Are you suffering from any of the below?
- A - F
- G - L
- M - R
- S - X
- Y - Z
Anxiety disorders are a very common cause of comorbid or secondary insomnia.
Complaints of inability to turn of one’s mind or racing thoughts are common complaints that prevent one from falling asleep. In addition awakening with palpitations, sweating can be presentations of nocturnal panic attacks.
The body’s normal emotion in response to stress is Anxiety which is beneficial in some situations. Feeling nervous during meetings, making an important decision is normal. However, in some patients this anxiety can become excessive and it may negatively affect their functioning.
Co-morbid Insomnia can be managed with biofeedback, behavior modification and if required pharmacotherapy.
Acute Stress Disorders
Acute Stress Disorder is characterized by the development of severe anxiety that occurs within one month after exposure to an extremely traumatic event. Patients with Acute Stress Disorder may find it difficult to experience pleasure in previously enjoyable activities and frequently feel guilty about pursuing usual life tasks.
Sleep bruxism, an abnormal oromotor activity characterized by jaw-muscle activity that presents with repetitive clenching or grinding of the teeth resulting in discomfort and damage to teeth and jaw pain and misalignment.
Central Sleep Apnea
Central Sleep Apnea Syndrome is a disorder characterized by repeated episodes of respiratory arrest during sleep with absence of associated ventilatory effort. Central Apnea increases in the presence of congestive heart and central nervous system abnormalities like stroke. Patients with this disorder frequently complain of insomnia, fragmented sleep, repeated awakenings, daytime drowsiness and depression.
Sudden loss of motor tone triggered by emotions is called cataplexy. It can also present as unexplained falls or droopiness of face or change in voice.
Drowsy Driving=Red Alert
Drowsiness and driving is a dangerous combination. Most people are aware of the dangers of drinking and driving but don’t realize that drowsy driving can be just as fatal. Like alcohol, sleepiness slows reaction time, decreases awareness, impairs judgment and increases your risk of car crashes. Several recent aviation pilot errors have been linked to undiagnosed and untreated sleep disorders.
Night Eating Syndrome (NES) or Sleep Related Eating Disorder (SRED) is an evening hyperphagia and/or nocturnal awakenings for ingestion of food in which the patient has recurrent episodes of nocturnal eating i.e. while asleep and/or eating or excessive consumption of food after the evening meal just prior to bedtime. Patient may have no recollection of this food intake. Weight gain is a common complication. It is more common in women.
GERD and Sleep
Gastroesophageal reflux disease (GERD) is a common and chronic condition also know as acid Reflux affecting nearly 5-7% of the world’s population and if untreated leads to serious medical conditions. There is significant amount of correlation between Sleep Disturbances and GERD and the cause is bidirectional. Sleep Apnea is aggravated by untreated GERD.
Sleep And Heart Diseases
Sleep is a time of rest for the entire body. Sleep-related breathing disorders have been shown to play a major role in causing several types of heart and blood vessel disease.
Numerous studies have clearly linked sleep-related breathing disorders like Sleep Apnea with high blood pressure and increased risk of heart diseases and stroke. In fact, treatment and optimum management of sleep-related breathing disorders decreases a person’s chances of developing certain cardiovascular diseases.
Effects of heart disease on SLEEP
Sleep-related breathing disorders can cause heart disease.
Patients with congestive heart failure often report difficulty falling asleep or staying asleep because of the shortness of breath that often accompanies heart failure. This shortness of breath is often worse when the patient lies on his/her back as blood in the legs flows back into the heart and can overwhelm the heart’s ability to pump.
In addition patients often worry about the long-term consequences of a heart attack or chronic heart disease. Such anxiety, by itself, can lead to the development of chronic insomnia.
It is very important that people with heart conditions need to take special care and seek medical attention in order to optimize their sleep quality.
Trouble falling asleep or staying asleep, early morning awakening or unrefreshed sleep is known as Insomnia. Insomnia is a problem for one out of every three American adults. If you have ever suffered from insomnia, you know how it can disturb your day and your night. It can make you feel fatigued during the day. It may cause you to have trouble focusing on tasks. Treating insomnia requires you and your doctor to work as partners to explore the causes and effects of the problem.
Air travel across multiple time zones are a part of our jet-setting lifestyles with today’s globalization. Jet Lag is a syndrome caused by Transmeridian travel across time zones. Jet Lag is caused by the desynchronization of our Biological Clock and the day-night rhythm of the place we are in. Jet lag is recognized as Circadian Rhythm Sleep Disorder. Gastro-intestinal symptoms, malaise and other somatic symptoms may co-exist.
Kleine-Levin syndrome (KLS)
This is a rare sleep disorder characterized by persistent episodic excessive sleepiness and cognitive or mood changes. Many patients also experience hyperphagia, hypersexuality and other symptoms. This results in obesity.
One finds the description of pathologic sleepiness (possibly a case of Kleine-Levin syndrome) in the mythologic character Kumbhakarna in the great Indian epic Ramayana. Kumbhakarna would sleep for months at a time, then get up to eat and drink voraciously before falling asleep again.
Leptin and Grehlin
Leptin and Grehlin play a major role in the energy balance of the body. Due to sleep disturbances or short duration of sleep, the levels of grehlin increase and the levels of Leptin decrease. This is a causative mechanism for Obesity in Sleep Disorders.
It is true that untreated sleep disorders can lead to estrangement with your partners. ‘Sleep Divorce’ or voluntarily sleeping apart results in lack of intimacy. In addition, decreased sexual drive is a complication of sleep apnea.
Memory Loss Due to Sleep Disruption
Patients with sleep apnea are at a high risk of developing memory problems and dementia. When we are young, we have deep sleep that helps the brain store and retain new facts and information, but as we get older, the quality of our sleep deteriorates and prevents those memories from being saved by the brain at night.
Narcolepsy is a characterized by excessive daytime sleepiness and a tendency to sleep at inappropriate times. Typically, a person with narcolepsy suffers sleep attacks as well as continual sleepiness and a feeling of tiredness that is not completely relieved by any amount of sleep. If not recognized and appropriately managed, narcolepsy can drastically and negatively affect the quality of a person’s life.
Narcolepsy may be idiopathic or secondary following head trauma, CNS infection in connection with tumor or other CNS degenerative disorders.
Obstructive Sleep Apnea
In OSA you’re breathing pauses while you are asleep because your airway has become narrowed or partly blocked. When you sleep, all of the muscles in your body become more relaxed. This includes the muscles that help keep your throat open so air can flow into your lungs. Normally, this passage remains open enough during sleep to let air pass through. When the muscles in their upper throat relax during sleep, the tissues close in and block the airway. This stop in breathing is called apnea
People with sleep apnea:
- Wake up Un-refreshed in the morning
- Feel sleepy or drowsy throughout the day
- Act Grumpy, Impatient, or Irritable
- Fall asleep while working, reading, or watching TV
- Feel sleepy while driving, or even fall asleep while driving
- Early morning Headaches
- Morning Confusion
- Personality and Mood Changes, including Depression and Anxiety
- Sexual Dysfunction, including Impotence and decreased Libido
- Gastro – esophageal Reflux
- Resistant Hypertension
When the anxiety is associated with panic attacks, the consequences can be significant, especially when these attacks interrupt your sleep. Studies suggest that between 50%-70% of people with Panic Disorder will experience at least one panic attack at night.
Periodic Limb Movement
Periodic Limb Movements of Sleep (PLMS) is when your legs or arms move when you’re asleep. It happens every 10 to 60 seconds and is out of your control. It can last from a few minutes to a few hours. PLMS is mainly seen in the first third of the night, during the deepest type of sleep. PLMS are associated with increased cardiovascular risk. There is also a correlation between PLMD and RLS
Abnormal motor movements that occur in and around sleep are called Parasomnias. Such as nightmares, sleep walking, sleep talking, confusional arousals etc
Questionnaires are effective tools in Assessing Sleep Disturbances
Questionnaire like Insomnia Severity Questionnaire, STOP BANG Questionairre, Etc help in self assessing your sleeping habits and helps your doctor to understand and analyze your Sleep in an effective way. No one knows you better than you.
Restless Leg Syndrome
An urge to move legs, usually accompanied or caused by uncomfortable and unpleasant leg sensation. Sometimes the arms or other body parts also are involved.
This sensation worsening during periods of rest or activity and can be partially or totally relived by movements, such as walking or stretching, at least while the activity continues. RLS is commonly associated with iron deficiency, pregnancy and kidney problems. RLS may also be familial.
Sleep apnea occurs when your breathing is disrupted during sleep. Sleep apnea is a common disorder in which you have one or more pauses in breathing or shallow breaths while you sleep.
They may occur 30 times or more an hour. Typically, normal breathing then starts again, sometimes with a loud snort or choking sound. Sleep apnea often goes undiagnosed. Doctors usually can’t detect the condition during routine office visits. Also, no blood test can help diagnose the condition.
Men, overweight people, and people over 40 are at greater risk for sleep apnea. Untreated sleep apnea can cause hypertension, stroke, or heart failure.
When you try to breathe, any air that squeezes past the blockage can cause loud snoring. Obstructive sleep apnea is more common in people who are overweight, but it can affect anyone. For example, small children who have enlarged tonsil tissues in their throats may have obstructive sleep apnea
Types of Apnea
- Obstructive sleep Apnea
- Central Sleep Apnea
- Mixed Apnea
Night terrors are vivid nighttime events that can cause feelings of fear, terror, and/or anxiety. Night terrors are fairly common in children, mostly between the ages of 3 and 5.
Urine Frequency – Nocturia
Nocturia is a condition in which you wake up frequently during the night because you have to urinate. This condition can increase with age as also in other medical conditions such as diabeters, sleep apnea and UTIs. Treatment depends on the type and cause of nocturia. If sleep apnea is considered, you may be referred to a sleep specialist.
Upper Airway Resistance Syndrome (UARS)
Upper Airway Resistance Syndrome (UARS), presents with excessive daytime sleepiness and snoring, typically in normal weight individuals. UARS is due to blockage in the nasal muscles, making it difficult to breathe that is taking air into the lungs.
Vibration of soft tissue results in snoring
During sleep, muscles and soft tissues in the throat and mouth relax, shrinking the airway. This increases the velocity of airflow during breathing. As the velocity of required air is increased, soft tissues like the soft palate and uvula vibrate. The vibrations of these tissues result in “noisy breathing” or snoring.1
Relaxed and collapsed airway produces soft tissue vibrations during breathing, which result in snoring.
This term often used in sleep studies to define the amount of time spent awake after sleep has been initiated and before final awakening. It is increased in people who have difficulty staying asleep, a common occurrence in sleep disorders such as insomnia. When WASO is increased it results in poor sleep efficiency and feeling of being unrefreshed on awakening.
Sleep walking is a NREM parasomnia that causes people to get up and walk while sleeping. It typically occurs in deep stages of sleep. The sleepwalker is unable to respond during the event and does not recall sleepwalking. It is common in childhood, typically between the ages of 4 and 8, but can last into adulthood.
X-rays of Cephalometry, Sinuses help also diagnose and allow the physician to analyze if there are any kind of physical obstructions that could be the cause of the Sleep Disorders.
Y me syndrome
Most patients visiting a sleep clinic are confounded by the Y-me syndrome and Y-now syndrome.
It is true that for an individual to become symptomatic with insomnia we propose a 3P model.
A Predisposing cause, a Precipitating cause and a Perpetuating cause that causes you to cross your individual Insomnia threshold and become symptomatic.
Hence, Cognitive behavior therapy is mandatory in the successful management of insomnia
The epidemic of Metabolic Syndrome and Sleep Apnea is called Syndrome Z.
The clustering of cardiovascular disease mechanisms in the metabolic syndrome and OSA are remarkably similar. Patients with OSA have abnormalities in each of the “core” components of the metabolic syndrome – high blood pressure, high fasting glucose, increased waist circumference, low HDL cholesterol, high triglycerides and insulin resistance.