Sleep Disorders

There are many sleep disorders that could influence the length, quality, and effects of sleep. Actually, sleep and sleep disorders are subjects of extensive study.

STAGES of SLEEP

Sleep stages are comprised of the non-rapid movement of eyes (NREM) sleep, which is the three initial phases of sleep. They are followed by rapid eye movements (REM) sleeping.

NREM-1 (5-10 minutes) This is the transitional stage between sleep and wakefulness. The activity of the brain and breathing, heart rate, and eye movements decrease, and the body begins to slow down. The brain remains active at this point.

NREM-2 (20 minutes/cycle 50% of the total sleep) In this phase the body is relaxed further, the awareness of the surroundings is diminished, body temperature decreases as eye movements are stopped and respiration and the heartbeat increase. It’s a way that helps in consolidating and processing the previous day’s experiences in the brain.

NREM-3 (20-40 minutes per cycle) This is the state of deep sleep in which it’s difficult to get up. The breathing rate and heart rate decrease and blood pressure decreases and muscles are relaxed. This is the time for recovery and rejuvenation of the body and consolidation of experience, knowledge lessons, experiences, and long-term memory.

The REM stage is the time of sleeping that begins around 90 minutes after having fallen asleep. When the muscles of the body are not working while the brain is active (like when you’re awake) breathing is more rapid and less regular and there is a fast eye movement (REM). It’s a way of recollecting emotional memories. It is also the time when dreams take place.

NREM-3, as well as REM, are phases of deep sleep, during which the body is rebuilt by boosting its immunity as well as encouraging growth and healing damaged tissues. The NREM-2 cycle, 3 and REM repeats each night 4-5 times each time between 90 and 110 minutes. The length of REM sleep is increased with each cycle beginning at 10 minutes during the initial cycle.

SLEEP DISEASES

Sleep disorders could be classified as:

INSOMNIA

It is the most frequent among sleep disorders. It can cause difficulties in getting to sleep the night, staying asleep or staying asleep, getting up too early and being unable to sleep again, and a decrease in the quality of the sleep that causes daytime sleepiness fatigue, or altered functioning.

Read the article in depth: Sleepiness or not getting adequate rest

HYPERSOMNIA

Hypersomnolence is also known as a disorder, which is the term used to describe excessive sleepiness during the day (EDS) and a longer amount of sleep or difficulty being awake throughout the daytime. Hypersomnia sufferers may sleep at any time during the day, thereby affecting and increasing the risk for work everyday activities, and even driving.

Primary hypersomnia can be attributed to abnormal control of sleep-wake cycles by the brain. Secondary hypersomnia may be the result of:

  • Sleepiness and poor sleeping at the night
  • Sleep Apnea
  • Weight gain or overweight
  • Hypothyroidism
  • Neurological disorders like MS, Alzheimer’s, and Parkinson’s disease
  • A head injury to the head
  • Abuse of narcotics or alcohol
  • Mental health conditions such as depression Bipolar disease, depression.
  • The use of prescription tranquilizers, sedatives, antihistamines, anxiety pills, and decongestants.
  • The liver or kidneys are affected by the disease.

Narcolepsy

Narcolepsy is a long-lasting sleep disorder that is characterized by uncontrollable daytime fatigue, sudden bouts of sleep, the inability to stay awake for long periods, and significant interruptions in everyday activities. It is possible to fall asleep when doing a task such as writing, typing, or driving, and do the task even when asleep and not remember the work done when the day of awakening.

Narcolepsy has been associated with insufficient or complete destruction (due to a misunderstood detection by our immune system) of a chemical in the brain known as hypocretin (also known as orexin) which regulates sleep. Narcolepsy could be type 1 if it is caused by abrupt loss of the muscle’s tone (cataplexy) that is triggered by intense emotions, or it could be type 2 with no cataplexy. Narcolepsy sufferers often go quickly into REM sleep, typically within 15 minutes after falling asleep. Sometimes, they suffer from sleep paralysis as well as vivid hallucinations, when they sleep (hypnagogic hallucinations) and when they wake up from sleep (hypnopompic hallucinations) which can be real and frightening.

Diagnostics and Treatment

Hypersomnia which is temporary is the body’s method of making up for the lack of sleep. If the condition persists and has a negative impact on day-to-day functioning It is best to seek medical advice. The doctor who treats you will evaluate the severity of the symptoms, conduct an examination of the body and conduct basic blood tests and imaging tests of the brain like CT/MRI if required. Psychological evaluations are also advised to treat depression or other issues.

Sometimes, a test known as polysomnography is carried out at night in a sleep center. It examines the brain’s activity eye movements, the time spent getting and maintaining different stages of sleep, as well as heart rates, levels of oxygen, and breathing patterns, in order to facilitate an accurate diagnosis and better treatment.

Treatment is based on lifestyle factors such as a healthy diet as well as regular physical and exercise, weight management, stress management, and avoidance of alcohol and substance abuse. The routine of establishing sleep-wake times and ensuring an adequate (8 hours of) quality sleeping at night, along with keeping sleep diaries or records and monitoring naps during the day is the most crucial aspect.

The use of medicines is when needed, specifically for narcolepsy. These include stimulant medicines such as modafinil and armodafinil and others that are more recent, such as pitosilant, solriamfetoland sodium oxybatethe two of them being effective medications in narcolepsy type 1. The traditional stimulant drugs such as methylphenidate or amphetamines may be prescribed, but they carry a high risk of addiction. Antidepressant medications (SSRIs, TCAs, and SNRIs) have been proven helpful in certain situations. The medicines listed have negative side effects and must be taken with strict medical supervision and advice only.

PARASOMNIA

It refers to disturbing and unnatural circumstances that disrupt sleep. Parasomnia can happen while you’re asleep, while sleeping or when you wake from asleep. Parasomnia can happen in the non-REM and REM stages of sleep.

Sleep disorders that are not REM (also known as arousal disorders) are those that are characterized by verbal and physical activities. A person is not fully alert or open to interactions or interventions in the course of the event but has the person having no or very few memories of the event the following day. These types of events are:

  • The sleep terrors: Waking up in a state of panic often crying and screaming as well as physical signs such as palpitations, sweating, hyperventilation, dilated pupils, and more. (lasts for about a half-minute).
  • Sleepwalking (somnambulism): Getting out of bed and walking with eyes open as well as performing activities that can increase the risk of accidents or injuries. It can also be caused by sleep talk or eating disorders related to sleep (eating foods that are not typically an integral element of normal eating habits).
  • Confusional awakenings: Being only partially alert, with eyes open, but unable to comprehend space and time, occasionally with emotional disturbances in speech, comprehension, and language (lasts for only a couple of hours to a few minutes and is more prevalent during childhood).

Sleep parasomnias in REMcan typically be recalled and explained if you wake up during the time of the event. Parasomnias can be more prevalent when there is trauma, stress and extreme fever, fatigue, and excessive alcohol consumption. This includes:

  • Dreams: Vivid frightening nightmares that can cause anxiety and fear, and sometimes wake up and have difficulty returning to sleep.
  • Sleep paralysis: Inability to move limbs or body when asleep, often during sleep or when waking up. The episode could last for a couple of minutes and is frightening but it can be stopped by someone in the family or a bed partner is touched.
  • A REM sleep disorder (RSBD): Acting (hitting out punching, grabbing, fighting, or kicking) or speaking (scolding screaming, swearing, or laughing). It is more frequent among the elderly, especially those suffering from neurological disorders.

Other possible parasomnias are exploding head syndrome (hearing an explosive, loud crashing sound or seeing flashes of light) as well as catatonia (groaning and grunting during sleep) and enuresis (bedwetting) in older children and adults hallucinations, sexsomnia, and hallucinations (performing sexual activities while asleep).

Risk factors for Parasomnia

These conditions increase the chance and severity of suffering from parasomnias.

  • Disturbed sleep, and transitions to sleep stages
  • Circadian sleep-wake disorders are caused by rhythms – irregular sleeping patterns (jet time or shift work) when the cycle of sleep is not in tune with the natural daylight-dark cycle.
  • Sleep sleep apnea
  • Abuse of alcohol or other substances
  • Children suffering from neurologic or psychiatric medical issues such as epilepsy, attention deficit hyperactive disorder (ADHD), or development delay.
  • People who are elderly or suffering from neurodegenerative disorders such as stroke, multiple sclerosis, Alzheimer’s, and Parkinson’s disease
  • Narcolepsy
  • Fever or body pain
  • Severe stress
  • Anxiety-Depression
  • A head injury to the head
  • Headaches and migraines
  • Brain tumors or infections (encephalitis)
  • During pregnancy hormone imbalance, menstrual cycles, or perimenopausal.
  • The syndrome of restless legs (RLS) Uncontrollable desire to move the legs in response to discomfort, which is often felt in the night and evening after lying or sitting for a long time. It is alleviated by moving your feet or moving the legs.
  • Genetic predisposition or the family history
  • Treatments for anxiety, sleep depression, sleep, and psychosis Certain medications for hyper BP or convulsions. Specific medications for antiallergics as well as antibiotics.

Diagnostics and Treatment

Sleep disorders are usually addressed by a multispecialty group comprised of a family physician psychologist, psychiatrist, and sleep specialists. The doctor who treats the patient will look at the severity of the symptoms and obtain a full medical history from both the patient who suffers from sleep disorders as along with the spouse and other family members. A physical examination of the general population and basic blood tests, as well as brain imaging tests such as CT/MRI, are performed when required, to determine any root reason. Psychological evaluations are as well.

Studies on sleep conducted overnight in an in-sleep center can include polysomnography. It monitors the eye movements, brain activity as well as the amount of time spent getting and maintaining different levels of sleep blood pressure, levels of oxygen, and breathing. Asleep video EEG (electroencephalogram) may also be done to record and observe brain activity during the parasomnia event.

Treatment is a mix of medication and lifestyle modifications when necessary.

The most important thing is keeping a consistent cycle of sleep and wake and a regular time for sleeping and rising. Setting up peaceful bedtime routines such as taking an ice-cold bath, relaxing books or music, abstaining from excessive exercise in the evening, and avoiding gadget use before bed is suggested as is keeping a regular time of bedtime and getting up.

A balanced and nutritious diet must be followed along with avoiding the use of alcohol, caffeine, and other drugs of abuse as well as recreational substances.

Psychotherapy that includes counseling and cognitive behavioral therapy can be beneficial particularly with stress-related issues and depression and anxiety. Relaxation and breathing techniques guided by a guide before bed can also be beneficial.

The safety of your house and the surrounding area is necessary to prevent injury and accidents in a parasomnia episode, especially sleepwalking. This includes removing glassware, sharp objects, or furniture that has sharp edges making sure alarms are secured at the entrance and windows.

Non-REM parasomnias are quite common in childhood and generally disappear when adolescents are in the process of becoming. A reassuring message to parents is all that’s usually required.

Medicines can be prescribed in persistent cases of non-REM sleep disorder and also treat REM parasomnia. Anti-anxiety medications (benzodiazepines) can be prescribed over short durations (4-6 months) to enhance sleep. Melatonin can be a helpful medicine that regulates your circadian sleep-wake cycle, increase sleep quality, and ease sleep phases, particularly REM sleep. Antidepressants can be beneficial to certain individuals.

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