There are many sleep disorders. The following are
covered:
Obstructive
Sleep Apnea 
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:
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Heart Problems |
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High Blood Pressure |
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Heart Attacks |
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Strokes |
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Poor Quality of Life |
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Death |
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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:
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If you smoke, quit smoking |
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If you are overweight, lose weight |
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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.
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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:
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Loud snoring
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Depression
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Morning headaches
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Difficulty concentrating
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Unrefreshing sleep
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Excessive perspiring during
sleep
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A dry mouth upon awakening |
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Heartburn |
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High blood pressure |
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Reduced libido |
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Overweight |
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Insomnia |
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Irritability |
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Restless sleep |
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Change in personality |
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Rapid weight gain |
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Confusion upon awakening |
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Restless sleep |
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Frequent nocturnal
urination (nocturia) |
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Nocturnal
snorting, gasping, choking (may wake self up)
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Chest retraction
during sleep in young children (chest pulls in) |
Snoring
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?
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You
wake up feeling refreshed
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No evidence of insomnia |
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You do not
experience excessive sleepiness during the day |
A polysomnogram (sleep study) that shows:
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Snoring and
other sounds often occurring for long episodes
during the sleep period
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No associated
abrupt arousals, arterial oxygen desaturation
(lowered amount of oxygen in the blood) or cardiac
disturbances
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Normal sleep
patterns
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Normal respiratory
patterns during sleep
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No signs
of other sleep disorders
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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.
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Some
devices
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> Bring
the jaw forward or
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> Elevate
the soft palate or
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> Retain
the tongue (from falling back in the airway
and thus decreasing snoring).
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There
is also surgery. There is uvulopalatopharyngoplasty
(UPPP) or Laser-Assisted Uvulopalatoplasty
(LAUP) that involves removing excess tissue
from the throat.
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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)
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
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
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Excessive
sleepiness
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Temporary
decrease or loss of muscle control, especially
when getting excited. |
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Vivid dream-like
images when drifting off to sleep or waking up.
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Waking up
unable to move or talk for a brief time.
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Simple Test For Narcolepsy
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Do
you feel like you could sleep for days and still
wake up sleepy?
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Do you ever
collapse or feel weak when laughing?
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Do you ever
collapse or feel weak when angry?
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Waking up unable
to move or talk for a brief time.
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Are you afraid
you may fall asleep while swimming? |
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Are you afraid
you may fall asleep while taking a bath? |
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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)
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
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Riding
in a car
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Watching TV
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Reading
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Inactivity,
sitting (in a movie theater for example)
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Lying in bed
trying to fall asleep
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Techniques To Provide Temporary Relief Symptoms
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Getting
up and walking around
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Taking a hot
shower
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Rubbing the
legs
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Regular exercise
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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
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Do you
feel that in some way your sleep is not refreshing
or restful?
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Do your legs ache
prior to bed or when getting up?
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Does your bed partner
report that you kick them during the night?
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Insomnia
The Four Major Types
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Difficulty
falling asleep
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No problem falling
asleep but difficulty staying asleep (many awakenings)
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Waking up too
early
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Sleep State Misperception
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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:
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Stress
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Environmental
noise
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Extreme temperatures
change in the surrounding environment
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Sleep/wake schedule
problems such as those
due to jet lag
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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:
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Poor
sleep hygiene in general
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Expecting
to have difficulty sleeping and worrying about it
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Ingesting
excessive amounts
of caffeine
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Drinking alcohol
before bedtime
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smoking cigarettes
before bedtime |
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excessive napping in
the afternoon or evening |
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Irregular or continually
disrupted sleep/wake schedule |
Difficulty sleeping is only one of the symptoms. Daytime
symptoms include:
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Sleepiness
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Anxiety
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Impaired concentration
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Impaired memory
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Irritability
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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:
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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.
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Identifying
behaviors that may worsen insomnia and stopping (or
reducing)
them.
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Possibly using
sleeping pills, although the long-term use of sleeping
pills for chronic insomnia
is controversial.
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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
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:
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Difficulty
in arousing the patient during an episode
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Amnesia following
an episode
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Episodes typically
occur in the first third of the sleep episode
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Polysomnographic
monitoring
demonstrates the onset of an episode during stage
3 or 4 sleep
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Other medical
and psychiatric disorders can be present but do not
account for the symptom
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The
ambulation is not due to other sleep disorders such
as REM sleep behavior disorder or sleep terrors
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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:
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Make
sure you get plenty of rest; being overtired can
trigger a sleepwalking
episode.
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Develop a calming
bedtime ritual. Some people meditate or do relaxation
exercises; stress can be another trigger for sleepwalking.
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Remove
anything from the bedroom that could be hazardous
or harmful.
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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.
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An assessment
of the sleepwalker should include a careful review
of the current medication
so that modifications can be made if necessary.
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Hypnosis
has been found to be helpful for both children and
adults. |
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An accurate
psychiatric evaluation could help to decide the need
for psychiatric intervention. |
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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.
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Night
Terrors In Children
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
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?
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A sudden
episode of intense terror during sleep
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The episodes usually
occur within the first third of the night
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Partial or total amnesia
occurs for the events during the episode
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Additional information includes:
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Polysomnographic
monitoring demonstrates the onset of episodes during
stage 3
or 4 sleep
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Tachycardia usually
occurs in association with the episodes.
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Other medical
disorders are not
the cause of the episode, e.g., epilepsy
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Other sleep
disorders can be present, e.g., nightmares.
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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
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:
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Abnormal
wear of the teeth
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Sounds associated
with bruxism (It's about as pleasant as fingernails
on a chalkboard!)
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Jaw
muscle discomfort
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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
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?
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Long
sleep periods
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Excessive
sleepiness or excessively deep sleep
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The onset is
insidious (gradually, so you are not aware of it
at first)
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Typically appears
before age 25
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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)
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
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:
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Insomnia
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Dry and irritated
nose and sinuses
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Daytime fatigue
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Earaches
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Stomach aches
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Muscle cramps
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Headaches
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Abdominal distension (bloating)
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Irritability
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Dizziness
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Dry Eyes
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Swollen feet & ankles
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Dry and irritated nose and sinuses |
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Decreased awareness |
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Irritability
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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.
