Other Sleep Problems

Since the work of building up the body takes place during the hours of rest, it is essential, especially in youth, that sleep should be regular and abundant.

Ed 205

Apnea

The most studied sleep disorder is apnea, a cessation of breathing during sleep that affects nearly 20 million Americans, mostly male. The fat buildup and loss of muscle tone from aging and obesity can allow the windpipe to collapse, preventing the flow of air to the lungs. Apnea is associated with loud snoring (although not everyone who snores has apnea) and can also occur if the neurons that control breathing malfunction during sleep. A person with apnea may struggle to breathe (with a surge in blood pressure and heart rate) for 10 seconds to more than a minute, awaken, snort or gasp then resume snoring. This cycle may be repeated hundreds of times a night. Although most sufferers will not remember these brief awakenings, they can leave the person sleepy and possibly irritable and depressed. This and the disruption of a bed partner’s sleep can cause a strain on relationships.

The type of apnea described above is called obstructive sleep apnea. Another type, though much less common is called central sleep apnea, in which the airway is not blocked but the brain fails to signal the body to breathe. Some people suffer from both types of apnea.

Apnea is associated with coronary heart disease, heart attack, high blood pressure, congestive heart failure, pulmonary hypertension, stroke, neuropsychiatric problems and mental impairment. People with severe, untreated sleep apnea are two to three times more likely to have automobile accidents than the general population. The National Center on Sleep Disorders Research estimates that sleep apnea accounts for $42 million in hospital bills yearly.

Apnea can only be diagnosed through a medical evaluation, usually an overnight study at a sleep laboratory. Mild sleep apnea can often be overcome by a person losing weight, not sleeping on his or her back and/or wearing special dental or oral appliances. Severe cases may be treated with special devices such as CPAP machines worn over the nose or surgery. People with sleep apnea should never take sleeping pills or sedatives because these could prevent them from awakening enough to breathe.

Snoring

Snoring is a strong marker for sleep apnea and upper airway resistance. Simple snoring (without apnea) is sometimes considered to be at the mildest end of the sleep disordered breathing spectrum and is likely to progress. Snoring is not benign according to many experts. A study found that snoring was positively associated with the hypertension, cardiovascular disease, and diabetes. The only intervention strategy accepted at present is weight loss.

Narcolepsy

An estimated 250,000 Americans are affected by narcolepsy, having frequent daytime sleepiness and falling asleep spontaneously even if they have had a normal amount of sleep at night. These “sleep attacks” can last from several seconds to more than 30 minutes and can include cataplexy (loss of muscle control during emotional situations), hallucinations and temporary paralysis upon awakening. The disorder is usually hereditary though it can be brought on by brain damage or neurological disease. Symptoms usually appear during adolescence. Stimulants, antidepressants and other drugs can help control the symptoms. Behavioral measures to control symptoms include strategically timed naps, regular timing of nighttime sleep and avoidance of alcohol and heavy meals.

There is a genetic predisposition to narcolepsy. The gene for narcolepsy in dogs has been identified and it appears to code for a family of neuropeptides called hypocretins. The brain cells that contain hypocretins make connections with many brain regions involved in regulating the sleep-wake cycle. The hypocretins may act as signals involved in the mechanisms of homeostasis and alertness.

Restless Legs Syndrome

For about 15% of the population, sleep is made difficult by Restless Legs Syndrome (RLS), an unpleasant crawling, prickling or tickling sensation in the legs and feet and the urge to walk or move them to find relief. Although not considered serious medically, RLS makes it difficult to fall asleep and stay asleep.

Most people with RLS also have Periodic Limb Movement Disorder (PLMD) or repetitive movements of the toe, foot and sometimes the knee and hip during sleep. Sufferers may be unaware of sleep disturbances but their bed partners often are not so lucky. There is controversy in the medical community about whether PLMD is really a disorder in a clinical sense or just a symptom of another condition.

These conditions are associated with other medical conditions such as iron-deficiency anemia, pregnancy and diabetes. There is increasing evidence that iron levels are correlated with RLS. People experiencing them should consult a health care professional. RLS generally responds well to medications. Severe RLS is most common among the elderly but symptoms can develop at any age.

Sleep Bruxism

The word bruxism is derived from the Greek and means gnashing of the teeth. In simple terms “sleep bruxism” means grinding of teeth during sleep.

This is basically the reflex activity of chewing which humans undertake when they are awake. But, while they are awake this reflex activity is under the superior control of the brain, so we chew only when there´s a necessity to do so. While we´re asleep, there is no superior control of the brain and it becomes a reflex activity. Since the mouth is empty and there´s nothing for it to chew, the upper row of teeth grinds against the lower one and a loud metallic screeching sound is generated.

Though no one seems to know why sleep bruxism takes place, many doctors attribute it to disturbed sleep due to either digestive disorder or anxiety. Some other doctors are of the opinion that it´s a side effect of drugs belonging to the amphetamine group.

This is a very common sleep disorder affecting not less 45 million Americans. Sometimes the gnashing is so loud that it wakes up the sleeping partner though generally such a situation occurs once in a while only. Bruxism does not include only grinding of teeth but also clenching of jaws during sleep.

The pressure exerted by the teeth on each other is extremely high when they grind. So, this causes unnaturally high wear and tear of teeth and in some cases if the tooth is already weak for other dental reasons, it might become loose.

There´s no known method of curing bruxism. Doctors can only provide accessories which reduce the impact of the gnashing. The most common procedure is to wear an acrylic based dental guard. Some doctors also suggest that a combination of vitamin supplements reduce the severity of bruxism. But there is no clinical evidence available to prove this contention conclusively.

This year certain innovative devices have also appeared in the markets which claim to reduce the abrasive effect of bruxism to a large extent. The most innovative among them first hit the market in 2005. It has certain sensors which closely monitor the activities of the muscles which actually cause the jaws to clench. As soon as it senses that the jaws are about to come too close to each other, it partially closes the nasal aperture and forces the sleeping person to breathe through the mouth. The jaws automatically move away from each other and the teeth never grind.

This device doesn´t disturb the sleep of the affected person unlike other devices which wake them up the moment the jaws come too close to each other. Some doctors dismiss these devices as fancy fads and are very skeptical about their efficiency.