A sleep disorder (somnipathy) is a medical disorder of the sleep Sleep is a naturally recurring altered state of consciousness of relatively suspended sensory and motor activity, characterized by the inactivity of nearly all voluntary muscles. It is distinguished from quiet wakefulness by a decreased ability to react to stimuli, and unconsciousness since it is more easily reversible than hibernation or coma patterns of a person or animal. Some sleep disorders are serious enough to interfere with normal physical, mental and emotional functioning. A test commonly ordered for some sleep disorders is the polysomnography Polysomnography , also known as a sleep study, is a multi-parametric test used in the study of sleep and as a diagnostic tool in sleep medicine. The test result is called a polysomnogram, also abbreviated PSG. The name is derived from Greek and Latin roots: the Greek πολύς (polus for "many, much", indicating many channels), the.

Common disorders

The most common sleep disorders include:

• Primary insomnia Insomnia is a symptom that can accompany several sleep, medical and psychiatric disorders, characterized by persistent difficulty falling asleep and/or difficulty staying asleep. Insomnia is typically followed by functional impairment while awake: Chronic difficulty in falling asleep and/or maintaining sleep when no other cause is found for these symptoms.
• Bruxism Bruxism (from the Greek βρυγμός , "gnashing of teeth") is characterized by the grinding of the teeth and is typically accompanied by the clenching of the jaw. It is an oral parafunctional activity that occurs in most humans at some time in their lives. In most people, bruxism is mild enough not to be a health problem. While: Involuntarily grinding or clenching of the teeth while sleeping.
• Delayed sleep phase syndrome Delayed sleep-phase syndrome , also known as delayed sleep-phase disorder (DSPD) or delayed sleep-phase type (DSPT), is a circadian rhythm sleep disorder, a chronic disorder of the timing of sleep, peak period of alertness, the core body temperature rhythm, hormonal and other daily rhythms relative to societal norms. People with DSPS tend to fall (DSPS): inability to awaken and fall asleep at socially acceptable times but no problem with sleep maintenance, a disorder of circadian rhythms A circadian rhythm is a roughly 24-hour cycle in the biochemical, physiological, or behavioural processes of living entities, including plants, animals, fungi and cyanobacteria . The term "circadian" comes from the Latin circa, "around", and diem or dies, "day", meaning literally "approximately one day". The. Other such disorders are advanced sleep phase syndrome Advanced sleep phase syndrome , also known as the advanced sleep-phase type (ASPT) of circadian rhythm sleep disorder, is a condition in which patients feel very sleepy and go to bed early in the evening (e.g. 18:00-20:00) and wake up very early in the morning (e.g. 01:00-03:00) (ASPS) and Non-24-hour sleep-wake syndrome Non-24-hour sleep-wake syndrome is a chronic circadian rhythm sleep disorder, classified within Chapter VI, Diseases of the Nervous System, in the ICD-10. It can be defined as "a chronic steady pattern comprising one- to two-hour daily delays in sleep onset and wake times in an individual living in society." The pattern of delay persists (Non-24), both much less common than DSPS.
• Hypopnea syndrome Hypopnea is a medical term for a disorder which involves episodes of overly shallow breathing or an abnormally low respiratory rate. This differs from apnea in that there remains some flow of air. Hypopnea events may happen while asleep or while awake: Abnormally shallow breathing or slow respiratory rate while sleeping.
• Narcolepsy Narcolepsy is a chronic sleep disorder, or dyssomnia, characterized by excessive daytime sleepiness in which a person experiences extreme fatigue and possibly falls asleep at inappropriate times, such as while at work or at school. Narcoleptics usually experience disturbed nocturnal sleep and an abnormal daytime sleep pattern, which is often: Excessive daytime sleepiness Excessive daytime sleepiness is characterized by persistent sleepiness, and often a general lack of energy, even after apparently adequate night time sleep. Sudden involuntary sleep onset, and microsleeps are common complications.[citation needed] EDS is a symptom of one of the two forms of the sleep disorder hypersomnia, the other being prolonged (EDS) often culminating in falling asleep spontaneously but unwillingly at inappropriate times.
• Cataplexy Cataplexy is a sudden and transient episode of loss of muscle tone, often triggered by emotions. It is a rare disease , but frequently affects people who have narcolepsy, a disorder whose principal signs are EDS (Excessive Daytime Sleepiness), sleep attacks, sleep paralysis, hypnagogic hallucinations and disturbed night-time sleep. Cataplexy is: a sudden weakness in the motor muscles that can result in collapse to the floor.
• Night terror A night terror, also known as a sleep terror or pavor nocturnus, is a parasomnia disorder characterized by extreme terror and a temporary inability to regain full consciousness. The subject wakes abruptly from slow-wave sleep, with waking usually accompanied by gasping, moaning, or screaming while waking. It is often impossible to awaken the: Pavor nocturnus, sleep terror disorder: abrupt awakening from sleep with behavior consistent with terror Fear is an emotional response to a perceived threat. It is a basic survival mechanism occurring in response to a specific stimulus, such as pain or the threat of danger. Some psychologists such as John B. Watson, Robert Plutchik, and Paul Ekman have suggested that fear is one of a small set of basic or innate emotions. This set also includes such.
• Parasomnias Parasomnias are a category of sleep disorders that involve abnormal and unnatural movements, behaviors, emotions, perceptions, and dreams that occur while falling asleep, sleeping, between sleep stages, or arousal from sleep. Most parasomnias are dissociated sleep states which are partial arousals during the transitions between wakefulness and: Disruptive sleep-related events involving inappropriate actions during sleep; sleep walking and night-terrors are examples.
• Periodic limb movement disorder Periodic Limb Movement Disorder , previously known as Nocturnal myoclonus, is a sleep disorder where the patient moves limbs involuntarily during sleep, and has symptoms or problems related to the movement. If the patient moves limbs during sleep but there are no negative consequences, the condition is simply called periodic limb movements of (PLMD): Sudden involuntary movement of arms and/or legs during sleep, for example kicking the legs. Also known as nocturnal myoclonus. See also Hypnic jerk A hypnic or hypnagogic jerk is an involuntary myoclonic twitch which occurs during hypnagogia, just as the subject is beginning to fall asleep. Physically, hypnic jerks resemble the "jump" made when a person is startled, which is not a disorder.
• Rapid eye movement behavior disorder Rapid eye movement sleep behavior disorder is a sleep disorder (more specifically a parasomnia) that involves abnormal behavior during the sleep phase with rapid eye movement (REM sleep). It was first described in 1986 (RBD): Acting out violent or dramatic dreams while in REM sleep.
• Restless legs syndrome Restless legs syndrome , also known as Wittmaack-Ekbom's syndrome, and colloquially as "the jimmylegs" is a condition that is characterized by an irresistible urge to move one's body to stop uncomfortable or odd sensations. It most commonly affects the legs, but can also affect the arms or torso and even phantom limbs. Moving the (RLS): An irresistible urge to move legs. RLS sufferers often also have PLMD.
• Situational circadian rhythm sleep disorders Circadian rhythm sleep disorders are a family of sleep disorders affecting, among other things, the timing of sleep. People with circadian rhythm sleep disorders are unable to sleep and wake at the times required for normal work, school, and social needs. They are generally able to get enough sleep if allowed to sleep and wake at the times: shift work sleep disorder Shift work sleep disorder is a circadian rhythm sleep disorder which affects people who change their work or sleep schedules frequently or who work longterm on other than the day shift (SWSD) and jet lag Jet lag, medically referred to as "desynchronosis," is a physiological condition which is a consequence of alterations to circadian rhythms; it is classified as one of the circadian rhythm sleep disorders. Jet lag results from rapid long-distance transmeridian travel, as on a jet plane.
• Obstructive sleep apnea Obstructive sleep apnea is a common sleep apnea caused by obstruction of the airway. It is characterized by pauses in breathing during sleep. These episodes, called apneas (literally, "without breath"), each last long enough that one or more breaths are missed, and occur repeatedly throughout sleep. In obstructive sleep apnea, breathing: Obstruction of the airway during sleep, causing lack of sufficient deep sleep; often accompanied by snoring. Other forms of sleep apnea Sleep apnea is a sleep disorder characterized by pauses in breathing during sleep. Each episode, called an apnea (Greek: ἄπνοια (ápnoia), from α- (a-), privative, πνέειν (pnéein), to breathe), lasts long enough that one or more breaths are missed, and such episodes occur repeatedly throughout sleep. The standard definition of any are less common.
• Sleep paralysis Sleep paralysis is paralysis associated with sleep that may occur in normal subjects or be associated with narcolepsy, cataplexy, and hypnagogic hallucinations. The pathophysiology of this condition is closely related to the normal hypotonia that occur during REM sleep. When considered to be a disease, isolated sleep paralysis is classified as: is characterized by temporary paralysis Paralysis is the complete loss of muscle function for one or more muscles. Paralysis can be accompanied by a loss of feeling in the affected area, if there is sensory damage as well as motor of the body shortly before or after sleep. Sleep paralysis may be accompanied by visual The visual system is the part of the central nervous system which enables organisms to see, as well as enabling several non-image forming photoresponse functions. It interprets information from visible light to build a representation of the surrounding world. The visual system accomplishes a number of complex tasks, including the reception of, auditory or tactile The somatosensory system is a diverse sensory system comprising the receptors and processing centres to produce the sensory modalities such as touch, temperature, proprioception , and nociception (pain). The sensory receptors cover the skin and epithelia, skeletal muscles, bones and joints, internal organs, and the cardiovascular system. While hallucinations A hallucination, in the broadest sense of the word, is a perception in the absence of a stimulus. In a stricter sense, hallucinations are defined as perceptions in a conscious and awake state in the absence of external stimuli which have qualities of real perception, in that they are vivid, substantial, and located in external objective space. The. Not a disorder unless severe. Often seen as part of Narcolepsy.
• Sleepwalking Sleepwalking, also known as somnambulism, is a sleep disorder belonging to the parasomnia family. Sleepwalkers arise from the slow wave sleep stage in a state of low consciousness and perform activities that are usually performed during the day. These activities can be as benign as sitting up in bed, walking to the bathroom, and cleaning, or as or somnambulism: Engaging in activities that are normally associated with wakefulness (such as eating Eating is the ingestion of food to provide for all humans and animals nutritional needs, particularly for energy and growth. Animals and other heterotrophs must eat in order to survive: carnivores eat other animals, herbivores eat plants, and omnivores consume a mixture of both. Eating is an activity of daily living or dressing A feature of all modern human societies is the wearing of clothing, a category encompassing a wide variety of materials that cover the body. The primary purpose of clothing is functional, as a protection from the elements. Clothes also enhance safety during hazardous activities such as hiking and cooking, by providing a barrier between the skin), which may include walking, without the conscious knowledge of the subject.
• Nocturia Nocturia , also called nycturia (Greek νυκτουρία), is the need to get up during the night in order to urinate, thus interrupting sleep. Its occurrence is more frequent in the elderly. Nocturia could result simply from too much liquid intake before going to bed (usually the case in the young), or it could be a symptom of a larger problem,: A frequent need to get up and go to the bathroom to urinate at night. It differs from Enuresis Enuresis refers to an inability to control urination. Use of the term is usually limited to describing individuals old enough to be expected to exercise such control, or bed-wetting, in which the person does not arouse from sleep, but the bladder nevertheless empties.^[1]
• Somniphobia: a dread of sleep.

Classifications

• Dyssomnias Patients may complain of difficulty getting to sleep or staying asleep, intermittent wakefulness during the night, early morning awakening, or combinations of any of these. Transient episodes are usually of little significance. Stress, caffeine, physical discomfort, daytime napping, and early bedtimes are common factors - A broad category of sleep disorders characterized by either hypersomnolence or insomnia. The three major subcategories include intrinsic (i.e., arising from within the body), extrinsic (secondary to environmental conditions or various pathologic conditions), and disturbances of circadian rhythm. MeSH
  • Insomnia Insomnia is a symptom that can accompany several sleep, medical and psychiatric disorders, characterized by persistent difficulty falling asleep and/or difficulty staying asleep. Insomnia is typically followed by functional impairment while awake
  • Narcolepsy Narcolepsy is a chronic sleep disorder, or dyssomnia, characterized by excessive daytime sleepiness in which a person experiences extreme fatigue and possibly falls asleep at inappropriate times, such as while at work or at school. Narcoleptics usually experience disturbed nocturnal sleep and an abnormal daytime sleep pattern, which is often
  • Obstructive sleep apnea Sleep apnea is a sleep disorder characterized by pauses in breathing during sleep. Each episode, called an apnea (Greek: ἄπνοια (ápnoia), from α- (a-), privative, πνέειν (pnéein), to breathe), lasts long enough that one or more breaths are missed, and such episodes occur repeatedly throughout sleep. The standard definition of any
  • Restless leg syndrome Restless legs syndrome , also known as Wittmaack-Ekbom's syndrome, is a condition that is characterized by an irresistible urge to move one's body to stop uncomfortable or odd sensations. It most commonly affects the legs, but can also affect the arms or torso. Moving the affected body part modulates the sensations, providing temporary relief. RLS
  • Periodic limb movement disorder Periodic Limb Movement Disorder , previously known as Nocturnal myoclonus, is a sleep disorder where the patient moves limbs involuntarily during sleep, and has symptoms or problems related to the movement. If the patient moves limbs during sleep but there are no negative consequences, the condition is simply called periodic limb movements of
  • Hypersomnia Hypersomnia is a disorder characterized by excessive amounts of sleepiness. There are two main categories of hypersomnia: primary hypersomnia and recurrent hypersomnia (also called primary recurrent hypersomnia). Both have the same symptoms but differ in how often they occur
    • Recurrent hypersomnia - including Kleine-Levin syndrome Kleine-Levin Syndrome or KLS is a neurological disorder characterized by recurring periods of excessive amounts of sleep and altered behavior. At the onset of an episode the patient becomes drowsy and sleeps for most of the day and night (hypersomnolence), waking only to eat or go to the bathroom. When awake, the patient’s whole demeanor is
    • Posttraumatic hypersomnia
    • "Healthy" hypersomnia
  • Circadian rhythm sleep disorders Circadian rhythm sleep disorders are a family of sleep disorders affecting, among other things, the timing of sleep. People with circadian rhythm sleep disorders are unable to sleep and wake at the times required for normal work, school, and social needs. They are generally able to get enough sleep if allowed to sleep and wake at the times
    • Delayed sleep phase syndrome Delayed sleep-phase syndrome , also known as delayed sleep-phase disorder (DSPD) or delayed sleep-phase type (DSPT), is a circadian rhythm sleep disorder, a chronic disorder of the timing of sleep, peak period of alertness, the core body temperature rhythm, hormonal and other daily rhythms relative to societal norms. People with DSPS tend to fall
    • Advanced sleep phase syndrome Advanced sleep phase syndrome , also known as the advanced sleep-phase type (ASPT) of circadian rhythm sleep disorder, is a condition in which patients feel very sleepy and go to bed early in the evening (e.g. 18:00-20:00) and wake up very early in the morning (e.g. 01:00-03:00)
    • Non-24-hour sleep-wake syndrome Non-24-hour sleep-wake syndrome is a chronic circadian rhythm sleep disorder, classified within Chapter VI, Diseases of the Nervous System, in the ICD-10. It can be defined as "a chronic steady pattern comprising one- to two-hour daily delays in sleep onset and wake times in an individual living in society." The pattern of delay persists
• Parasomnias Parasomnias are a category of sleep disorders that involve abnormal and unnatural movements, behaviors, emotions, perceptions, and dreams that occur while falling asleep, sleeping, between sleep stages, or arousal from sleep. Most parasomnias are dissociated sleep states which are partial arousals during the transitions between wakefulness and - A category of sleep disorders that involve abnormal and unnatural movements, behaviors, emotions, perceptions, and dreams in connection with sleep.
  • REM sleep behaviour disorder Rapid eye movement sleep behavior disorder is a sleep disorder (more specifically a parasomnia) that involves abnormal behavior during the sleep phase with rapid eye movement (REM sleep). It was first described in 1986
  • Sleep terror A night terror, also known as a sleep terror or pavor nocturnus, is a parasomnia disorder characterized by extreme terror and a temporary inability to regain full consciousness. The subject wakes abruptly from slow-wave sleep, with waking usually accompanied by gasping, moaning, or screaming while waking. It is often impossible to awaken the
  • Sleepwalking Sleepwalking, also known as somnambulism, is a sleep disorder belonging to the parasomnia family. Sleepwalkers arise from the slow wave sleep stage in a state of low consciousness and perform activities that are usually performed during the day. These activities can be as benign as sitting up in bed, walking to the bathroom, and cleaning, or as (or somnambulism)
  • Bruxism (Tooth-grinding)
  • Bedwetting or sleep enuresis.
  • Sleep talking (or somniloquy)
  • Sleep sex (or sexsomnia)
  • Exploding head syndrome - Waking up in the night hearing loud noises.
• Medical or Psychiatric Conditions that may produce sleep disorders
  • Psychoses (such as Schizophrenia)
  • Mood disorders
    • Depression
    • Anxiety
  • Panic
  • Alcoholism
• Sleeping sickness - a parasitic disease which can be transmitted by the Tsetse fly.
• Snoring - Not a disorder in and of itself, but it can be a symptom of deeper problems.

General principles of treatment

Treatments for sleep disorders generally can be grouped into four categories:

• behavioral/ psychotherapeutic treatments
• rehabilitation/management
• medications
• other somatic treatments

None of these general approaches is sufficient for all patients with sleep disorders. Rather, the choice of a specific treatment depends on the patient's diagnosis, medical and psychiatric history, and preferences, as well as the expertise of the treating clinician. Often, behavioral/psychotherapeutic and pharmacological approaches are not incompatible and can effectively be combined to maximize therapeutic benefits. Management of sleep disturbances that are secondary to mental, medical, or substance abuse disorders should focus on the underlying conditions.

Medications and somatic treatments may provide the most rapid symptomatic relief from some sleep disturbances. Some disorders, such as narcolepsy, are best treated pharmacologically. Others, such as chronic and primary insomnia, may be more amenable to behavioral interventions, with more durable results.

Chronic sleep disorders in childhood, which affect some 70% of children with developmental or psychological disorders, are under-reported and under-treated. Sleep-phase disruption is also common among adolescents, whose school schedules are often incompatible with their natural circadian rhythm. Effective treatment begins with careful diagnosis using sleep diaries and perhaps sleep studies. Modifications in sleep hygiene may resolve the problem, but medical treatment is often warranted. ^[2]

Special equipment may be required for treatment of several disorders such as obstructive apnea, the circadian rhythm disorders and bruxism. In these cases, when severe, an acceptance of living with the disorder, however well managed, is often necessary.

Sleep medicine

Due to rapidly increasing knowledge about sleep in the 20th century, including the discovery of REM sleep and sleep apnea, the medical importance of sleep was recognized. The medical community began paying more attention than previously to primary sleep disorders, such as sleep apnea, as well as the role and quality of sleep in other conditions. By the 1970s in the USA, clinics and laboratories devoted to the study of sleep and sleep disorders had been founded, and a need for standards arose.

Sleep Medicine is now a recognized subspecialty within internal medicine, family medicine, pediatrics, otolaryngology, psychiatry and neurology in the United States. Certification in Sleep Medicine shows that the specialist:

"has demonstrated expertise in the diagnosis and management of clinical conditions that occur during sleep, that disturb sleep, or that are affected by disturbances in the wake-sleep cycle. This specialist is skilled in the analysis and interpretation of comprehensive polysomnography, and well-versed in emerging research and management of a sleep laboratory."^[3]

Competence in sleep medicine requires an understanding of a myriad of very diverse disorders, many of which present with similar symptoms such as excessive daytime sleepiness, which, in the absence of volitional sleep deprivation, "is almost inevitably caused by an identifiable and treatable sleep disorder", such as sleep apnea, narcolepsy, idiopathic central nervous system (CNS) hypersomnia, Kleine-Levin syndrome, menstrual-related hypersomnia, idiopathic recurrent stupor, or circadian rhythm disturbances.^[4] Another common complaint is insomnia, a set of symptoms which can have a great many different causes, physical and mental. Management in the varying situations differs greatly and cannot be undertaken without a correct diagnosis.

Sleep dentistry (bruxism, snoring and sleep apnea), while not recognized as one of the nine dental specialties, qualifies for board-certification by the American Board of Dental Sleep Medicine (ABDSM). The resulting Diplomate status is recognized by the American Academy of Sleep Medicine (AASM), and these dentists are organized in the Academy of Dental Sleep Medicine (USA).^[5] The qualified dentists collaborate with sleep physicians at accredited sleep centers and can provide oral appliance therapy and upper airway surgery to treat or manage sleep-related breathing disorders.^[6]

In the UK, knowledge of sleep medicine and possibilities for diagnosis and treatment seem to lag. Guardian.co.uk quotes the director of the Imperial College Healthcare Sleep Centre: "One problem is that there has been relatively little training in sleep medicine in this country – certainly there is no structured training for sleep physicians."^[7] The Imperial College Healthcare site^[8] shows attention to obstructive sleep apnea syndrome (OSA) and very few other sleep disorders.

See also

• Auditory masking
• Chronotypes
• Environmental noise health effects
• International Classification of Sleep Disorders
• National Sleep Foundation
• Reversed vegetative symptoms
• Sleep hygiene
• Sundowning (dementia)
• White noise machine
• Sleep medicine
• Polysomnography
• Polysomnographic technician

References

1. ^ www.sleepfoundation.org
2. ^ Ivanenko A and Massey C (October 1, 2006). "Assessment and Management of Sleep Disorders in Children". Psychiatric Times 23 (11). http://www.psychiatrictimes.com/sleep-disorders/article/10168/52051.
3. ^ "American Board of Medical Specialties : Recognized Physician Specialty and Subspecialty Certificates". http://www.abms.org/Who_We_Help/Physicians/specialties.aspx. Retrieved 2008-07-21.
4. ^ Mahowald, M.W. (March 2000). "What is causing excessive daytime sleepiness?: evaluation to distinguish sleep deprivation from sleep disorders" (Online, full text). Postgraduate Medicine 107 (3): 108–23. doi:10.3810/pgm.2000.03.932. http://www.postgradmed.com/issues/2000/03_00/mahowald.shtml. Retrieved 2008-07-27.
5. ^ "About AADSM". Academy of Dental Sleep Medicine. 2008. http://aadsm.org/. Retrieved 2008-07-22.
6. ^ "About the ADBSM". American Board of Dental Sleep Medicine. http://www.abdsm.org/. Retrieved 2008-07-22.
7. ^ Wollenberg, Anne (July 28 2008). "Time to wake up to sleep disorders". Guardian News and Media Limited. http://www.guardian.co.uk/commentisfree/2008/jul/28/health. Retrieved 2008-08-03.
8. ^ "Sleep services". Imperial College Healthcare NHS Trust. 2008. http://www.imperial.nhs.uk/services/sleepservices/index.htm. Retrieved 2008-08-02.

External links

• Sleep Problems - information leaflet from mental health charity The Royal College of Psychiatrists
• Sleep Disorders ePatient website

Categories: Sleep disorders

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