About Sleep Disorders
Sleep. It’s a basic necessity of life, as important to our health
and well being as air, food and water. When we sleep well, we wake up
feeling refreshed, alert and ready to face daily challenges. When we don’t,
every part of our lives can suffer. Our jobs, relationships, productivity,
health and safety are all put at risk. Lack of sleep due to sleep loss
or sleep disorders is taking a serious toll. In the past century, we have
reduced our average amount of sleep. Though our society has changed, our
brains and bodies have not. Sleep deprivation is affecting us all and
we are all paying the price.
Common Sleep Disorders
Sleep Apnea or Obstructive Sleep Apnea Syndrome (OSAS)
Sleep apnea (sleep-disordered breathing) is a serious and common sleep
disorder affecting about 12 million Americans, according to the National
Institutes of Health (NIH). Its name comes from a Greek word, apnea, meaning
"without breath." People with sleep apnea stop breathing briefly
many times during the night. The breathing pauses last 10 seconds or more,
and there may be 20 to 30 or more pauses per hour. The main symptoms of
sleep apnea are persistent loud snoring at night and daytime sleepiness.
Another symptom of sleep apnea is frequent long pauses in breathing during sleep, followed
by choking and gasping for breath. People with sleep apnea don't get enough
restful sleep, and their daytime performance is often seriously affected.
Sleep apnea may also lead to high blood pressure, heart disease, heart
attack, and stroke. OSAS, or Obstructive Sleep Apnea Syndrome, can be diagnosed and treated.
Insomnia
It is not unusual to have trouble sleeping from time to time. However,
if you feel you do not get enough sleep or satisfying sleep, you may have
insomnia. People with insomnia have one or more of the following:
- difficulty falling asleep;
- waking up often during the night and having trouble going back to
sleep;
- waking up too early in the morning;
- unrefreshing sleep.
Insomnia can cause problems during the day, such as sleepiness, fatigue,
difficulty concentrating, and irritability. A person with insomnia may
also have another sleep disorder such as sleep apnea, narcolepsy, and
restless leg syndrome. Insomnia is not defined by the number of hours
you sleep every night. The amount of sleep a person needs varies. While
most people need between 7 and 8 hours of sleep a night, some people do
well with less, and some need more. About 60 million Americans each year
suffer from insomnia, which can lead to serious sleep deficits and health
problems. Insomnia tends to increase with age and affects about 40 percent
of women and 30 percent of men.
Narcolepsy
Narcolepsy is a chronic sleep disorder with no known cause. It affects
the body's central nervous system, which is made up of nerves that carry
messages from the brain to other parts of the body. When a person has
narcolepsy, messages about when to sleep and when to be awake can get
mixed up. This can cause a person to fall asleep when they do not want
to, and often without any warning like feeling drowsy. The desire to sleep
can be overwhelming and hard to resist, and can happen to a person several
times during the day. Night sleep may also be poor, broken up by waking
up often during the night. If not controlled with medication, narcolepsy
can cause serious problems in personal, social, and work life. It can
also limit activities, such as driving a car, work, and exercising. Studies
indicate narcolepsy may run in families.
Restless Leg Syndrome
Restless leg syndrome (RLS) is a sleep disorder in which a person has
unpleasant feelings or sensations in the legs. These feelings are described
as creeping, crawling, tingling, pulling, or painful. While these sensations
happen most often in the calf or lower leg area, they can be felt anywhere
from the ankle to the upper thigh. RLS symptoms can occur in one or both
legs and can also be felt in the arms. These symptoms occur most often
when lying down, but can also occur when sitting for long periods of time,
such as at a desk, riding in a car, or watching a movie. People with RLS
talk about having an irresistible urge to move the legs. Moving the legs,
walking, rubbing or massaging the legs, or doing knee bends can bring
relief, at least for a short time. Unlike other conditions, RLS symptoms
get worse when relaxing or lessening activity, particularly during the
evening and nighttime sleeping hours. Many people with RLS have trouble
falling asleep and staying asleep. If not treated, RLS can cause extreme
daytime fatigue. A job, personal life and daily activities can be strongly
affected due to exhaustion. A person can lose their ability to focus and
may have memory loss.
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Common Treatments
Sleep Apnea or Obstructive Sleep Apnea Syndrome (OSAS)
The specific therapy for sleep apnea is based on your medical history,
physical exam, and the results of polysomnography or other tests. A polysomnography,
commonly called a sleep study, is an overnight test that measures how
the activity of the body changes during sleep.
Possible treatments for sleep apnea include:
- Behavioral changes such as weight loss, learning to sleep on one's
side instead of the back, and avoiding alcohol, sleeping pills, and
smoking. In milder cases of sleep apnea, behavioral changes may be enough to stop the
sleep apnea.
- Nasal Continuous Positive Airway Pressure (CPAP) therapy, is generally
required for successful treatment of sleep apnea. In CPAP therapy, a mask is worn over
the nose while sleeping, and a machine supplies pressurized room air
to the mask through a flexible tube. The pressurized air keeps the airway
open. There are various types of CPAP machines that are used in the treatment of sleep apnea.
- An oral or dental device that holds the tongue or jaw forward.
- Surgery. Some procedures include removal of adenoids and tonsils,
especially in children; removal of nasal polyps or other growths; and
correction of structural deformities.
Medications are generally not effective in the treatment of sleep apnea.
However, if nasal congestion is contributing to breathing problems, decongestants
may help in the treatment of sleep apnea.
Insomnia
Acute, or short-term insomnia may not require treatment. But if your
insomnia makes it hard to function during the day because you are sleepy
and tired, your health care provider may prescribe sleeping pills for
a limited time. The rapid onset, short-acting medications now available
avoid many of the earlier problems with continuing effects (like feeling
drowsy or groggy) the following day. Some medications may be less effective
after several weeks of nightly use, however, and long-term safety and
effectiveness has not yet been established. Side effects of sleeping pills
(and over-the-counter sleep medicines) can be a problem, too. Mild insomnia
often can be prevented or cured by practicing good sleep habits.
Treatment for chronic (long-term) insomnia includes first treating any
underlying conditions or health problems which are causing the insomnia.
If insomnia continues, your health care provider may suggest behavioral
therapy or medication. Most medicines used for sleep have side effects
and must be used with caution. It is not recommended to use over-the-counter
sleeping pills for insomnia. Behavioral approaches to treatment focus
on changing behaviors that may worsen insomnia and learning new behaviors
to promote sleep.
Narcolepsy
There is no cure for narcolepsy. It is a life-long condition, but there
is help for a person with this condition to have a good and productive
life. Symptoms can be controlled with medicine and lifestyle changes.
The extreme daytime sleepiness can be treated with stimulant drugs (or
drugs that keep you awake). Caffeine and over-the-counter stimulants do
not work to reduce daytime sleepiness. People with narcolepsy who have
other health conditions, such as high blood pressure, diabetes, or heart
disease, should talk with their doctor about other medicines they are
taking. Some over-the-counter and prescription drugs may interact with
those drugs taken for narcolepsy. Changes in lifestyle can help to treat
and control narcolepsy. Taking daytime naps and developing good sleep
habits are important. Taking short naps (10 to 15 minutes) 2 to 3 times
a day can help control extreme daytime sleepiness and sleep attacks. Having
good sleep habits helps a person to get good quality nighttime sleep.
If you have narcolepsy, it is important to talk on a regular basis with
your health care provider. This will help you to get the best treatment
possible for your symptoms.
Restless Leg Syndrome
There is no cure for RLS. Sometimes RLS can be controlled by diagnosing
and treating an underlying condition, such as peripheral neuropathy or
diabetes. Treating the underlying disease can relieve many of the symptoms
of RLS. For people who have RLS with no diagnosed cause, treatment is
focused on symptom relief. For those with mild to moderate symptoms, lifestyle
changes are often suggested including:
- reducing or stopping use of caffeine, alcohol, and tobacco products;
- taking supplements to increase iron, folate, and magnesium in the
body;
- developing and keeping a regular sleep schedule;
- getting moderate exercise;
- taking hot or cold baths, rubbing or massaging the legs or other
affected body parts, or using a heating pad or ice pack.
Health care providers may also prescribe medicine for symptom relief.
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Frequently Asked Questions
- What are sleep disorders?
Sleep disorders are sleep problems that, if untreated, can affect a
person's physical health, daily activities, and mental health. More
than the once-in-a-while tossing and turning or waking up early, sleep
disorders are potentially serious medical conditions. However, there
is treatment for all of these disorders. Talk with your health care
provider if you think you may have a sleep disorder. Common sleep disorders
include sleep apnea, narcolepsy, restless leg syndrome and insomnia.
(See Common Sleep Disorders for more information)
- Why do I need to worry about sleep?
If you are having problems with sleeping, you are not alone. Studies
show 1 out of every 2 Americans has problems with not being able to
sleep at some point in their lives. And, almost 40 million Americans
have sleep disorders. We all know how great we feel when we've had a
good night's sleep - we are ready to take on the day and handle whatever
may come. But when we've had a bad night's sleep, we also all know the
toll it can take on every part of our lives the next day. Sleep can
affect not only how we function during the day, but it can also affect
our physical and mental health. Not getting enough sleep, even just
for one night, can affect our moods and our ability to focus, make decisions,
and remember things. When we don't get enough sleep over a period of
time, our "sleep debt" adds up and can cause serious problems,
such as heart problems, depression, and anxiety. Over time, long-term
sleep problems can also affect relationships, work, and quality of life.
- What happens when you sleep?
Many people think of sleep as a passive activity, but sleep is actually
an active state. It restores us, helps the body to repair damage and
grow new cells, keeps the body's nervous system working properly, and
helps us to consolidate memory. During sleep, a person passes through
5 phases, or stages, of sleep - stages 1, 2, 3, 4 of quiet sleep and
stage 5, called REM (rapid eye movement) sleep.
- Stage 1 sleep is light sleep, where we drift in and out
of sleep and can be awakened easily. Eyes move very slowly and muscle
activity slows down.
- A person spends almost half of their total sleep time in Stage
2 sleep. Eye movements stop and brain waves (or activity) become
slower.
- Stage 3 and Stage 4 are called deep sleep. During
Stage 3 sleep, brain waves slow down even more and the brain makes
mostly delta waves (slow brain waves). The brain makes only delta
waves during Stage 4 sleep and there is no eye movement or muscle
activity. People often feel groggy and disoriented for a few minutes
when they are awakened during deep sleep. Some children have bedwetting,
night terrors, or sleepwalking during deep sleep. Deep sleep restores
us, helping to grow new cells and repair cells from damage.
- During Stage 5, a person's breathing becomes more rapid,
irregular, and shallow in REM sleep. The eyes jerk quickly in many
directions, heart rate increases, and blood pressure rises. When
people wake up during REM sleep, they often describe strange dreams
that don't make any sense. Most dreaming happens during REM sleep.
REM sleep is important, perhaps in part because it stimulates the
parts of the brain that help us learn.
A person cycles through these 5 stages of sleep during the night. The
first sleep cycles contain short REM periods and long periods of deep
sleep. REM sleep periods become longer in length while deep sleep decreases.
By morning, almost all sleep time is in stages 1, 2, and REM.
- How can I tell if I have a sleep problem or a sleep disorder?
Because so many people have large sleep debts, sleep problems are common.
Side effects from medications and stress can also cause sleep problems.
For women, hormone changes during pregnancy, menopause, and the menstrual
cycle can cause sleep problems. Sleep experts say if you feel sleepy
during the day, even when doing something boring, you haven't had enough
sleep. If you usually fall asleep within 5 minutes of lying down, you
probably have a severe sleep debt, maybe even a sleep disorder. Very
short periods of sleep throughout the day (sometimes you may not even
know you are sleeping) are also another sign of a sleep disorder. Talk
with your health care provider if you are having a problem with sleep
or think you may have a sleep disorder.
- How can I get a good night’s sleep?
- Try to go to bed at the same time every night and get up at the
same time every morning. Try not to take naps during the day because
naps may make you less sleepy at night.
- Try to avoid caffeine, nicotine, and alcohol late in the day.
Caffeine and nicotine are stimulants and can keep you from falling
asleep. Alcohol can make you wake up later in the night.
- Get regular exercise. Try not to exercise close to bedtime because
it may stimulate you and make it hard to fall asleep. Experts suggest
not exercising for 3 hours before the time you go to sleep.
- Don't eat a big meal late in the day, although a light snack before
bedtime may help you sleep.
- Make your sleeping place comfortable. Be sure that it is dark,
quiet, and not too warm or too cold. If light is a problem, try
a sleeping mask. If noise is a problem, try earplugs, a fan, or
a "white noise" machine to cover up the sounds.
- Create a routine to help you relax and wind down before sleep,
such as reading a book or taking a bath.
- If you can't fall asleep and don't feel sleepy, get up and do
something else until you feel sleepy. Just make sure you don't do
anything stimulating.
- If you have trouble lying awake worrying about things, try making
a to-do list before you go to bed. This may help you to "let
go" of those worries overnight.
- See your health care provider if you think you have a sleep problem
or a sleep disorder.
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Highlights of Sleep
in America 2003
The National Sleep Foundation commissioned WB&A Market Research
to conduct a national survey among adults 55 to 84 years of age living
in the United States – the 2003 Sleep in America poll. In
order to collect the information, telephone interviews were conducted
between September 17 and December 10, 2002 among a random sample of 1506
older adults.
- A significant proportion of older adults rate their sleep as fair
to poor with 55-64 year-olds (26%) more likely to rate the quality of
their sleep this way than 65-84 year-olds (21%).
- Respondents were asked how the quality of their sleep has changed
in the past ten years. Though many report that the quality of their
sleep is about the same as it was ten years ago, more 55-64 year-olds
(34%) than 65-84 (25%) report that their sleep quality has gotten somewhat
or much worse. Women (32%) were more likely than men (24%) to rate the
change in quality of their sleep as somewhat or much worse.
- About one-half of the older adults report having one or more symptoms
of insomnia at least a few nights a week (48%).
- Snoring – Frequent snoring can be a symptom of sleep
apnea. Men are significantly more likely than women to report snoring
at least a few nights a week in the past year (40% vs. 26%).
- Pauses in breathing – Observed or experiences pauses
in breathing during sleep can be a symptom of sleep apnea. Less than
one in ten older adults (7%) report having pauses in their breathing
during sleep at least a few nights a week in the past year.
- Unpleasant, tingling feelings in the legs is a common symptom for
those with restless leg syndrome. Overall, about one-sixth of
older adults (17%) report having unpleasant, tingling feelings in their
legs at least a few nights a week in the past year.
- Older adults were asked if a doctor had told them that they have
any of the following sleep disorders: insomnia, sleep apnea or restless
leg syndrome. About one in eight older adults (13%) report having been
diagnosed with at least one of these sleep disorders, with the percentage
decreasing slightly by age (16% of 55-64 year-olds, 12% of 65-74 year-olds,
11% of 75-84 year-olds). About one in ten (9%) of all older adults report
receiving treatment for a sleep disorder.
- When older adults were asked about daytime sleepiness, 15% report
they have daytime sleepiness so severe that it interferes with their
daily activities at least a few times a week.
- During the past year, four times as many younger adults (18-54 year-olds)
report driving while feeling drowsy (60%) compared with 65-84 year-olds
(15%).
- Overall, about two-thirds of older adults report experiencing one
or more of these symptoms (difficulty falling asleep, waking a lot during
the night, waking up too early and cannot get back to sleep, waking
up feeling unrefreshed, snoring, pauses in breathing, or unpleasant
feeling in the legs) of a sleep problem at least a few nights a week
(67%), with 55-64 year-olds (71%) being the most likely to report having
sleep problems compared to adults 65-74 year-olds (65%) and 75-84 year-olds
(64%).
- Older adults who report having been diagnosed with depression (16%)
differ from those who have not been diagnosed in that they are more
likely to:
- Report their sleep quality as fair or poor (44% vs. 19%)
- Have a diagnosis of a sleep disorder, such as insomnia, sleep
apnea or restless leg syndrome (30% vs. 10%)
- Report experiencing a symptom of insomnia, such as difficulty
falling asleep, waking a lot during the night, waking too early
and cannot get back to sleep, and waking feeling unrefreshed (70%
vs. 44%)
- Report having difficulty falling asleep (35% vs. 14%)
- Report daytime sleepiness (32% vs. 11%)
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Sleep and Women
- More than 100 million Americans of all ages regularly fail to get
a good night of sleep. This number is more than one-third of the US
population. At least 84 percent of sleep disorders lead to a lowered
quality of life and reduced personal health. Some sleep disorders can
be life threatening.
- Loud snoring can be a sign of something seriously wrong with patient
breathing during one-third of their life. Organ systems can be stressed
everyday during sleep.
- An estimated 10% of 30% of adults snore. For 5%, extremely loud nightly
snoring is the first indication of a potentially life threatening disorder:
obstructive sleep apnea syndrome (OSAS).
- Women are twice as likely as men to have difficulties falling asleep
or staying asleep. Physical factors, including arthritis, disorders
of breathing or hot flashes may disturb sleep and threaten female health.
Stress, depression, fear or other strong emotions may also disrupt sleep.
- Premenstrual symptoms, such as abdominal cramping, irritability,
food cravings and emotional changes can also directly affect women’s
sleep. While these sleep problems generally disappear a few days after
menstruation begins, some women who suffer more severe disturbances,
increased tension and irritability may experience lingering sleep problems
and even chronic insomnia.
- Several factors influence the quality of sleep in postmenopausal
women: psychosocial environment, physical health and emotional state.
The connection between worry and insomnia may be obvious, but, at times,
subtle signs and concerns can be less visible in their influence on
tension and insomnia.
- Insomnia is one of the most common symptoms of depression at any
age. Getting professional help and treatment for the depression
can often solve the insomnia problem.
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An estimated 10% to 30% of adults snore. For 5% extremely loud nightly snoring
is the first indication of a potentially life threatening disorder known
as obstructive sleep apnea syndrome (OSAS).
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