“Common Sleep Disorders Overview”
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1. Sleep Apnea

2. Restless Legs Syndrome

3. REM Behavior Disorder

4. Insomnia

5. Adjustment Sleep Disorder

6. Psychophysiologic Insomnia

7. Snoring

8. Pregnancy Insomnia

9. Talking in Sleep

10. Bed Wetting

11. Sleep Walking

12. Narcolepsy

13. Life Stages – sleep requirements for all ages.

Effects of sleep deprivation:

Although scientists are still trying to learn exactly why people need sleep, animal studies show that sleep is necessary for survival.

For example, while rats normally live for two to three years, those deprived of REM sleep survive only about 5 weeks on average, and rats deprived of all sleep stages live only about 3 weeks.

Sleep-deprived rats also develop abnormally low body temperatures and sores on their tail and paws.

The sores may develop because the rats’ immune systems become impaired. Some studies suggest that sleep deprivation affects the immune system in detrimental ways.

Sleep appears necessary for our nervous systems to work properly. Too little sleep leaves us drowsy and unable to concentrate the next day.

It also leads to impaired memory and physical performance and reduced ability to carry out math calculations. If sleep deprivation continues, hallucinations and mood swings may develop.

Some experts believe sleep gives neurons used while we are awake a chance to shut down and repair themselves.

Without sleep, neurons may become so depleted in energy or so polluted with byproducts of normal cellular activities that they begin to malfunction.

Sleep also may give the brain a chance to exercise important neuronal connections that might otherwise deteriorate from lack of activity.

Deep sleep coincides with the release of growth hormone in children and young adults. Many of the body’s cells also show increased production and reduced breakdown of proteins during deep sleep.

Since proteins are the building blocks needed for cell growth and for repair of damage from factors like stress and ultraviolet rays, deep sleep may truly be "beauty sleep."

Activity in parts of the brain that control emotions, decision-making processes, and social interactions is drastically reduced during deep sleep, suggesting that this type of sleep may help people maintain optimal emotional and social functioning while they are awake.

A study in rats also showed that certain nerve-signaling patterns which the rats generated during the day were repeated during deep sleep. This pattern repetition may help encode memories and improve learning.

Sleep disorders are common. According to the National Sleep Foundation, more than 50 million Americans suffer from a sleep disorder at some time in their lives. These disorders have a significant impact on the daytime functioning, quality of life, and health of the sufferer.

For example, research data have shown that people with insomnia report more problems with attention, concentration, and memory than healthy individuals; and they are more likely to suffer from psychiatric disorders like depression and anxiety.

Those who suffer from sleep apnea, a sleep-related breathing disorder, are at greater risk for high blood pressure, cardiac arrhythmias (irregular heartbeats), stroke, and death.

The significant health consequences of sleep disorders have led experts to agree that these problems warrant medical attention.

There are more than 80 different sleep disorders identified by the International Classification of Sleep Disorders. Some are rare, some quite common, and all can present significant distress, daytime impairment, or health consequences for those who suffer from them. Evaluation and treatment hold the keys to finding relief.

1. Sleep Apnea

Sleep apnea is a serious, potentially life-threatening condition that is far more common than generally understood, thought to affect between 2 and 4 percent of the adult population.

First described in 1965, sleep apnea is a breathing disorder characterized by brief interruptions of breathing during sleep. It owes its name to a Greek word, apnea, meaning “want of breath.”

There are two types of sleep apnea: central and obstructive. Central sleep apnea, which is less common, occurs when the brain fails to send the appropriate signals to the breathing muscles to initiate respirations.

Obstructive sleep apnea is far more common and occurs when air cannot flow into or out of the person’s nose or mouth although efforts to breathe continue.

Other, milder respiratory events during sleep known as “hypopneas” are defined as periods lasting 10 seconds or longer during which breathing is significantly reduced.

Sleep apnea is characterized by multiple respiratory pauses during sleep. These pauses, or “apneas,” are defined as periods of 10 seconds or longer during which the sleeper stops breathing altogether.

In a given night, the number of involuntary breathing pauses or “apneic events” may be as high as 20 to 60 or more per hour.

Most people with sleep apnea will have periods of abnormal breathing that last between 30 and 40 seconds more than 400 times per night.

So the average person with sleep apnea spends more than 3 hours a night when he’s not breathing normally – or not breathing at all!

These breathing pauses are almost always accompanied by snoring between apnea episodes, although not everyone who snores has this condition. Sleep apnea can also be characterized by choking sensations.

The frequent interruptions of deep, restorative sleep often leads to excessive daytime sleepiness and may be associated with an early morning headache.

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

Sleep apnea occurs in all age groups and both sexes but is more common in men (it may be under-diagnosed in women) those over 40, and those who are overweight and possibly young African Americans.

It has been estimated that as many as 18 million Americans have sleep apnea. Four percent of middle-aged men and 2 percent of middle-aged women have sleep apnea along with excessive daytime sleepiness.

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 some 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.

Certain mechanical and structural problems in the airway cause the interruptions in breathing during sleep. In some people, apnea occurs when the throat muscles and tongue relax during sleep and partially block the opening of the airway.

When the muscles of the soft palate at the base of the tongue and the uvula (the 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.

Sleep apnea also can occur in obese people when an excess amount of tissue in the airway causes it to be narrowed. With a narrowed airway, the person continues his or her efforts to breathe, but air cannot easily flow into or out of the nose or mouth.

Unknown to the person, this results in heavy snoring, periods of no breathing, and frequent arousals (causing abrupt changes from deep sleep to light sleep). Ingestion of alcohol and sleeping pills increases the frequency and duration of breathing pauses in people with sleep apnea.

Sleep apnea refers to a breathing problem that can occur during sleep. In sleep, the muscles in the pharynx (the back of the throat) relax, allowing it to constrict. This partial collapse of the pharynx can sometimes lead to inadequate airflow.

The body senses poor airflow and takes a deep breath, which leads to an arousal. These deep breaths and consequent arousals can occur 50-100 times an hour, severely disrupting sleep.

Sleep Apnea is diagnosed by an overnight study of sleep and breathing patterns called a polysomnogram. While there are many treatments for sleep apnea, the most common utilizes a nasal CPAP – a machine that blows pressurized air in through the nose, helping people with this condition get adequate airflow to the lungs, allowing them to sleep well and feel refreshed.

People with sleep apnea report a number of symptoms that they often fail to report as problems, and thus miss detection by healthcare professionals. (A spouse or bed partner often provides helpful information about the sleep and daytime functioning of the sufferer.) Symptoms of sleep apnea include:

• Loud snoring

• Pauses in breathing while asleep

• Snoring interrupted by gasping, snorting, or choking

• Excessive daytime sleepiness, often with the tendency to fall sleep in inappropriate situations such as while at work, while watching movies, or while driving

• Trouble with attention, concentration, or memory

• Low mood, depression, or irritability

• Loss of sexual interest, impotence (in men),

• or menstrual irregularities (in women)

• Acid stomach, or heartburn at night

• Dry mouth upon awakening

• Headaches upon awakening

• Nausea upon awakening

• The need to urinate many times at night (without having a large prostate) or even bedwetting

• Being overweight

• Non-refreshing sleep

It is important to note that many people over the age of 70 may have sleep apnea without snoring.

Sleep apnea is associated with significant health and safety risks.

Because of the serious disturbances in their normal sleep patterns, people with sleep apnea often feel very sleepy during the day and their concentration and daytime performance suffer. The consequences of sleep apnea range from annoying to life-threatening.

They include symptoms suggesting depression, irritability, sexual dysfunction, learning and memory difficulties, and falling asleep while at work, on the phone, or driving. Untreated sleep apnea patients are 3 times (or more) likely to have automobile accidents

It has been estimated that up to 50 percent of sleep apnea patients have high blood pressure. It has recently been shown that sleep apnea contributes to high blood pressure. Risk for heart attack and stroke may also increase in those with sleep apnea

Health risks include:

High blood pressure. One review of the medical literature reports that approximately 6 of every 10 people with sleep apnea suffers from high blood pressure.

Irregular heartbeats. Heart rhythms that are either too slow or too fast, or rhythms that are abnormal (such as premature ventricular contractions, or PVCs) occur in about half of those with sleep apnea.

Stroke is approximately 10 times greater in those with sleep apnea than those without.

Low blood oxygen, a common occurrence in people with sleep apnea, appears to be associated with a number of medical problems. This condition may result in seizure during sleep.

Death rates are higher in those with sleep apnea or untreated than those without.

Excessive daytime sleepiness: Sleepiness is a “hallmark” of sleep apnea, and often results in impaired daytime functioning. People with sleep apnea may be at greater risk of accidents or injuries due to fatigue. For example, people with sleep apnea are five times more likely to be involved in a fatigue-related motor vehicle accident than healthy individuals.

Sleep apnea treatment

There are many treatments for sleep apnea. Weight loss is a common recommendation for overweight people with sleep apnea.

However, most doctors usually recommend treatment with nasal continuous positive airway pressure (CPAP).

CPAP is delivered using a small bedside machine that is attached to a plastic hose and nose mask worn by the sleeper.

The machine gently delivers air that helps the sleeper breathe normally.

Effective surgical treatments are available, including those offered by Ear, Nose, and Throat specialists, and weight loss specialists.

Mild cases of sleep apnea may benefit from the use of an oral appliance.

Non-specific Therapy

Behavioral changes are an important part of the treatment program, and in mild cases behavioral therapy may be all that is needed.

Overweight persons can benefit from losing weight. Even a 10 percent weight loss can reduce the number of apneic events for most patients. Individuals with apnea should avoid the use of alcohol and sleeping pills, which make the airway more likely to collapse during sleep and prolong the apneic periods.

In some patients with mild sleep apnea, breathing pauses occur only when they sleep on their backs. In such cases, using pillows and other devices that help them sleep in a side position may be helpful.

Weight Loss

Weight loss is a common recommendation for overweight people with sleep apnea.

Most people with sleep apnea are overweight. Excess weight can contribute significantly to the occurrence and severity of sleep apnea. Sometimes weight loss of 5 or 6 pounds can have a significant impact on the problem. Therefore, weight loss is a common treatment recommendation made by sleep specialists.

There is no linear relationship between the amount of weight one loses and improvement in sleep apnea, so it is impossible to predict how much weight loss is needed in order to be helpful. It is most common to find that apnea improves once the patient falls below a critical, “threshold” weight.

Weight loss often is difficult to achieve, and may not result in the therapeutic outcome desired. Therefore, weight loss recommendations often are complemented by recommendations for other treatments.

CPAP/BiPAP

Nasal continuous positive airway pressure (CPAP) is the most common effective treatment for sleep apnea. In this procedure, the patient wears a mask over the nose during sleep, and pressure from an air blower forces air through the nasal passages.

The air pressure is adjusted so that it is just enough to prevent the throat from collapsing during sleep. The pressure is constant and continuous. Nasal CPAP prevents airway closure while in use, but apnea episodes return when CPAP is stopped or it is used improperly.

These treatments deliver room air to the sleeper’s nasal airway through a nose mask at a pressure that is sufficient to keep the upper airway open and facilitate normal breathing.

The machine must be used on a nightly basis, every time the patient sleeps, in order for it to be truly effective. This can be challenging for some people, who find it difficult to use the system regularly.

Others may experience “adverse effects” associated with nasal CPAP use, such as nasal congestion, dryness, or feelings of claustrophobia. The difficulties one has accommodating to nasal CPAP can interfere with treatment compliance. Studies have shown that 20% - 60% of patients abandon the use of nasal CPAP despite the health consequences of doing so.

Variations of the CPAP device attempt to minimize side effects that sometimes occur, such as nasal irritation and drying, facial skin irritation, abdominal bloating, mask leaks, sore eyes, and headaches.

Some versions of CPAP vary the pressure to coincide with the person’s breathing pattern, and other CPAPs start with low pressure, slowly increasing it to allow the person to fall asleep before the full prescribed pressure is applied.

Dental appliances that reposition the lower jaw and the tongue have been helpful to some patients with mild to moderate sleep apnea or who snore but do not have apnea. A dentist or orthodontist is often the one to fit the patient with such a device.

However, most doctors usually recommend treatment with nasal continuous positive airway pressure (CPAP).

Surgery

Some patients with sleep apnea may need surgery. Although several surgical procedures are used to increase the size of the airway, none of them is completely successful or without risks. More than one procedure may need to be tried before the patient realizes any benefits.

There are several physical factors that can contribute to the occurrence of sleep apnea.

Excessive or redundant tissue in the upper airway (the part of the airway between the tip of one’s nose to the base of one’s tongue) can be one important causative factor.

Therefore, some specialists, known as “Ear, Nose, and Throat” doctors have developed several techniques that can be used to effectively treat snoring and sleep apnea.

Somnoplasty is a simple, bloodless procedure that is used to treat snoring by using needle-tip radiofrequency to minimize the soft tissue in the upper airway. Somnoplasty is a procedure that uses radiowaves to reduce the size of some airway structures such as the uvula and the back of the tongue. This technique is being investigated as a treatment for apnea

Uvulopalatopharyngoplasty (UPPP) is a procedure used to remove excess tissue at the back of the throat (tonsils, uvula, and part of the soft palate). The success of this technique may range from 30 to 60 percent.

The long-term side effects and benefits are not known, and it is difficult to predict which patients will do well with this procedure. Uvulopalatopharyngoplasty (UPPP) and laser-assisted uvulopalatoplasty (LAUP) are two procedures that excise (cut out) or reduce excessive tissue in the back of the throat.

Like UPPP, LAUP may decrease or eliminate snoring but not eliminate sleep apnea itself. Elimination of snoring, the primary symptom of sleep apnea, without influencing the condition may carry the risk of delaying the diagnosis and possible treatment of sleep apnea in patients who elect to have LAUP.

To identify possible underlying sleep apnea, sleep studies are usually required before LAUP is performed.

Tracheostomy is used in persons with severe, life-threatening sleep apnea. In this procedure, a small hole is made in the windpipe and a tube is inserted into the opening.

This tube stays closed during waking hours, and the person breathes and speaks normally. It is opened for sleep so that air flows directly into the lungs, bypassing any upper airway obstruction. Although this procedure is highly effective, it is an extreme measure that is rarely used.

Other procedures: Patients in whom sleep apnea is due to deformities of the lower jaw may benefit from surgical reconstruction. Finally, surgical proced-ures to treat obesity are sometimes recommended for sleep apnea patients who are morbidly obese.

Some of the more common procedures include removal of adenoids and tonsils (especially in children), nasal polyps or other growths, or other tissue in the airway and correction of structural deformities. Younger patients seem to benefit from these surgical procedures more than older patients.

Other surgical procedures such as genioglossus advancement, bimaxillary advancement, also may be attempted during the course of surgical treatment of sleep apnea. Approximately 1/3 of patients who undergo surgical treatment for sleep apnea will realize improvement in respiration during sleep.

The well-documented relationship between obesity (overweight) and sleep apnea has led to the use of certain surgeries for obesity, known as bariatric surgery, used in the interest of treating some cases of sleep apnea.

Patients who are considering surgical treatments for sleep apnea should speak to their primary care doctors and/or Ear, Nose, & Throat doctors. Thorough evaluation in an accredited sleep laboratory is appropriate before and after surgery in order to document the problem and improvement with treatment.

Oral Appliances

Snoring and mild sleep apnea may be treated with the use of an oral appliance. An oral appliance is a device that is worn over the teeth during sleep in order to keep the sleeper’s jaw fixed in a “forward” position.

Some devices also aid in maintaining a stationary position of the sleeper’s tongue. Oral appliances help to open the upper airway and facilitate airflow during sleep. A dental sleep specialist usually must fit these devices.

2. Restless Legs Syndrome

Restless legs syndrome (RLS) is not often discussed, but is actually fairly common, occurring in 10-15% of the population. People with RLS complain of a discomfort in the legs (rarely the arms or chest) that is relieved only by walking. The feeling is often described as ants crawling on the skin.

This uncomfortable sensation only occurs when a person is not moving (either sitting still or lying down) and is always worse at night. Generally, people afflicted with RLS also notice that they unconsciously move their legs as well.

Sometimes they describe their legs as jumping on their own, or they notice that while sitting, they are constantly jiggling them. Since RLS occurs mostly at night while the body is at rest and is relieved by movement, falling asleep and staying asleep can become very difficult.

Even when RLS sufferers manage to fall asleep, they have frequent jerking of the limbs called periodic limb movements of sleep (PLMS). Many elderly people develop PLMS – 34% of those over age 60 – even people who do not suffer from RLS and who have no other sleep complaints.

The number of people who have the symptoms of RLS increases with age, and some people who had mild symptoms when they were younger may find that the symptoms get much worse as they age.

There are many different medications available to treat both RLS and PLMS. These include medications that are usually used for Parkinson's disease, pain control and seizure disorders. It is important never to treat yourself for this condition, but instead to see a doctor with special knowledge about the diagnosis and treatment of RLS.

If you have restless legs syndrome (RLS), you may recognize these symptoms:

An urge to move the legs, often accompanied by uncomfortable sensations in the legs, usually described as a creeping or crawling feeling, but sometimes as a tingling, cramping, burning or just plain pain. Some patients have no definite sensation, except for the need to move. (The arms may also be affected, but that's much less common.)

The need to move the legs to relieve the discomfort, by stretching or bending, rubbing the legs, tossing or turning in bed, or getting up and pacing the floor. Moving usually offers some temporary relief of symptoms.

A definite worsening of the discomfort when lying down, especially when you're trying to fall asleep at night, or during other forms of inactivity, including just sitting.

A tendency to experience the most discomfort late in the day and at night. Sleep disturbances are common with RLS and are a major effect. The sleep disturbances can range from mild to severe, but sleep problems are often the reason that people suffering from RLS seek a doctor's help.

If leg twitching or jerking is also present, a related disorder called periodic limb movements during sleep (PLMS) may be the cause. With PLMS, the leg movements may be severe enough to awaken you. In RLS, PLMS-like symptoms can sometimes occur during wakefulness, as well as in sleep.

According to the National Center on Sleep Disorders Research, "restless legs syndrome is a common, under diagnosed, and treatable condition." Recent research suggests it affects about 10% of adults in North America and Europe with rates increasing with age. Lower prevalence has been found in India, Japan and Singapore, indicating that racial or ethnic factors are associated with RLS.

The cause of RLS is still unknown, but the symptoms tend to worsen over the years and become more severe in middle-to-old age. The fact that it occurs three to five times more frequently in first-degree relatives of people with RLS than in people without RLS suggests that heredity may be involved. Pregnancy or hormonal changes may temporarily worsen RLS symptoms.

Some cases of RLS are associated with iron deficiency anemia or nerve damage in the legs due to diabetes, kidney problems, alcoholism and Parkinson's disease. Stress, diet or other environmental factors may play a role for some people.

All of these cases are said to be secondary RLS. If there is no family history of RLS and no associated condition causing the disorder, RLS is said to be idiopathic, meaning without a known cause.

Because RLS patients were found to respond positively to treatment with levodopa, scientists have been investigating whether RLS is caused by dopamine deficiency. Dopamine is a chemical found naturally in the central nervous system where it largely functions as a neurotransmitter.

RLS can begin at any age and many individuals with RLS can trace their symptoms back to childhood, when their symptoms may have been called "growing pains" or attributed to hyperactivity because they had difficulty sitting quietly

The symptoms of RLS can range anywhere from bothersome to incapacitating. Fluctuations in severity are common, and occasionally the symptoms may disappear for periods of time.

Anxiety as bedtime approaches, frustration with nighttime awakenings, moodiness and depression, difficulty concentrating and excessive daytime sleepiness have all been reported in association with RLS. It also can affect marital, family and social relations as well as having an adverse effect on school, work or other activities. Another effect can be increased drowsiness while driving or great difficulty performing overnight shift work.

The International Restless Legs Syndrome Study Group has established the following clinical criteria for diagnosis of RLS:

• A compelling urge to move the limbs.

• Motor restlessness; for example, floor pacing, tossing and turning, and rubbing the legs.

• The symptoms may be worse or exclusively present at rest, with variable and temporary relief by activity.

• Symptoms are worse in the evening and at night.

• Other associated features commonly found in RLS include:

• Sleep disturbances and daytime fatigue.

• Normal neurological exam in primary RLS.

• Involuntary, repetitive, periodic, jerking limb movements, either in sleep or while awake and at rest.

Most cases of RLS respond well to medical treatment. According to NCSDR, there are a number of pharmacological treatments for RLS.

Iron (ferrous sulfate), which is used in patients with serum ferritin levels of <50 mcg. Clonidine may be useful in hypertensive patients.

Try sleeping with your feet at a cooler temperature than the rest of your body, especially if you currently sleep with bed socks. Simply stick your feet out from under the covers and let yourself adjust to the coolness of your feet. If very hot weather, soak your feet in cool water before going to bed.

NCSDR notes that dopaminergic agents are the first-line drugs for most RLS patients. They are usually used to treat Parkinson's disease, but they also help to relieve RLS symptoms.

Periodic limb movements in sleep are repetitive movements, most typically in the lower limbs, that occur about every 20-40 seconds. If you have PLMS, or sleep with someone who has PLMS (also referred to as PLMD, periodic limb movement disorder), you may recognize these movements as brief muscle twitches, jerking movements or an upward flexing of the feet. They cluster into episodes lasting anywhere from a few minutes to several hours.

Individuals with PLMS may also experience restless legs syndrome (RLS), an irritation or uncomfortable sensation in the calves or thighs, as they attempt to fall asleep or when they awaken during the night. Walking or stretching may relieve the sensations, at least temporarily (see the RLS fact sheet).

However, research also shows that many individuals have PLMS without experiencing any symptoms at all. It's not unusual for the bed partner to be the one who's most aware of the movements, since they may disturb his/her sleep.

3. REM Behavior Disorder

REM behavior disorder (RBD) occurs when someone acts out a dream in his or her sleep. Usually when you dream, your muscle tone is decreased – you are, in fact, partially paralyzed. In rare instances, some people do not have a decrease in their muscle tone and begin to act out their dreams.

In addition, the dreams frequently become more violent than normal, and are often described as nightmares. The classic situation is one in which someone wakes up punching a pillow and remembers dreaming he was in a fight.

RBD is very rare, occurring most frequently in older men. Common causes of RBD include the use of certain medications (especially anti-depressants such as Prozac and Paxil) and withdrawal from certain sedatives (such as alcohol).

RBD can also be associated with Parkinson's Disease, narcolepsy, and certain other neurologic diseases (e.g. rare brain degeneration disorders, strokes in certain areas of the brain).

Usually, however, the cause is a mystery. Fortunately, there is effective medication for this problem.

4. Insomnia

There is no medical test that can tell us conclusively whether a person has insomnia.

Sometimes, sleep tests can be normal in the face of severe sleep complaints

Simply stated, insomnia is the inability to fall asleep or stay asleep, the tendency to awaken early in the morning, or the sense of light and un-refreshing sleep.

Insomnia is simply an impression that the sufferer has regarding the quantity or quality of his sleep.

Insomnia is a common malady.

Half of the adult population has it over the course of a year; 35% experience insomnia on an occasional basis;12% on an ongoing basis.

It is not surprising that sleep difficulties are also among the most frequently encountered problems in clinical medicine.

Insomnia affects all ages, yet increases in prevalence with age.

Women are twice as likely to have it compared to men. It is seen in all cultures and races.

Physicians often overlook the misery and debilitation associated with insomnia. Additionally, only 5% of all insomniacs approach their physicians specifically for insomnia as a primary complaint.

Recent studies have shown, however, that insomnia can have profound negative effects on health and well being. Insomniacs report difficulties with memory and task completion, are often irritable, and have greater difficulty staying awake during daytime tasks than non-insomniacs.

Inadequate sleep is associated with decreased work efficiency. Although the long-term risks of insomnia have not been adequately assessed, there is an emerging sense that unrelenting insomnia can bring on depression and other emotional difficulties.

Insomnia has long been assumed to be simply the result of tension or stress. However, key developments over the past four decades have helped tease apart and identify the many physical and emotional disorders that can be responsible for insomnia.

The first of these was the discovery that sleep is not a uniform state, but a combination of five separate sleep stages. The second was the technical discovery of "polysomnography," the physiological study of sleep in a laboratory setting, which led to the establishment of the field of sleep disorders medicine.

It is now clear that insomnia is not one entity, but can be a symptom of many different types of disorders, each with its own set of treatments.

The first step in proper treatment, therefore, is accurate diagnosis.

Advice for people first experiencing insomnia

If someone's experiencing sleep problems and they find these problems distressing, or if they're associated with any impairment in daytime functioning, that's the time to talk to a doctor.

We know that insomnia is associated with a number of significant problems in daytime functioning, in health and so on, so there's no need really to go on with the problem unattended. Talk to a doctor whenever insomnia results in distress or impairment.

If you have trouble falling or staying asleep, or you wake up feeling un-refreshed, you may be suffering from insomnia.

Insomnia is a symptom. It may be caused by stress, anxiety, depression, disease, pain, medications, sleep disorders or poor sleep habits.

The cause of insomnia has been identified and is best treated with medication.

5. Adjustment Sleep Disorder

Sudden emotional stress, such as a job loss or a hospitalization, can induce transient insomnia. Sudden changes in work shift and travel across time zones can also cause difficulties with sleep.

However, these difficulties usually resolve within a brief period of time, typically a few weeks. Many insomniacs, however, unknowingly intensify the effect of, or unnecessarily prolong, these insomnias by engaging in behaviors that make matters worse.

Therefore, proper adherence to sleep hygiene rules can be helpful in producing a more rapid resolution to this type of insomnia. Examples of sleep hygiene measures include:

• Maintain a regular bedtime schedule.

• Avoid excessive time in bed.

• Avoid taking naps.

• Use the bed only for sleeping and sexual relations.

• Do not watch the clock.

• Do something relaxing before bedtime.

• Make the bedroom as quiet as possible.

• Avoid the consumption of alcohol and caffeine within 12 hours of bedtime

• Exercise moderately, regularly, and not within 4 hours of bedtime.

• Avoid going to bed hungry.

Learn strategies to make bedtime as relaxing and tension-free as possible.

In general, no formal medical treatment is necessary for such short-lasting insomnia.

In certain cases, however, such as when daytime fatigue begins to interfere with daily activities, seeking medical attention is warranted.

Medical treatment is also warranted if the insomnia lasts for more than just a few weeks. Although in many insomnia cases, self-help strategies such as those mentioned above are sufficient in overcoming insomnia rapidly, insomnia can escalate and become chronic.

In this case, the causes of insomnia may represent more significant medical or emotional disorders. Therefore, sufferers should seek help if their own strategies do not relieve insomnia within a few weeks.

The disorders below are examples of some of the more common chronic insomnia conditions that warrant further medical attention.

6. Psychophysiologic Insomnia

Psychophysiologic insomnia can follow a few nights of sleeplessness due to an adjustment sleep disorder.

Concern regarding the prospect of facing yet another night of sleeplessness can result in an escalation of tension and anxiety with each successive night.

The insomniac begins to dread going to bed and often feels tension increasing as bedtime approaches.

He may become preoccupied with insomnia. Sufferers often spend hours in bed awake focused upon and brooding over their sleeplessness.

In severe cases, the focus of their thoughts, and even conversations with others, may begin to revolve around insomnia. Curiously, sufferers often have little difficulty falling asleep during the course of the day when their minds are focused on other issues, such as during meetings.

They also may experience relief from their own bedrooms as they fall asleep easily when away from home, such as on vacation on in a hotel room.

Psychophysiologic insomnia is often managed with a combination of behavioral measures and medications. The most commonly utilized behavioral measures are relaxation training with EMG biofeedback training, psychotherapy (cognitive and insight-oriented), and stimulus control therapy (asking patients to use the bed only for sleep and to not stay in bed trying to sleep for more than ten minutes at a time, but to go into another room and to return to bed only after feeling sleepy). Sleep hygiene measures should be closely adhered to during and after the termination of treatment, regardless of type.

7. Snoring

Snoring is a breathing noise that occurs during sleep. It is a common problem among all ages and both genders, and it affects approximately 90 million American adults — 37 million on a regular basis.

Persons most at risk are males and those who are overweight, and it usually becomes more serious as people age.

Snoring can cause disruptions to your bed partner's sleep and is also associated with cardiovascular problems such as high blood pressure, headaches and diabetes.

While breathing in, the air passage between the upper soft palate, or uvula, and the throat or base of the tongue may open and close.

During sleep, the muscles surrounding these structures relax and the air passage may narrow or close — causing a blockage of the airway.

Air cannot flow through easily and may need to be drawn between these structures. The tissues then vibrate — resulting in the familiar sound of snoring.

Snoring represents abnormal breathing during sleep. The loudness and tone of the noise is affected by how much air is going through the passage. The greater the obstruction, the greater is the effort to draw air and the louder the noise.

As it becomes harder to breath and snoring becomes worse, you may actually stop breathing. This is a sign of a serious condition called apnea (meaning "want of breath"), which requires medical attention and may lead to other serious conditions.

The National Sleep Foundation’s (NSF) 2002 Sleep in America Poll revealed that 37% of adults report they had snored at least a few nights a week during the previous year. In fact, 27% said that they snore every night or almost every night. Males were more likely than females to report snoring at least a few nights a week (42% vs. 31%).

NSF’s 2003 poll, which focused on older adults between the ages of 55-84, reveals that about one-third of older adults overall (32%) report they had snored at least a few nights a week in the past year, with about four in ten 55-64 year-olds (41%) most likely to have said they snore compared to about one-fourth of 65-74 year-olds (28%) and 75-84 year-olds (22%).

Men were significantly more likely than women to report snoring at least a few nights a week (40% vs. 26%).

Snoring may occur due to any of a variety of illnesses, from the common cold to sleep apnea. Although snoring is often a sign of sleep apnea, most snorers do not, in fact, suffer from sleep apnea.

Obesity and a large neck can contribute to snoring. People who drink alcohol before bedtime may snore more than usual. And snoring is sometimes caused by an illness or a sleep disorder.

Risk factors for snoring include: obesity (overweight), hypothyroidism (low thyroid function), and tobacco use. Some people are born with a small or narrow airway, while others have conditions that interfere with normal breathing (such as nasal polyps or deviated septum).

In either case, snoring is more likely to occur. Snoring also can arise with sleep deprivation, with common colds or allergies, when sleeping on one’s back, or as a result of the use of alcohol or certain sleeping pills

Snoring cures

Most snoring probably is not associated with health concerns, but is a problem that snorers and their loved ones would like resolved.

Simple treatments include weight loss, avoidance of alcohol or sleep aids that relax muscles, treatment of nasal congestion or allergies, or the use of over-the-counter devices such as tape strips that help open your nasal passages.

Every spouse of a snorer can tell you that sleeping on your side also reduces the likelihood of snoring. Some people can sleep on their sides at will; others might want to try using an old tennis ball sewn into the center of the back of a T-shirt, which “reminds” the sleeper to roll over whenever he’s on his back.

Oral appliances, usually fit by a dentist, may be helpful. Finally, a variety of surgical procedures provided by Ear, Nose, and Throat specialists can provide a long-term solution to the problem of snoring.

Snoring actually may be a health concern for some. Medical reports have shown that snoring is associated with high blood pressure and reports of daytime dysfunction. Snoring also may be a “warning sign” of a sleep-related breathing disorder known as “sleep apnea.”

Approximately five out of every 100 snorers has sleep apnea, a very serious medical condition that is associated with breathing pauses during sleep (see Sleep Apnea).

People with sleep apnea often suffer from debilitating daytime fatigue and sleepiness, and they are at significantly greater risk than others for stroke, irregular heartbeats, high blood pressure, and death.

The treatment plan for a person with sleep apnea is quite different from one for an individual with simple snoring, so medical evaluation and follow-up care is essential.

There are many different ways to reduce snoring:

• One of the most effective is through weight loss. Reducing your weight will reduce fat deposits in the throat, providing a more spacious airway and usually less snoring.

• Another way to reduce snoring is to improve nasal breathing by using a nasal strip that gently opens your nostrils during sleep. Dental appliances that are also available can be prescribed by your dentist or orthodontist.

• Sleeping on your side with a pillow is the preferable position to help alleviate snoring.

• Two lifestyle changes to consider are avoiding alcohol and cigarettes. Abstaining from alcohol, which relaxes muscles in the airway, at least four hours before bedtime; and abstaining completely from smoking, which is associated with nasal congestion, can help alleviate snoring.

• Finally, ask your doctor for recommendations, so he or she can address your specific snoring situation.

Snoring represents abnormal breathing during sleep. The loudness and tone of the noise is affected by how much air is going through the passage. The greater the obstruction, the greater is the effort to draw air and the louder the noise.

As it becomes harder to breath and snoring becomes worse, you may actually stop breathing. This is a sign of a serious condition called apnea (meaning "want of breath"), which requires medical attention and may lead to other serious conditions.

When your partner snores…..

Nothing is quite as frustrating as trying to sleep and hearing the guttural sounds of your loved one next to you snoring. It was supposed to be for better or for worse, but no one told you anything about endless nights of being woken up by the frustrating sounds, the bags under your eyes that would follow, and the necessity for you to consume five cups of coffee a day just to stay awake.

So is there a way to get your partner to stop snoring, or will you have to resort to separate bedrooms in order to get the much-needed sleep that you have been deprived of? Don’t give up hope just yet.

Allergies, colds, and blocked airways are common causes of the condition. Sometimes snoring can be caused by a serious condition, but usually snoring can be treated with simple preventative measures.

Since snoring is most common when lying on the back, sometimes getting your partner to stop snoring is as easy as asking them to roll over and sleep on their side.

At other times, the remedy may be much more elusive. Sometimes adding a humidifier to the room will aid in moisturizing the airways and will help reduce snoring symptoms since a dry throat can contribute to soft palate vibrations.

There are also sprays and nose strips that one can use to prevent snoring, though these methods are not as effective as some other widely-available methods have proven to be.

One popular remedy for persistent snoring is the use of a “memory foam” pillow that will properly support the shoulder, neck and head areas. Since improper support of these areas can restrict airflow, a quality pillow can work wonders literally overnight.

If the above remedies don’t eliminate the snoring problem, there could potentially be a more serious condition causing your partner to snore and an appointment with a physician should be made to determine the underlying cause of the condition.

8. Pregnancy insomnia

Pregnancy is an exciting and physically demanding time. Physical symptoms (body aches, nausea, leg cramps, fetus movements and heart-burn), as well as emotional changes (depression, anxiety, worry) can interfere with sleep.

In the NSF poll, 78% of women reported more disturbed sleep during pregnancy than at other times although some women have few sleep problems.

Sleep related problems also become more prevalent as the pregnancy progresses.

One recent study reported that changes in sleep occur in 13-20% of women in the first trimester and increase to 66-90% by the third trimester.

In general, nausea can be experienced early whereas general discomfort may disrupt sleep later in the pregnancy.

First Trimester (Months 1-3)

Overall, women have lower quality of sleep during the last trimester of pregnancy. High levels of progesterone are produced, increasing feelings of sleepiness. Also, the enlarged uterus can press up against the diaphragm, making it more difficult to breathe.

The number of times a woman wakes up during the night to urinate increases as well. Disturbed sleep patterns may begin. Interrupted sleep can cause daytime sleepiness. Women tend to sleep more during this time than before they were pregnant, or later in pregnancy.

Second Trimester (Months 4-6)

During this trimester, the growing fetus reduces pressure on the bladder by moving above it and decreasing the need for frequent bathroom visits.

Sleep quality is still worse than it was before pregnancy and many women become restless as they search for a comfortable position.

Third Trimester (Months 7-9)

Women experience the most pregnancy-related sleep problems at this time although they may sleep longer and nap more by the end of the pregnancy. They may often feel physically uncomfortable.

Heartburn, leg cramps and sinus congestion are common reasons for disturbed sleep, as is an increased need to go to the bathroom. (The fetus puts pressure on the bladder again.)

One recent study reported, that by the end of pregnancy, 97% of women were waking during the night.

Post-Partum

As might be expected, mothers of newborn babies experience a lot of sleeplessness and daytime sleepiness, which may contribute to the "postnatal blues" experienced by 75-80% of most new mothers.

This is usually a temporary condition, but it can become extremely serious and even put a new mother at risk for suicide. In general, it is treatable with professional help and will improve as the baby develops and establishes regular, nighttime sleep.

Snoring and Severe Daytime Sleepiness

Pregnant women who have never snored before may begin doing so. About 30% of pregnant women snore because of increased swelling in their nasal passages. This may partially block the airways.

Snoring can also lead to high blood pressure, which can put both the mother and fetus at risk. If the blockage is severe, sleep apnea may result, characterized by loud snoring and periods of stopped breathing during sleep.

The lack of oxygen disrupts sleep and may affect the unborn fetus. If loud snoring and severe daytime sleepiness (another symptom of sleep apnea and other sleep disorders) occur, consult your physician.

Secondary Restless Legs in Pregnancy

Up to 15 percent of pregnant women develop Restless Legs Syndrome (RLS) during the third trimester. A contributing cause may be iron and/or folate acid deficiency. In general, RLS is more prevalent in women than men. RLS symptoms make it difficult to fall and stay asleep due to an uncontrollable urge to move the legs in response to unpleasant, restless, creepy feelings in the legs.

These feelings appear when at rest and often disrupt sleep as well. Moving the legs can stop these symptoms temporarily, but the irritation returns when the limb is still. Fortunately, RLS symptoms usually end after delivery of the baby. Medications used to treat RLS may cause harm to the fetus and should be discussed with a doctor.

Sleep Tips for Pregnant Women

1. In the third trimester, sleep on your left side to allow for the best blood flow to the fetus and to your uterus and kidneys. Avoid lying flat on your back for a long period of time.

2. Drink lots of fluids during the day, but cut down before bedtime.

3. To prevent heartburn, do not eat large amounts of spicy, acidic (such as tomato products), or fried foods. If heartburn is a problem, sleep with your head elevated on pillows.

4. Exercise regularly to help you stay healthy, improve your circulation, and reduce leg cramps.

5. Try frequent bland snacks (like crackers) throughout the day. This helps avoid nausea by keeping your stomach full.

6. Special "pregnancy" pillows and mattresses may help you sleep better. Or use regular pillows to support your body.

7. Naps may help. The NSF poll found that 51% of pregnant or recently pregnant women reported at least one weekday nap; 60% reported at least one weekend nap.

8. Learn to relax with relaxation and breathing techniques, which can also help when the contractions begin. A warm bath or shower before bed can be helpful.

9. Talk to your doctor if you develop medical problems and/or insomnia persists.

Once her baby is born, a mother's sleep is frequently interrupted, particularly if she is nursing.

Mothers who nurse and those with babies that wake frequently during the night should try to nap when their babies do.

Sharing baby care to the extent possible, especially during the night, is important for the mother's health, safety, performance and vitality.

Check out our site pages for natural herbal remedies as a sleep aid.Note: Although generally safe, clary sage and chamomile oils should be avoided during pregnancy. If in doubt about any essential oils, consult a medical practitioner.

Women’s Sleep Habits

Sleep loss in women has reached epidemic proportions. Unfortunately, many women are unaware of the negative impact sleep problems can have on their health and performance. Identifying the unique complications that contribute to sleep problems in women is an important step in achieving better sleep.

Almost three out of four women do not get eight or more hours of sleep per night during the workweek. On average, women sleep approximately 6.5 hours per night during the workweek.

While many women experience difficulty sleeping, only 4% of adults currently see a physician regarding their sleep problems.2

Hormones Affect Sleep

Sleep is disturbed 2.5 days on average during the menstrual cycle. More women complain of sleep problems during menstruation (71%), when hormone levels are at their lowest, than during the premenstrual week (43%).

A majority (79%) of women report an increase in sleep problems during pregnancy. Forty percent of menopausal women suffer from sleep problems, which are usually related to hot flashes. A majority of menopausal/postmenopausal women report frequent insomnia.

Medical Conditions

Depression and anxiety, conditions associated with sleep loss, are twice as common in women as they are in men.

More women than men suffer from nighttime pain, including pain due to arthritis, which may make it more difficult to get a good night’s sleep.

Maternal Responsibilities

Most moms develop a high sensitivity to the sounds of their children and awaken more easily than women without children. This heightened sensitivity may continue long after their children sleep through the night.

Consequences of Sleep Loss

Middle-aged women who sleep an average of five hours or less nightly may be more likely to have heart disease than women who sleep eight hours nightly.

Sleep loss may increase hunger and affect the body’s metabolism, which may make it more difficult to maintain or lose weight.

A majority of women surveyed say that sleep problems hinder their ability to perform daily activities at least a few days per month.

Of those women who report that their sleep problems hinder their daily activities, forty-six percent report that sleep problems interfere with household duties, and nearly two thirds say sleep problems interfere with their relationship with either their spouse or their children.

How Women Can Achieve Better Sleep

Avoid alcohol as well as foods or beverages high in caffeine (eg, coffee, colas, tea, chocolate), sugar (including honey), and salt.

Exercise regularly, but do so at least three hours before bedtime.

Try warming up your feet if you’re having trouble sleeping. Inadequate vasodilation (opening of blood vessels to increase blood flow) may cause sleep problems.

If you can’t fall asleep, participate in a quiet, relaxing activity in a dimly lit room.

Sleep Loss Affects Health and Performance

The amount of sleep a woman gets may directly affect her health. Studies published in the Journal of the American Medical Association and the Lancet suggest that sleep loss may increase hunger and affect the body’s metabolism, which may make it more difficult to maintain or lose weight.

Sleep loss may also interfere with the body’s ability to metabolize carbohydrates and cause high blood levels of glucose, a basic sugar. Excess glucose promotes the overproduction of insulin, and can also lead to insulin resistance, a critical feature of adult-onset diabetes.

In addition, research shows that short-term sleep deprivation may increase blood pressure. In fact, a recent study published in the Archives of Internal Medicine demonstrated that chronic sleep loss is associated with an increased risk of heart disease.

Women between the ages of 45 and 65 who slept an average of five hours or less per night were 39% more likely to have heart problems than women who slept eight hours per night.

Sleep loss can also hinder a woman’s ability to perform daily responsibilities and may also impact her relationships. According to the National Sleep Foundation’s Women and Sleep Poll, a majority of women (51%) say that their sleep problems hinder their ability to perform daily activities at least a few days per month.

Of those women, 46% report interference with carrying out household duties, 27% report interference with job performance, and nearly two thirds say that lack of sleep causes problems with their relationship with either their spouse or their children.

Sleep aid tips for Mothers

Avoid alcohol as well as foods or beverages high in caffeine (eg, coffee, colas, tea, chocolate), sugar (including honey), and salt.

Exercise regularly, but finish your workout at least three hours before bedtime. Exercise may relieve some PMS symptoms and promotes a good night’s sleep.

If you are having trouble falling asleep, try warming up your feet. Inadequate vasodilation (opening of blood vessels to increase blood flow) may cause sleep problems. This remedy might be especially helpful to older women with poor circulation in their extremities.

If you can’t fall asleep in bed after a reasonable period, get up, go into a darkened or dimly lit room, and participate in a quiet activity such as reading, knitting, or listening to soothing music. Do not use this time to catch up on laundry or paperwork.

If you experience sleep disturbances for more than a few weeks, see your doctor. In addition to behavioral and lifestyle modifications, there are prescription sleep medications that may help individuals fall asleep quickly and increase their total sleep time with minimal next-day effects.

9. Talking in sleep

More than one in ten preschool and school-age children talk in their sleep at least a few nights a week (11% and 12% respectively), according to NSF’s 2004 Sleep in America poll

What is sleep talking? Has anyone ever accused you of sleep talking?

Long ago, people used to think sleep talking had other worldly connotations.

Some people were accused of being possessed by the devil or spirits. Some people thought it was a supernatural premonition of some sort. Well, for the most part we know better now, at least most of us do.

Sleep talking is the utterance of speech or sounds without awareness of the event. Sometimes you can even hold conversations with someone who is sleep talking.

Sleep talking episodes are not associated with awareness of talking. Sleep recordings show episodes of sleep talking that can occur in any stage of sleep.

It can be associated with other health disorders such as, psychiatric, anxiety, as well as other sleep disorders like sleepwalking, sleep apnea, or REM sleep behavior disorder.

Nobody really knows why sleep talking is so common, especially among children. Some experts believe certain factors in our lives have something to do with sleep talking.

What some people think are common causes of sleep talking are lack of sleep, stress, fever, extreme distress or even pain or sever trauma.

Again nobody is really sure what causes sleep talking, but it is an interesting phenomenon.

Talking, laughing or crying during sleep is not usually considered a problem.

10. Bed Wetting

“Enuresis” is what doctors call bedwetting. This can be quite embarrassing for older children, who are often fearful of having sleepovers at a friend's house, knowing they could have an "accident".

Bed-wetting (or nocturnal enuresis) is an inability to control the flow of urine during the night.

It is fairly common for kids to wet the bed, one or more times per night. At age 5, about 15 percent of children have enuresis.

By the age of 15, one to two percent of adolescents still have it. If left untreated, some will wet the bed for life.

Devices that set off an alarm to awaken the child when he urinates in bed can be quite effective for some.

Most medicines stop working after a period of time or the problem recurs as soon as the medicine is discontinued.

Most children grow out of this problem eventually and parents need to be patient and supportive.

Research revealed that enuresis is often inherited. There is a 77 percent chance that a child might inherit it if both parents were bed-wetters. It is more prevalent with boys.

Contrary to belief, bed-wetting is not a mental or behavior problem. Neither does it come from emotional stress, poor self-esteem or emotional maturity.

It is a common developmental phenomenon related to physical and physiologic factors.

There are two types of nocturnal enuresis: primary and secondary. Primary nocturnal enuresis is when a child has not yet developed complete night-time bladder control.

Secondary nocturnal enuresis is when a child accidentally wets the bed after having had bladder control for six or more months.

Some factors linked to bed-wetting include:

Bladder size - may be too little to hold the normal amount of urine.

Infection - abnormalities due to diabetes or chronic urinary tract infection.

Antidiuretic Hormone (ADH) hormone which suppresses the rate of urine production. Some bed-wetters make less ADH or have kidneys less responsive to ADH.

Delayed growth and development– nervous system is not mature enough to have the ability to stop the bladder from emptying at night.

Imbalance of the bladder muscle– the muscle that contracts to squeeze the urine out is stronger than the sphincter muscles that holds the urine in.

Diet– foods containing high levels of artificial color and sweetener such as dairy products, citrus fruits, caffeinated cola drinks and chocolate have been associated with bed-wetting.

Constipation or encopresis (uncontrolled passing of stools)

Difficulties waking up from sleep

Not much can be done to prevent children from bed-wetting. Most children outgrow it without treatment.

It is important to stress to the child that bed-wetting is natural and should not be viewed as humiliating or shameful.

Adult bed wetting

Adult Bed Wetting remedies

Obviously, go to the toilet before you go to bed, even if you don’t think you “need to,” go anyway and see if you can empty your bladder.

It makes sense to limit your fluid intake for up to 6 hours before you go to sleep. Experiment to see how much you need to reduce your drinks.

It may simply be a case of working backwards for a few nights until you realize that as long as you have your last drink at XX p.m. you are OK for the whole night.

Avoid caffeine if possible, as it is a diuretic and stimulant.

Alcohol is a stimulant and also dulls your system, so you are less likely to easily wake up in time when you need to, to be able to get to the bathroom in time. Definitely avoid drinking yourself into a stupor, as obviously you have little chance of being mentally alert and fully functional when you need to respond to the call of nature.

If you are not experiencing any insomnia problems, try setting the alarm clock to wake you halfway in the night, to allow you to go to the bathroom and empty your bladder before you go back to sleep.

If you only have light bed wetting problems, purchase the adult pads that can be placed in your underwear to catch any light spillage during the night.

EXERCISES: One of the best natural remedies is to exercise your bladder muscles. Simply tense your lower abdominal muscles – pretend you are trying to stop yourself while you are urinating.

Only practice this exercise in “theory” as stopping yourself when you are actually urinating can lead to back leakage and infections in your urinary tract.

Exercising your abdominal muscles also helps tone up your urinary muscles and tones you over all.

Also practice not going to the toilet the very instant you feel the need to urinate, instead try waiting 10 minutes, or more if you can. When we are home based we tend to “conveniently” go to the toilet more often than if we were out shopping, or in a work environment where we would have to wait for a “break”.

The more your bladder is naturally trained to “hold on” until it is convenient for you to “go” the better for you. It may even make the difference in being able to “hold on” at night until your body is able to wake you up, to leave the bed for the bathroom.

Women who have had children often have very weak bladders after childbirth and may need surgery to remedy this.

If the above home remedies don’t work, you need to see your doctor for the latest update on treatments available.

14. Sleep Walking

Parasomnias include a variety of disorders such as sleep walking (somnambulism), night eating, sleep-related bruxism (tooth grinding), nightmares, night terrors, and REM sleep behavior disorder.

Parasomnias occur most commonly in children, but adults can experience parasomnias at any age.

For example, night eating appears to occur most commonly in young female patients, and REM sleep behavior disorder appears to be most common in elderly men.

Most parasomnias involve some behavioral abnormality that occurs during sleep. For example, sleepwalkers may rise from bed, walk about the house, and finally come to rest somewhere other than their beds.

While most sleep walking is benign, some sleepwalkers engage in remarkable behaviors during their excursions, such as eating during sleep.

Some parasomnias involve some violent (e.g., hitting a spouse), bizarre or unhealthy (e.g., eating large amounts of food or unusual food items), or even criminal behavior during sleep.

Parasomnias require a careful evaluation by a physician. Behavioral treatments or medications may be appropriate.

One of the doctor’s primary concerns is the health and safety of the patient, as well as the safety of others in the patient’s environment.

Sleepwalking, often occurring very early in the night, is most common for children between the ages of three and seven.

Sleepwalking can run in the family, but sometimes suggests the presence of other problems, such as sleep apnea.

Sleepwalking is experienced by as many as 40 percent of children, usually between ages three and seven. Sleepwalking usually occur an hour or two after sleep onset and may last five to 20 minutes. As sleep deprivation often contributes to sleepwalking, moving bedtime earlier can be helpful.

Sleepwalking, like night terrors, tends to run in families. This problem emerges more frequently sometime after age 6.

A child can get up and walk around while still in a sleep state.

Gently guide the sleepwalker back to bed; you may not be able to wake him up fully.

At times, the child can open doors and go outside. Make sure your house is safe for your child’s wanderings.

When the problem is this severe and can possibly endanger the child, medication is used.

Generally the child should be led back to bed without attempting to awaken him.

Sleepwalking tends to spontaneously resolve.

12. Narcolepsy

Narcolepsy is a chronic (long-lasting) neurological (affecting the brain or nerves) disorder that involves your body's central nervous system. The central nervous system is the "highway" of nerves that carries messages from your brain to other parts of your body.

For people with narcolepsy, the messages about when to sleep and when to be awake sometimes hit roadblocks or detours and arrive in the wrong place at the wrong time.

This is why someone who has narcolepsy, not managed by medications, may fall asleep while eating dinner or engaged in social activities - or at times when he or she wants to be awake.

Recent discoveries indicate that people with narcolepsy lack a chemical in the brain called hypocretin, which normally stimulates arousal and helps regulate sleep.

They also discovered that there is a reduction in the number of Hcrt cells or neurons that secrete hypocretin. This may be due to a degenerative process or an immune response. How this occurs is unknown.

About one in 2,000 people suffers from narcolepsy. It affects both men and women of any age, but its symptoms are usually noticed after puberty begins. For the majority of persons with narcolepsy, their first symptoms appear between the ages of 15 and 30.

Major symptoms

Excessive daytime sleepiness is usually the first symptom to appear, and often the most troubling. It is an overwhelming and recurring need to sleep at times when you want to be awake. In addition to sleepiness, key symptoms of narcolepsy can include regular episodes of:

cataplexy - a sudden loss of muscle control ranging from slight weakness (head droop, facial sagging, jaw drop, slurred speech, buckling of knees) to total collapse. It is commonly triggered by intense emotion (laughter, anger, surprise, fear) or strenuous athletic activity. Most persons with narcolepsy have some degree of cataplexy.

sleep paralysis - being unable to talk or move for a brief period when falling asleep or waking up. Many persons with narcolepsy suffer short-lasting partial or complete sleep paralysis.

hypnagogic hallucinations - vivid and often scary dreams and sounds reported when falling asleep. People without narcolepsy may experience hypnagogic hallucinations and sleep paralysis as well.

automatic behavior - familiar, routine or boring tasks performed without full awareness or later memory of them.

Diagnosing Narcolepsy

In addition to a medical history and physician examination, a diagnosis is made from polysomnogram tests in an overnight sleep laboratory to measure brain waves and body movements as well as nerve and muscle function.

A diagnosis also includes the results of the Multiple Sleep Latency Test (MSLT), which measures the time it takes to fall asleep and to go into deep sleep while taking several naps over a period of time.

Many physicians are not familiar with identifying the symptoms and diagnostic procedures specific to narcolepsy. Often, these symptoms are associated with other disorders. Asking for a referral to a sleep specialist or sleep center will avoid the delay in both diagnosis and treatment so often experienced by those who suffer from this serious disorder.

Treatment options

The best treatment plan is the one that works for you. Treatment with medications is the first line of defense. The goal in using medications should be to approach normal alertness while minimizing side effects and disruptions to daily activities.

Changes in behavior combined with drug treatment have helped most persons with narcolepsy improve their alertness and enjoy an active lifestyle.

Common medications and side effects

Doctors generally prescribe stimulants to improve alertness and antidepressants to control cataplexy, hypnagogic hallucinations and sleep paralysis.

Common stimulants include: dextroamphetamine sulfate (DexedrineTM), methylphenidate hydrochloride (RitalinTM), and pemoline (CylertTM). Methamphetamine hydrochloride (DesoxynTM) is prescribed less frequently for narcolepsy.

Some of the most common side effects of stimulants are headache, irritability, nervousness, insomnia, irregular heart beat, and mood changes.

A wake-promoting drug, modafinil (ProvigilTM) was approved by the U.S. Food and Drug Administration (FDA) in 1999 for use in treating the excessive daytime sleepiness associated with narcolepsy.

It does not act as a stimulant for other body systems and studies have shown that modafinil is effective in improving alertness with few side effects and low abuse potential.

Several classes of antidepressants are prescribed to treat cataplexy, hypnagogic hallucinations and sleep paralysis. One class, multicyclics, includes imipramine (TofranilTM), desimpramine (NorpraminTM), clomipramine (AnafranilTM), and protriptyline (VivactilTM).

Another class are selective serotonin re-uptake inhibitors (SSRIs). These include fluoxetine (ProzacTM), paroxetine (PaxilTM), and sertraline (ZoloftTM).

Side effects vary from one class of antidepressants to another. Those most often reported are drowsiness, sexual dysfunction and lowered blood pressure. In a small percentage of patients, SSRIs cause overexcitement, anxiety, insomnia, nausea and reduced sexual drive.

Sodium oxybate (XyremTM) is the first and only FDA-approved medication for the treatment of cataplexy associated with narcolepsy. It produces consolidation of sleep and improvement of disturbed nighttime sleep characteristic of narcolepsy.

It is sedating and should only be used at night. Xyrem is a Schedule III controlled drug substance with abuse potential that is available by prescription.

Narcolepsy patients who have other health conditions (like high blood pressure, heart disease or diabetes) should ask their doctor or pharmacist how medications for those conditions may interact with those taken for narcolepsy. If you take over-the-counter cold and allergy medications, keep in mind that they may make you sleepy.

Narcolepsy is a rare condition that affects approximately 0.05% of the population, with symptoms peaking between the ages of 15 and 20.

Narcolepsy is marked by excessive daytime sleepiness which can be so severe that it interferes with functioning and sometimes results in unexpected “sleep attacks.”

People with narcolepsy often report the associated symptoms of sleep paralysis, hypnogogic hallucinations, cataplexy, and automatic behavior.

Sleep paralysis usually occurs when the sleeper is lying in bed prior to sleep onset or after awakening. He or she is unable to move for a few seconds, minutes, or longer. Sometimes sleepers can move only their eyes. The episodes are generally harmless, although they can result in genuine distress for the sufferer.

Narcolepsy is a chronic (long-lasting) neurological (affecting the brain or nerves) disorder that involves your body's central nervous system. The central nervous system is the "highway" of nerves that carries messages from your brain to other parts of your body.

For people with narcolepsy, the messages about when to sleep and when to be awake sometimes hit roadblocks or detours and arrive in the wrong place at the wrong time.

This is why someone who has narcolepsy, not managed by medications, may fall asleep while eating dinner or engaged in social activities - or at times when he or she wants to be awake.

Recent discoveries indicate that people with narcolepsy lack a chemical in the brain called hypocretin, which normally stimulates arousal and helps regulate sleep.

They also discovered that there is a reduction in the number of Hcrt cells or neurons that secrete hypocretin. This may be due to a degenerative process or an immune response. How this occurs is unknown.

About one in 2,000 people suffers from narcolepsy.

It affects both men and women of any age, but its symptoms are usually noticed after puberty begins. For the majority of persons with narcolepsy, their first symptoms appear between the ages of 15 and 30.

Hypnogogic hallucinations also generally occur when the sleeper is lying in bed prior to sleep onset or after awakening. The sufferer may experience auditory, visual, tactile, or olfactory (smell) hallucinations for brief periods.

People sometimes describe these as brief, dreamlike experiences. Although these experiences are not concerning to many, some people can have terrifying or disturbing hallucinations that cause them great distress.

Cataplexy is characterized by the sudden loss of muscle tone while awake. The sufferer may experience a mild, transient drop in muscle tone (e.g., a droopy arm or periods of clumsiness associated with dropping things), or may experience severe loss of muscle tone that literally results in falling to the floor, and speech can be affected during the attacks.

Cataplexy often is brought on by stress, fatigue, or the experience of intense emotion such as anger or laughter. Narcolepsy and cataplexy are so rare that healthcare providers often fail to accurately diagnose the problem.

Automatic behavior refers to actions for which the person has no memory. Sometimes the sufferer reports that she is acting in a “fog.” For example, one woman with narcolepsy entered her dining room to find a beautiful vase on her table.

She had no idea where it came from until she looked at her checkbook and realized that she had purchased it on a recent shopping trip. Both the vase and the shopping trip had been forgotten! Automatic behavior probably is due to severe sleepiness.

Narcolepsy often is diagnosed in a sleep laboratory facility. One diagnostic indicator of narcolepsy is the occurrence of rapid-eye-movement (REM) sleep on daytime nap testing.

Narcolepsy usually is treated with stimulant medication to address daytime sleepiness, and tricyclic or other medications to address sleep paralysis, hypnogogic hallucinations, and cataplexy. These medications include stimulants such as methylphenidate

"Stop Your Snoring For Good - Without Undertaking Surgery, Getting Dental Implant, Taking Medicine, Or Wearing Any Devices While Sleeping. Practice a few easy exercises for three minutes a day, whenever you feel like it, and cure your snoring permanently!” the stop snoring exercise program

Is It Possible to Reduce Your Sleep by 3 Hours, and Have More Energy in Your Life than When You Slept 8 Hours or Longer?

What Would It Be Like to Have 27 Hours in Your Day Instead of 24?

There’s actually a method to optimize your body’s inner sleep system to sleep less, and have more energy in your life than when you slept LONGER. Sleep expert Kacper Postawski spills the beans in his fascinating new ebook “Powerful Sleep.”

While most people think sleep is just “sleep,” it is actually a complex and fascinating system which you can OPTIMIZE in order to sleep less, and create an abundance of energy in your life.

In this fascinating new eBook, Kacper Postawski shares with you:

* The four most important elements which your inner sleep clock relies on to determine when to sleep, how long you sleep, and how energizing your sleep is. Discovering these principles will allow you to gain a firm understanding of how to gain control over your sleep and daily energy level.

* How to optimize your Inner Sleep Clock so that it's possible for you to reduce your sleep by up to 3 hours, and increase the quality, and power of your sleep (If you don't do this, you will do more damage to your body than good by sleeping less.)

* What really happens to your body while you sleep? While most people think sleep is just "sleep", your body is busier when you're sleeping than when you're awake. The inner sleep system is a complex mechanism which is affected by many things you do on a daily basis. (Most of them you're not aware of). This is a key understanding to optimizing your sleep.

“Powerful Sleep - Secrets of the Inner Sleep Clock” can show you how to reduce your sleep by up to 3 hours, create more time, and an abundance of energy in your body by sleeping LESS! Not more. This system dispels the “8 hour sleep myth”, tells you what most people never realize about sleep, and what the drug companies DONT WANT YOU to know. Go to: www.PowerfulSleep.com to find out more about Powerful Sleep Aids.

Get your free copy of Optimum Health Lifetime Sleep Cycles with sleep aid tips for all ages and a Bonus Section on how to prevent kids sleep problems as well.
Sleep Cycles Free self help Book

A - Z Dream Meanings: How to interpret your dreams when you finally do get to sleep!
Dream Meanings Free self help Book

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