Sleep Disorders

Humans typically need 6-8 hours of sleep every night, but individuals vary in their need for sleep. During sleep, we rest and repair our muscles and organize our thoughts and memories. Therefore, if we become sleep deprived, we feel both physically fatigued and mentally exhausted. Many studies show that sleep deprivation causes a decrease in problem solving ability, attention, and manual reflex times.

Snoring

Snoring facts

  • Snoring is caused by vibrating tissues within the airways of the nose and throat.
  • The vibrations that cause snoring are caused by turbulent airflow through narrowed airways.
  • Snoring is affected by the stage of sleep, sleeping position, and the use of medications and alcohol.
  • Snoring may be a problem for family members and sleeping partners of the snorer.
  • Snoring also may be a sign of an underlying medical problem.
  • Treatments for snoring are nonsurgical and surgical.

UARS (Upper Airway Resistance Syndrome)


Upper Airway Resistance Syndrome Facts
When the snoring and resistance through the airway is significant enough to disrupt the quality of sleep, we call this disorder "Upper Airway Resistance Syndrome" or UARS. In patients with UARS, the sleep quality is generally disrupted to the point of causing clinical consequences such as difficulty initiating or maintaining sleep (insomnia), non-refreshing sleep, or excessive daytime sleepiness. Because of the very brief nature of the many arousals triggered by snoring, patients with UARS are typically unaware of these awakenings and generally do not know that they may be snoring if it were not for the witnessed reports from a bed partner or family member.

It is also important to note that not all patients with UARS have audible snoring. Some patients may have an increase in respiratory effort during inhalation or inspiration because of an anatomical limitation to the airway such as from an enlarged tongue base, which may be heard as “heavy breathing” instead of snoring. The increased effort to inhale can lead to EEG (brain wave) arousals and has been referred to in the sleep medicine field as "respiratory effort-related arousals" (RERAs). For this reason, an absence of snoring does not imply an absence of obstructive breathing in sleep. Such individuals, however, may have other symptoms such as a dry mouth upon awakening, morning headaches, and symptoms of insomnia or daytime sleepiness.

We now believe that UARS represents a progression of disease bridging the transition from "benign snoring" to obstructive sleep apnea. Patients simply do not go to bed normal one night, only to awaken the next morning with obstructive sleep apnea. Instead, they typically go through natural progression over time or following weight gain from “benign snoring”, to UARS, and finally to obstructive sleep apnea. This progression may take years or decades to occur.

Sleep Apnea

Sleep apnea facts

  • Sleep apnea is defined as a reduction or cessation of breathing during sleep.
  • The three types of sleep apnea are central apnea, obstructive apnea, and a mixture of central and obstructive apnea.
  • Central sleep apnea is caused by a failure of the brain to activate the muscles of breathing during sleep.
  • Obstructive sleep apnea is caused by the collapse of the airway during sleep.
  • The complications of obstructive sleep apnea include high blood pressure, strokes, heart disease, diabetes, automobile accidents, and daytime sleepiness as well as difficulty concentrating, thinking and remembering.
  • Obstructive sleep apnea is diagnosed and evaluated by history, physical examination and polysomnography (sleep study).
  • The nonsurgical treatments for obstructive sleep apnea include behavior therapy, medications, dental appliances, continuous positive airway pressure, bi-level positive airway pressure, and auto-titrating continuous positive airway pressure.
  • The surgical treatments for obstructive sleep apnea include nasal surgery, palate implants, uvulopalatopharyngoplasty (UPPP), tongue reduction surgery, genioglossus advancement, maxillo-mandibular advancement, tracheostomy, and bariatric surgery.

Insomnia

Insomnia facts

  • Insomnia is a condition characterized by poor quality and/or quantity of sleep, despite adequate opportunity to sleep, which leads to daytime functional impairment.
  • Many medical and psychiatric conditions may be responsible for causing insomnia.
  • Some common symptoms of insomnia include daytime sleepiness and fatigue, mood changes, poor concentration and attention, anxiety, headaches, lack of energy, and increased errors and mistakes.
  • Insomnia may, at times, be unrelated to any underlying condition.
  • There are several useful non-medical behavioral techniques available for treating insomnia.
  • Medications are widely used to treat insomnia in conjunction with non-medical strategies.
  • Sleep specialists are medical doctors who can play an important role in evaluating and treating long-standing (chronic) insomnia.

Narcolepsy (Hypersomnia)

Narcolepsy facts

  • Narcolepsy is a chronic disease of the central nervous system. The symptoms include excessive daytime sleepiness (EDS), loss of muscle tone (cataplexy), distorted perceptions (hypnagogic hallucinations), inability to move or talk (sleep paralysis), disturbed nocturnal sleep, and automatic behavior.
  • Narcolepsy usually begins in teenagers or young adults and affects both sexes equally.
  • The diagnosis of narcolepsy is based on a clinical evaluation, specific questionnaires, sleep logs or diaries, and the results of sleep laboratory tests (polysomnography and multiple sleep latency tests).
  • Treatment options for narcolepsy include drug and behavioral modification therapies and disease-specific education of the patient and family members. The treatment should be individualized, depending on the types and severity of the symptoms, the life conditions of the patients, and the specific goals of therapy.
  • Optimal management usually takes weeks to months to achieve and requires continued communication among the physician, patient, family members, and others.
  • Behavioral approaches to treating narcolepsy include establishing a structured sleep-wake cycle and planned naps, and involve diet, exercise, and occupational, marriage, and family counseling.

Sleepwalking (Parasomnia)

Sleepwalking facts

  • Sleepwalking is not a serious disorder, although children can be injured by objects during sleepwalking.
  • Although disruptive and frightening for parents in the short-term, sleepwalking is not associated with long-term complications.
  • Prolonged disturbed sleep may be associated with school and behavioral issues.
  • The outlook for resolution of the disorder is excellent.

Sleep Patterns for Children


How much sleep do children need?
Just as with adults, the amount of sleep children need varies with both age and unique needs of the individual. Below are general guidelines for children of various ages. If your child is happy and thriving, but needs more or fewer hours of sleep than indicated below - rest assured they will remain healthy. The National Sleep Foundation's 2015 Guidelines recommend the following for sleep in children and teens.
  1. 1 to 4 weeks old: Neonates spend approximately 65% to 75% of their daily activity in a sleep state. Waking time is of short duration and it is rare for a child of this age to have a "day-night" cycle. Their day-night "clock" is not functional until 6 to 8 weeks of age. Mothers of newborns should use their infant's sleep pattern to sleep also.
  2. 1 to 4 months old: Infants at this early age require sleep 14 to 17 hours of sleep per day. Many begin to develop a day-night cycle during the early weeks of this period. At this age, many infants have the ability to sleep evening blocks of 5 to 6 hours without interruption; however most will wake for feedings or diaper changes during the night.
  3. 4 to 12 months old: Infants in this age range require 12 to 15 hours of sleep daily. Good news for parents - they begin to sleep for longer continuous periods at night. Also, early in this time period, many children benefit from multiple daytime naps, though there is significant variability between different infants.
  4. 1 to 3 years old: While specialists point out that most toddlers need about 12 to 14 hours of daily sleep, many may be forced to survive on less. Daycare and erratically spaced car trips necessary for the needs of older siblings often deny or disrupt continuous sleep patterns, most often naps.
  5. 3 to 6 years old: This age range commonly needs approximately 10 to 13 hours of sleep per day with younger individuals taking a nap after lunch. Any need for napping is generally absent by the time a child enters 1st grade.
  6. 7 to 12 years old: Younger children in this age range commonly require 9 to 11 hours of sleep each night; pre-teens often receive 9 to 10 hours (though some may require more).The outlook for resolution of the disorder is excellent.
Can a lack of sleep impact a child's behavior?
The symptoms of a lack of sleep are often obvious to watchful parents. Some of these tell-tale signs include:
  • Recurrently falling asleep in the car (excluding young infants);
  • Requiring extreme stimulation and repetitive reminders to get up in the morning;
  • Behavioral abnormalities such as excessive emotionalism, aggression, and crankiness; and attention deficit.
  • An older child's (over 8 years of age) recurrent need for an afternoon nap.
Signs of Sleep Problems in Children
  • Snoring or heavy breathing
  • Breathing pauses during sleep
  • Difficulty falling asleep
  • Problems with sleeping through the night
  • Difficulty staying awake during the day
  • Unexplained decrease in daytime performance
  • Unusual events during sleep such as sleepwalking or nightmares
  • Nocturnal enuresis (bed wetting)

Sleep Hygiene


What is sleep hygiene?
A common definition of sleep hygiene is "all behavioral and environmental factors that precede sleep and may interfere with sleep." Daytime sleepiness and trouble sleeping may be a reflection of poor sleep hygiene. Detailed specifics are listed below. General areas to consider include:
  • Personal habits: Establish consistent routines around bedtimes and awakening times.
  • Sleep environment: The bedroom should be a slightly cooler temperature (between 60 F to 67 F or 15.5 C to 19.4 C), and eliminate any distracting noise in the bedroom.
  • Getting ready for bed: Establish a calming pre-sleep ritual (for example, reading, not watching TV) and avoid the use of computers or personal electronic devices right before bedtime.
  • Miscellaneous: Examples include limiting intake of foods/liquids/medications which may disrupt a restful sleep