INTRODUCTION

Sleep problems, including snoring, sleep apnea, insomnia, sleep do privation, and restless legs
syndrome, are common. Good sleep is necessary for optimal health and can affect hormone
levels, mood and weight.
A sleep disorder, or somnipathy, is a medical disorder of the sleep patterns of a person or animal.
Some sleep disorders are serious enough to interfere with nonnalphysical, mental, social and
emotional functioning. Polysomnography and actigraphy are tests commonly ordered for some
sleep disorders.
Disruptions in sleep can be caused by a variety of issues, from teeth grinding (bruxism) to night
terrors. When a person suffers from difficulty falling asleep and/or staying asleep with no
obvious cause, it is referred to as insomnia.
Sleep disorders are broadly classified into dyssomnias, parasomnias, circadian rhythm sleep
disorders involving the timing of sleep, and other disorders including ones caused by medical or
psychological conditions and Sleeping sickness.
Some common sleep disorders include sleep apnea (stops in breathing during sleep), narcolepsy
and hypersomnia (excessive sleepiness at inappropriate times), cataplexy (sudden and transient
loss of muscle tone while awake), and sleeping sickness (disruption of sleep cycle due to
infection). Other disorders include sleepwalking, night terrors and bed wetting. Management of
sleep disturbances that are secondary to mental, medical, or substance abuse disorders should
focus on the underlying conditions.
PHYSIOLOGAY OF SLEEP AND WAKEFULNES:
Most of adults sleep 7-8 hours per night , although the timing, duration and internal structure of
sleep vary among healthy individuals and as a function of age.
Two principal systems govern the sleep wake cycle :
1. One actively generates sleep and sleep related process.
2. Another times sleep within 24 hours day .
Either intrinsic abnormalities in these systems or extrinsic disturbances
( environmental, drug or illness ) can lead to sleep disorders.

STATES AND STAGES OF SLEEP:- States and stages of human sleep are defined on the basis
of characteristics pattern in the electro-oculogram (EOG-a measure of eye movement activity)
and the surface electromyogram (EMG) measured on the chin and neck. The continuous
recording of this arry of electro physiologic parameters to define sleep and wakefulness is termed
polysomnography.
Polysomnographic profiles define two states of sleep:
1. Rapid-eye-movement (REM) sleep
2. Non-rapid-eye-movement (N REM) sleep.

VARIOUS SLEEP DISORDERS ARE:

1.Insomnia
2.Sleep related breathing disorders
3.Narcolepsy
4.Circadian rhythm disorders
5.Parasomnias
6.Sleep related movement disorders

INSOMNIA:

 Inability to sleep or maintain sleep,despite the patient having adequate opportunity and
circumstances to sleep,when associated with impairment of daytime functioning or mood
symptoms.
 Patient may complain of difficulty falling asleep (sleeping on set insomnia) or difficulty
remaining asleep (sleep maintenance insomnia ) with frequent nocturnal awakenings or
early morning awakenings associated with non restorative sleep.
 Insomnia can heighten the perception of pain and may be associated with development of
endocrine disturbances. It also has an association with increased risk for hypertension or
cardiovascular disease. Insufficient sleep and lead to increase risk for motor vehicle
accidents and occupational errors.

Causes:
 Primary (idiopathic)
 Depression, anxiety or somatoform disorder.
 Medication or substance use, including stimulants, corticosteroids, caffeine alcohol etc.
 Medical conditions including chronic pain, chronic obstructive pulmonary disease,
asthma, menopause, nocturia and neurological disordes.
Treatment :

 Cognitive behavioral therapy.

 Pharmacologic therapy:
•Triazolam, zolpidem and ramelteon for sleep onset insomnia.
• Estazolam and eszopiclone for sleep maintenance insomnia.
• zalepeon and sustained -release zolpidem for both sleep onset and sleep maintenance
insomnia.

NARCOLEPSY
 It is excessive daytime sleep that a patient cannot resist.

Diagnosis :
 Severe excessive daytime sleepiness occurring almost daily for at least 3 months that
interfere with functioning.
 Rapid eye movement (REM) intrusion phenomena that includes:
•Cataplexy-sudden self-limited episodes of loss of muscle tone when patient is
awake, which is usually triggered by laughter or other strong emotions.
•Hypnagogic hallucinations- vivid and often frightening perceptual hallucinatory
experiences, which occur during the transition between waking and sleep.
•Sleep paralysis-occurs as the patient transitions from sleep to waking, and consists
of episodes up to several minutes in duration of inability to move and occasionally feeling
unable to breathe despite being awake.
• Electrographic evidence:
•An abnormal multiple sleep latency test done during day, with a sleep latency of 8
minutes or less.
•At least two sleep onset REM periods on polysomnography (normally, REM sleep
occurs 60-90 minutes after onset of sleep).

Treatment
•Modafinil, a wakefulness-promoting drug is useful. It has low addiction potential.
•Sodium oxybate, a sodium salt of y-hydroxybutyrate is administered at night to help
consolidate REM sleep and
increase slow-wave sleep. It significantly reduces daytime sleepiness and also improves
cataplexy.
•Others: Selegiline (a monoamine oxidase-B inhibitor), clomipramine, fluoxetine and
venlafaxine.
CIRCADIAN RHYTHM SLEEP DISORDERS:
Chronic or recurring sleep disturbances (insomnia or hypersomnia) are because of misalignment
between their endogenous circadian timing and external influences.
Common types:

 Delayed sleep phase type-sleep and wake times are later than desired, often
resulting in daytime sleepiness, when conventional waking times are enforced.
 Advanced sleep phase typesleep and wake times are earlier than desired.
 Jet lag—transient symptoms of difficulty falling asleep at the appropriate time and
daytime sleepiness following rapid change in time zones altering the timing of
exogenous light stimuli.
Diagnosis:

 Based on history and a sleep diary

 Actigraphy -based on a wrist - mounted motion detector worn as an outpatient for at least
7 days that can help to quantify time spent asleep.
Treatment

 Bright light therapy - exposure to bright light around 2500 lux for 2 to 3 hours in the
mornings.
 Chronotherapy-useful in delayed sleep phase type of circadian rhythm disorders; patient
delays sleep 3 hours every 2 days until he/she adjusts to the conventional sleep and wake
time.
 Melatonin-administered in the afternoon or evening in patients with delayed sleep phase.
 For jet lag:
• Behavioural strategies (good sleep hygiene, shifting sleep and wake times gradually
before travel to conform to the destination’s time zone and avoiding bright light exposure
before bedtime).
•Melatonin administered before bedtime in the new time zone.
Parasomnias:

 Undesirable experiences or behaviours that occur during transitions between sleep

and walking.
 Represent central nervous System activation and intrusion of wakefulness into sleep,
producing non-volitional motor emotional or autonomic activity.
 Non-REM SIeep parasomnias include confusional arousals and sleep terrors. Sleep
terrors are dramatic sudden arousals from non-REM Sleep with associated screaming,
 fear and increased autonomic activity: patients may be disoriented, unresponsive to
the environment and typically do not remember the event afterward.
 REM sleep associated parasomnias include nightmares and behaviour disorders.
Nightmares typically occur towards the end of night and are not associated with
autonomic activity or amnesia. Behaviour disorders consist of abnormal loss of
muscle tone inhibition during REM sleep, permitting vigorous movements while
dreaming. Sleep behaviours can include screaming, punching and kicking for up to
several minutes, sometimes resulting in injury to the patient or bed partner.
Polysomnography shows anomalous increase in muscle tone on electromyogram
during REM sleep.
Treatment

 Avoid serotonin reuptake inhibitors, MAO inhibitors, caffeine or alcohol.

 Remove dangerous objects from the sleep environment.
 Drugs include clonazepam, tricyclic antidepressants, dopamine agonists or levodopa,
carbamazepine and melatonin.
SLEEP RELATED MOVEMENT DISORDERS:

 Include restless leg syndrome and periodic limb movement disorder.

Restless Leg Syndrome:

 An overwhelming urge to move legs, usually accompanied by an uncomfortable

sensation.
 May disrupt sleep initiation.
 Rest or inactivity exacerbates the urge to move the legs.
 Physical activity temporarily relieves the urge to move the legs.
 Symptoms more prominent in the evening or night time that may disrupt sleep initiation.
 May be secondary to pregnancy, end-stage renal disease, iron or folate deficiency,
peripheral neuropathy, radiculopathy,rheumatoid arthritis or fibromyalgia.
Treatment

 antihistamines, dopamine receptor antagonists and antidepressants (with the

exception of bupropion)may exacerbate it.
 First-line drugs are dopaminergic medications (ropinirole, pramipexole).
 Others include gabapentin, benzodiazepines,clonidine or opiates.

Periodic limb movement disorder

 Symptoms include repetitive, stereotyped limb movements occurring in non-REM

sleep, typically involving the lower limbs.
  Occur every 20-30 seconds.
 Movements often disrupt sleep and lead to dayume Sieepness.hsins enseonai

Treatment

 similar to restless leg syndrome.

OTHER COMMON SLEEP DISORDERS :

Sleepwalking or somnambulism:

 Engaging in activities normally associated with wakefulness(such as eating or dressing),

which may include walking, without the conscious knowledge of the subject.
 It is the phenomenon of combined sleep and wakefulness.
 It is classified as a sleep disorder belonging to the parasomnia family.
 It occurs during slow wave sleep stage, in a state of low consciousness,with performance
of activities that are usually performed during a state of full consciousness.
 These activities can be as benign as sitting up in bed, walking to a bathroom, and
cleaning, or as hazardous as cooking,driving, violent gestures, grabbing at hallucinated
objects or even homicide.

Bed wetting or sleep enuresis or nocturnal enuresis:

 It is involuntary urination while asleep after the age at which bladder controls usually
occurs.
 Bed wetting in children and adults can result in emotional stress.
 Complication - urinary tract infections.

Bruxism:

 Bruxism is excessive teeth grinding or jaw clenching.

 It is an oral para functional activity that is unrelated to normal functions such as eating or
talking.
 Bruxism is a common behaviour,reports of prevalence rains from 8 to 31% in the general
population.
 symptoms are commonly associated with bruxism including hypersensitive teeth, aching
jaw muscles,headache, tooth wear and damage to dental restorations to teeth.
 Symptoms may be minimal without patient awareness of the condition.
Sleep paralysis :

 Characterised 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 it is severe.

Klein – levin syndrome:

 It is a rare disorder characterised by persistent episodic hypersomnia and cognitive or

mood changes .

Nocturia:

 It is a sleep disorder in which the person need to get up frequently and urinate at night.
 It is the differ from enuresis or bedwetting in which the person does not arouse from the
sleep.

CONCLUSION
sleep disorders present a complex array of challenges that significantly impact both physical and
mental well-being. The diverse nature of these disorders, ranging from insomnia to sleep apnea,
underscores the importance of understanding and addressing them comprehensively. The
repercussions extend beyond mere fatigue, as inadequate sleep disrupts cognitive function,
emotional stability, and overall quality of life.
Effective management and treatment of sleep disorders involve a multi-faceted approach,
incorporating lifestyle modifications, behavioral therapies, and sometimes medical interventions.
Awareness and education play pivotal roles in fostering a proactive approach to sleep health, as
individuals need to recognize the signs and seek professional guidance promptly.
Moreover, the societal implications of untreated sleep disorders are substantial, contributing to
impaired productivity, increased healthcare costs, and even safety concerns. As we navigate the
complexities of modern life, prioritizing and prioritizing sleep health becomes increasingly
crucial.
In fostering a culture that values and prioritizes adequate sleep, we can collectively work towards
mitigating the prevalence and impact of sleep disorders. By acknowledging the intricate interplay
between sleep, physical health, and mental well-being, we pave the way for a healthier, more
resilient society.
BIBLIOGRAPHY
1. A Text book of medicine by K George Mathew and Praveen Aggarwal.
2. Davidson’s Principles and Practice of Medicine.
3. Harrison’s Principles of Internal Medicine.