Sleep Disorders Explained

Sleep Disorders Explained

A snoring man can reach 85 decibels, making as much racket as a vacuum cleaner or a blender mashing margaritas. Sleepwalkers have been known to cook and eat full meals and even have sex during sleep. Narcoleptics can nod off at any time -- during conversations, meals and while operating heavy machinery. Fatal Familial Insomnia, a rare brain-wasting disease, throws people into a fit of wakefulness that eventually kills them.

disturbed slumber

There are plenty of things that can mess up a good night's sleep, and some are more common than others. Bouts of insomnia brought on by stress, mental illness or even an overactive imagination are an everyday occurrence. Snoring has probably broken up more marriages than adultery. Narcolepsy, sleepwalking and night terrors are rare, but still affect millions all over the world.

It's estimated that 40 million Americans have some sort of sleep disorder. Sleep disorders can do more than just make you drowsy; if untreated, they can cause high blood pressure, increased heart rate and heart disease. As with any illness, the first step in treatment is identification.

If you think you have a sleep disorder, or if you know you have one and don't know what to do about it, read on to find out about the types of disorders, their causes (when known) and possible treatments.

Sleep Apnea
Some guys snore softly, while others tear into the night with the ear-splitting howl of a chainsaw on sheet metal. Severe snoring may be annoying, but it can also be the symptom of a life-threatening condition called sleep apnea. During a bout of sleep apnea, men seemingly drown in their own flesh. Relaxation of the muscles of the upper part of the throat can obstruct the airways of people who have a narrower passage, starving the heart and brain of oxygen.

The American Sleep Apnea Association estimates that 12 million Americans have the disorder, but many doctors believe the true number could be much greater. Those with sleep apnea often don't know they have it until a spouse notices them gasping for air in the middle of the night. Once the problem is recognized, a doctor can determine how bad it is after a night in a sleep clinic.

In some cases, men may gasp for air as many as 1,100 times during the night, each bout lasting up to 45 seconds. Guys who suffer from sleep apnea are often drowsy and irritated. They snooze during board meetings or the evening commute, and are plagued by headaches, absentmindedness and memory loss. Over time, the condition can become more serious, triggering hypertension, increased heart rate, coronary artery disease, heart failure, and stroke.

What you can do about it: Luckily, treatment is relatively simple. Sleep apnea is most common in overweight and obese individuals; in most cases, weight loss will drastically reduce the severity of the condition. In tough cases, however, doctors may prescribe Continuous Positive Airway Pressure (CPAP) machines. CPAPs apply positive air pressure through a small mask during sleep. The pressure pushes tonsils and obstructions aside. CPAPs cost between $400 and $1,000 each, depending on models and options. Unfortunately, the machine has to be worn continuously -- once a patient stops using it, sleep apnea returns.

Sleepwalking, Sleepeating and Night Terrors
In 1987, Kenneth Parks left his house in Toronto in the middle of the night, drove 14 miles, stabbed his mother-in-law to death, and strangled his father-in-law unconscious. He claimed that he was sleepwalking. After hearing testimony from several sleep specialists, the jury acquitted Parks.

Most sleepwalkers don't kill people. Sleepwalking, known in scientific circles as somnambulism, usually involves a rote routine: getting dressed and undressed, organizing your CD rack or simply strolling around the house. Sleepwalkers have absolutely no memory of their late-night adventures.

Scientists estimate that 10% of the adult population has experienced sleepwalking at one time or another. The disorder, classified as a parasomnia, also affects about 17% of children (mostly boys). Nobody knows exactly what causes it. Some scientists believe that sleepwalking is the result of a short circuit in the brain's sleep wiring.

When you doze off, your brain usually shuts down all non-essential motor control. This keeps you from acting out your dreams, which can be hazardous, to say the least. In some people, this safety mechanism fails.

Sleepeating is an even more perplexing parasomnia. The disorder begins with sleepwalking and often ends in a binge. This isn't your typical "midnight snack." Sleepeaters are truly asleep when they feast and have no memory of their meals. Most discover the aftermath -- empty cupboards and refrigerators -- in the morning.

According to a recent paper released by the Texas Christian University Harris School of Nursing in Fort Worth, more than four million Americans may be sleepeaters. Some scientists think that the disorder is caused by stress, depression or low levels of melatonin in the brain, but nobody is sure.

Night terrors are the bad cousins of somnambulism. They usually begin with the sufferer bolting upright in bed and screaming bloody murder. In some cases, people have been known to dash out of bed and down the hall, apparently fleeing some kind of danger. Oddly enough, they have no recollection of what they were running from.

What you can do about it: If you or a loved one is experiencing any sleep disorder such as sleepwalking, sleepeating or night terrors, it wouldn't be a bad idea to spend a night in the local sleep clinic. Sleep specialists can determine how bad the parasomnia is and recommend stress-reduction techniques that could mitigate the disorder. Those with parasomnia seem to follow their own distinct rhythms, though, and relieving stress may not stop them.

Safety is the biggest concern for sleepwalkers. They should be closely monitored to ensure they don't fall down stairs, stub toes, cut themselves, or strangle father-in-laws.

Narcolepsy
Narcoleptics have been the butt of bad sitcom jokes for ages. They're typically portrayed as nodding off during conversations, while laughing or even while shoveling food into their mouths. Narcolepsy, however, is no joke. As many as 200,000 Americans live with this sleep disorder, which can be debilitating.

To separate myth from fact, know the following: Narcoleptics are usually tired all the time. They don't go from hyperexcited to completely catatonic in a matter of seconds. They do tend to fall asleep when others don't -- during action flicks and Sunday afternoon drives. They can also experience cataplexy, a sudden loss of muscle control that causes them to drop like marionettes with cut strings.

Episodes of cataplexy last for a few minutes, at most. Narcoleptics can go from awake to sleepwalking in a matter of seconds, acting out routines or tasks while asleep. They can also experience vivid hallucinations.

Like other parasomnias, narcolepsy is a mystery. At one time, scientists thought it was linked to epilepsy, but that theory has recently been ruled out. There does seem to be a strong genetic link: People who have a narcoleptic in the family are 60 times more likely to have the disorder.

What you can do about it: If you are experiencing any narcoleptic symptoms, see a doctor right away. Your family physician can refer you to a sleep specialist who can prescribe medications to keep you awake during the day; Ritalin and Dexedrine are the most common drugs for the disorder. In 1999, a new drug called Provigil was released to treat the disease. Antidepressants are also used to treat cataplexy and other symptoms of narcolepsy.

Insomnia
It's 3 a.m. and I'm awake. The ruddy digits on my clock radio tick off every agonizing minute until sunrise. My mind is like a broken AM radio at full volume -- a thousand talk-show hosts yammering all at once. It will only get worse: At 6 a.m., the sun will stream through the gaps in the blinds and I will peel back the covers and stagger into tomorrow, the walking dead, a certified insomniac.

Plenty of things can keep a guy up all night: stress, an overactive imagination, the pretty redhead next door. Insomnia is the most common of the sleep disorders, experienced by nearly everyone at one point in their lifetime. Still, it's nothing to shrug off. Short-term sleep loss can kill problem-solving skills, alertness and even sex drive.

A joint study by the University of Pennsylvania and the Harvard Medical School found that running on fewer than five hours of sleep a night over a period of 14 days has the same effect on the brain as staying up two days straight.

We're talking major dysfunction. The National Center on Sleep Disorders Research describes the brain freeze caused by sleep deprivation as a "progressive, cumulative deterioration in neurobehavioral function including vigilance, neurocognitive performance and mood." In short, when you're tired, you're dumb, angry and depressed.

Temporary insomnia -- caused by jetlag or a stressful situation -- can resolve itself in time without a treatment program. Long-term insomnia can be trickier to treat. Most doctors are hesitant to prescribe drugs for insomnia, as patients can grow dependent on them. However, some newer drugs, like Ambien, are less likely to be addictive. Still, anyone who takes medication to sleep should be closely supervised by a doctor.

What you can do about it: The experts agree that setting a regular sleep schedule and observing proper "sleep hygiene" can do a lot to help insomnia. Go to bed at the same time every night. Avoid alcohol before bed. Sleep in a neat, quiet room free of light and extreme temperatures. Avoid exercise and excitement before bed. Following these simple, commonsense steps can be just as effective as any drug.

Fatal Familial Insomnia
One form of insomnia, Fatal Familial Insomnia (FFI), cannot be treated. This rare genetic disorder, identified in 1985, is caused by prions, the same brand of rogue proteins that cause mad cow disease. FFI affects the thalamus, the part of the brain that regulates sleep. The thalamus acts like a router in your brain, relaying messages from sense organs to the cerebral cortex. Doctors think that FFI kills the part of the thalamus that blocks sensory input during sleep. Essentially, people with FFI are always alert and cannot fall asleep, even with drugs.

FFI usually hits in mid-life. Patients who have FFI last about five months after they first have symptoms. Toward the end, they hallucinate and all bodily functions simply cease due to lack of sleep.

The disease is exceedingly rare, occurring in just a few people in the United States every year. Another form of "spontaneous" FFI has been discovered and could conceivably strike anyone. Thankfully, there have been only a few documented cases of spontaneous FFI.

What you can do about it: So far, no cure or treatment has been found.

don't sleep on it

If you think you have any sleep disorder, you should seek the advice of a good doctor. A sleep disorder isn't something you can just walk off or push yourself through; it's a serious ailment that can destroy your life. Your doctor can determine what makes you toss and turn, and find the right treatment that will put you on the path to a good night's sleep.

Resources:
www.sleep-deprivation.com
www.talkaboutsleep.com
www.nlm.nih.gov
www.helpguide.org
http://health.discovery.com
www.sleepdisorderchannel.net