Sleep Disorders; Overview
Like eating healthily and exercising, getting enough restful sleep is critical to good health. Sleep allows your body to rest and restore energy, while at the same time carrying out important physiological and psychological functions that affect your physical and mental health.
Healthy sleep can be defined as the amount and quality of sleep that allows one to maintain optimal alertness while awake. Most adults need about eight hours of sleep each night, although sleep requirements are somewhat variable among individuals. Children and adolescents typically need more than eight hours of sleep, but after age four, most children require little-to-no daytime sleep. However, many people don’t get the ideal amount of sleep they need and become chronically sleep deprived. For those who suffer from sleep disorders such as narcolepsy and other illnesses, daytime sleepiness is present even if the amount of nighttime sleep is adequate.
Research finds that sleep loss accumulates over time leading to a “sleep debt.” Insufficient restful sleep can lead to mental and physical health problems, low energy and memory lapses.
Normal sleep patterns can be disrupted by many factors including:
family demands or an overly busy schedule
hormonal influences and changes in core body temperature (e.g., during ovulation or menstruation, or the hot flashes and night sweats characteristic of menopause)
dieting, which can lower a woman’s body temperature
pregnancy, which can result in body aches, nausea, leg cramps, fetal movements and heartburn
intrinsic sleep disorders such as sleep apnea and restless legs syndrome
depression, anxiety and worry
sleepiness and fatigue
In 2005, the National Sleep Foundation (NSF) conducted a national poll of 1,506 adults, half of whom were women, to better understand the impact of sleepiness and fatigue. Of the women polled, 57 percent reported some symptoms of insomnia; 31 percent reported daytime sleepiness at least three days a week; and 24 percent said they got less sleep than they needed.
For many women, feeling tired is simply the result of hectic and demanding lifestyles that make it difficult to get a full night’s sleep. However, this tiredness can be a sign of an underlying medical condition. What’s more, sleepiness and fatigue are two distinct problems that signal different kinds of medical conditions.
Sleepiness during the day, or excessive daytime sleepiness (EDS), is defined as an inability to stay awake, especially in situations when wakefulness is important. These include at work, while caring for children and while behind the wheel of a car.
Fatigue, on the other hand, is a state of overwhelming, sustained exhaustion and a reduced capacity for physical and mental work that rest doesn’t improve. Fatigue can be a sign of an underlying medical or psychiatric disorder. The most common neurological disorders associated with fatigue are multiple sclerosis (MS) and Parkinson’s disease (PD). However, many medical and psychiatric conditions can be associated with fatigue. So you need a thorough medical and psychiatric examination to determine the cause.
Fatigue is a common symptom of depression, as is a change in sleeping patterns–either sleeping too much or too little. It’s estimated that one in five women will experience depression at some point in her lifetime. And according to the National Institute of Mental Health, fatigue or decreased energy is one of the main symptoms of depression.
In general, EDS can be a symptom of a sleep disorder or insufficient sleep, while fatigue can occur even after a full night’s sleep and is more likely to be associated with an underlying medical condition or an underlying psychiatric condition such as depression.
While the medical community distinguishes between sleepiness and fatigue, both conditions negatively affect a woman’s quality of life, performance, safety and productivity.
There are more than 70 sleep disorders. Five of the most common disorders are:
Insomnia, the most common sleep disorder, is defined as difficulty falling and staying asleep every night or most nights, despite an adequate opportunity to sleep. Other symptoms of insomnia include waking up too early in the morning and being unable to fall back to sleep, and experiencing an unrefreshing night’s sleep. As a result of a poor night’s sleep, you typically feel tired and irritable the next day and have trouble concentrating on everyday tasks. Insomnia also can be a symptom of other physical and mental conditions, such as depression, or even of another sleep disorder, such sleep apnea.
Insomnia can last one night or up to several weeks. In some people, it can be a chronic condition lasting for months or years.
Transient insomnia lasts for a short time and is described as “intermittent” when it occasionally reoccurs.
Chronic insomnia occurs most nights and lasts one month or more. According to the National Center for Sleep Disorders Research at the National Institutes of Health, about 30 to 40 percent of adults say they have some symptoms of insomnia within a given year, and about 10 to15 percent of adults say they have chronic insomnia. The National Sleep Foundation’s 2005 Sleep in America poll found that 38 percent of adults reported waking up feeling unrefreshed, 32 percent reported waking up often during the night, and 21 percent reported waking up too early.
Narcolepsy is a condition characterized by sudden sleep attacks during the day. Individuals with narcolepsy may fall asleep at inappropriate times and without warning several times a day. Although an estimated 200,000 people in the United States have narcolepsy, less than 50,000 have been diagnosed. Along with sleep apnea, restless legs syndrome and insomnia, narcolepsy is one of the most commonly diagnosed sleep disorders in people seeking treatment in sleep clinics. Often mistaken for depression, epilepsy or the side effects of medications, narcolepsy can occur in men or women at any age although its symptoms are typically first noticed in adolescence and young adulthood. There is some evidence that narcolepsy may run in families; 10 percent of people with narcolepsy report having a close relative with the same symptoms.
Recent research finds that people with narcolepsy lack a chemical in the brain known as hypocretin. This substance normally stimulates arousal and helps regulate sleep.
Other symptoms that may appear alone or in combination months or years after the daytime sleep attacks begin include:
Cataplexy. These sudden episodes of loss of muscle function can range from slight weakness (such as limpness at the neck or knees, sagging facial muscles or an inability to speak clearly) to complete body collapse. Attacks are typically triggered by sudden emotional reactions such as laughter, anger or fear, and may last from a few seconds to several minutes. Cataplexy is seen almost exclusively in patients with narcolepsy.
Sleep paralysis. These episodes, which may last for a few seconds to a few minutes, are characterized by a temporary inability to talk or move when falling asleep or waking up. Sleep paralysis may also occasionally occur in people with no sleep-related disorder.
Hypnagogic hallucinations. These vivid, often frightening, dream-like experiences occur while dozing or falling asleep. Like sleep paralysis, they are common in people with narcolepsy but can also occur in those with no identified sleep disorder.
The development, severity and order of appearance of narcoleptic symptoms vary. Only about 10 to 25 percent of those with narcolepsy experience all four symptoms. While excessive daytime sleepiness generally persists throughout life, sleep paralysis and hypnagogic hallucinations may not. The symptoms of narcolepsy, especially the excessive daytime sleepiness and cataplexy, may cause serious disruptions to personal and professional life and severely limit activities.
Sleep apnea is a serious, potentially life-threatening condition that is far more common than generally appreciated. It is characterized by repetitive, brief interruptions of airflow during sleep.
Obstructive sleep apnea, the most common form of apnea, occurs when airflow is blocked, often due to narrowing of the airway by excess tissue (typically as a result of obesity), enlarged tonsils or a large uvula (the small fleshy pendulum of tissue that hangs from the soft palate at the back part of the roof of the mouth).
If air cannot easily flow into or out of the nose or mouth, it’s more difficult to breathe. The increased effort of breathing causes a suction force in the upper part of the airway that causes it to collapse further. This can result in heavy snoring or a pause in airflow, low levels of oxygen and increased levels of carbon dioxide in the blood, which, in turn, may wake a person from sleep. With each abrupt change from deep sleep to light sleep, a signal goes from the brain to the upper airway muscles to open the airway; normal breathing resumes, often with a loud snort or gasp.
Frequent arousals, although necessary for breathing to restart, prevent restorative, deep sleep. Drinking alcohol or taking sleeping pills increases the frequency and duration of breathing pauses by sedating the brain and preventing the arousal.
Sleep apnea occurs in all age groups and both sexes but is more common in men. However, it may be underdiagnosed in women. As many as 18 million people in the United States suffer from sleep apnea. Four percent of middle-aged men and two percent of middle-aged women experience sleep apnea along with excessive daytime sleepiness (EDS), and the rate of sleep apnea increases significantly in women after menopause.
Although not everyone who snores has this condition, if you snore loudly and are also overweight, have high blood pressure or have some physical abnormality in the nose, throat or other part of the upper airway and are excessively sleepy, you may have sleep apnea. This sleep disorder also seems to run in some families, suggesting a possible genetic predisposition.
Restless legs syndrome is a sleep disorder characterized by unpleasant sensations in the legs or arms, often described as creeping, crawling, tingling, pulling or painful burning. These symptoms occur when lying down or sitting for prolonged periods. RLS symptoms tend to follow a set daily cycle, with worse symptoms at night.
The sensations usually occur in the legs but can also occur in the arms, genital region, face and torso. One or both legs may be as simple as talking to your primary health care professional about the amount of sleep you’re getting and taking simple steps (going to bed earlier, avoiding caffeine and alcohol) to sleep longer and better each night.
Many people with RLS also have a related sleep disorder called periodic limb movement disorder (PLMD). This disorder is characterized by involuntary jerking or bending leg movements that typically occur every 20 to 40 seconds during sleep. Some people experience hundreds of such movements a night. They may wake up, sleep fitfully or disturb their partner’s sleep.
The National Sleep Foundation’s 2005 Sleep in America poll found that 15 percent of adults reported symptoms of RLS a few nights a week and 86 percent of them said their condition kept them from sleeping. Symptoms can begin at any time but are usually more common and more severe among older people. Children with RLS are sometimes thought to have “growing pains” or may be labeled hyperactive because they have trouble sitting still in school.
Circadian rhythm disorder refers to a group of conditions in which the body’s natural psychological and biological rhythms are disrupted. They are very common; shift workers who work nontraditional hours are particularly vulnerable to this condition. According to the National Sleep Foundation, more than 15 million Americans are shift workers.
Other people at risk for circadian rhythm disorders are frequent travelers who experience jet lag, those with irregular sleep patterns, teenagers and people with a genetic predisposition for this condition.
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