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Sleep Disorders

This patient handout is courtesy of: ana cristina cruz, MD rua desembargador isidro 40/506 rio de janeiro 20521-160

What are sleep disorders?


Sleep disorders are conditions that cause you to have trouble falling asleep, staying asleep or to have unrefreshing sleep. The result is daytime sleepiness that may interfere with your ability to function at work, school, or in other daily activities.

Common sleep disorders in adults include:

Insomnia Inadequate or poor-quality sleep due to one or more of the following: Difficulty falling asleep Waking up frequently during the night with trouble returning to sleep Waking up too early in the morning Unrefreshing sleep Circadian Rhythm Disturbances (Jet Lag and Shift Work) Circadian rhythms are part of the bodys natural biological clock. These rhythms are influenced by exposure to sunlight and they control sleep and wake cycles. Travel to different time zones or working at night and sleeping during the day can disrupt these cycles, causing sleep problems. Sleep Apnea Breathing during sleep is briefly interrupted; air flow can be blocked for 10 seconds to a minute, which causes blood oxygen levels to fall. The brain responds to the oxygen deprivation by awakening the person enough to tighten the upper airway muscles and open the windpipe. These awakenings may occur hundreds of times each night. The person is not aware of being awakened, but the interrupted sleep causes daytime sleepiness. The pauses in breathing are almost always accompanied by snoring, although not everyone who snores has sleep apnea. Narcolepsy Mixed up messages from the brain about when to sleep and when to be awake lead to sleep attacks during the day. These attacks last from several seconds to more than 30 minutes. They occur even with adequate nighttime sleep. Restless Legs Syndrome (RLS) Crawling, prickling, or tingling sensations in the legs and feet during inactivity cause the urge to move them for relief. This leads to insomnia at night. Periodic Limb Movement Disorder (PLMD) Repetitive jerking movements of the limbs, especially the legs, occur every 20 to 40 seconds and cause repeated awakening and fragmented sleep.

What causes sleep disorders?


The various sleep disorders have many causes, including: Psychological Stress Most short-term sleep problems are caused by stress, such as work or family stresses or traumatic events (divorce or death of a loved one, etc.). Lifestyle The following habits can cause sleep problems: exercising, drinking caffeine or alcohol, intense mental activity before bedtime, or irregular bedtime and waking schedules.

To access patient handouts by therapeutic topic, visit www.pri-med.com/patienthandouts 2006 Pri-Med Institute. All Rights Reserved

Sleep Disorders
Circadian Rhythm Disturbances Activities that interrupt the bodys biological clock such as traveling across time zones and shift work. Physical and Medical Conditions Conditions that can cause trouble sleeping include: arthritis, back pain and other chronic pain, sleep apnea, restless legs syndrome, limb movements, menopause, and pregnancy. Sleep Environment Noise, extreme temperatures, an uncomfortable bed, or a sleep partners snoring can all affect quality of sleep. Medications Drugs that may disrupt sleep include: decongestants, steroids and some medicines for high blood pressure, asthma, or depression. Genes Research in dogs has identified a gene that causes narcolepsy. Defects in this gene, called hypocretin receptor 2, interfere with messages from the brain regarding wakefulness. This gene exists in humans and research is ongoing.

When should you seek help?


If you have trouble falling asleep night after night, or if you always feel tired the next day, you may have a sleep disorder. See your doctor if your sleep problems persist for longer than a week and are bothersome, or if sleepiness interferes with the way you feel or function during the day.

How are sleep disorders diagnosed?


Your primary care physician may be able to help you or may recommend a sleep specialist. The doctor will ask questions about your sleep habits and daytime sleepiness. It helps to keep notes about your sleep in a sleep diary for at least seven days. A sleep diary can help the doctor understand your specific problem and evaluate potential causes. Your doctor may want to do a sleep study that will provide more information about your sleep pattern and whether you are breathing regularly while you sleep. In a sleep study, you spend the night at a sleep research center where your brain waves, heartbeat and breathing are monitored during an entire night.

What are the treatments for sleep disorders?


Treatment for sleep disorders depends on the type of sleep disorder and the cause. Before taking any over-the-counter sleep medicine, talk to your doctor about the different types of medications and which would be most effective for you. Do not use alcohol as a sleep aid. Insomnia Mild insomnia can often be corrected with good sleep habits (see below). Sleeping pills are often used for short-term insomnia, but most stop working after several weeks. In fact, long-term use can actually interfere with good sleep. For more serious cases of insomnia, researchers are studying light therapy and other ways to alter circadian cycles. Circadian Rhythm Disorders Melatonin pills may be taken by shift workers and travelers with jet lag to relieve or prevent insomnia. Melatonin is made from a natural human hormone. It is sold as a dietary supplement and so it is not regulated as strongly by the Food and Drug Administration as drugs are. Melatonin is considered an experimental treatment for sleep disorders. Talk to your doctor before trying melatonin. Sleep Apnea For mild sleep apnea, weight loss or not sleeping on your back may correct the problem. For more serious cases, special air devices or surgery to correct the obstruction may be needed. People with sleep apnea should never take sedatives or sleeping pills, because they can prevent them from awakening enough to breathe. RLS and PLMD Drugs that affect the neurotransmitter, dopamine, are used to treat these two conditions. This suggests that dopamine abnormalities underlie the symptoms of these disorders. Narcolepsy Stimulants, antidepressants or other drugs can help control symptoms of narcolepsy and prevent falling asleep at improper times. Naps at certain times of the day also may reduce daytime sleepiness.

What can you do to improve sleep?


The following sleep tips are adapted from When You Cant Sleep: The ABCs of ZZZs by the National Sleep Foundation: Set a sleep schedule. Go to bed at the same time each night and get up at the same time each morning. This can prevent insomnia by keeping a consistent sleep-wake cycle. Exercise, but not before bedtime. Try exercising on most days of the week, but do so at least five to six hours before going to bed. Avoid caffeine, nicotine, and alcohol. Sources of caffeine include coffee, chocolate, soft drinks, non-herbal teas, diet drugs, and some pain relievers. Smoking tends to lead to light sleep and early morning waking due to nicotine withdrawal. Alcohol robs you of deep sleep and REM sleep. Relax before bed. Make it a habit to do restful activities before bedtime, such as a warm bath, reading or listening to soothing music.

To access patient handouts by therapeutic topic, visit www.pri-med.com/patienthandouts 2006 Pri-Med Institute. All Rights Reserved

Sleep Disorders
Sleep until sunlight. Try to wake up with the sun or expose yourself to light when you wake. Sunlight helps the body reset its internal biological clock each day. Sleep experts recommend exposure to an hour of morning sunlight for people having problems falling asleep. Dont lie in bed awake. If you cant fall asleep, dont just lie in bed. Worrying about not falling asleep can actually contribute to insomnia. Do something else, like reading, watching television, or listening to music until you feel tired. Keep the bedroom temperature comfortable. An overly hot or cold room may keep you awake or cause you to wake in the night.

Are there any alternative or herbal therapies for sleep disorders?


Melatonin is a hormone produced by the brain that is believed to help the body know when to fall asleep and when to wake up. Melatonin pills are sold in health food stores and drug stores without a prescription. As mentioned above, melatonin may be effective in treating insomnia and preventing jet lag. Research has not yet been conducted to understand how melatonin works, how it affects people of different ages and people with medical conditions, and how it may interact with drugs. Valerian is an herb often taken to relieve mild insomnia. The genus Valerian includes over 250 species, but Valerian officinalis is the species most often used in the United States and Europe. Scientific studies of valerian suggest it may help with insomnia, but the evidence is not conclusive and interactions with other drugs have not been studied. Caution: Valerian and melatonin are sold in the United States as dietary supplements. This means the Food and Drug Administration regulates them as foods rather than drugs. As dietary supplements, valerian and melatonin are not required to undergo the same manufacturing consistency tests as drugs. Talk with your doctor before taking valerian or melatonin.

For more information:


National Sleep Foundation, www.sleepfoundation.org Sources: National Institute of Neurological Disorders and Stroke; July 2003 National Sleep Foundation

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTH CARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

To access patient handouts by therapeutic topic, visit www.pri-med.com/patienthandouts 2006 Pri-Med Institute. All Rights Reserved