Sleep Disorders
Sleep disorders are varied and can affect anyone at any time. With proper diagnosis and treatment, it is possible to develop healthy sleep patterns which in turn contribute to a healthy life.
Please click on a sleep disorder below for more information on diagnosis and treatment:
- Sleep Apnoea
- Restless Legs Syndrome (RLS) and Periodic Limb Movements of Sleep (PLMS)
- Narcolepsy
- Insomnia
- Sleep disorders associated with other diseases
- Parasomnias, such as sleep walking and night terrors, and REM behaviour disorder
Sleep Apnoea
Obstructive Sleep Apnoea (OSA) is a common disorder of sleep affecting twice as many men as women. It usually occurs in mid-life, but can affect people at any age. People with OSA have repeated collapse of the upper airway while asleep, resulting in poor sleep quality and in some cases, low blood oxygen levels.
Common features of OSA include:
- Obesity (a major risk factor)
- Long-standing snoring
- Stop breathing episodes in sleep noticed by the bed partner
- Morning headache and/or dry mouth
- Excessive sleepiness during the day
- People with OSA are frequently more sleepy than normal during the day, and may have an increased risk of fall-asleep motor vehicle accidents
- Untreated severe OSA may increase the risk of developing high blood pressure, diabetes, stroke and heart disease
There are also rarer forms of sleep apnoea syndromes, for example, those related to heart failure and use of opiate medications.
Diagnosis
Diagnosis of OSA usually involves an overnight stay in hospital for a sleep study. This commonly performed procedure enables doctors to measure your breathing and sleep patterns, as well as your blood oxygen levels while you are asleep, and thus determine the presence and severity of OSA.
Treatment
OSA can be treated in a number of ways. In the majority of patients this is with a device called CPAP (Continuous Positive Airway Pressure), a pump which uses air pressure to splint open the airway at night. In milder cases avoiding sleeping on your back or a dental splint can be helpful. Weight loss is an important part of the treatment in many if not most patients. Surgery for the upper airway may also be considered for selected patients.
Clink on the links below for more detailed information on treatment:
- Treatment for OSA - Weight Loss
- Treatment for OSA - Mandibular Advancement Splint (MAS)
- Treatment for OSA - Postural Control Device (PCD)
Restless Legs Syndrome (RLS) & Periodic Limb Movements of Sleep (PLMS)
These relatively common conditions usually affect older adults. While distinct conditions, RLS and PLMS commonly occur together and are generally treated in the same manner. They may be associated with underlying medical conditions, such as diabetes or kidney diseases.
RLS is usually described as creeping sensations in the legs, accompanied by a strong desire to move the legs. These symptoms are worse at rest, usually occur in the evening and may get worse as the evening progresses. As a result, patients with RLS may have difficulty falling asleep.
PLMS consist of frequent rhythmic movements of the legs and feet during sleep. People with PLMS are often described as restless sleepers, and may feel tired during the day due to the sleep disruption caused by the leg movements in sleep. PLMS are easily diagnosed by an overnight stay in hospital for a sleep study.
A number of different treatments are available which have been shown to be effective in both RLS and PLMS.
Click here for more detailed information on RLS & PLMS
Narcolepsy
This is a rare genetic cause of debilitating chronic daytime sleepiness, which is often accompanied by feelings of paralysis and/or hallucinations on dropping off or waking up from sleep. Emotions, particularly laughter, can cause a sudden loss of muscle tone in some patients, a phenomenon termed cataplexy, which is a hallmark of this disorder.
The onset of symptoms is typically late teens or early twenties. This disorder is confirmed by daytime sleep laboratory testing and is responsive to stimulant medication.
Click here for more detailed information on Narcolepsy
Insomnia
Insomnia is common and affects people of all ages. Typical features include:
- Difficulty getting off to sleep
- Trouble staying asleep
- Waking early in the morning
- Worrying about not sleeping
- Tiredness during the day
There are many different reasons for insomnia. Bad sleep habits, called "poor sleep hygiene", and conditioned or habitual insomnia are the most common causes. Some simple strategies to improve sleep hygiene include:
- Avoid alcohol and caffeine-containing drinks after 6pm
- Use the bedroom for sleeping only (e.g. not for studying or working)
- Avoid long daytime naps
- Aim to rise at the same time each day
- Avoid excessive time in bed (>7 hours)
- If unable to sleep, stay out of bed until sleepy again
Other strategies to treat conditioned insomnia include relaxation techniques, and more specialised methods such as Stimulus Control and Sleep Restriction Therapies. Some types of insomnia may be caused by a mis-timed body clock which can be treated with bright light therapy.
Less commonly, insomnia may be due to side effects of certain medications or an underlying medical disorder such as depression.
An information booklet called "Insomnia – How to Sleep Easy" published by the Women's Weekly Health Series is an excellent resource and can be purchased from bookstores.
Click here for more information on the Insomnia Treatment Program at the Adelaide Institute for Sleep Health.
Sleep disorders associated with other diseases
A number of medical conditions may be associated with disorders of sleep. In some cases severe obesity alone may also lead to breathing abnormalities in sleep.
Patients who develop sleep-related breathing problems may commonly experience morning headache, daytime sleepiness or difficulty concentrating during the day.
It is important to recognise these problems when they exist, as they may lead to worsening of the underlying condition. For conditions associated with breathing abnormalities in sleep treatment similar to that for OSA (obstructive sleep apnoea) is often effective.
While it is not possible to describe an exhaustive list, a few examples are described here:
- Hypertension (high blood pressure)
- Heart failure
- Parkinson's disease
- Chronic pain syndromes treated with opiate medications
- Muscular dystrophies including Motor Neurone Disease
Hypertension / High blood pressure
This disorder is frequently associated with obstructive sleep apnoea, particularly in patients with difficult to control blood pressure, i.e. needing three or more blood pressure medications. In short term studies, treatment of obstructive sleep apnoea has been shown to improve blood pressure control. If someone with high blood pressure has symptoms to suggest sleep apneoa it would be important to check for this condition.
Heart failure
Heart failure is strongly associated with both obstructive sleep apnoea and a condition called central sleep apnoea or Cheyne Stokes Respiration. In central sleep apnoea, subjects recurrently stop breathing. This is not because of airway obstruction but results from abnormal control of breathing. More than 40% of patients with heart failure have either obstructive sleep apnoea or central sleep apnoea or both. Treatment of obstructive sleep apnoea has been shown to improve the function of the heart in short term studies. While treatment of central sleep apnoea may improve symptoms of sleep disruption, it has not yet been shown to improve heart function.
Parkinson's disease
Parkinson's disease is often associated with excessive daytime sleepiness. This is often due to the sleep disruption caused by stiffness and abnormal movements or the disease process itself. Some of the medications used to treat Parkinson's disease have been associated with what have been described as "sleep attacks".
Chronic pain syndromes treated with opiate medications
Having a chronic pain disorder not surprisingly may interfere with sleep quality. It is becoming apparent however that being on high doses of opiate pain medications may predispose to abnormal breathing at night, which is a form of central sleep apnoea syndrome. This may contribute to additional sleep disruption. This disorder is very difficult to treat medically. Reducing the dose of opiates to the minimum required to maintain pain control may help.
Muscular dystrophies and Motor Neurone Disease
The muscle weakness caused by these disorders may cause significant underbreathing at night. This causes the waste gas carbon dioxide to build up at night and a low oxygen level during sleep. Symptoms of the sleep-related breathing abnormality in these neuromuscular conditions may include shortness of breath while lying flat, gasping at night and morning headaches. These symptoms can be eased markedly by a machine to assist breathing at night.
Parasomnias
Parasomnias are abnormal movements or behaviours in sleep. Common examples include:
Sleep walking and night terrors
These are relatively common in children and young adults and will normally get better with age. In severe cases, such as those which cause significant sleep disruption or risk of injury, further investigation and treatment may be needed. They are less common in adults, and if present will often require investigations to exclude other medical disorders.
REM Behaviour Disorder
REM behaviour disorder is a very interesting disorder from both a neurological and sleep point of view. People usually have dreams during rapid eye movement (REM) sleep. At this time, there is normally a profound paralysis of the body's muscles. In this disorder, for some reason, the paralysis does not occur. Thus patients often act out their dreams, particularly if violent.
Symptoms: It usually manifests as repetitive violent movements during REM or "dreaming" sleep, which can sometimes injure both the patient and their bed partner. Patients are often aware that they have been dreaming during these episodes.
This disorder usually occurs later in life. Some patients may later develop Parkinson's disease.
Diagnosis and Treatment: It is important to exclude other sleep disorders that may appear similar to this condition by having a sleep study. Treatment with certain medications is usually extremely effective.