Common Sleep Disorders

Narcolepsy is a sleep disorder in which a person has a high level of daytime sleepiness that causes repeated and irresistible “sleep attacks” along with other symptoms.

Symptoms

• Narcolepsy symptoms usually first occur during ages 15 to 30. The most common symptoms are:
• Periods of extreme drowsiness during the day. You may feel a strong urge to sleep, often followed by a short nap (sleep attack).
  • These periods last for about 15 minutes each, although they can be longer.
  • They may happen after eating, while driving, talking to someone, or during other situations.
  • Most often, you wake up feeling refreshed.

• Dream-like hallucinations between sleep and wakefulness. They involve seeing or hearing, and possibly other senses.
• Sleep paralysis. This is when you cannot move as you start falling asleep or when you first wake up. It may last up to 15 minutes, but typically only lasts a few seconds.
• Cataplexy. This is a sudden loss of muscle tone while awake that makes you unable to move. Strong emotions, such as laughter or anger, can trigger this.
  • Most attacks last for less than 30 seconds and can be missed.
  • Your head will suddenly fall forward, your jaw will become slack, and your knees will buckle.
  • In severe cases, a person may fall and stay paralyzed for as long as several minutes.

Narcolepsy is a nervous system disorder. The exact cause is unknown. In some patients, narcolepsy is linked to reduced amounts of a protein called hypocretin, which is made in the brain. What causes the brain to produce less of this protein is unclear.

There is a possibility that narcolepsy is an autoimmune disorder. An autoimmune disorder is when the body's immune system mistakenly attacks healthy tissue. Narcolepsy tends to run in families. Certain genes are linked to narcolepsy.

Diagnosis

The doctor will perform a physical exam and order blood work to rule out conditions that can cause similar symptoms. Conditions that can cause excessive sleepiness include:

• Insomnia and other sleep disorders
• Restless leg syndrome
• Seizures
• Sleep apnea
• Other medical, psychiatric, or nervous system diseases

Other tests may include:

• ECG (measures the heart's electrical activity)
• EEG  measures the brain's electrical activity)
• Genetic testing to look for narcolepsy gene
• Sleep Study (polysomnogram)
• Multiple Sleep Latency Test (MSLT) to see how long it takes you to fall asleep during a daytime nap. Patients with narcolepsy fall asleep much faster than people without the condition.

Treatment

There is no known cure for narcolepsy. The goal of treatment is to control symptoms. Lifestyle changes and emotional counseling may help you do better in work and social activities. This involves:

• Planning naps to control daytime sleep and reduce the number of unplanned, sudden sleep attacks
• Scheduling a brief nap (10 to 15 minutes) after meals, if possible
• Telling teachers and supervisors about the condition

You may need to take prescription medications to help you stay awake.

Antidepressant medications can help reduce episodes of cataplexy, sleep paralysis, and hallucinations. Antidepressants include:

• Selective norepinephrine reuptake inhibitors (SNRIs) such as venlafaxine
• Selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine, paroxetine, or citalopram
• Tricyclic antidepressants such as protriptyline or imipramine

Sodium oxybate (Xyrem) is prescribed to some patients for use at night. If you have narcolepsy, you may have driving restrictions. Restrictions vary from state to state.

Narcolepsy is a lifelong (chronic) condition.

It is not deadly, but it may be dangerous if episodes occur during driving, operating machinery, or similar activities.

Narcolepsy can usually be controlled with treatment. Treating other underlying sleep disorders can improve symptoms of narcolepsy.

Possible Complications

• Difficulty functioning at work
• Difficulty with social activities
• Injuries and accidents, if attacks occur during activities
• Side effects of medications used to treat the disorder

When to Contact a Medical Professional

Call your health care provider if:

• You have symptoms of narcolepsy
• Narcolepsy does not respond to treatment, or you develop other symptoms

Prevention

There is no known way to prevent narcolepsy. Treatment may reduce the number of attacks. Avoid situations that aggravate the condition if you are prone to attacks of narcolepsy.

Insomnia is a sleep complaint that occurs when you have one or more of these problems:

• You have a hard time falling asleep on most nights.
• You struggle to stay asleep or wake up frequently overnight.
• You feel tired during the day or are falling asleep during the day.
• You do not feel refreshed when you wake up.

Episodes of insomnia may come and go throughout your life (episodic), last up to 3 weeks (short-term), or be long-lasting (chronic). How much sleep is enough varies from person to person, but most adults need seven to eight hours a night.

Symptoms

• Fatigue
• Moodiness
• Irritability or anger
• Daytime sleepiness
• Anxiety about sleep
• Lack of concentration
• Poor memory
• Poor quality performance at school or work
• Lack of motivation or energy
• Headaches or tension
• Upset stomach
• Mistakes/accidents at work or while driving

If insomnia makes it hard for you to function during the day, see your doctor to identify the cause of your sleep problem and how it can be treated.

It is common to have an occasional sleepless night, but your risk of insomnia is greater if:

• You are a middle-aged or older adult. With age, sleep patterns tend to change. Many people find that aging causes them to have a harder time falling asleep and that they wake up more often.
• You are a woman. Hormonal shifts during the menstrual cycle and during menopause may play a role.
• You have a medical or psychiatric illness. Many issues that affect your health can also affect your sleep.
• You are under a lot of stress. Stressful times and events can cause insomnia.
• You don’t have a regular schedule. If you change shifts are work regularly or are traveling, that can disrupt your sleep-wake cycle.

Symptoms of insomnia can be caused by a variety of factors. Sleep habits that we learn as children may affect our sleep behaviors as adults.

Poor sleep or lifestyle habits that may cause insomnia or make it worse:

• Going to bed at different times each night
• Daytime napping
• Poor sleeping environment, such as too much noise or light
• Spending too much time in bed while awake
• Working evening or night shifts
• Not getting enough exercise
• Using the television, computer, or smartphone in bed

The use of some medications and drugs may also affect sleep. This includes:

• Alcohol or other drugs
• Heavy smoking
• Too much caffeine, especially late in the day
• Getting used to certain types of sleep medications
• Some cold medications and diet pills
• Other medicines, herbs, or supplements prescribed by a health care provider or bought on your own

Physical, social, and mental health issues can affect sleep patterns, including:

• Anxiety disorder
• Bipolar disorder
• Certain medical conditions, such as thyroid disease
• Feeling sad or depressed. Often, insomnia is the symptom that causes people with depression to seek medical help.
• Physical pain or discomfort
• Stress, whether it is short-term or long-term. For some people, the stress caused by the insomnia makes it even harder to fall asleep

Diagnosis

Your health care provider will do a physical exam and ask you questions about your current medications, drug use and medical history. Usually, these are the only methods needed to diagnose insomnia. Polysomnography, an overnight sleep study, can help rule out other types of sleep disorders (such as sleep apnea.) 

Treatment

Treatment often begins by reviewing any drugs or medical conditions that may be causing your insomnia or making it worse.

Cognitive behavioral therapy (CBT)

CBT can be a helpful tool in treating insomnia. CBT involves a combination of the following:

• Cognitive therapy: Changing attitudes and beliefs that hinder your sleep
• Relaxation training: Relaxing your mind and body
• Sleep hygiene training: Correcting bad habits that contribute to poor sleep
• Sleep restriction: Severely limiting and then gradually increasing your time in bed
• Stimulus control: Going to bed only when sleepy, waking at the same time daily, leaving the bed when unable to sleep, avoiding naps, using the bed only for sleep and sex

Medications

Using medicine to treat insomnia can sometimes be useful, but there can be risks.  Medications should only be used short term.

• Prescription medications
  • Prescription medications can help you fall asleep, stay asleep or both.
    • Doctors don’t recommend relying on prescription sleeping pills for more than a few weeks. Some possible side effects include daytime grogginess and increased risk of falling. Only use sedatives under the close care of a doctor, because you can build a tolerance and sometimes become dependent. Stopping these medications suddenly can cause rebound insomnia and withdrawal symptoms.
    • Lower doses of certain antidepressant medicines may help. These medicines do not carry the same problems with tolerance and dependence as sedatives.

• Over-the-counter (OTC) medications
  • Nonprescription sleep medications are not intended for regular use. Antihistamines (the main ingredient in over-the-counter sleeping pills) may cause memory problems over time, especially in the elderly.

Talk with your doctor before taking any herbal supplements or OTC products. The Food and Drug Administration does not mandate that manufacturers show proof of effectiveness or safety before marketing dietary supplement sleep aids. Some products can be harmful, especially if you’re taking certain medications.

Alternative Medicine

Many people never see their doctor for their insomnia and try to cope on their own. Although in many cases, the safety and effectiveness have not been proven, some people try therapies such as:

• Meditation/breathing exercises
• Yoga
• Tai chi
• Acupuncture

Your body has an internal clock that signals your body when it is time to fall asleep and wake up. This clock also controls other body functions like blood pressure and digestion.

Your internal clock runs on a 24 hour schedule that is known as circadian rhythm. Your body recognizes light to determine if it is night or day time. Normally, people are alert during the day and sleepy at night. Your circadian rhythm can shift or change with changes in your environment and may cause you to be sleepy during the day and alert at night.

When the time that you are awake and alert does not match the time you need to be doing your job or socializing, you may have a circadian rhythm disorder.

1. Genetic Circadian Rhythm Disorders

Some people naturally fall asleep and wake up at different hours than most people.  This may make it difficult to work and socialize with friends at normal times.

Delayed Sleep Phase Disorder:

If you have trouble falling asleep before 3-4am, and then sleep late into the morning, you may have delayed sleep phase disorder

Advance Sleep Phase Disorder:

If you find yourself ready for bed at 5 or 6pm and then wake up as early as 2 or 3 am, you may have advanced sleep phase disorder.

Non-24 Sleep Phase Disorder:

This disorder occurs when you have the desire to sleep in 3-4 hour intervals throughout the day.

2. Jet Lag

Jet lag occurs when traveling across several time zones and you have trouble adjusting to the new schedule.

Symptoms include:

• Trouble falling asleep
• Feeling tired or disoriented
• Stomach problems

3. Shift Work Disorder

Shift work disorder happens when you have trouble adjusting to a work schedule that goes against your body’s internal clock.  You may have to work when your body is ready to sleep and sleep when your body is ready to be awake.

Often, people who consider themselves “night owls” and choose a later bedtime may have an easier time working night shifts. However, many people have trouble adjusting to night and rotating shifts.

Not everyone who does shift work has a shift work disorder. Signs that you may have shift work disorder after a week or more of shift work include:

• Trouble falling asleep
• Trouble staying asleep
• Feeling tired even after sleeping 7-8 hours

There are many treatments for circadian rhythm disorders:

• Medications
• Melatonin
• Light therapy
• Behavioral changes

There are many medications that can help you stay awake, or to fall asleep.

Melatonin is a natural hormone produced in the brain that tells your body when it’s time for sleep. It is available as an over-the-counter supplement. You should discuss with your sleep specialist whether this medicine is right for you.

Light Therapy helps to reinforce your internal clock. It involves exposure to special artificial lights at certain times. Your sleep specialist can develop a light therapy treatment plan to help re-set your internal clock.

1. Keep a Regular Routine

Night shift workers who sleep during regular night-time hours on weekends or days off have a harder time adjusting to a shift work schedule. If you work rotating shifts, try to keep a later sleep schedule on your days off.

2. Eat Regular Meals

Try to maintain a regular meal schedule, otherwise you may wake during the day because of hunger.  Avoid greasy/heavy foods because they can make you uncomfortable during sleep.

3. Sleep Environment

Keep your bedroom dark and quiet. Use black-out curtains or use and eye mask. Try to keep your bedroom comfortable. While most people prefer a bedroom around 68F, but keep it a temperature you are most comfortable with.

4. Exercise

Exercising during the time you are awake can help you fall asleep better. Also, exercise can be a part of your healthy life plan to help ward off weight gain that is often seen in shift workers.

5. Modify Your Sleep Schedule

If you are traveling, try to start shifting your schedule before you leave for the new time zone. Once in the new time zone, don’t nap and try to sleep on the new schedule.