Disorder
• Periodic Limb Movement Disorder