Sleep Apnea

Do you know someone who snores?

Excessive snoring may be a signal that something is seriously wrong with one’s breathing during sleep. Snoring is indicative of an airway that is not properly open; indeed, the sounds of snoring come from the body’s extra effort to force air through such a narrowed passageway. Snoring can be one of the important signals of a potentially dangerous sleep disorder called sleep apnea.

Obstructive Sleep Apnea Syndrome

Sleep apnea is a medical condition that requires careful attention and proper treatment. This disorder, which can become life threatening, involves the frequent collapsing of the breathing passageway during sleep. This collapsing can cause a partial or complete blockage of the airway. Symptoms of sleep apnea include excessive daytime sleepiness, weight gain, sexual dysfunction, and depression. If left untreated, obstructive sleep apnea can often lead to high blood pressure, heart failure, heart attack and stroke.

Diagnosis

Snoring and obstructive sleep apnea affect millions of Americans, often with significant impact on social relationships, energy levels, and cardiovascular health. Although every patient can be helped, our goal is to identify the precise source of the problem and to use noninvasive office treatments whenever possible as opposed to surgery.

Through recent advances, sleep specialists are now able to detect and diagnose breathing disorders at earlier, more treatable stages. The first step in diagnosis is to conduct a sleep study. A sleep study is used to identify and measure the different stages of sleep, as well as to record and classify various physiological activities and the problems that may be associated with these during sleep. After the study, a board-certified physician will review and interpret these records to determine whether the patient suffers from sleep apnea, how severe it may be, and how to best proceed with treatment.

Insomnia

What is Insomnia?

Insomnia is characterized by an inability to sleep and/or to remain asleep for a reasonable period. Insomniacs typically complain of being unable to close their eyes or “rest their mind” for more than a few minutes at a time. Insomnia is a symptom, though a common misconception is that it is itself a sleep disorder. Insomnia is most often caused by sleep disorders, but other causes include fear, stress, anxiety, medications, herbs, and caffeine. An overactive mind or physical pain may also be a cause. Finding the underlying cause of insomnia is usually necessary to cure it.

Common Causes

• Sleep apnea is a condition that occurs when a sleeping person’s breathing is interrupted, thus interrupting the normal sleep cycle. With the obstructive form of the condition, some part of the sleeper’s respiratory tract loses muscle tone and partially collapses. People with obstructive sleep apnea often do not remember any of this, but they complain of excessive sleepiness during the day. Central sleep apnea interrupts the normal breathing stimulus of the central nervous system, and the individual must actually wake up to resume breathing. This form of apnea is often related to a cerebral vascular condition, congestive heart failure, and premature aging.
• Jet lag is seen in people who travel through multiple time zones on a regular basis, as the time relative to the rising and falling of the sun no longer coincides with the body’s internal concept of it, and is also seen in people who consistently work night shifts. See also: circadian rhythm.
• Parasomnia includes a number of disorders of arousal or disruptive sleep events including nightmares, sleepwalking, violent behavior while sleeping, and REM behavior disorder, in which a person moves his/her physical body in response to events within his/her dreams. These conditions can often be treated successfully through medical intervention or through the use of a sleep specialist.
• Gastroesophageal Reflux Disease causes repeated awakenings during the night due to unpleasant sensations resulting from stomach acid flowing up into the throat while asleep.
• Mania or Hypomania in bipolar disorder can cause difficulty falling asleep. A person going through a manic or hypomanic episode may feel a reduced need for sleep. Sleep deprivation can worsen a manic episode or cause hypomania to develop into mania.

Hypersomnias

What are Hypersomnias?

According to the National Institutes of Health, hypersomnia is characterized by recurrent episodes of excessive daytime sleepiness or prolonged nighttime sleep.

Different from feeling tired due to lack of or interrupted sleep at night, persons with hypersomnia are compelled to nap repeatedly during the day, often at inappropriate times such as at work, during a meal, or in conversation. These daytime naps usually provide no relief from symptoms. Patients often have difficulty waking from a long sleep, and may feel disoriented.

 

Other symptoms may include anxiety, increased irritation, decreased energy, restlessness, slow thinking, slow speech, loss of appetite, hallucinations, and memory difficulty. Some patients lose the ability to function in family, social, occupational, or other settings. Hypersomnia may be caused by another sleep disorder (such as narcolepsy or sleep apnea), dysfunction of the autonomic nervous system, or drug or alcohol abuse.

 

In some cases it results from a physical problem, such as a tumor, head trauma, or injury to the central nervous system. Certain medications, or medicine withdrawal, may also cause hypersomnia. Medical conditions including multiple sclerosis, depression, encephalitis, epilepsy, or obesity may contribute to the disorder. Some people appear to have a genetic predisposition to hypersomnia; in others, there is no known cause. Typically, hypersomnia is first recognized in adolescence or young adulthood.

Periodic Limb Movements Disorder

What is Periodic Limb Movement Disorder (PLMD)?

Periodic limb movements in sleep are repetitive movements, most typically in the lower limbs, that occur about every 20-40 seconds. If you have PLMD or if you sleep with someone who has PLMD, you may recognize these movements as brief muscle twitches, jerking movements, or an upward flexing of the feet. They cluster into episodes lasting anywhere from a few minutes to several hours.

 

Individuals with PLMD may also experience restless legs syndrome (RLS), an irritation or uncomfortable sensation in the calves or thighs, as they attempt to fall asleep or when they awaken during the night. Walking or stretching may relieve the sensations, at least temporarily. However, research also shows that many individuals have PLMD without experiencing any symptoms at all. It is not unusual for the bed partner to be the one who is most aware of the movements, since they may disturb his/her sleep.

Restless Legs

 

What is Restless Leg Syndrome?

Restless leg syndrome is a common cause of painful legs. The leg pain of restless leg syndrome typically eases with motion of the legs and becomes more noticeable at rest. Restless leg syndrome also features worsening of symptoms during the early evening or later at night. The characteristic nighttime worsening of symptoms in persons with restless legs syndrome frequently leads to insomnia. Restless leg syndrome usually begins slowly. Over time, the legs become more affected. Less frequently, restless leg syndrome can affect the arms.

 

Common Causes

The cause of restless leg syndrome is unknown in most patients. However, restless leg syndrome has been associated with pregnancy, obesity, smoking, iron deficiency and anemia, nerve disease, polyneuropathy (which can be associated with hypothyroidism, heavy metal toxicity, toxins, and many other conditions), other hormone diseases such as diabetes, and kidney failure (which can be associated with vitamin and mineral deficiency). Some drugs and medications have been associated with restless leg syndrome including caffeine, alcohol, H2-histamine blockers (such as Zantac and Tagamet) and certain antidepressants (such as Elavil). Occasionally, restless legs run in families. Recent studies have shown that restless leg syndrome appears to become more common with age.

Narcolepsy

 

What is Narcolepsy?

Narcolepsy is a chronic neurological disorder that affects the brain’s ability to control sleep-wake cycles. People with narcolepsy usually feel rested after waking, but then feel very sleepy throughout much of the day. Many individuals with narcolepsy also experience uneven and interrupted sleep that can involve waking up frequently during the night.

 

Narcolepsy can greatly affect daily activities. People may unwillingly fall asleep even if they are in the middle of an activity like driving, eating, or talking. Other symptoms may include sudden muscle weakness while awake that makes a person go limp or unable to move (cataplexy), vivid dream-like images or hallucinations, and total paralysis just before falling asleep or just after waking up (sleep paralysis).

 

In a normal sleep cycle, a person enters rapid eye movement (REM) sleep after about 60 to 90 minutes.

 

Dreams occur during REM sleep, and the brain keeps muscles limp during this sleep stage, which prevents people from acting out their dreams. People with narcolepsy frequently enter REM sleep rapidly, within 15 minutes of falling asleep.

 

Also, the muscle weakness or dream activity of REM sleep can occur during wakefulness or be absent during sleep. This helps explain some symptoms of narcolepsy.

 

If left undiagnosed or untreated, narcolepsy can interfere with psychological, social, and cognitive function and development and can inhibit academic, work, and social activities.