Patient: Someone recommended a sleeping tablet, and I have been sleeping ‘like a baby’.
Doctor: Really? How many have you taken?
Patient: Well, I am not actually taking them. I give them to my wife!
While most doctors have probably been faced by some patients, and explanations (or conspiracy theories) about the reasons for poor sleep, there are actually a variety of ‘medical’ sleep disorders. Sleep disorders are a group of conditions that affect the ability to sleep well on a regular basis. Sleep disorders can be caused by a health problem or by too much stress. Some people occasionally experience sleeping problems due to hectic schedules, loud neighbourhoods or other influences. However, when these issues begin to occur on a regular basis and interfere with daily life, they may indicate a sleep disorder.
Depending on the type of sleep disorder, people may have a difficult time falling asleep and may feel extremely tired throughout the day. The lack of quality sleep can have a negative impact on energy, mood, concentration, ability to work or play, and overall health.
It’s important to receive a diagnosis and treatment right away if you suspect you might have a sleep disorder. When left untreated, the negative effects of sleep disorders can lead to further adverse health consequences. They can also affect your performance at work, cause strain in relationships, and impair your ability to perform daily activities.
The symptoms associated with sleep disorders differ depending on the type and severity of the sleeping disorder. However, general symptoms of sleep disorders include difficulty falling or staying asleep; strong urge to take naps during the day or daytime fatigue; unusual breathing patterns; unusual movement or other experiences while asleep; depression, irritability or anxiety; or impaired performance at work or school.
There are different types of sleep disorders, including insomnia, sleep apnea, restless legs syndrome, parasomnias and narcolepsy.
Insomnia
Insomnia refers to the inability to fall asleep or to remain asleep. It can be caused by jet lag, stress and anxiety, hormones, or digestive problems. It may also be a symptom of another condition. Insomnia can be problematic for your overall health and quality of life, potentially causing issues like depression, or difficulty concentrating at work or school; irritability.
Unfortunately, insomnia seems to be very common (although official figures are not available).
Sleep apnea
Sleep apnea is characterised by interrupted breathing during sleep. This is a serious condition that causes the body to take in less oxygen. It can also cause you to wake up during the night.
Parasomnias
Parasomnias are a class of sleep disorders that cause abnormal movements and behaviours during sleep. They include sleepwalking, groaning, nightmares, bed wetting, teeth grinding or jaw clenching.
Restless leg syndrome
Restless legs syndrome (RLS) is an overwhelming need to move the legs. This urge is sometimes accompanied by a tingling sensation in the legs. While these symptoms can occur during the day, they are most prevalent at night. RLS is often associated with other health conditions, including attention deficit hyperactivity disorder (ADHD) and Parkinson’s disease, but the exact cause isn’t known.
Narcolepsy
Narcolepsy is characterised by “sleep attacks” that occur while awake. This means that you will suddenly feel extremely tired and fall asleep without warning. The disorder can also cause sleep paralysis, which may make you physically unable to move right after waking up. Although narcolepsy may occur on its own, it is also associated with certain neurological disorders, such as multiple sclerosis.
In some cases, sleep disorders develop as a result of an underlying health problem. Some of these conditions include:
Allergies and respiratory problems
Allergies, colds, and upper respiratory infections can make it challenging to breathe at night.
Frequent urination
Frequent urination may disrupt your sleep by causing you to wake up during the night. In our population, elderly men with large prostates and slightly younger women with uterine fibroids fall into these categories. Diseases like diabetes and heart failure, among others, are often associated with frequent urination, especially at night.
Chronic pain
Constant pain can make it difficult to fall asleep. It might even wake you up after you fall asleep. Some of the most common causes of chronic pain include conditions such as arthritis, severe headaches and low back pain.
Stress and anxiety
Stress and anxiety often have a negative impact on sleep quality. It can be difficult to fall asleep or to stay asleep. Nightmares, sleep talking, or sleepwalking may also disrupt sleep.
Nowadays, advances in medical technology, as well as advances in the new specialty of sleep medicine, have allowed improved diagnostic and treatment options for sleep disorders.
Lifestyle adjustments can help treat sleep disorders, especially when they’re done along with medical treatments. Such adjustments may include having more vegetables and fish into your diet, reducing sugar intake, reducing stress and anxiety by exercising and stretching, creating and sticking to a regular sleeping schedule, drinking less water before bedtime, and limiting your caffeine intake, especially in the late afternoon or evening. Decreasing tobacco and alcohol use, eating small low carbohydrate meals before bedtime, maintaining a healthy weight based on your doctor’s recommendations, going to bed and waking up at the same time every day can also significantly improve your sleep quality. While you might be tempted to sleep in on the weekends, this can make it more difficult to wake up and fall asleep during the workweek.
Medical treatment for sleep disturbances might include any of the following: sleeping pills, melatonin supplements, allergy or cold medication, medications for any underlying health issues, breathing device or surgery (usually for sleep apnea), a dental guard (usually for teeth grinding).
If you suspect you have insomnia, sleep apnea, or another sleep disorder, talk with your family doctor. Many sleep disorders can be managed through lifestyle changes and pharmacotherapy. Your doctor may advise you to change your sleep environment or habits, practice meditation or other relaxation strategies, prescribe medications, or suggest you have a sleep study, known as a polysomnogram, to further evaluate the cause of your sleep disturbance.
Dr Colin V Alert, MB, BS, DM, is a family physician and associate UWI family medicine lecturer.
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