Sleep Disorders

There are many sleep disorders. The following are covered:


Obstructive Sleep Apnea Return to Sleep Disorders Index
Sleep apnea is a serious sleep disorder. People who have sleep apnea either stop breathing (obstructions) or inhale a third or less of a typical breath (hypopneas) for 10 to 30 seconds or more at a time while they are sleeping. These stops or uneven breathing can happen hundreds of times every night. If you have sleep apnea, the periods of not breathing or shallow breathing may make you wake up so your body can get the oxygen it needs. If you are waking up all night long, you aren't getting enough rest from your sleep.

There are two primary types of sleep apnea and one combination: obstructive apnea, central apnea and mixed apnea. Obstructive sleep apnea is the most common type. Nine out of 10 people with sleep apnea have this type of apnea. If you have obstructive sleep apnea, something is blocking the passage or windpipe (called the trachea) that brings air into your body. When you try to breathe, you can't get enough air because of the blockage. Your windpipe might be blocked by your tongue, tonsils or uvula (the little piece of flesh that hangs down in the back of your throat). It might also be blocked by a large amount of fatty tissue in the throat or even by relaxed throat muscles.

Central sleep apnea is not as common. This type of sleep apnea is related to the function of the central nervous system. If you have this type of apnea, the muscles you use to breathe don't get the "go-ahead" signal from your brain. Either the brain doesn't send the signal, or the signal gets interrupted. A combination of both obstructive sleep apnea and central sleep apnea is called mixed sleep apnea.

What Causes Sleep Apnea?
Obstructive sleep apnea occurs when the muscles in the back of your throat relax. These muscles support the soft palate, the triangular piece of tissue hanging from the soft palate (uvula), tonsils and tongue.

When the muscles relax, your airway narrows or closes as you breathe in, and breathing momentarily cuts off. This may lower the level of oxygen in your blood. Your brain senses this inability to breath and briefly awakens you from sleep so that you can reopen your airway. This awakening is usually so brief that you don't remember it.

You can awaken with a momentary shortness of breath that corrects itself quickly, within one or two deep breaths. You may make a snorting, choking or gasping sound. This pattern can repeat itself 10 to 30 times or more each hour, all night long. These disruptions impair your ability to reach those desired deep, restful phases of sleep, and you'll probably feel sleepy during your waking hours.

People with obstructive sleep apnea may not be aware that their sleep was interrupted. In fact, many people with this type of sleep apnea think they sleep well all night.

Central sleep apnea, which is far less common, occurs when your brain fails to transmit signals to your breathing muscles. You may awaken with shortness of breath or headaches. The most common cause of central sleep apnea can be caused by heart disease. People with central sleep apnea may be more likely to remember awakening than people with obstructive sleep apnea are.

Is Sleep Apnea Dangerous?
Sleep apnea can cause serious problems if it isn't treated. Your risk of the following medical conditions is higher if sleep apnea goes untreated:

 
Heart Problems
High Blood Pressure
Heart Attacks
Strokes
Poor Quality of Life
Death
Car accidents and work related accidents due to sleepiness


Currently, there is no cure for sleep apnea, so it is very important that you continue your therapy, whether by CPAP, BiPAP or oral appliances. If you stop therapy, your sleep apnea will come back.

Is There Anything I Can Do To Help My Sleep Apnea?
Yes. The following steps help many people who have sleep apnea sleep better:

 
If you smoke, quit smoking
If you are overweight, lose weight
Stop all use of alcohol or sleep medicines at night. These relax the muscles in the back of your throat, making it harder for you to breathe.


How Do You Know If You Have OSA?
Below are many of the symptoms associated with sleep apnea. You may take The Epworth Sleepiness Test to assess just how tired you are. This test is for daytime sleepiness not specifically for snoring and apnea. If you score high on the test be sure to visit your physician, contact us or fill out our Certificate of Medical Necessity to request a sleep study.

Symptomology for Sleep Apnea includes:

 
Loud snoring
Depression
Morning headaches
Difficulty concentrating
Unrefreshing sleep
Excessive perspiring during sleep
A dry mouth upon awakening
Heartburn
High blood pressure
Reduced libido
Overweight
Insomnia
Irritability
Restless sleep
Change in personality
Rapid weight gain
Confusion upon awakening
Restless sleep
Frequent nocturnal urination (nocturia)
Nocturnal snorting, gasping, choking (may wake self up)
Chest retraction during sleep in young children (chest pulls in)


Snoring Return to Sleep Disorders Index
Snoring is a noise produced when an individual breathes (usually produced when breathing in) during sleep which in turn causes vibration of the soft palate and uvula (that tissue that hangs down in the back of the throat).

All snorers have a partial obstruction of the upper airway. Many habitual snorers have complete episodes of upper airway obstruction where the airway is completely blocked for a period of time, usually 10 seconds or longer. This silence is usually followed by snorts and gasps as the individual fights to take a breath. When an individual snores so loudly that it disturbs others, obstructive sleep apnea is almost certain to be present.

There is snoring that is an indicator of obstructive sleep apnea and there is also primary snoring.

Primary Snoring, also known as simple snoring, snoring without sleep apnea, noisy breathing during sleep, benign snoring, rhythmical snoring and continuous snoring is characterized by loud upper airway breathing sounds in sleep without episodes of apnea (cessation of breath).

How Does Primary Snoring Differ from Snoring with OSA?

 
You wake up feeling refreshed
No evidence of insomnia
You do not experience excessive sleepiness during the day


A polysomnogram (sleep study) that shows:

 
Snoring and other sounds often occurring for long episodes during the sleep period
No associated abrupt arousals, arterial oxygen desaturation (lowered amount of oxygen in the blood) or cardiac disturbances
Normal sleep patterns
Normal respiratory patterns during sleep
No signs of other sleep disorders


What Can Be Done About Primary Snoring?
First of all, it is absolutely necessary to rule out obstructive sleep apnea or other sleep disorders. Behavioral and lifestyle changes may be suggested. Losing weight, sleeping on your side, refraining from alcohol and sedatives at night are often recommended.

There are mouth/oral devices (that help keep the airway open) on the market that may help to reduce snoring in three different ways.

 
Some devices
 
> Bring the jaw forward or
 
> Elevate the soft palate or
 
> Retain the tongue (from falling back in the airway and thus decreasing snoring).
There is also surgery. There is uvulopalatopharyngoplasty (UPPP) or Laser-Assisted Uvulopalatoplasty (LAUP) that involves removing excess tissue from the throat.
Another surgery, approved by the FDA in July 1997 for treating snoring is called somnoplasty. Somnoplasty uses radio frequency waves that deliver controlled thermal energy into targeted areas to reduce tissue volume and stiffen soft tissue.


Upper Airway Resistance Syndrome (UARS) Return to Sleep Disorders Index
The term Upper Airway Resistance Syndrome (UARS) is used to describe chronic daytime sleepiness in the absence of actual apneas or hypopneas, but often associated with snoring in turn associated with brief, frequent arousals with an only slightly abnormal breathing pattern. Patients may present with the clinical features of hypersomnolence but lack the typical findings of apnea, hypopnea and nocturnal oxygen desaturation during polysomnography (PSG).

Patients with UARS lack the typical findings of apnea on PSG and, therefore, are often not diagnosed. The arousals and sleep fragmentation are related to an increased effort to breathe which can be diagnosed by measurement of pressure changes in the esophagus.

Narcolepsy Return to Sleep Disorders Index
Narcolepsy is a disabling disorder of sleep regulation that affects the control of sleep and wakefulness. It may be described as an intrusion of the dream sleep (called REM or rapid eye movement) into the waking state. Symptoms generally begin between the ages of 15 and 30. The four classic symptoms of the disorder are excessive daytime sleepiness; cataplexy (sudden, brief episodes of muscle weakness or paralysis brought on by strong emotions such as laughter, anger, surprise or anticipation); sleep paralysis (paralysis upon falling asleep or waking up); and hypnagogic hallucinations (vivid dreamlike images that occur at sleep onset). Disturbed nighttime sleep, including tossing and turning in bed, leg jerks, nightmares, and frequent awakenings, may also occur. The development, number and severity of symptoms vary widely among individuals with the disorder. There appears to be an important genetic component to the disorder as well.

Narcoleptics, no matter how much they sleep, continue to experience an irresistible need to sleep. People with narcolepsy can fall asleep while at work, talking, and driving a car for example. These "sleep attacks" can last from 30 seconds to more than 30 minutes. They may also experience periods of cataplexy (loss of muscle tone) ranging from a slight buckling at the knees to a complete, "rag doll" limpness throughout the body.

The prevalence of narcolepsy has been calculated at about 0.03% of the general population. Its onset can occur at any time throughout life, but its peek onset is during the teen years. Narcolepsy has been found to be hereditary along with some environmental factors.

Symptoms

Excessive sleepiness
Temporary decrease or loss of muscle control, especially when getting excited.
Vivid dream-like images when drifting off to sleep or waking up.
Waking up unable to move or talk for a brief time.


Simple Test For Narcolepsy

Do you feel like you could sleep for days and still wake up sleepy?
Do you ever collapse or feel weak when laughing?
Do you ever collapse or feel weak when angry?
Waking up unable to move or talk for a brief time.
Are you afraid you may fall asleep while swimming?
Are you afraid you may fall asleep while taking a bath?
Did one of your parents or close relatives have the "sleeping sickness"?
Answering yes to any of these questions may be an indication of narcolepsy.
You should discuss this with your physician.


Treatment
There is no cure for narcolepsy; however, the symptoms can be controlled with behavioral and medical therapy. The excessive daytime sleepiness may be treated with stimulant drugs, while cataplexy and other REM-sleep symptoms may be treated with antidepressant medications. At best, medications will reduce the symptoms, but will not alleviate them entirely. Also, some medications may have side effects. Basic lifestyle adjustments such as keeping a good sleep schedule, improving diet, increasing exercise and avoiding "exciting" situations may also help to reduce the effects of excessive daytime sleepiness and cataplexy.

Restless Leg Syndrome (RLS) Return to Sleep Disorders Index
RLS is a neurological disorder characterized by unpleasant sensations in the legs and an uncontrollable urge to move when at rest in an effort to relieve these feelings. It can be insufferable at night - forcing the person to get out of bed numerous times to move about, causing them to be deprived of meaningful sleep. A similar condition known as Periodic Limb Movement Disorder (PLMD) only occurs at night. Individuals with PLMD are often unaware they have the condition since muscles in their legs contract involuntarily throughout the night, partially awakening them.

Most Likely Situations For Symptoms To Occur

Riding in a car
Watching TV
Reading
Inactivity, sitting (in a movie theater for example)
Lying in bed trying to fall asleep


Techniques To Provide Temporary Relief Symptoms

Getting up and walking around
Taking a hot shower
Rubbing the legs
Regular exercise


Periodic Limb Movements
One variation of RLS is Periodic Limb Movements in Sleep (PLM). PLM’s are characterized by leg movements or jerks which typically occur every 20 to 40 seconds during sleep. PLM’s causes sleep to be disrupted. These movements are typically reported by the bed partner. These movements fragment sleep leaving the person with excessive daytime sleepiness.

Simple Test For Restless Legs

Do you feel that in some way your sleep is not refreshing or restful?
Do your legs ache prior to bed or when getting up?
Does your bed partner report that you kick them during the night?


Insomnia Return to Sleep Disorders Index

The Four Major Types

Difficulty falling asleep
No problem falling asleep but difficulty staying asleep (many awakenings)
Waking up too early
Sleep State Misperception


What Causes Insomnia?
Many things can cause insomnia. Insomnia is not a disorder it is a complaint. The goal is to find the underlying problem causing the complaint. Almost any sleep disorder can present themselves as insomnia including circadian disorders, sleep apnea, restless legs, and the list goes on. So ruling out a sleep disorder can be important. Medications, herbs and caffeine can cause insomnia. Most medications will report the possible side effect of insomnia and sleepiness. The same medication can cause both since we all react to medications differently. Life events can cause insomnia but it is usually temporary. Anxiety about falling asleep can also be responsible, however, if the anxiety is due to a long history of insomnia, the anxiety is probably not the problem and you need to find out what is the underlying cause. Once sleep is restored to normal the anxiety will usually go away. Physical problems such as pain can be the underlying cause. There is also the possibility of mental problems, and a good sleep doctor that works with insomnia can rule this in or out sometimes without an all night sleep study.

Three Classes of Insomnia:

Transient insomnia - lasting for a few nights
Short-term insomnia - two or four weeks of poor sleep
Chronic insomnia - poor sleep that happens most nights and last a month or longer

Transient and short-term insomnia generally occur in people who are temporarily experiencing one or more of the following:

Stress
Environmental noise
Extreme temperatures change in the surrounding environment
Sleep/wake schedule problems such as those due to jet lag
medication side effects


Chronic insomnia is more complex and often results from a combination of factors, including underlying physical or mental disorders. One of the most common causes of chronic insomnia is depression. Other underlying causes include arthritis, kidney disease, heart failure, asthma, sleep apnea, restless legs syndrome, Parkinson's disease, and hyperthyroidism. However, chronic insomnia may also be due to behavioral factors, including the misuse of caffeine, alcohol, or other substances; disrupted sleep/wake cycles as may occur with shift work or other nighttime activity schedules; and chronic stress.

In addition, the following behaviors have been shown to perpetuate insomnia in some people:

Poor sleep hygiene in general
Expecting to have difficulty sleeping and worrying about it
Ingesting excessive amounts of caffeine
Drinking alcohol before bedtime
smoking cigarettes before bedtime
excessive napping in the afternoon or evening
Irregular or continually disrupted sleep/wake schedule


Difficulty sleeping is only one of the symptoms. Daytime symptoms include:

Sleepiness
Anxiety
Impaired concentration
Impaired memory
Irritability


Treatment or transient and short-term insomnia

Transient and short-term insomnia may not require treatment since episodes last only a few days at a time. For example, if insomnia is due to a temporary change in the sleep/wake schedule, as with jet lag, the person's biological clock will often get back to normal on its own. However, for some people who experience daytime sleepiness and impaired performance as a result of transient insomnia, the use of short-acting sleeping pills may improve sleep and next-day alertness. As with all drugs, there are potential side effects. The use of over-the-counter sleep medicines is not usually recommended for the treatment of insomnia.

Treatment for chronic insomnia consists of:

First, diagnosing and treating underlying medical or psychological problems. Patients are required to keep a sleep diary for a length of time before visiting with their doctor. To get a diary click here.
Identifying behaviors that may worsen insomnia and stopping (or reducing) them.
Possibly using sleeping pills, although the long-term use of sleeping pills for chronic insomnia is controversial.


A patient taking any sleeping pill should be under the supervision of a physician to closely evaluate effectiveness and minimize side effects. In general, these drugs are prescribed at the lowest dose and for the shortest duration needed to relieve the sleep-related symptoms. For some of these medicines, the dose must be gradually lowered as the medicine is discontinued because, if stopped abruptly, it can cause insomnia to occur again for a night or two.

Trying behavioral techniques to improve sleep, such as relaxation therapy, sleep restriction therapy, reconditioning, and bright light.


Relaxation Therapy. There are specific and effective techniques that can reduce or eliminate anxiety and body tension. As a result, the person's mind is able to stop "racing," the muscles can relax, and restful sleep can occur. It usually takes much practice to learn these techniques and to achieve effective relaxation.

Sleep Restriction. Some people suffering from insomnia spend too much time in bed unsuccessfully trying to sleep. They may benefit from a sleep restriction program that at first allows only a few hours of sleep during the night. Gradually the time is increased until a more normal night's sleep is achieved.

Reconditioning. Another treatment that may help some people with insomnia is to recondition them to associate the bed and bedtime with sleep. For most people, this means not using their beds for any activities other than sleep and sex (some experts even say using the bed for sex can cause performance anxiety which could lead to insomnia). As part of the reconditioning process, the person is usually advised to go to bed only when sleepy. If unable to fall asleep, the person is told to get up, stay up until sleepy, and then return to bed. Throughout this process, the person should avoid naps and wake up and go to bed at the same time each day. Eventually the person's body will be conditioned to associate the bed and bedtime with sleep.

Bright Light. If you are having trouble getting to sleep early enough at night it will help to wake up at the same time every morning and try to get as much bright light in the morning as possible. This will help reset the internal clock to an earlier time at night for sleep. If you are having trouble staying awake in the evening and waking up too early in the morning then try to get bright light in the evening. This will help reset the internal clock to go to sleep later and wake up later. You may want to avoid early morning light using this method until you have stabilized your sleeping pattern.

Sleepwalking Return to Sleep Disorders Index

Sleepwalking (Somnambulism) is a series of complex behaviors that are initiated during slow wave sleep and result in walking during sleep.

What Are The Symptoms Of Sleepwalking?

Ambulation (walking or moving about) that occurs during sleep. The onset typically occurs in prepubertal children.

Associated features include:

Difficulty in arousing the patient during an episode
Amnesia following an episode
Episodes typically occur in the first third of the sleep episode
Polysomnographic monitoring demonstrates the onset of an episode during stage 3 or 4 sleep
Other medical and psychiatric disorders can be present but do not account for the symptom
The ambulation is not due to other sleep disorders such as REM sleep behavior disorder or sleep terrors


How Common Is Sleepwalking?
Medical reports show that about 18% of the population is prone to sleepwalking. It is more common in children than in adolescents and adults. Boys are more likely to sleepwalk than girls. The highest prevalence of sleepwalking was 16.7% at age 11 to 12 years of age. Sleepwalking can have a genetic tendency. If a child begins to sleepwalk at the age of 9, it often lasts into adulthood.

How Serious Is Sleepwalking?
For some, the episodes of sleepwalking occur less than once per month and do not result in harm to the patient or others. Others experience episodes more than once per month, but not nightly, and do not result in harm to the patient or others. In its most severe form, the episodes occur almost nightly or are associated with physical injury. The sleepwalker may feel embarrassment, shame, guilt, anxiety and confusion when they are told about their sleepwalking behavior.

If the sleepwalker exits the house, or is having frequent episodes and injuries are occurring -- DO NOT delay, it is time to seek professional help from a sleep disorder center in your area. There have been some tragedies with sleepwalkers, don't let it happen to your loved one!

What Can Be Done About Sleepwalking?

There are some things a sleepwalker can do:

Make sure you get plenty of rest; being overtired can trigger a sleepwalking episode.
Develop a calming bedtime ritual. Some people meditate or do relaxation exercises; stress can be another trigger for sleepwalking.
Remove anything from the bedroom that could be hazardous or harmful.
The sleepwalker's bedroom should be on the ground floor of the house. The possibility of the patient opening windows or doors should be eliminated.
An assessment of the sleepwalker should include a careful review of the current medication so that modifications can be made if necessary.
Hypnosis has been found to be helpful for both children and adults.
An accurate psychiatric evaluation could help to decide the need for psychiatric intervention.
Benzodiazepines have been proven to be useful in the treatment of this disorder. A small dose of diazepam or lorazepam eliminates the episodes or considerably reduces them.


Night Terrors In Children Return to Sleep Disorders Index
Some children have a different kind of scary dream from a nightmare called a "night terror." Night terrors happen during deep sleep (usually between 1 a.m. and 3 a.m.). A child having a night terror will often wake up screaming. He or she may be sweating and breathing fast. Your child's pupils (the black center of the eye) may look larger than normal. At this point, your child may still be asleep, with open eyes. He or she will be confused and might not answer when you ask what's wrong. Your child may be difficult to wake. When your child wakes, he or she usually won't remember what happened.

Nightmares and night terrors don't happen as much as children get older. Often, nightmares and night terrors stop completely when your child is a teenager. Some people, especially people who are imaginative and creative, may keep having nightmares when they are adults.

Nightmares and night terrors in children are usually not caused by mental or physical illness. Often nightmares happen after a stressful physical or emotional event. In the first 6 months after the event, a child might have nightmares while he or she gets used to what happened in the event. If nightmares keep happening and disturb your child's sleep, they can affect your child's ability to function during the day. Talk with your doctor about whether treatment will help your child. Typically, children outgrow night terrors after the age of 12.

Sleep Terrors In Adults Return to Sleep Disorders Index

Sleep Terrors are characterized by a sudden arousal from slow wave sleep with a piercing scream or cry, accompanied by autonomic (Controlled by the part of the nervous system that regulates motor functions of the heart, lungs, etc.) and behavioral manifestations of intense fear.

What Are The Symptoms Of Sleep Terrors?

A sudden episode of intense terror during sleep
The episodes usually occur within the first third of the night
Partial or total amnesia occurs for the events during the episode


Additional information includes:

Polysomnographic monitoring demonstrates the onset of episodes during stage 3 or 4 sleep
Tachycardia usually occurs in association with the episodes.
Other medical disorders are not the cause of the episode, e.g., epilepsy
Other sleep disorders can be present, e.g., nightmares.


How Serious Are Sleep Terrors?
Some people have episodes of sleep terror that may occur less than once per month, and do not result in harm to the patient or others. While some people experience episodes less than once per week, and do not result in harm to the patient or others. In its severest form, the episodes occur almost nightly, or are associated with physical injury to the patient or others. Consult a sleep specialist if you are concerned.

Sleep Bruxism Return to Sleep Disorders Index

Sleep Bruxism is a stereotyped movement disorder characterized by grinding or clenching of the teeth during sleep. The disorder has also been identified as nocturnal bruxism, nocturnal tooth-grinding and nocturnal tooth-clenching.

What Are The Symptoms?
The symptoms of Sleep Bruxism are tooth-grinding or tooth-clenching during sleep that may cause:

Abnormal wear of the teeth
Sounds associated with bruxism (It's about as pleasant as fingernails on a chalkboard!)
Jaw muscle discomfort


How Serious Is The Disorder?
Some people have episodes that occur less than nightly with no evidence of dental injury or impairment of psychosocial functioning. And others experience nightly episodes with evidence of mild impairment of psychosocial functioning. Yet others have nightly episodes with evidence of dental injury, tempomandibular (jaw) disorders, other physical injury or moderate or severe impairment of psychosocial functioning.

When someone with suspected sleep bruxism has a polysomnographic test there is evidence of jaw muscle activity during the sleep period and the absence of abnormal movement during sleep. Other sleep disorders may be present at the same time, e.g., obstructive sleep apnea, restless legs syndrome.

Hypersomnia Return to Sleep Disorders Index

Hypersomnia is excessive sleepiness. It is an excessively deep or prolonged major sleep period. It may be associated with difficulty in awakening. It is believed to be caused by the central nervous system and can be associated with a normal or prolonged major sleep episode and excessive sleepiness consisting of prolonged (1-2 hours) sleep episodes of non-REM sleep.

What Are The Symptoms?

Long sleep periods
Excessive sleepiness or excessively deep sleep
The onset is insidious (gradually, so you are not aware of it at first)
Typically appears before age 25
Has been present for at least six months


How Do I Know If I Have Hypersomnia?
The first step is to consult a sleep specialist or take the Epworth Sleepiness Test. The sleep specialist will probably order a polysomnography test (sleep study) where you stay overnight while technologists monitor your muscle movement, heartbeat, eye movement, leg movements and respiration. The specialist may also want to do a Multiple Sleep Latency Test (MSLT) that tests how sleepy you are.

Treatment
Since the cause is still unknown, treatment consists of behavioral changes, good sleep hygiene and taking stimulants to help you be more alert. Limit your naps to one (preferably in the afternoon) lasting no longer than 45 minutes. Get at least 8 1/2 hours of sleep. Avoid shiftwork, alcohol and caffeine. Your doctor will determine the amount and type of stimulant you should take.

REM Behavior Disorders (RBD) Return to Sleep Disorders Index

In RBD, neurotransmitters are not blocked, and the voluntary muscles become tonic, or tensely contracted, allowing a sleeping person to move his or her muscles during REM. Rapid eye movement behavior disorder is characterized by significant submental tone (under the chin) and limb muscle tone. The combination of heightened cerebral activity and muscular tonicity results in physically acting out dreams that involve excited and sometimes violent movement.

The body can be rigid and extremely tense during episodes of RBD. For example, a person might straighten his or her leg, flexing it intensely for several seconds or a minute. Often, sleepers curl up slightly, while flexing their limbs and chin.

People with RBD typically remember little or nothing of this activity, unless they fall out of bed, bump into the furniture, or injure themselves and wake up. But they can usually remember the dreams they were having during an episode.

Dreams that involve physical or violent activity such as fighting, dancing, running, chasing, attacking, being attacked, and running from an assailant are more likely to trigger RBD activity. Sleepers with RBD sometimes injure their bed partners. Some people have been known to leave the bed, run into a wall, run through a window, or run down the stairs. But RBD activity is usually confined to the bed and the surrounding area.

Though physicians do not thoroughly understand the complex processes, it is known that the brainstem undergoes changes in REM sleep that result in paralysis of the body’s voluntary muscles. Certain neurotransmitters, like acetylcholine (Ach), become dormant and do not communicate motor activity. The absence of muscular contraction during REM can be seen with polysomnography.

Treatment
Diagnosis and treatment involves polysomnography, drug therapy, and the exclusion of potentially serious neurological disorders.

Jet Lag Return to Sleep Disorders Index

Jet lag, or desynchronosis, is a temporary condition that some people experience following air travel across several time zones in a short period of time. This causes the traveler's internal clock to be out of sync with the external environment. People experiencing jet lag have a difficult time maintaining their internal, routine sleep-wake pattern in their new location, because external stimuli, like sunshine and local timetables, dictate a different pattern. For this reason, one can feel lethargic one moment and excited the next. Jet lag creates a double bind for vacationers and business people who must cross several time zones to reach their destination, but who are also intent on maximizing sightseeing or productivity. As travelers attempt to adjust their internal clock to a new external environment, symptoms result with varying intensity.

Jet lag occurs while rapidly crossing time zones, or, more specifically, it occurs after crossing the Earth’s meridians. Meridians demarcate geographic position in relation to the Earth’s poles and, ultimately, define time zones. Jet lag is a unique sleep disorder because its onset is not necessarily caused by abnormal sleep patterns, like insomnia. Travelers who sleep normally prior to transmeridian travel are not immune to jet lag; the symptoms result when a person’s internal clock attempts to acclimate to a new external environment. This acclimation involves circadian rhythms that, among other functions, are associated with the body’s management of sleep.

Signs & Symptoms
In addition to the tired-wired, soar-crash feeling that travelers experience after long, rapid air travel, there are numerous symptoms that may occur with jet lag, such as:

Insomnia
Dry and irritated nose and sinuses
Daytime fatigue
Earaches
Stomach aches
Muscle cramps
Headaches
Abdominal distension (bloating)
Irritability
Dizziness
Dry Eyes
Swollen feet & ankles
Dry and irritated nose and sinuses
Decreased awareness
Irritability
   


The degree of disruption varies greatly among people; some may not be bothered at all. Although jet lag occasionally lasts for a week or more, travelers usually return to their normal sleep-wake pattern after a day or two. For many travelers, jet lag can catalyze the effects of certain conditions associated with the head and nervous system that are not related to specific sleep-wake patterns. For example, many symptoms attributed to jet lag are actually caused by the environment of the airplane--dry air (humidity in an airplane is very low), pressurization, noise, vibrations, and a cramped environment.

Management
There is no specific treatment for jet lag, but trying to adapt to the new time zone as soon as possible may help. For instance, some travelers may benefit from the psychological effect of resetting their watches to the new time zone as soon as they depart. Most people try to minimize the impact of crossing time zones by planning their activities to accommodate the effects of jet lag. One useful strategy for easier eastbound travel is to take a daytime flight. If a traveler flies eastward by several time zones during the day, they may arrive at their destination in the middle of the afternoon, home time, and in the middle of the evening, local time. For example, if they leave Boston at 10 a.m. on a flight to London, England, they will arrive in London at 9:30 p.m., GMT. However, their body clock tells them it's only 4:30 EST. They should try to go to sleep at a normal time in the new time zone. If a traveler needs to take an evening eastbound flight, they will arrive in the middle of the night, home time. In this case, immediate rest helps. They should try to sleep for a few hours when they arrive and then try to stay up until bedtime. For most people, westward travel is easier to adapt to than eastward travel. This is probably because it is generally easier to elongate one's day by staying up later, than to try to shorten one’s day by going to sleep earlier.

Can I Stop Jet Lag?
Avoiding the factors that contribute to jet lag may be the best defense against it. Primary prevention means getting good sleep prior to a transmeridian flight. This includes avoiding alcohol, caffeine, and nicotine, which are associated with restless sleep. Early morning bright light may advance a person's sleep phase and allow them to go to sleep earlier. Travelers who arrive in sunny places may find it easier to adjust to a new bedtime.

Conversely, bright light in the evening can delay a person's sleep phase and make it difficult for them to fall asleep at night. Therefore, depending on the contrasts between a traveler’s time zone and a new time zone, exposure and avoidance of bright light at certain times may help resynchronize one’s rhythm.

Sleeping pills (hypnotics) may be of limited benefit for the first two days following flight, especially if one needs a full night's sleep to perform the next day. Short-acting hypnotics are generally recommended to avoid effects that carry over into the day hours. Over-the-counter medications typically have a lot of carry-over effects that can cause drowsiness and other significant problems for travelers who must perform. Physicians can advise travelers about what method of management is best for them.

   
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