Sleep Disorders Guide

What It Is

Incomplete Awakening: Sleepwalking occurs during deep, non-REM sleep (N3 sleep), where a person partially wakes up but their brain isn't fully alert, allowing them to move and act while still asleep.

Symptoms: A person may sit up, walk around, or perform complex actions like dressing or moving furniture. Other signs include a blank facial expression, confused awakening, and no memory of the event.

Timing: Episodes typically happen within the first two to three hours of falling asleep and can last a few minutes to over half an hour, though most are under 10 minutes.

Causes

Genetics: There is a strong genetic link; sleepwalking tends to run in families.

Lack of Sleep & Fatigue: Being overtired can trigger episodes.

Stress and Anxiety: Emotional factors are significant triggers.

Alcohol and Medications: Alcohol, sedatives, and certain sleep or narcolepsy medications can induce sleepwalking.

Underlying Medical Conditions: Seizures, epilepsy, sleep apnea, and certain neurological disorders can also cause sleepwalking.

Treatment

Safety Measures: Secure the environment by removing or securing dangerous objects, taping down electrical cords, locking doors and windows, and installing gates at the top of stairs.

Lifestyle Changes: Improve sleep hygiene with regular bedtime routines, get enough sleep, manage stress and anxiety, and avoid alcohol.

Behavioral Therapies: Scheduled waking 15-30 minutes before expected episodes, relaxation techniques, psychotherapy, and hypnosis can be beneficial.

Medical Treatment: Address underlying conditions like sleep apnea, review medications, and consult a sleep specialist for persistent or dangerous episodes.

Types and Symptoms

Obstructive Sleep Apnea (OSA): The most common type, occurring when the throat's soft tissues relax and collapse, blocking the airway.

Central Sleep Apnea (CSA): Less common, this happens when the brain doesn't send signals to the muscles that control breathing.

Complex Sleep Apnea: A combination of obstructive and central events.

Symptoms: Loud snoring, gasping or choking during sleep, waking with dry mouth, morning headaches, daytime fatigue, difficulty concentrating, and mood changes.

Risk Factors

OSA Risk Factors: Obesity, male sex, family history, age, and enlarged tonsils or adenoids.

CSA Risk Factors: Heart disorders (like congestive heart failure), stroke, narcotic pain medicine use, and being middle-aged or older.

Diagnosis: Sleep Study (Polysomnography) monitors breathing, heart rate, brain waves, and blood oxygen levels during sleep.

Treatment

CPAP Therapy: The gold standard treatment using a mask to deliver constant air pressure, keeping airways open during sleep.

Lifestyle Changes: Weight loss, sleeping on your side, avoiding alcohol and sedatives, and regular aerobic and strength training.

Other Treatments: Oral appliances, surgical procedures on jaw/nose/throat, and hypoglossal nerve stimulation devices.

Types and Symptoms

Acute Insomnia: Short-term difficulty sleeping, often triggered by stress, new job, trauma, or illness.

Chronic Insomnia: Ongoing difficulty occurring at least three nights per week for three months or more.

Symptoms: Trouble falling or staying asleep, frequent night wakings, early morning awakening, not feeling refreshed, daytime fatigue, concentration difficulties, mood problems, and increased accident risk.

Common Causes

Contributing Factors: Stress and psychological factors, medical conditions (chronic pain, heart disease, diabetes), other sleep disorders, lifestyle substances (caffeine, nicotine, alcohol), and environmental factors (noise, light, temperature).

Treatment

Lifestyle Modifications: Regular sleep schedule, relaxing bedtime routine, avoiding caffeine/alcohol before bed, comfortable sleep environment, and regular physical activity.

Cognitive Behavioral Therapy (CBT-I): Psychotherapy focusing on changing thoughts and behaviors contributing to insomnia, including sleep hygiene education and relaxation training.

Medications: Sedatives (benzodiazepines, non-benzodiazepine sedatives), melatonin supplements, and dual orexin receptor antagonists (DORAs).

Other Therapies: Light therapy, relaxation techniques (yoga, meditation), and herbal remedies (chamomile, lavender).

CHEST Symptoms

Cataplexy: Sudden muscle weakness triggered by emotions, like laughter.

Hallucinations: Vivid, dream-like experiences when falling asleep (hypnagogic) or waking up (hypnopompic).

Excessive Daytime Sleepiness: Overwhelming drowsiness and fatigue during the day.

Sleep Paralysis: Temporary inability to move or speak when falling asleep or waking up.

Troubled Nighttime Sleep: Poor and disrupted sleep at night, despite daytime exhaustion.

Types and Causes

Type 1 Narcolepsy: Characterized by excessive daytime sleepiness and cataplexy, with hypocretin deficiency.

Type 2 Narcolepsy: Involves excessive daytime sleepiness without cataplexy and with normal hypocretin levels.

Causes: Autoimmune loss of hypocretin neurons, genetic predisposition (HLA-DQB106:02 gene), and environmental triggers like infections.

Treatment

Lifestyle Adjustments: Strategic napping throughout the day, consistent sleep schedule, and avoiding alcohol and sleep-affecting substances.

Medications: Central nervous system stimulants to reduce daytime sleepiness, and other medications to address cataplexy, hallucinations, and disturbed nighttime sleep.

Symptoms and Diagnosis

Four Core Criteria: Urge to move legs with uncomfortable sensations, symptoms begin/worsen during rest, symptoms relieved by movement, and symptoms worse in evening/night.

Sensations: Crawling, creeping, tingling, or burning feelings in the legs.

Impact: Sleep disruption, daytime sleepiness, and often associated with Periodic Limb Movement Disorder (PLMD).

Causes and Risk Factors

Contributing Factors: Dopamine dysfunction, iron deficiency, genetics, medical conditions (kidney disease, diabetes, Parkinson's), pregnancy, and triggers like caffeine, alcohol, and tobacco.

Treatment

Lifestyle Remedies: Moderate exercise, warm baths and massage, hot/cold packs, compression stockings, good sleep hygiene, and avoiding caffeine/alcohol/tobacco.

Medications: Iron supplements (if deficient), alpha-2-delta ligands (gabapentin, pregabalin), low-dose opioids for severe cases, and dopaminergic agents (with caution for augmentation risk).

Innovative Treatments: Peroneal nerve stimulation devices and Tonic Motor Activation (TOMAC) technology.

Common Types

Delayed Sleep-Wake Phase Disorder: Naturally falling asleep late and waking late, common in teens and young adults.

Advanced Sleep-Wake Phase Disorder: Naturally falling asleep and waking earlier than desired, more common in older adults.

Jet Lag Disorder: Sleep pattern disruption from rapid travel across time zones.

Shift Work Disorder: Inability to adapt to working nights or irregular schedules.

Non-24-Hour Sleep-Wake Disorder: Constantly shifting sleep times, more common in visually impaired individuals.

Causes

Contributing Factors: Environmental changes, lack of natural light exposure, too much artificial light at night, age-related brain changes, genetics, and certain medical conditions.

Treatment

Non-Pharmacological: Light therapy (bright light in morning for most disorders), sleep hygiene practices, regular exercise, and dietary modifications.

Medications: Melatonin supplements, sedatives for short-term use, and chronotherapy medications targeting the internal clock.

Other Therapies: Cognitive Behavioral Therapy (CBT-I) and treatment of contributing sleep apnea.

Specific Approaches: Jet lag requires light exposure at destination, ASWPD needs morning light therapy, and DSWPD benefits from evening light therapy.