Are Sleep Disorders Robbing Your Sleep?

How do you explain irrepressible yawns during key meetings? Is it boredom, fatigue, poor motivation, or is it plain sleep deprivation? Well if you ask a doctor he would say its sleep deprivation. Sleep deprivation is indeed the most common cause of daytime sleepiness. Some bring it upon themselves by working (or partying) too much. The others may be fighting a sleep disorder even without knowing so. While sleep disorders like insomnia are obvious, others such as sleep apnea may be surreptitiously robbing your sleep. Sleep disorders are a serious hazard to your health and safety and should not be ignored.

Why You Must Sleep

If you thought you were wasting a third of your life sleeping, think again! A lot of important stuff gets done in your mind and body while you snooze. For e.g.:

1. Neurons repair themselves and remove by-products accumulated during the day.
2. Your brain revises messages from the day to encode memories and improve learning.
3. There is increased production of proteins for growth and repair.
4. Growth hormone is released, which is crucial for normal growth and development.

More Reasons To Sleep

If we go by studies in rats, it seems sleep deprivation can kill! The normal 2 to 3 years lifespan of rats is shortened to a few weeks if they are totally deprived of sleep. In humans, sleep deprivation surely truncates life by causing accidents (car crash, air crash, . it's a long list). Poor job performance, relationship troubles, depression and anxiety are common in sleep deprived people. In the long run, it weakens your immunity resulting in many health troubles. Recent research has also linked it to increased risk of heart diseases, obesity and diabetes.

Are you getting enough sleep?

Your sleep need depends primarily on your age (Table 1). Do note that there are some natural "long sleepers" needing 10 hours to recharge and some "short sleepers" who do fine with 5 hours.

Normal Sleep Cycle

Sleep occurs in cycles consisting of two main types of sleep: NREM (Non-rapid eye movement) sleep and REM (rapid-eye movement) sleep. You first pass through 4 stages of NREM sleep transitioning from light sleep (stage 1) to deep sleep (stage 4), followed by a brief period of REM sleep. Each sleep cycle is of about 90 minutes duration and we go through about 4 to 6 cycles each night. Dreams occur during REM sleep. Sleep disorders mess with the sleep cycle leaving you tired and confused.

Common Sleep Disorders

Insomnia

Insomnia is the most common sleep disorder across the world. About 30% adults in the US report experiencing it at some point and some 10% suffer from it chronically. The term "insomnia" is often used loosely for sleep problems, but certain criteria must be met to make a diagnosis:

1. The person has difficulty falling asleep (taking more than 30 minutes to sleep off), or gets up repeatedly during the night, or gets up too early in the morning (total sleep time less than 6 hours on most nights).
2. The above problems interfere with daytime functioning.
3. They occur despite the time and will to sleep being present.

Thankfully, a large number of cases of insomnia can be corrected with adequate sleep hygiene (Table 2). Try these measures if you are experiencing insomnia. Avoid taking sleeping pills without your doctor's advice as most of them stop working after few weeks of use and can have serious side effects. In case your problem doesn't resolve, do see a doctor. Your doctor can help by:

1. Evaluating your mental health. Depression, anxiety, stress, post-traumatic stress disorder (PTSD) often cause insomnia. Treatment requires correcting the underlying condition.
2. Evaluating your physical health. Joint pain, breathing trouble, thyroid problems, heartburn and many more medical conditions interfere with sleep. They need to be treated aggressively if they are not letting you sleep well.
3. Making sure you do not have some other sleep disorder.
4. Suggesting cognitive and behavior therapy if needed.
5. Suggesting safe and effective medicines if needed.

Sleep Apnea

Sleep apnea is a disorder where a person stops breathing momentarily while asleep. This causes them to move from deep sleep to light sleep or may even awaken them. The sleep interruption is very brief but can occur several hundred times during the night. Most people with sleep apnea do not know that they have it. The more common type of sleep apnea is obstructive sleep apnea (OSA) caused by blockage of airways during sleep. Some typical features of OSA are:

1. Loud snoring, often noticed by partner. As many as 50% loud snorers have OSA.
2. Stopping breathing and then waking up with a snort or gasp, mostly noted by spouse.
3. It typically affects obese middle aged men, but can affect all ages and both sexes.
4. Some children may have OSA because of enlarged tonsils.

If you think you or your partner could be having OSA, seek help. Mild cases related to obesity respond well to weight loss. More serious cases can be effectively treated with measures such as continuous positive airway pressure (CPAP) mask or an oral device to keep airway open during sleep. People with OSA should avoid taking sleeping pills.

Restless Leg Syndrome (RLS)

RLS causes an irresistible urge to keep moving the legs because of strange sensations such as creeping, crawling, tingling, burning, or pricking. It may sound rare or trivial, but it is neither. About 5% to 10% adults in the US have RLS. Severe RLS can significantly impair sleep. Here are some facts about the illness:

1. Symptoms are typically relieved by movement such as walking around
2. It affects women twice often as men
3. It runs in families
4. It can start at any age, right from early childhood to old age
5. Some cases are caused by iron deficiency, pregnancy, medication side effect

If you think RLS is interfering with your sleep, consult a doctor. Several medicines such as dopamine agonists, some anti-seizure medicines, and some narcotic pain killers are known to provide relief. Self-help measures include regular exercise, massage, and soaking legs in a tub of warm water.

Jet Lag

Business travelers are often faced with jet lag. It happens because travel across time zones makes it necessary for you to sleep and wake up at a time that does not match your biological clock. The more number of time zones crossed, the more severe is the jet lag. The difficulty with sleep may be accompanied by a feeling of mild sickness and stomach problems. Jet lag mostly gets better over a few days. In severe cases a doctor may give you light therapy to reset your biological clock.

Parasomnias

Parasomnias are a group of sleep disorders characterized by abnormal actions or events that occur during sleep. Sleep walking, sleep talking and grinding teeth in sleep are common parasomnias.

Sleepwalking (Somnambulism)

It's a situation where a person who is actually in deep NREM sleep walks around, at times doing various activities. He or she doesn't respond to questions and won't remember the episode on waking up. It is common in children and goes away with age. But it can occur at all ages. It often runs in families. The main risk is injury for which preventive measures should be taken. Contrary to popular notion, there is no harm in waking up a sleepwalker during an episode.

Sleep Talking (Somniloqy)

Sleep talking is a rather common condition, affecting nearly 50% children and 5% adults at some point. It is harmless except of course the disruption caused to your partner's sleep. It tends to run in families and is at times associated with emotional stress, fever etc. If sleep talking is violent or abusive it may be associated with another parasomnia such as sleep terror or REM sleep behavior disorder (RBD).

Teeth Grinding (Bruxism)

Teeth grinding can occur at any age but is more common in children. A highly driven personality, stress, and anxiety have been associated with bruxism. Mild cases are harmless and need no treatment. In severe cases it can damage the teeth and cause jaw pain and headaches. A mouth guard that protects teeth can be prescribed in such cases.

Nightmare Disorder

Unlike a bad dream, nightmares abruptly wake up a person from sleep. Nightmare disorder is the occurrence of nightmares on a frequent basis. The dream content can usually be clearly remembered. Nightmare disorder can make a person fear going to sleep and cause excessive daytime sleepiness. Stress, anxiety, traumatic events and use of some medications can be the underlying cause of nightmare disorder. It can be treated with counseling and psychotherapy.

Night Terrors

People having a night terror abruptly awaken screaming and shouting. They do not respond to voices. They can't recall the event next morning. Approximately 5% of children between the ages of three to five experience night terrors. Stress and alcohol are known to increase the occurrence of night terrors among adults.

Rem Sleep Behavior Disorder (Rbd)

RBD is a rare parasomnia in which the affected person acts out his vivid dreams, for e.g. jumping out of bed to catch a ball or attacking a person. If woken up during an episode, they tend to remember the dream content and their actions match their dream. It mostly affects men later in life. RBD responds to medications, but preventing injury to self and others is the most important aspect of management.