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Sleep plays an essential part in maintaining health. There are several disorders and disturbances that affect the duration and depth of sleep. In adequate sleep or over sleep can cause numerous behavioral and cognitive problems. Some of the sleep disturbances include:-
This is the commonest sleep disorder. This usually means the inability to initiate or maintain continuous sleep.
Insomnia affects nearly 40% of women and 30% of men. It affects over 50% of people over the age of 65. Insomnia may be loss of quantity (number of hours) and/or quality (depth) of sleep.
In the elderly insomnia may be due to frequent arousals and reversal of sleeping hours from night to day.
Insomnia may be caused by three important factors:-
Insomnia can manifest in several ways. Some may suffer from transient insomnia that usually lasts just a few nights. This is commonly caused by an emotional change, stress, anxiety, shift work or jet lag etc.
Chronic insomnia lasts longer than a month. The symptoms of insomnia rarely require confirmed diagnosis. Acute insomnia generally does not require a sleep study for confirmed diagnosis.
In cases where insomnia is present for at least 6 months and there is no response to behavioral, medical, or psychiatric treatment, a sleep study is needed.
While insomnia is a common form of sleep disturbance, excessive sleepiness especially during daytime is another common complaint in sleep clinics.
The causes include sleep apnea, narcolepsy or disorders of the nerves including head injury, myotonic dystrophy, Parkinson’s disease, Alzheimer’s disease, postviral infection and developmental disorders.
Parasomnias like sleep-walking, talking in sleep, grinding teeth while sleeping (bruxism) may also result in day time sleepiness.
For diagnosis of these conditions the multiple sleep latency test (MSLT) is employed along with polysomnogram to check for adequacy and pattern of sleep the night before. History from the bed partner or family is also important.
This type of disorder occurs when there is complete or partial obstruction of the upper airway. This may be of varying severity ranging from snoring to severe obstruction and arousal from sleep. This leads to interrupted sleep and day time sleepiness.
Narcolepsy occurs in young adults in their second to third decades of life. It affects men and women equally. There is excessive daytime sleepiness, paralysis of the muscles during sleep, hallucinations during sleep and cataplexy (abnormal movements, emotional changes etc.). The patient may be awake but be completely paralyzed - unable to move and experience hallucinations.
These are problems that are associated with timing of sleep and wakefulness. The human body has its own clock called the circadian rhythm. This resides in the suprachiasmatic nucleus (SCN). This clock regulates the sleep and wake rhythms of the body. Types of circadian rhythm sleep disorders include:-