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
• Common Treatments
• Frequently Asked Questions
• Highlights of Sleep in America 2003
• Sleep and Women
• Without Breath Video

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

1. Do I need a referral to have a sleep study?
   We get your referral.
2. Will this be covered by my insurance?
   In most cases, yes, although you may be responsible for a co-pay. Questions about coverage of your particular policy should be directed to the Customer Service number on the back of your Insurance Card.
3. What do I need to bring with me?
   Any normal bedtime medications and comfortable sleeping attire.
4. Do I need to take my medications?
   Unless instructed differently by your physician, please take all normal medications, in the normal dosage, at the normal times as you do every day.
5. Can I bring my pillow?
   You may bring your pillow or favorite blanket, if you wish. Please don't forget to take it with you the next morning.
6. What do I wear?
   Comfortable sleeping attire is recommended. T-shirts and gym shorts are what most patients wear for the study.
7. May I bring my pet or spouse?
   Neither pets nor spouses are allowed at the sleep lab. We need to get an accurate picture of YOUR uninterrupted sleep.
8. How long will this take?
   You will need to arrive at the Sleep Lab at 8.45 p.m. You will leave around 6:00 a.m. the following morning.
9. Are there any needles?
   There are no needles involved. A sleep study is non-invasive.
10. How closely are you going to watch me?
    You will have several leads attached to you. This is the most valuable way we 'watch' you sleep. There is also an infrared camera in the patient room so we may monitor your position, movements and need for assistance.
11. Does it hurt?
    The study itself does not hurt. Occasionally a patient will have slight irritation the following day in sites where leads were placed.
12. Will you give me medications to sleep?
    The technicians at the Sleep Lab are not licensed to dispense medications. If your ordering physician has prescribed a specific medication for your sleep study, please fill the prescription prior to arriving at the Sleep Lab and you will self-administer your medication prior to the study.
13. What if I can't go to sleep?
    Many patients believe they will not be able to fall asleep; if you feel you fall into this category, please discuss it with your ordering physician. He may prescribe a mild sleep aid, which will not affect your study, but will help you to fall asleep.
14. May I drink or eat?
    If you normally have a snack before bedtime, please bring it with you, remembering to avoid caffeinated products.
15. Are there TV's in the rooms?
    Patient rooms are equipped with televisions and cable. TV's must be turned off by 11:00 p.m.
16. Are showers available?
    There are no patient showers in the sleep lab. However, you may want to go home to shower before going to work after your sleep study.
17. Will there be someone there with me?
    A sleep tech will be in the Lab all night, monitoring patients for the entire night.
18. How soon will I know if I have sleep apnea?
    Ordering physicians receive a 'scored' copy of your sleep report within 1 week. They interpret the results.
19. If I need a CPAP machine, does the Sleep Lab provide one?
    No. Your physician at the Florida Sleep Disorder Center will order your CPAP machine. The machine is delivered by a Durable Medical Equipment Company, which is not associated with our sleep lab.
20. Does insurance cover the cost of a CPAP machine?
    Yes, however insurance coverage varies greatly according to individual policies. It is best to contact your insurance company for details.

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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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