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Sleep Disorders

Sleep disorders or disturbances of sleep can be caused by many things including changes in social patterns or medications. In the past, changes in sleep patterns have been viewed as part of the normal aging process. However new information indicates that many of these disturbances may be related to physical changes to the body that are associated with aging. In addition to affecting the quality of life, troubled sleep can also be connected to more serious physical problems.

Why are you losing sleep?

The causes of sleep disorders depend on the particular type of sleep disorder a person has. Some sleep pattern disruptions, such as insomnia, may be caused by things as simple as a change in your daily schedule or some medications. Other forms of sleep disorders, such as sleep apnea (breathing stops for brief periods of time during sleep), develop from specific physical causes.

Some of the most common sleep disorders include:

  • Insomnia

    Insomnia is the complaint or perception of inadequate or poor-quality sleep due to one or more of the following:

    • Difficulty falling asleep
    • Waking up frequently during the night with difficulty returning to sleep
    • Waking up too early in the morning
    • Unrefreshing sleep

    Insomnia is not defined by the number of hours of sleep or how long it takes to fall asleep. Individuals vary normally in their need for, and their satisfaction with, sleep. Insomnia may cause problems during the day, such as tiredness, lack of energy, difficulty concentrating, and irritability.

    Causes of insomnia

    Women, especially in perimenopause often experience sleep disturbances as a result of hot flashes and night sweats; approximately 40% of perimenopausal women have sleep problems caused by hot flashes. Menopause sleep disorders are caused by disturbed hormone levels. The estrogen level declines, causing a variety of physical side effects including a decrease in serotonin (chemical in the brain), used to create melatonin (sleep hormone).

    Without a balanced estrogen level, the body is not able to produce the right amounts of serotonin or melatonin. Therefore maintaining a balanced estrogen level is important to control and prevent menopause sleep disorders. If you are unable to handle the frequency or intensity of these symptoms, check with your provider to see if hormone replacement therapy may be appropriate for you.

    Other causes of insomnia include a history of depression, stress, anxiety, a medical problem, or the use of certain medications.

    Transient (short term) and intermittent (on and off) insomnia generally occur in people who are temporarily experiencing one or more of the following:

    • stress
    • environmental noise
    • extreme temperatures
    • change in the surrounding environment
    • sleep/wake schedule problems such as those due to jet lag
    • medication side effects

    Chronic insomnia is more complex and often is the result of a combination of factors, including underlying physical or mental disorders. One of the most common causes of chronic insomnia is depression. Other underlying causes include arthritis, kidney disease, heart failure, asthma, sleep apnea, narcolepsy, restless legs syndrome, Parkinson's disease, and hyperthyroidism.

    However, chronic insomnia also may be due to behavioral factors, including the misuse of caffeine, alcohol, or other substances; disrupted sleep/wake cycles that may occur with shift work or other nighttime activity schedules; and chronic stress.

    Some behaviors may prolong existing insomnia, and also can be responsible for causing the sleep problem in the first place:

    • expecting to have difficulty sleeping and worrying about it
    • excessive amounts of caffeine
    • drinking alcohol before bedtime
    • smoking cigarettes before bedtime
    • excessive napping in the afternoon or early evening
    • irregular or continually disrupted sleep/wake schedules

    Stopping these behaviors may eliminate the insomnia altogether. Patients with prolonged insomnia should be evaluated and referred to a sleep specialist.

    Treatments for insomnia

    To improve sleep during menopause:
    • Keeping your bedroom well-ventilated to prevent night sweats and disturbed sleep
    • Staying cool during hot flushes by wearing loose clothing to bed
    • Exercising regularly but not right before sleep.

    The use of short-acting sleeping pills may improve sleep and next-day alertness. As with all drugs, there are potential side effects. The use of over-the-counter sleep medicines is not usually recommended for treatment of insomnia. Discuss with your physician if a sleeping pill is right for you.

  • Restless Legs Syndrome

    Restless legs syndrome (RLS) is a sleep disorder in which a person experiences unpleasant sensations in the legs described as tingling, creeping, crawling, pulling, or painful. These sensations usually occur in the calf area but may be felt anywhere from the thigh to the ankle. One or both legs may be affected; for some people, the sensations are also felt in the arms. These sensations occur when the person with RLS lies down or sits for prolonged periods of time, such as riding in a car, or watching a movie. People with RLS describe an irresistible urge to move the legs when the sensations occur. Usually, moving the legs, walking, rubbing or massaging the legs, or doing knee bends can bring relief, at least briefly.

    RLS symptoms worsen during periods of relaxation and decreased activity. RLS symptoms also tend to follow a set daily cycle, with the evening and night hours being more troublesome for RLS sufferers. The severity of symptoms varies from night to night and over the years as well. For some individuals, there may be periods when RLS does not cause problems, but symptoms usually return. Other people may experience severe symptoms daily.

    Causes of Restless Legs Syndrome

    RLS occurs in about 10% of people. Although the cause is unknown in most cases, certain factors may be associated with RLS. It is known to run in some families — parents may pass the condition on to their children. The incidence of RLS is higher in women. RLS can occur during pregnancy, especially in the last months though symptoms usually disappear after delivery. Patients with low iron levels or anemia may be more prone to developing RLS; symptoms may improve once the iron level or anemia is corrected. Kidney failure often leads to RLS. Other chronic diseases such as diabetes, rheumatoid arthritis, and peripheral neuropathy also may be associated with RLS. Decreasing caffeine consumption may improve symptoms.

    Diagnosis of Restless Legs Syndrome

    There is no laboratory test that can make a diagnosis of RLS and usually there is nothing abnormal the doctor can see or detect on examination. The diagnosis therefore depends on what a person describes to the doctor. To help determine the diagnosis, your doctor may ask about all current and past medical problems, family history, and current medications.

    A complete physical and neurological exam may help to identify other conditions that may be associated with RLS, such as nerve damage (neuropathy or pinched nerve) or abnormalities in the blood vessels.

    Treatment of Restless Legs Syndrome

    In mild cases of RLS, some people find that activities such as taking a hot bath, massaging the legs, using a heating pad or ice pack, exercising, and eliminating caffeine help alleviate symptoms. In more severe cases, medication may be helpful in controlling symptoms.

    Unfortunately, no one drug is effective in treating everyone with RLS. Individuals respond differently to medications based on severity of symptoms, other medical conditions, and other medications being taken. A medication that is initially found to be effective may lose its effectiveness with nightly use; so it may be necessary to alternate between different categories of medication to keep symptoms under control.

    A non-drug approach called transcutaneous electric nerve stimulation may also improve symptoms in some RLS sufferers who also experience periodic limb movement disorder (PLMS).

  • Sleep Apnea

    Sleep apnea is a serious, potentially life-threatening breathing disorder. It is far more common than generally understood. Sleep apnea is a characterized by brief interruptions of breathing during sleep. It owes its name to a Greek word, apnea, which means "want of breath".

    There are two types of sleep apnea: central and obstructive. Central sleep apnea is less common; it occurs when the brain fails to send appropriate signals to the breathing muscles to initiate respiration during sleep. Obstructive sleep apnea is far more common and occurs when air cannot flow into or out of a person's nose or mouth although efforts to breathe continue.

    In a given night, the number of involuntary breathing pauses or "apneic events" may be as high as 20 to 30 or more per hour. These breathing pauses are almost always accompanied by snoring between apnea episodes, though not everyone who snores has this condition.

    Early recognition and treatment of sleep apnea is important because it may be associated with irregular heartbeat, high blood pressure, heart attack, and stroke.

    Causes of sleep apnea

    Certain mechanical and structural problems in a person’s airway cause breathing interruptions during sleep. In some people, apnea occurs when throat muscles and the tongue relax during sleep, partially blocking the opening of the airway. When muscles of the soft palate at the base of the tongue and the uvula (small fleshy tissue hanging from the center of the back of the throat) relax and sag, the airway becomes blocked, making breathing labored and noisy and even stopping it altogether.

    People most likely to have or develop sleep apnea include those who snore loudly and also are overweight, or have high blood pressure, or have a physical abnormality in the nose, throat, or other parts of the upper airway. Sleep apnea seems to run in some families, suggesting a possible genetic basis. Sleep apnea also can occur in obese people when an excess amount of tissue in the airway causes narrowing of the airway.

    Symptoms and effects of sleep apnea in Women

    Women present symptoms of sleep apnea differently than men. Typically women complain of fatigue, insomnia, morning headaches, mood disturbances, lack of energy, restless legs or other symptoms that suggest reasons other than sleep apnea for their symptoms. A women's risk for sleep apnea increases as they transition through menopause, so post-menopausal women are up to three times more likely to have sleep apnea than premenopausal women. Also, women who are overweight and obese are at greater risk for having sleep apnea. Women with high blood pressure that is difficult to control despite taking medication who have some of these symptoms may also wish to be evaluated for sleep apnea, as diagnosis and treatment of sleep apnea can help with blood pressure control. Women with polycystic ovary syndrome are more likely to have sleep apnea.

    Because of the serious disturbances in their normal sleep patterns, people with sleep apnea often feel very sleepy during the day causing their concentration and daytime performance to suffer. The consequences of sleep apnea range from annoying to life threatening; they include depression, high blood pressure, sexual dysfunction, irritability, learning and memory difficulties, and falling asleep while at work, on the phone, or driving. The risk for heart attack and stroke also may increase.

    People with sleep apnea usually aren’t even aware they have a problem and may not believe it when told. Spouses of sleep apnea patients often are the first ones to suspect something is wrong (heavy snoring and apparent struggle to breathe). Coworkers or friends also may notice that the individual falls asleep during the day at inappropriate times (such as working, talking, or even while driving a car,). It is important that the person see a doctor for evaluation of the sleep problem.

    Diagnosis and treatment of sleep apnea

    In addition to the primary care physician, pulmonologists (lung specialists), neurologists, or other physicians with specialty training in sleep disorders may be involved in making a definitive diagnosis and initiating treatment. Diagnosis of sleep apnea is not simple because there can be many different reasons for disturbed sleep. Several tests are available to evaluate a person for sleep apnea and usually are performed in a sleep center.

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