Sleep disorder

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Sleep disorder
Classification and external resources
ICD-10 F51, G47
ICD-9 307.4, 327, 780.5
DiseasesDB 26877
MedlinePlus 000800
eMedicine med/609
MeSH D012893

A sleep disorder, or somnipathy, is a medical disorder of the sleep patterns of a person or animal. Some sleep disorders are serious enough to interfere with normal physical, mental, social and emotional functioning. Polysomnography and actigraphy are tests commonly ordered for some sleep disorders.

Disruptions in sleep can be caused by a variety of issues, from teeth grinding (bruxism) to night terrors. When a person suffers from difficulty falling asleep and/or staying asleep with no obvious cause, it is referred to as insomnia.[1]

Sleep disorders are broadly classified into dyssomnias, parasomnias, circadian rhythm sleep disorders involving the timing of sleep, and other disorders including ones caused by medical or psychological conditions and sleeping sickness. Some common sleep disorders include sleep apnea (stops in breathing during sleep), narcolepsy and hypersomnia (excessive sleepiness at inappropriate times), cataplexy (sudden and transient loss of muscle tone while awake), and sleeping sickness (disruption of sleep cycle due to infection). Other disorders include sleepwalking, night terrors and bed wetting. Management of sleep disturbances that are secondary to mental, medical, or substance abuse disorders should focus on the underlying conditions.

Common disorders[edit]

The most common sleep disorders include:

Types[edit]

Diagnosing insomnia[edit]

Insomnia is characterized by an extended period of symptoms including trouble with retaining sleep, fatigue, decreased attentiveness, and dysphoria. To diagnose insomnia, these symptoms must persist for a minimum of 4 weeks. The DSM-IV categorizes insomnias into primary insomnia, insomnia associated with medical or mental illness, and insomnia associated with the consumption or abuse of substances. Individuals with insomnia often worry about the negative health consequences, which can lead to the development of anxiety and depression.[8]

The following tests are used to diagnose insomnia as well as several other sleep disorders.[citation needed]

  • Sleep diary: Tracking sleep patterns may help a doctor reach a diagnosis.
  • Epworth Sleepiness Scale: a validated questionnaire that is used to assess daytime sleepiness
  • Polysomnogram: a test measuring brain and muscle activity including breathing during sleep
  • Multiple Sleep Latency Test: a test for daytime sleepiness, usually administered the day after overnight polysomnography
  • Actigraphy: a test to assess sleep-wake patterns, usually for a week or more. Actigraphs are wrist-worn devices, about the size of a wristwatch, that measure movement.
  • Mental health exam: Because insomnia may be a symptom of depression, anxiety, or another mental health disorder, a mental status exam, mental health history, and basic mental evaluations may be part of the assessment for a person complaining of insomnia.

General principles of treatment[edit]

Pediatric polysomnography

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

  • Rehabilitation and management
  • Medication

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. Certain disorders like narcolepsy, are best treated with prescription drugs such as Modafinil.[8] 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.[10]

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.

Some sleep disorders have been found to compromise glucose metabolism.[11]

Hypnosis treatment[edit]

Research suggests that hypnosis may be helpful in alleviating some types and manifestations of sleep disorders in some patients.[12] "Acute and chronic insomnia often respond to relaxation and hypnotherapy approaches, along with sleep hygiene instructions."[13] Hypnotherapy has also helped with nightmares and sleep terrors. There are several reports of successful use of hypnotherapy for parasomnias[14][15] specifically for head and body rocking, bedwetting and sleepwalking.[16]

Hypnotherapy has been studied in the treatment of sleep disorders in both adults[16] and children.[17]

Sleep medicine[edit]

Main article: Sleep medicine
Normison (temazepam) is a benzodiazepine commonly prescribed for insomnia and other sleep disorders.[18]

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."[19]

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 hypersomnia, Kleine–Levin syndrome, menstrual-related hypersomnia, idiopathic recurrent stupor, or circadian rhythm disturbances.[20] 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).[21] 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.[22]

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."[23] The Imperial College Healthcare site[24] shows attention to obstructive sleep apnea syndrome (OSA) and very few other sleep disorders.

See also[edit]

References[edit]

  1. ^ Hirshkowitz, Max (2004). "Chapter 10, Neuropsychiatric Aspects of Sleep and Sleep Disorders (pp 315-340)". In Stuart C. Yudofsky and Robert E. Hales, editors. Essentials of neuropsychiatry and clinical neurosciences (Google Books preview includes entire chapter 10) (4 ed.). Arlington, Virginia, USA: American Psychiatric Publishing. ISBN 978-1-58562-005-0. ...insomnia is a symptom. It is neither a disease nor a specific condition. (from p. 322) 
  2. ^ www.sleepfoundation.org[full citation needed]
  3. ^ http://www.healthscout.com/ency/1/457/main.html[full citation needed]
  4. ^ O'Conan, Zaak. Print
  5. ^ MeSH 68020920
  6. ^ Melinda Smith, M.A., Lawrence Robinson, Robert Segal, M.A. (September 2011). "Sleep Disorders and Sleeping Problems". 
  7. ^ National Institute of Neurological Disorders and Stroke (June 27, 2011). "NINDS Narcolepsy". 
  8. ^ a b c Voderholzer, Ulrich; Guilleminault, Christian (2012). "Sleep disorders". Neurobiology of Psychiatric Disorders. Handbook of Clinical Neurology 106. pp. 527–40. doi:10.1016/B978-0-444-52002-9.00031-0. ISBN 978-0-444-52002-9. PMID 22608642. 
  9. ^ Thorpy, Michael J. "PARASOMNIACS." The International Classification of Sleep Disorders: Diagnostic and Coding Manual. Rochester: American Sleep Disorders Association, 1990. Print.
  10. ^ Ivanenko A and Massey C (October 1, 2006). "Assessment and Management of Sleep Disorders in Children". Psychiatric Times 23 (11). 
  11. ^ Keckeis, Marietta; Lattova, Zuzana; Maurovich-Horvat, Eszter; Beitinger, Pierre A.; Birkmann, Steffen; Lauer, Christoph J.; Wetter, Thomas C.; Wilde-Frenz, Johanna; Pollmächer, Thomas (2010). Finkelstein, David, ed. "Impaired Glucose Tolerance in Sleep Disorders". PLoS ONE 5 (3): e9444. doi:10.1371/journal.pone.0009444. PMC 2830474. PMID 20209158. 
  12. ^ Stradling, J; Roberts, D; Wilson, A; Lovelock, F (1998). "Controlled trial of hypnotherapy for weight loss in patients with obstructive sleep apnoea". International Journal of Obesity 22 (3): 278–81. doi:10.1038/sj.ijo.0800578. PMID 9539198. 
  13. ^ Ng, Beng-Yeong; Lee, Tih-Shih (2008). "Hypnotherapy for Sleep Disorders". Annals of the Academy of Medicine, Singapore 37 (8): 683–8. PMID 18797562. 
  14. ^ Graci, Gina M.; Hardie, John C. (2007). "Evidenced-Based Hypnotherapy for the Management of Sleep Disorders". International Journal of Clinical and Experimental Hypnosis 55 (3): 288–302. doi:10.1080/00207140701338662. PMID 17558719. 
  15. ^ Hauri, PJ; Silber, MH; Boeve, BF (2007). "The treatment of parasomnias with hypnosis: A 5-year follow-up study". Journal of clinical sleep medicine 3 (4): 369–73. PMC 1978312. PMID 17694725. 
  16. ^ a b Hurwitz, Thomas D.; Mahowald, Mark W.; Schenck, Carlos H.; Schluter, Janet; Bundlie, Scott R. (April 1991). "A retrospective outcome study and review of hypnosis as treatment of adults with sleepwalking and sleep terror". Journal of Nervous & Mental Disease 179 (4): 181–241. 
  17. ^ Owens, Laurence J; France, Karyn G; Wiggs, Luci (1999). "REVIEW ARTICLE: Behavioural and cognitive-behavioural interventions for sleep disorders in infants and children: A review". Sleep Medicine Reviews 3 (4): 281–302. doi:10.1053/smrv.1999.0082. PMID 12531150. 
  18. ^ Dictionary | Definition of Temazepam
  19. ^ "American Board of Medical Specialties : Recognized Physician Specialty and Subspecialty Certificates". Retrieved 2008-07-21. 
  20. ^ Mahowald, Mark (2000). "What is causing excessive daytime sleepiness? Evaluation to distinguish sleep deprivation from sleep disorders". Postgraduate Medicine 107 (3): 108–10, 115–8, 123. doi:10.3810/pgm.2000.03.932. PMID 10728139. 
  21. ^ "About AADSM". Academy of Dental Sleep Medicine. 2008. Retrieved 2008-07-22. 
  22. ^ "About the ADBSM". American Board of Dental Sleep Medicine. Retrieved 2008-07-22. 
  23. ^ Wollenberg, Anne (July 28, 2008). "Time to wake up to sleep disorders". Guardian News and Media Limited. Retrieved 2008-08-03. 
  24. ^ "Sleep services". Imperial College Healthcare NHS Trust. 2008. Retrieved 2008-08-02. 

External links[edit]

  • Sleep Problems - information leaflet from mental health charity The Royal College of Psychiatrists
  • [1] Sleep Disorders Health Center
  • [2] The Sleep Paralysis Project - an online resource and film exploring the phenomenon of sleep paralysis