Sleep Disorders
Two Groups: Parasomnias & Dyssomnias
Parasomnias Sleep Disorders: These are unusual experiences or behaviors that occur during sleep; they include sleep terror disorder and sleepwalking (which occur during stage 4 sleep) and nightmare disorder (which occurs during rapid eye movement [REM] sleep).
Nightmares: Nightmares are vivid nocturnal events that can cause feelings of fear, terror, and/or anxiety. Usually, the person having a nightmare is abruptly awakened from REM sleep and is able to describe detailed dream content. Usually, the person having a nightmare has difficulty returning to sleep. Nightmares can be caused by many factors including illness, anxiety, any traumatic event such as the loss of a loved one, or negative reactions to a medication. Contact your doctor if nightmares occur more often than once a week or if nightmares prevent you from getting a good nights rest for a prolonged period of time. Sleep terrors/night terrors: A person experiencing a night terror or sleep terror abruptly awakes from sleep in a terrified state often accompanied by crying or screaming, an increase in heart rate or breathing, sweating or flushing of the skin. The person may appear to be awake, but is confused and unable to communicate. Night terrors last about 15 minutes, after which time the person usually lies down and appears to fall back asleep. People who have sleep terrors usually don't remember the events the next morning. Night terrors occur during stage 3 sleep (deep sleep). People experiencing sleep terrors may pose dangers to themselves or others because of jumping on the bed or running around. Night terrors are fairly common in children aged four to twelve. This sleep disorder, which may run in families, also can occur in up to 3% of adults. Strong emotional tension and/or the use of alcohol can increase the incidence of night terrors among adults. Sleepwalking (somnambulism): Sleepwalking occurs when a person appears to be awake and moving around with eyes wide open but is actually asleep. Sleepwalkers have no memory of their actions. Sleepwalking most often occurs during deep non-REM sleep (stage 3), early in the night. These episodes vary widely in complexity and duration. This disorder is most commonly seen in children aged six to twelve; however, sleepwalking can occur among younger children, adults, and the elderly. Sleepwalking appears to run in families. Sleepwalking can sometimes be dangerous because the sleepwalker is unaware of his or her surroundings and can bump into objects or can fall down. Confusional arousals: Confusional arousals usually occur when a person is awakened from a deep sleep during the first part of the night. This disorder, which also is known as excessive sleep inertia or sleep drunkenness, involves an exaggerated slowness upon awakening. People experiencing confusional arousals react slowly to commands and may have trouble understanding questions that they are asked. The childhood form is benign and resolves spontaneously while the adult variant may persist for a long time with consequences such as sleep related injury, sub-optimal performance at work, etc. Sleep paralysis. People with sleep paralysis are not able to move the body or limbs when falling asleep or waking up. Brief episodes of partial or complete skeletal muscle paralysis can occur during sleep paralysis. Sometimes sleep paralysis runs in families, but the cause of sleep paralysis is not known. Sleep deprivation and irregular sleep-wake schedules can also cause sleep paralysis. It is also seen in narcolepsy, a disorder characterized by severe excessive daytime sleepiness. This disorder is not harmful, but people experiencing sleep paralysis often are very fearful because they do not know what is happening. An episode of sleep paralysis often is terminated by sound or touch. Within minutes, the person with sleep paralysis is able to move again. REM sleep behavior disorder (RBD): People with rapid eye movement (REM) sleep behavior disorder act out dramatic and/or violent dreams during REM sleep. REM sleep usually involves a state of paralysis (atonia), but people with this condition move the body or limbs while dreaming. Usually, RBD occurs in men aged 50 and older, but the disorder also can occur in women and in younger people. In the diagnosis and treatment of RBD, potentially serious neurological disorders must be ruled out. Polysomnography (sleep study) and drug treatments are involved in the diagnosis and treatment of this disorder. Sleep enuresis: In this condition, also called bedwetting, the affected person is unable to maintain urinary control when asleep. There are two kinds of enuresis—primary and secondary. In primary enuresis, a person has been unable to have urinary control from infancy onward. In secondary enuresis, a person has a relapse after previously having been able to have urinary control. Enuresis can be caused by medical conditions (including diabetes, urinary tract infection) or by psychiatric disorders. Some treatments for bedwetting include behavior modification, alarm devices, and medications. Dyssomnias Sleep Disorders:Dyssomnia is a disturbance of the body's natural resting and waking patterns.
Dyssomnias may be intrinsic i.e. having their cause in the body, or extrinsic i.e. having an external cause. Person’s problems with a person's circadian rhythm, or internal clock may also cause dyssomnia. Dyssomnia covers a range of specific sleep disorders, Insomnia, Sleeplessness, the Inability to Sleep, Wakefulness. Chronic and persistent difficulty in either; falling asleep, remaining asleep through the night, or waking up too early. Daytime sleepiness, poor concentration, and the inability to feel refreshed and rested in the morning are caused due to all types of insomnia. Dyssomnias are disorders of the amount, quality, or timing of sleep. Causes of Dyssomnia:
Also, a detailed Mental Status Examination should be carried out. Patients found to have an underlying psychological or psychiatric disorder should be seen by a psychologist or psychiatrist, and appropriate therapy should be offered. Drug treatment should only be opted to as a last alternative. You should practice good sleep hygiene; avoid using alcohol in the evening and to avoid caffeine before bedtime. Counseling may be helpful for psychological disorders that lead to insomnia and the practice of relaxation methods may also be helpful. Dyssomnia Medications are not necessary in many cases. If everything else has failed your health care provider can investigate with you the possibility of using prescribed medications. Benzodiazepines such as Valium (diazepam) or Ativan (lorazepam) are anti-anxiety medications that can also help induce sleep. Some antidepressants such as Elavil (amitriptyline) can be used at bedtime because they are sedating. They require a prescription. Proper treatment of the depression with other appropriate medications or therapy should solve the problem, if insomnia is caused by depression. They must be used with caution because they can be addictive. They too require a prescription. Newer medications called hypnotics are now available. They help reduce the time needed to fall asleep but are far less likely to be addictive than benzodiazepines. Ambien (zolpidem) and Sonata (zaleplon) are two examples. Prevention Methods Good sleep habits can prevent many cases from developing dyssomnias. Recommendations from sleep experts include:
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