Common Sleep Disorders
Restless Leg Syndrome/Periodic Limb Movement Disorder
Sleep Apnea (OSA)
Overview
The majority of sleep apnea that individuals suffer from is the obstructive type rather than the central type. Obstructive Sleep Apnea (OSA) is due to upper airway closure that occurs repetitively throughout the night. Central Sleep Apnea (CSA), however, occurs as a result of the intermittent lapses in the brain to signal the body to take a breath for various reasons. Although CSA occurs not infrequently, the overwhelming majority of patients seen in the sleep laboratory have OSA and the remainder of the discussion will focus on OSA.
Who Gets Sleep Apnea?
OSA typically occurs in a) older individuals, b) men, c) overweight individuals, and d) individuals where a strong family history of the condition exists. Just because you don’t fit these profiles doesn’t mean you can’t have sleep apnea.
What are the Symptoms of Sleep Apnea?
Because of the repetitive nature of OSA, it frequently disrupts the quality of the sleep in sufferers of OSA. As a result, individuals with OSA frequently report: a) excessive daytime sleepiness despite sleeping an adequate amount of time, b) sore/dry throat upon awakening, c) headaches upon awakening, d) depression, e) irritability, and f) difficulty with memory/concentration.
Those are some of the outward symptoms of untreated OSA. However, growing medical evidence suggests that in patients with severe OSA, conditions such as high blood pressure (hypertension), insulin resistance (“pre”-diabetes), and early strokes (cerebrovascular accidents) may occur more frequently if the OSA is left untreated.
How Do I Know if I Have OSA?
OSA can be definitively diagnosed by one of two ways. 1) ambulatory (take home) sleep study or 2) in-laboratory polysomnography (PSG). The majority of individuals can be tested adequately with current ambulatory sleep studies. However, in a minority of patients whose sleep apnea may be milder or have other co-existent sleep disorders, a full in-laboratory sleep study (PSG) may be necessary.
What are the Treatment Options Available for OSA?
- CPAP (Continuous Positive Airway Pressure) therapy. Using pressurized air, the machine provides a mechanical air “splint” to maintain the airway opening to reduce/eliminate the airway closure that is characteristic in OSA. Emmi CPAP.
- Surgery. Surgical techniques and options vary for the individual depending on the severity and individual anatomic considerations. A consultation with a sleep medicine specialist or a surgeon can help you decide if this is a good option.
- Mandibular Advancement Device (MAD). By adjusting the alignment of the lower jaw during sleep, this device can alleviate upper airway obstruction due to OSA. However, individual consultation with a sleep medicine specialist is needed due to the limited success related to this device, particularly in cases of moderate to severe OSA.
- Sleep positioning devices. These so-called sleep pillows usually “force” the patient to sleep in the side positions. By doing so, these may alleviate the most severe obstructive events. This is most effective in patients in whom there is no significant sleep apnea in the lateral (side) positions compared with the supine (back) sleep position.
- Weight loss. Given that most individuals who suffer from OSA are overweight, weight reduction can improve and on occasion “cure” the sleep apnea.
I Have Been Diagnosed with OSA and am Using My Treatment Faithfully But I Don’t Feel Any Better. Why?
While most individuals who exhibit daytime symptoms improve quickly once begun on OSA treatment, a few may appreciate improvement later. It is important to be re-evaluated if symptoms recur or do not improve on treatment so that the sleep lab can determine the adequacy of your treatment and potentially evaluate for other possible disorders.
Restless Leg Syndrome/Periodic Limb Movement Disorder
Overview
Restless Leg Syndrome (RLS) is a common disorder that may impair an individual’s ability to fall asleep.
What are the Symptoms of RLS/PLMD?
Individuals with RLS usually report: 1) urge to move the legs, usually accompanied by an uncomfortable sensation in the legs, 2) the uncomfortable sensation is brought on/exacerbated by inactivity, 3) symptoms are present most notably in the evening hours, 4) movement of the legs (i.e. stretching, “walking it off” usually alleviate the discomfort
Periodic Limb Movement Disorder (PLMD) is usually characterized by leg movements that occur during sleep that may be noted by the individual’s bed partner.
How is RLS/PLMD Diagnosed?
While the diagnosis of RLS can be made based on the symptoms outline above, the diagnosis of PLMD usually requires an in-laboratory sleep study.
What are the Treatment Options for RLS/PLMD?
The treatment of RLS/PLMD usually requires the use of medications. However, in some individuals whose iron stores (ferritin) are low, iron supplementation may significantly alleviate the symptoms. Non-pharmacologic treatments such as avoidance of alcohol and caffeine in the evening, taking a warm bath at night, and gentle massage have shown variable success.
Insomnia
Overview
Difficulty with falling and/or staying asleep affects every individual at one point or another. However, treatment may be needed if the problem persists (usually more than 1 month’s duration).
What Causes Insomnia?
Insomnia can be due to many reasons. While all of us lose sleep over stressors in life, it is important to make sure that potential medical problems are not playing a role. Common mimickers of insomnia include medications, mental health conditions, medical conditions (i.e. pain), and even some sleep disorders.
What are the Treatments for Insomnia?
Once other potential conditions have been adequately evaluated, treatment for insomnia falls into two general categories: pharmacologic (medication) versus non-pharmacologic (behavioral).
Pharmacologic. Typically, these involve use of various types of sleep aides. These can be highly effective in the short term. However, long term evidence suggests that the non-pharmacologic approach may be more efficacious.
Non-pharmacologic. This generally involves the approach broadly known as Cognitive Behavioral Therapy for insomnia (CBT-I). While CBT-I is practiced by psychologists, insomnia symptoms may be improved by healthy sleep hygiene practices. These practices include:
- Maintain a consistent sleep-wake schedule regardless of the day of the week. Even more importantly, maintain a set wake up time.
- Avoid daytime naps if possible. If you must take a nap, limit it to no more than 30 minutes early in the afternoon.
- Avoid caffeine containing products after noon
- Avoid alcoholic products 4-5 hours before planned bedtime
- Exercise such as brisk walks can improve sleeping if performed at least 3-4 hours before bedtime
- Use the bedroom only for sleeping and sex. No TV, reading while in bed.
- Create a conducive environment for sleeping. Dark, somewhat cooler rooms free of excess noise are examples.
Other resources available to you as a Kaiser Permanente member include A 5 week series group entitled “Improving Your Sleep Series”, available through South Sacramento Kaiser Permanente as well. For more information, please call (916) 525-6100.
An additional resource is the online insomnia program available through kp.org:
- Go to kp.org
- Once there, click on the link: Healthy Living Resources – ONLINE PROGRAMS
- Then click on Healthy Lifestyle Programs
- Choose link: Get a good night’s sleep with Dream
Parasomnias
Overview
Broadly speaking, these are physical behaviors that occur during sleep that may or may not be readily apparent to the individual and his/her bed partner.
What are Some Symptoms in Individuals with Parasomnias?
Individuals suffering from parasomnias may have no recall to complete recollection of events leading up to the behavior. However, due to the injurious nature that these behaviors are often times associated with, medical attention is sought.
Patients with parasomnias may have little to significant daytime symptoms of sleepiness as well.
What Can I do about My Sleep Behaviors?
Safety is foremost. If there is a history of potentially dangerous behavior or injury, it is critical take appropriate measures. These include:
- Locking upstairs windows and doors and possibly installation of window/door alarms to alert others
- Installation of heavy drapes over windows to reduce the risk of injury
- Not storing dangerous items, especially in the sleeping area (e.g. knife, guns, etc.)
- Sleeping in a sleeping bag
Finally, alert your physician/provider so that an appropriate evaluation can be performed.
Less Common Sleep Disorders
Examples include narcolepsy, idiopathic hypersomnia, etc.
If you feel that you may have any of the above conditions, please talk with your doctors about referring you for further evaluation.