Insomnia

If you have insomnia, you may have trouble falling asleep, staying asleep or getting good-quality sleep. Short-term insomnia can last for a few days or weeks, and generally is caused by stress or changes in your environment or schedule. Chronic, or long-term, insomnia happens three or more nights a week, lasts more than three months, and can’t be fully explained by another health problem that could be keeping you awake, such as joint pain.

Up to 30% of adults have chronic insomnia and the lifetime risk for women is as much as 40% higher than that of men, according to the Sleep Foundation.

To diagnose insomnia, your healthcare provider may ask you to keep a sleep diary or describe your sleep habits. To manage insomnia, you may be advised to adopt a regular sleep schedule or participate in cognitive behavioral therapy. Medications may be available, but are not the optimal treatment.

Snoring and Sleep-Disordered Breathing

Snoring is caused by a narrowing or partial blockage of the airways at the back of your mouth, throat, or nose. The obstruction results in increased air turbulence when breathing in, causing the soft tissues in your upper airways to vibrate.

A compromised airway causes varying degrees of sleep-disordered breathing (SDB), in which floppy tissues block the airway, interrupting breathing and briefly rousing you from sleep. Research has shown that loud snoring with breathing pauses is associated with an increased risk of cardiovascular disease and increased healthcare utilization, and among women, the risk of mild cognitive impairment. SDB is closely associated with sleep apnea, and management for the two disorders is similar.

Sleep Apnea

There are two types of sleep apnea: obstructive sleep apnea (OSA) and central sleep apnea (CSA). OSA is more common by far, affecting about 30 million people in the United States — though only about six million are diagnosed with the condition, according to the American Medical Association, probably due to lack of awareness.

In OSA, breathing is interrupted when the upper airway is blocked when the soft tissue in the back of the mouth collapses during sleep. The effect is like trying to drink through a wet paper straw: You suck on it, but nothing gets through. Someone with OSA can have 5-100 apneas (cessation of breathing) per hour, totaling hundreds during the night. The cutoff of air may lead to low levels of oxygen and increased levels of carbon dioxide in the blood; you get less deep sleep, and the sleep you do get is interrupted. You may awaken suddenly, gasping for breath. The frequent awakenings keep you from getting deep, restorative sleep, and also sets the stage for hypersomnia.

OSA increases the risk of high blood pressure, heart failure, atrial fibrillation and other arrhythmias, stroke and nonalcoholic fatty liver disease. among other complications. Perioperative complications such as cardiac arrest may occur if a person undergoing surgery has OSA and doesn’t know it.

Central sleep apnea (CSA) is less common than OSA and the main symptom is different. Instead of snoring, CSA causes pauses in breathing. Symptoms include being very tired during the day, frequent awakenings at night, and having headaches in the early morning. With CSA, you regularly stop breathing because your brain doesn’t tell your muscles to take in air, not because something physically blocks your breathing. CSA often happens after a serious illness and is more common in people over age 65, who may have health conditions such as congestive heart failure, kidney failure or a neurological disease.

Management of both conditions is similar, and the gold-standard treatment is nasal continuous positive airway pressure or CPAP. The CPAP device delivers air through a small mask that fits over the nose or through plastic nasal prongs. The correct air pressure is calibrated after a night in the sleep lab. Some devices can vary the flow of air to match an individual’s specific breathing pattern, while others start out the night with a lower air pressure. CPAP is not a cure for OSA or CSA (neither condition is curable), but treatment may lower high blood pressure and reduce the risk of cardiovascular events such as heart attacks and cardiac deaths. It also helps reduce daytime sleepiness and depressive symptoms, which many people with OSA experience.

Hypersomnia

Hypersomnia involves episodes of excessive daytime sleepiness (EDS) or prolonged sleep at night. With hypersomnia, you may feel driven to nap during the day, often for long periods of time — but these naps usually are not refreshing. Other symptoms include difficulty awakening from a long sleep and feeling disoriented; anxiety, irritability, lack of energy, restlessness, slowed thinking and speech, appetite loss, and memory problems.

Hypersomnia may be caused by another sleep disorder such as sleep apnea; drug or alcohol abuse; medication withdrawal (or by some medications themselves); head trauma or a tumor. Research suggests that some medical conditions — depression, epilepsy, multiple sclerosis, and obesity — may contribute to hypersomnia, and some people may have a genetic predisposition. Not surprisingly, hypersomnia can lead to drowsy driving and motor vehicle accidents.

While hypersomnia usually affects adolescents and young adults, it also can occur later in life and may be mistakenly attributed to aging.

Restless Legs Syndrome (TK)

Periodic Limb Movement Disorder (TK)

Parasomnias (TK)

During non-REM sleep:

• – Sleepwalking
• – Sleep terrors
• – Sleep-related eating disorder
• – Sleep drunkenness (confusional arousals)

During REM sleep

• – REM sleep behavior disorder
• – Sleep paralysis
• – Nightmares
• – Sleep-related groaning (catathrenia)
• – Sexsomnia

Narcolepsy (TK)

Other Sleep Stealers (TK – will include Jet Lag, Sleep Phase Problems, Chronic Pain, Leg Cramps, Medication Side Effects)