By

Col Mukteshwar Prasad(Retd)

Sleep Disorders

According to the American Psychiatric Association, sleep disorders are major disturbances of normal sleep patterns that lead to distress and disrupt functioning during the day.

Not only are sleep disorders extremely common, affecting virtually everyone at some point in their lives, but they can also lead to serious stress and other health consequences.

According to a major survey by the National Sleep Foundation, more than half of Americans reported experiencing at least one symptoms of insomnia several times a week during the previous year.

Highlighting another major danger of sleep disorders, the survey also reported that 60 percent of respondents had driven while drowsy during the previous year.

1.Insomnia:

Insomnia is most common sleep disorder, affecting nearly 60 percent of U.S. adults at least one night each week.

Common symptoms of insomnia include difficulty getting to sleep and waking before it is time to get up.

There are many factors that can contribute to insomnia including stress and underlying medical conditions.

Typical treatments include sleeping pills and behavior therapy.

Practicing good sleep habits can be effective for treating mild cases of insomnia.

2.Sleep Apnea:

Sleep apnea is the second most common sleep disorder and affects 20 million Americans.

This disorder causes people to stop breathing abruptly while they are asleep.

During this brief period, carbon dioxide builds up in the blood and the sleeper wakes suddenly to gasp for breath.

The length of time that the sleeper stop breathing can vary from a few seconds to so long that the individuals skin actually turns blue from oxygen deprivation.

3.Narcolepsy: Narcolepsy is a neurological sleep disorder that leads to periods

of intense sleepiness during the daytime.

People suffering from narcolepsy often experience bouts of overwhelming sleepiness and may fall asleep for brief periods of time during the day.

These sleeping periods may last from a few seconds to several minutes and in some cases may last up to an hour or more.

Those with narcolepsy can fall asleep in the middle of a conversation, during a meal or even while driving a vehicle.

Narcolepsy is a chronic condition that typically begins during adolescence.

In addition to sleepiness, narcolepsy is frequently accompanied by cataplexy, which involves a sudden loss of muscle tone and control that can last seconds or minutes.

Other symptoms include hallucinations and paralysis during sleep.

The Four Defining Features of Narcolepsy

Narcolepsy has four defining features that make it unique among the sleep disorders.

Though only one in three people with narcolepsy have all four features, they can be useful in identifying those at risk for the disorder.

1. Excessive Daytime Sleepiness

This is the increased desire to fall asleep and lack of energy during the day even after an adequate night's sleep.

In narcolepsy, sleep begins to intrude upon wakefulness, and elements of wakefulness intrude upon sleep.

Therefore, narcoleptics are prone to falling asleep at all times with little warning (so-called "sleep attacks").

The sleepiness may result in double or blurred vision and automatic behaviors such as "zoning out" while driving.

The Epworth sleepiness scale identifies the scores higher than 15 out of 24.

The sleepiness in narcolepsy typically improves after a brief nap. In addition, narcoleptics typically wake up feeling refreshed in the morning.

Excessive Daytime Sleepiness

Definition: It is the subjective report of an increased desire to fall asleep and lack of energy during the day even after an adequate night’s sleep. It may indicate the presence of a medical disorder.

Examples:

Excessive daytime sleepiness, including the desire to nap, can be due to sleep deprivation or an underlying medical condition.

The Four Defining Features of Narcolepsy

2. Hypnagogic Hallucinations

These involve vivid, often frightening hallucinations that occur in the transitions between sleep and wakefulness.

This is most often as the person is falling asleep or waking up.

Hypnagogic hallucinations result when REM sleep and the associated dreaming mixes with wakefulness.

Hypnagogic Hallucination

Definition: A hypnagogic hallucination is a vivid, dream-like sensation that is heard, seen or felt and that occurs near the onset of sleep. It is one of the four cardinal symptoms of narcolepsy.

Examples:

As I fall asleep, I experience intense hypnagogichallucinations and imagine people in my room.

The Four Defining Features of Narcolepsy

3. Sleep Paralysis

Sleep paralysis is a common experience that may occur normally in people, but it can also be found in narcolepsy.

It consists of the inability to move for one or two minutes upon awakening.

There may be accompanying feelings of suffocation or even a presence within the room. The episodes tend to be quite frightening.

Understanding the Terrors of Sleep Paralysis

What Exactly Is Sleep Paralysis?

If you have experienced something similar while awakening, you are familiar with the unforgettable horrors of sleep paralysis.

Sleep paralysis is a transient inability to move or speak as one goes from sleep to wakefulness, without other findings characteristic of narcolepsy.

In sleep paralysis, this often occurs while awakening (hynopompic) as opposed to falling asleep (hypnagogic), which is more common in narcolepsy.

Features of Sleep Paralysis

There are some common features that characterize the symptoms of sleep paralysis, including:

Eye movements are typically preserved.

It more often occurs while sleeping on one’s back.

Visual and auditory hallucinations often occur and may include a sense of an evil presence, of being touched, or hearing voices or noises in the room.

Occasionally faces or people may be seen at the bedside.

A sense of breathlessness (or chest pressure, even someone standing on one’s chest) may exist.

Understanding the Terrors of Sleep Paralysis

How Often Does Sleep Paralysis Occur?

It is common and may be experienced by 20% to 60% of people, depending on the population examined.

In a study of college students, 21% were found to have had at least one episode of sleep paralysis, but only 4% had 5 or more episodes.

It is believed to be precipitated by sleep deprivation, stress, and sleep schedule disruption.

In experiments, it has been shown to occur with disruption of rapid eye movement (REM), or dream sleep. It also is associated with anxiety disorders.

Understanding the Terrors of Sleep Paralysis

Sleep paralysis sounds unbelievable.

You wake from sleep.

As you lie in bed, you feel like someone is standing over you in the darkness.

You try to move your head only slightly to take a subtle glance, but you can't.

Someone -- something -- is surely holding you down.

You attempt to struggle, to thrash your arms and legs, but you are frozen in place.

Sheer panic washes over you as your paralysis lingers.

Though this may sound all too unreal, sleep paralysis is indeed a very real experience.

What Causes Sleep Paralysis? Although there may be certain triggers, ultimately sleep paralysis is believed to

be a problem with the regulation of REM. During this phase of sleep, the body is kept relaxed so that dreams are not

acted out. If this relaxation, or atonia, occurs while the person is awake, it can cause

temporary paralysis. This may be experienced when a REM period is disrupted.

Treatment of Sleep Paralysis Though these episodes may be frightening, the disorder itself is not harmful

and will generally resolve on its own. No treatment is needed, but avoiding sleep deprivation, stress, and other

precipitants may be helpful. These are summarized in the sleep hygiene guidelines.

For those who suffer from multiple episodes and who are unable to tolerate the psychological distress, a selective serotonin receptor inhibitor (or SSRI) may be prescribed.

In addition, evaluation by a physician may be important to address sleep, mental health, or other medical disorders that can disrupt sleep.

The Four Defining Features of Narcolepsy

4. Cataplexy

Finally, cataplexy is the sudden and transient loss of muscle tone that is triggered by an emotional event.

For example, laughter, joking, or excitement may cause a temporary weakness.

This weakness may only involve a part of the body, such as the face, neck, or knees and recovery may be quick.

It typically lasts only a few minutes and consciousness remains intact.

Severe episodes may cause falls.

Interestingly, cataplexy occurs in almost no other disorder, so if it is present, narcolepsy is the likely diagnosis.

Its presence again relates to an intrusion of REM sleep into wakefulness, for paralysis normally occurs when we are asleep so that we do not act out our dreams.

Cataplexy

Definition: A sudden loss of muscle tone often triggered by intense emotions such as laughter, surprise or anger. This can lead to a slackening of muscles, weakness, temporary paralysis or collapse in posture. It is one of the four cardinal symptoms of narcolepsy.

Pronunciation: ka-tuh-plex-see

Examples:

When she gets an episode of cataplexy, she collapses to the floor.

4.Sleepwalking & Night Terrors:

While insomnia and sleep apnea are more common in adults, other sleep disorders such as sleepwalking and night terrors are far more common in young children.

Sleepwalking, also known as somnambulism, is characterized by periods of getting out of bed while asleep.

Night terrors are most frequently seen in very young children (between the ages of 2 and 6), but people of any age can be affected by this sleep disorder.

Typical symptoms include excessive sweating, shaking and obvious fear.