Emery Sleep Solutions

Sleep Disorders FAQ

	What is Sleep Apnea? ______________________________________________________ Sleep Apnea is a disorder of breathing during sleep. Typically it is accompanied by loud snoring. Apnea during sleep consist of brief periods throughout the night in which breathing stops. People with sleep apnea do not get enough oxygen during sleep. There are 2 major types. Obstructive Sleep Apnea is the most common type and is due to an obstruction in the throat during sleep. Bed partners notice pauses approx. 10 to 60 seconds between loud snores. The narrowing of the upper airway can be a result of several factors including inherent physical characteristics, excess weight, and alcohol consumption before sleep. Central Sleep Apnea - caused by a delay in the signal form the brain to breath. With both obstructive and central apnea you must wake up briefly to breathe, sometimes hundreds of times during the night. Usually there is no memory of these brief awakenings. Most common symptoms: Loud Snoring Waking up unrefreshed and having trouble staying awake during the day Waking up with headaches Waking up during the night with the sensation of choking Waking up sweating Frequent trips to the bathroom during the night Insomnia - problem staying asleep Being overweight but not necessary Waking and gasping for air Is this a serious condition? It is a potentially life-threatening condition that may require immediate medical attention. The risks of undiagnosed obstructive sleep apnea include heart attacks, strokes, impotence, irregular heartbeat, high blood pressure and heart disease. In addition, obstructive sleep apnea causes daytime sleepiness that can result in accidents, lost productivity and interpersonal relationship problems. The severity of the symptoms may be mild, moderate or severe. How is Sleep Apnea treated? Mild Sleep Apnea is usually treated by some behavioral changes. Losing weight, sleeping on your side are often recommended. There are oral mouth devices (that help keep the airway open) on the market that may help to reduce snoring in three different ways. Some devices (1) bring the jaw forward or (2) elevate the soft palate or (3) retain the tongue (from falling back in the airway and blocking breathing). Sleep Apnea is a progressive condition (gets worse as you age) and should not be taken lightly. Moderate to severe Sleep Apnea is usually treated with a C-PAP (continuous positive airway pressure). CPAP is a machine that blows air into your nose via a nose mask, keeping the airway open and unobstructed. For more severe apnea, there is a Bi-level (Bi-PAP) machine. The BI-level machine is different in that it blows air at two different pressures. When a person inhales, the pressure is higher and in exhaling, the pressure is lower. Your sleep doctor will "prescribe" your pressure and a home healthcare company will set it up and provide training in its use and maintenance. Some people have facial deformities that may cause the sleep apnea. It simply may be that their jaw is smaller than it should be or they could have a smaller opening at the back of the throat. Some people have enlarged tonsils, a large tongue or some other tissues partially blocking the airway. Fixing a deviated septum may help to open the nasal passages. Removing the tonsils and adenoids or polyps may help also. Children are much more likely to have their tonsils and adenoids removed. There are several other surgical treatments. Usually a surgeon will ask the patient to be on CPAP for at least month to see if they get better. If CPAP cannot help then surgery is probably not the right thing to do. These treatments include, removing excess tissue to clear the airway, moving the tongue forward, and moving the upper and lower jaw forward. There and other procedures try to increase the size of the upper airway. Insomnia___________________________________________________________________ There are four major types of Insomnia: Difficulty falling asleep No problem falling asleep but difficulty staying asleep (many awakenings) Waking up too early Sleep State Misperception What can cause Insomnia? Many things can cause insomnia. Insomnia is not a disorder it is a complaint. The goal is to find the underlying problem causing the complaint. Almost any sleep disorder can present themselves as insomnia including circadian disorders, sleep apnea, restless legs, and the list goes on. So ruling out a sleep disorder can be important. Medications, herbs and caffeine can cause insomnia. Most medications will report the possible side effect of insomnia and sleepiness. The same medication can cause both since we all react to medications differently. Life events can cause insomnia but it is usually temporary. Anxiety about falling asleep can also be responsible, however, if the anxiety is due to a long history of insomnia, the anxiety is probably not the problem and you need to find out what is the underlying cause. Once sleep is restored to normal the anxiety will usually go away. Physical problems such as pain can be the underlying cause. There is also the possibility of mental problems, and a good sleep doctor that works with insomnia can rule this in or out sometimes without an all night sleep study. This problem can be treated using many different techniques. (More information coming) Three basic types of Insomnia: Transient insomnia - lasting for a few nights Short-term insomnia - two or four weeks of poor sleep Chronic insomnia - poor sleep that happens most nights and last a month or longer Transient and short-term insomnia generally occur in people who are temporarily experiencing one or more of the following: • stress • environmental noise • extreme temperatures change in the surrounding environment • sleep/wake schedule problems such as those due to jet lag • medication side effects Chronic insomnia is more complex and often results from a combination of factors, including underlying physical or mental disorders. One of the most common causes of chronic insomnia is depression. Other underlying causes include arthritis, kidney disease, heart failure, asthma, sleep apnea, restless legs syndrome, Parkinson's disease, and hyperthyroidism. However, chronic insomnia may also be due to behavioral factors, including the misuse of caffeine, alcohol, or other substances; disrupted sleep/wake cycles as may occur with shift work or other nighttime activity schedules; and chronic stress. In addition, the following behaviors have been shown to perpetuate insomnia in some people: poor sleep hygiene in general expecting to have difficulty sleeping and worrying about it ingesting excessive amounts of caffeine drinking alcohol before bedtime smoking cigarettes before bedtime excessive napping in the afternoon or evening irregular or continually disrupted sleep/wake schedule Difficulty sleeping is only one of the symptoms. Daytime symptoms include: Sleepiness Anxiety Impaired concentration Impaired memory Treatment for transient and short-term insomnia: Transient and short-term insomnia may not require treatment since episodes last only a few days at a time. For example, if insomnia is due to a temporary change in the sleep/wake schedule, as with jet lag, the person's biological clock will often get back to normal on its own. However, for some people who experience daytime sleepiness and impaired performance as a result of transient insomnia, the use of short-acting sleeping pills may improve sleep and next-day alertness. As with all drugs, there are potential side effects. The use of over-the-counter sleep medicines is not usually recommended for the treatment of insomnia. Treatment for chronic insomnia consists of: * First, diagnosing and treating underlying medical or psychological problems. * Identifying behaviors that may worsen insomnia and stopping (or reducing) them. * Possibly using sleeping pills, although the long-term use of sleeping pills for chronic insomnia is controversial. A patient taking any sleeping pill should be under the supervision of a physician to closely evaluate effectiveness and minimize side effects. In general, these drugs are prescribed at the lowest dose and for the shortest duration needed to relieve the sleep-related symptoms. For some of these medicines, the dose must be gradually lowered as the medicine is discontinued because, if stopped abruptly, it can cause insomnia to occur again for a night or two. Trying behavioral techniques to improve sleep, such as relaxation therapy, sleep restriction therapy, reconditioning, and bright light. Relaxation Therapy.There are specific and effective techniques that can reduce or eliminate anxiety and body tension. As a result, the person's mind is able to stop "racing," the muscles can relax, and restful sleep can occur. It usually takes much practice to learn these techniques and to achieve effective relaxation. Sleep Restriction. Some people suffering from insomnia spend too much time in bed unsuccessfully trying to sleep. They may benefit from a sleep restriction program that at first allows only a few hours of sleep during the night. Gradually the time is increased until a more normal night's sleep is achieved. Reconditioning. Another treatment that may help some people with insomnia is to recondition them to associate the bed and bedtime with sleep. For most people, this means not using their beds for any activities other than sleep and sex (some experts even say using the bed for sex can cause performance anxiety which could lead to insomnia). As part of the reconditioning process, the person is usually advised to go to bed only when sleepy. If unable to fall asleep, the person is told to get up, stay up until sleepy, and then return to bed. Throughout this process, the person should avoid naps and wake up and go to bed at the same time each day. Eventually the person's body will be conditioned to associate the bed and bedtime with sleep. Bright Light. If you are having trouble getting to sleep early enough at night it will help to wake up at the same time every morning and try to get as much bright light in the morning as possible. This will help reset the internal clock to an earlier time at night for sleep. If you are having trouble staying awake in the evening and waking up too early in the morning then try to get bright light in the evening. This will help rest the internal clock to go to sleep later and wake up later. You may want to avoid early morning light using this method until you have stabilized your sleeping pattern. Sleep State Misperception: Many people will sleep most of the night and believe they didn't sleep at all. Sleep State Misperception can cause anxiety which increases the symptoms. All night sleep recordings show normal sleep, but the next morning the patient will report not sleeping. Seeing their sleep data and education can help with this problem. If you feel you are not sleeping at all during the night but are not sleepy the next day you may have this complaint. Narcolepsy_________________________________________________________________ Narcolepsy is a chronic sleep disorder characterized by overwhelming daytime drowsiness and sudden attacks of sleep. People with narcolepsy often find it difficult to stay awake for long periods of time, regardless of the circumstances. Narcolepsy can cause serious disruptions in your personal and professional lives. Some people mistake narcolepsy for depression, seizure disorder, fainting, simple lack of sleep, or other conditions that may cause abnormal sleep patterns. Narcolepsy is a chronic condition that doesn't go away completely. Although there's no cure for narcolepsy, medications and lifestyle changes can help you manage the symptoms. And talking to others — family, friends, employer, teachers — can help you cope better with narcolepsy. Signs and symptoms: The signs and symptoms of narcolepsy include: Excessive daytime sleepiness. The primary characteristic of narcolepsy is overwhelming drowsiness and an uncontrollable need to sleep during the day. People with narcolepsy fall asleep without warning, anywhere and at any time. For example, you may suddenly nod off while at work or talking with friends. You may sleep for just a few minutes or up to a half-hour before awakening and feeling refreshed, but then you fall asleep again. In addition to sleeping at inappropriate times and places, you also may experience decreased alertness throughout the day. Excessive daytime sleepiness usually is the first symptom to appear and is often the most troublesome, making it difficult for you to concentrate and function fully. Sudden loss of muscle tone. This condition, called cataplexy, can cause a range of physical changes, from slurred speech to complete weakness of most muscles, and may last for a few seconds to a few minutes. Cataplexy is uncontrollable and is often triggered by intense emotions, usually positive ones such as such as laughter or excitement, but sometimes fear, surprise or anger. For example, your head may droop uncontrollably or your knees may suddenly buckle when you laugh. Some people with narcolepsy experience only one or two episodes of cataplexy a year, while others have numerous episodes each day. About 70 percent of people with narcolepsy experience cataplexy. Sleep paralysis. People with narcolepsy often experience a temporary inability to move or speak while falling asleep or upon waking. These episodes are usually brief — usually lasting only several seconds to several minutes — but they can be frightening. You may be aware of the condition and have no difficulty recalling it afterward, even if you had no control over what was happening to you. This sleep paralysis mimics the type of temporary paralysis that normally occurs during rapid eye movement (REM) sleep, the period of sleep during which most dreaming occurs. This temporary immobility during REM sleep may prevent your body from acting out dream activity. Not everyone with sleep paralysis has narcolepsy, however. Many normal people experience a few attacks of sleep paralysis, especially in young adulthood. Hallucinations. These hallucinations, called hypnagogic hallucinations, may take place when a person with narcolepsy falls quickly into REM sleep, as they do at sleep onset at night and periodically during the day. Because you may be semiawake when you begin dreaming, you experience your dreams as reality, and they may be particularly vivid and frightening. Screening and diagnosis: Your doctor may make a preliminary diagnosis of narcolepsy based on your experience of both excessive daytime sleepiness and sudden loss of muscle tone (cataplexy). After an initial diagnosis, your doctor may refer you to a sleep specialist for additional studies and evaluation. Formal diagnosis may require staying overnight at a sleep center where you undergo an in-depth analysis of your sleep by a team of specialists. Methods of diagnosing narcolepsy and determining its severity include: Sleep questionnaire. The Epworth Sleepiness Scale uses a series of short questions to diagnose narcolepsy. You'll rank on a numbered scale whether certain situations, such as sitting down after lunch, make you sleepy and, if so, how sleepy. Polysomnogram. This test involves a variety of measuring tactics conducted through electrodes placed on your scalp before you fall asleep. For this test, you must stay overnight for observation at a medical facility. The test measures the electrical activity of your brain (electroencephalogram) and heart (electrocardiogram), and the movement of your muscles (electromyogram) and eyes (electro-oculogram). Multiple sleep latency test. This method measures how long it takes for you to fall asleep during the day. You'll be asked to fall asleep for a series of four or five naps, each nap two hours apart. Specialists will observe your sleep patterns. People who have narcolepsy fall asleep easily and enter into rapid eye movement (REM) sleep quickly. These tests also can help doctors rule out other possible causes of your signs and symptoms. Other sleep disorders, such as sleep apnea, can cause excessive daytime sleepiness. Treatment: Narcolepsy has no cure, but medications and lifestyle modifications can help you manage the symptoms. Medications include: Stimulants. Drugs that stimulate the central nervous system are the primary treatment to help people with narcolepsy stay awake during the day. Modafinil (Provigil), a newer stimulant, isn't as addictive and doesn't produce the highs and lows often associated with older stimulants. Some people need treatment with methylphenidate (Ritalin) or various amphetamines. Although these medications are effective, they may cause side effects, such as nervousness and heart palpitations, and can be addictive. Antidepressants. Doctors often prescribe antidepressant medications, which suppress REM sleep, to help alleviate the symptoms of cataplexy, hypnagogic hallucinations and sleep paralysis. These medications include the tricyclic antidepressants protriptyline (Vivactil) and imipramine (Tofranil). Sodium oxybate (Xyrem). This medication controls cataplexy, sleep paralysis and hallucinations in people with narcolepsy. Sodium oxybate helps to improve nighttime sleep, which is often poor in narcolepsy. In high doses it may also help control daytime sleepiness, even though you take it only at night. However, because the use of this drug has been associated with serious side effects, such as trouble breathing during sleep, sleepwalking and bed-wetting, it's strictly regulated by the Food and Drug Administration. If you have other health problems, such as high blood pressure or diabetes, ask your doctor how medications for existing conditions may interact with those taken for narcolepsy. Certain over-the-counter drugs, such as allergy and cold medications, can cause drowsiness as a side effect. If you have narcolepsy, your doctor will likely recommend that you avoid taking these medications. Medications to treat narcolepsy can help reduce your signs and symptoms, but they can't alleviate them entirely. Lifestyle changes also are an integral part of treating narcolepsy. Restless Leg Syndrome______________________________________________________ Restless Legs Syndrome (RLS) affects up to 10% of American adults. They may have difficulty lying down and sleeping, or sitting down and relaxing, because their legs just won't let them. Air travel and long car trips are a trial. Even enjoying a television show may be more than they can manage. Restless Legs Syndrome can have a significant physical and emotional impact on sufferers. Symptoms may interfere with their sleep, and as a result, they may feel sleepy during the day, too tired to participate in their daily activities. Restless Legs Syndrome is a real medical condition, like diabetes, depression, or high blood pressure. Many people are unaware that there is a name for their condition: it's called Restless Legs Syndrome. People with Restless Legs Syndrome describe their symptoms in many ways. The International Restless Legs Syndrome Study Group (IRLSSG) has categorized RLS symptoms into four major areas that must be present for diagnosis: There is a compelling urge to move the legs, usually accompanied or caused by uncomfortable and unpleasant sensations in the legs. Because the sensations that accompany RLS are unusual, patients may have a hard time describing them. They may use words like uncomfortable, creeping, itching, pulling, or creepy-crawly to describe feelings inside the leg. It is not uncommon for the sensations to spread to the arms or other body parts, in addition to the legs. The symptoms are partially or completely relieved by movement, as long as the movement continues. The urge to move is irresistible, and the only way to stop or partially relieve the sensations is to move around. However, the relief is not always complete and ends when the activity ends. The symptoms begin or worsen during periods of rest or inactivity, such as lying or sitting. This doesn't necessarily mean sleep - any prolonged period of inactivity, such as sitting in a chair in the evening, traveling by plane, train, or car, as well as sitting behind a desk or in a movie theater seat - can trigger symptoms. The more restful the position and the longer the duration, the more likely it becomes that the symptoms will occur. The symptoms are worse or only occur in the evening and at night. Morning often brings some relief to people with RLS, as symptoms occur most frequently during the early evening and overnight. Studies show RLS symptoms peak between the hours immediately after midnight and lessen in the late morning. Although Restless Legs Syndrome is a fairly common medical condition, its exact cause is unknown. Restless Legs Syndrome is a physical condition, which many researchers believe may be related to dopamine. Dopamine is a chemical that carries the signals between nerve cells that control body movement. When the dopamine system does not function properly, it may upset the normal communication of these signals. There are two forms of Restless Legs Syndrome: primary and secondary. Primary Restless Legs Syndrome: While the exact cause of primary Restless Legs Syndrome is unknown, patients with primary Restless Legs Syndrome often report having a family member with Restless Legs Syndrome symptoms. Secondary Restless Legs Syndrome: Restless Legs Syndrome caused by other underlying medical conditions is called secondary Restless Legs Syndrome. It is important for your healthcare provider to rule out causes of secondary Restless Legs Syndrome when evaluating your symptoms. Conditions that are associated with secondary Restless Legs Syndrome include: Iron deficiency Renal (kidney) failure Pregnancy What is treatment for Restless Leg Syndrome? Treatment of restless leg syndrome is first directed toward any underlying illness, if known. For example, a search for iron deficiency by blood testing to reveal underlying iron deficiency anemia. Reduction or elimination of caffeine and alcohol can be very helpful. Stopping smoking can also diminish symptoms. Getting better sleep and exercise can help some persons affected by restless legs. Medications used to treat restless leg syndrome include carbidopa-levodopa, opioids (such as propoxyphene) or tramadol (Ultram) for intermittent symptoms, carbamazepine, clonazepam, diazepam, triazolam, temazepam, baclofen, bromocriptine and clonidine. Also, recently, gabapentin (Neurontin) has been found helpful. The FDA has now approved ropinirole (Requip) for the treatment of restless leg syndrome. Other treatments that have been helpful for some patients include avoiding caffeine, warm/cold baths, electric nerve stimulation, oral magnesium, and acupuncture. Restless Leg Syndrome At A Glance Restless leg syndrome is a condition marked by unpleasant leg sensations at bedtime. Restless leg syndrome frequency leads to insomnia. The cause of restless leg syndrome is unknown in most patients, but many conditions have been associated with it. Treatment of restless leg syndrome is directed toward any underlying illness, if known. Medications are available for restless leg syndrome. Sleepwalking_______________________________________________________________ Sleepwalking is a Sleep Disorder characterized by walking or other activity while seemingly still asleep. Sleepwalking (Somnambulism) is a series of complex behaviors that are initiated during slow wave sleep and result in walking during sleep. Sleepwalking is a rapid eye movement (REM) behavior disorder occurring in the dream stage of sleep. During this phase, the body releases a chemical that paralyzes the body. However, those who sleepwalk do not have this chemical trigger, hence the behavior. Symptoms and Features Ambulation (walking or moving about) that occurs during sleep. The onset typically occurs in pre-pubertal children. Difficulty in arousing the patient during an episode Amnesia following an episode Episodes typically occur in the first third of the sleep episode Polysomnographic monitoring demonstrates the onset of an episode during stage 3 or 4 sleep Other medical and psychiatric disorders can be present but do not account for the symptom The ambulation is not due to other sleep disorders such as REM sleep behavior disorder or sleep terrors. Fatigue (which is not the same as drowsiness) Stress and Anxiety The normal sleep cycle involves distinct stages from light drowsiness to deep sleep. Rapid eye movement (REM) sleep is a different type of sleep, in which the eyes move rapidly and vivid dreaming is most common. During a night, there will be several cycles of non-REM and REM sleep. Sleep walking (somnambulism) most often occurs during deep non-REM sleep (stage 3 or stage 4 sleep) early in the night. It can occur during REM sleep near morning. In children, the cause is usually unknown but may also be related to fatigue, prior sleep loss, or anxiety. In adults, sleep walking is usually associated with a disorder of the mind but may also be seen with reactions to drugs and/or medications and alcohol, and medical conditions such as partial complex seizures. In the elderly, sleep walking may be a symptom of an organic brain syndrome or REM behavior disorders. The sleep walking activity may include simply sitting up and appearing awake while actually asleep, getting up and walking around, or complex activities such as moving furniture, going to the bathroom, dressing and undressing, and similar activities. Some people even drive a car while actually asleep. The episode can be very brief (a few seconds or minutes) or can last for 30 minutes or longer. One common misconception is that a sleep walker should not be awakened. It is not dangerous to awaken a sleep walker, although it is common for the person to be confused or disoriented for a short time on awakening. Another misconception is that a person cannot be injured when sleep walking. Actually, injuries caused by such things as tripping and loss of balance are common for sleep walkers. Sleep walking occurs at any age, but it occurs most often in children aged 6 to 12 years old. It may occur in younger children, in adults, or in the elderly, and it appears to run in families. Sleepwalking (somnambulism) is fairly common, especially among children. An estimated 15 percent of all children between the ages of 5 and 12 have walked in their sleep at least once, and most outgrow the disorder. Typically, the child (or adult) sleepwalker sits up, gets out of bed, and moves about in an uncoordinated manner. Less frequently, the sleepwalker may dress, open doors, eat, or go to the bathroom without incident and usually will avoid obstacles. But sleepwalkers don't always make their rounds in safety. They sometimes hurt themselves, stumbling against furniture and losing their balance, going through windows, or falling down stairs. In children, sleepwalking is not believed to be influenced by psychological factors. In adults, it could indicate a personality disturbance. Usually, it is enough for parents of sleepwalkers to provide their children with emotional support. They should also lock windows and doors and make sure the child does not sleep near stairways and potentially dangerous objects. For severe cases, a doctor may prescribe drugs. Medical reports show that about 18% of the population are prone to sleepwalking. It is more common in children than in adolescents and adults. Boys are more likely to sleepwalk than girls. The highest prevalence of sleepwalking was 16.7% at age 11 to 12 years of age. Sleepwalking can have a genetic tendency. If a child begins to sleepwalk at the age of 9, it often lasts into adulthood. For some, the episodes of sleepwalking occur less than once per month and do not result in harm to the patient or others. Others experience episodes more than once per month, but not nightly, and do not result in harm to the patient or others. In its most severe form, the episodes occur almost nightly or are associated with physical injury. The sleepwalker may feel embarrassment, shame, guilt, anxiety and confusion when they are told about their sleepwalking behavior. Amnesia is another danger that usually follows a sleepwalking episode. Sleepwalkers usually remember little to nothing. But there are times sleepwalkers have a vague memory of an episode where they think they were being burned, buried alive, caught under a roof or trying to escape a dangerous situation. Sleepwalking primarily occurs in young children and is more prevalent in boys than girls. Sleepwalking episodes can range from sitting up in bed to walking, and can even lead to frantic attempts to escape as if threatened or fleeing. During an episode, a sleepwalker exhibits behaviors such as sitting up with glassy eyes, picking at the blankets, making body movements and walking around the house. Sleepwalkers may also urinate, defecate or avoid looking at another person who attempts to communicate with them. Exiting through a window is not an uncommon practice, either. Homicide or suicide during sleepwalking has rarely been reported when a person has tried to awaken a sleepwalker. Sleepwalking can be treated with drugs, but hypnosis has also proven to be successful on a short-term basis. An important component in dealing with this disorder is to make the environment as safe as possible, such as having sleepwalker's bedroom on the ground floor, removing hazardous items from the house, locking windows and placing an alarm on the bedroom door. It is very important that if the sleepwalker exits the house, or is having frequent episodes and injuries are occurring -- DO NOT delay, it is time to seek professional help. In a few instances, sleepwalking can result in violent behavior. It is very important that a chronic sleepwalker seek professional help. Treatment: There are some things a sleepwalker can do: Make sure you get plenty of rest; being overtired can trigger a sleepwalking episode. Develop a calming bedtime ritual. Some people meditate or do relaxation exercises; stress can be another trigger for sleepwalking. Remove anything from the bedroom that could be hazardous or harmful. The sleepwalker's bedroom should be on the ground floor of the house. The possibility of the patient opening windows or doors should be eliminated. An assessment of the sleepwalker should include a careful review of the current medication so that modifications can be made if necessary. Hypnosis has been found to be helpful for both children and adults. An accurate psychiatric evaluation could help to decide the need for psychiatric intervention. Sleep Terrors________________________________________________________________ Sleep Terrors are characterized by a sudden arousal from slow wave sleep with a piercing scream or cry, accompanied by autonomic (Controlled by the part of the nervous system that regulates motor functions of the heart, lungs, etc.) and behavioral manifestations of intense fear. Also known as Pavor Nocturnus, incubus, severe autonomic discharge, night terror. What are the symptoms of Sleep Terrors? A sudden episode of intense terror during sleep The episodes usually occur within the first third of the night Partial or total amnesia occurs for the events during the episode. Associated features include: Polysomnographic monitoring demonstrates the onset of episodes during stage 3 or 4 sleep Tachycardia usually occurs in association with the episodes Other medical disorders are not the cause of the episode, e.g., epilepsy Other sleep disorders can be present, e.g., nightmares. How serious are Sleep Terrors? Some people have episodes of sleep terror that may occur less than once per month, and do not result in harm to the patient or others. While some people experience episodes less than once per week, and do not result in harm to the patient or others. In its severest form, the episodes occur almost nightly, or are associated with physical injury to the patient or others. Consult a sleep specialist if you are concerned. Bruxism (Teeth Grinding)____________________________________________________ Bruxism is the medical term for grinding, gnashing or clenching your teeth. This condition affects both kids and adults. Some people with bruxism unconsciously clench their teeth together during the day, often when they feel anxious or tense. Most kids who have bruxism — and some adults with the condition — grind or gnash their teeth during sleep, usually in the early part of the night. This is called sleep bruxism. In most cases, bruxism is mild and may not even require treatment. However, it can be frequent and violent and can lead to jaw disorders, headaches, damaged teeth and other problems. Unfortunately, people with sleep bruxism usually aren't aware of the habit, so they aren't diagnosed with the condition until complications occur. That's why it's important to know the signs and symptoms of bruxism and to seek regular dental care. Signs and symptoms: The signs and symptoms of bruxism may include: Teeth grinding or clenching, which may be loud enough to wake your sleep partner Teeth that are worn down, flattened or chipped Worn tooth enamel, exposing the inside of your tooth Increased tooth sensitivity Jaw pain or tightness in your jaw muscles Earache — because of violent jaw muscle contractions, not a problem with your ear Dull morning headache Chronic facial pain Chewed tissue on the inside of your cheek Causes Doctors don't completely understand the causes of bruxism. In some adults, abnormal alignment of upper and lower teeth (malocclusion) may contribute to the problem. More often, psychological factors cause bruxism, including: Anxiety, stress or tension Suppressed anger or frustration Aggressive, competitive or hyperactive personality type In children, bruxism may be related to growth and development. Some researchers think children brux because their top and bottom teeth don't fit together comfortably. Others believe that children grind their teeth because of tension, anger, allergy problems, or as a response to pain from an earache or teething. Bruxism occurs in up to 30 percent of children, often around the ages of 5 and 6. It's particularly common in children with cerebral palsy or severe mental retardation. But most children outgrow bruxism before they get their adult teeth. In some cases, bruxism isn't caused by stress or dental problems. It can be a complication of another disorder, such as Huntington's disease or Parkinson's disease. It can also be an uncommon side effect of some psychiatric medications including antidepressants. Risk factors These factors increase your risk of bruxism: Stress. Increased anxiety or stress can lead to teeth grinding. So can anger and frustration. Age. Bruxism is common in young children, but usually goes away by age 10. In adults, the condition is common between the late teen years and the 40s. It tends to decrease with older age. Caffeine, nicotine and other drugs. Using caffeine, tobacco, cocaine or amphetamines seems to increase the risk of bruxism. Treatment In many cases, no treatment is necessary. Many kids outgrow bruxism without special treatment, and many adults don't brux badly enough to require therapy. However, if the problem is severe, treatment options include: Stress management. If you grind your teeth because of stress, you may be able to prevent the problem with professional counseling or strategies that promote relaxation, such as exercise and meditation. If your child grinds his or her teeth because of tension or fear, it may help to talk about your child's fears just before bed or to help your child relax with a warm bath or a favorite book. Dental approaches. If you or your child has bruxism, your doctor may suggest a mouth guard or protective dental appliance (splint) to prevent damage to your teeth. Your dentist can make a custom mouth guard to fit your mouth. Over-the-counter mouth guards are available and they're less expensive than custom guards, but they generally don't fit well and can dislodge during bruxing. If your bruxism seems to stem from dental problems, your dentist may also correct misaligned teeth. In severe cases — when tooth wear has led to sensitivity or the inability to chew properly — your dentist may need to use overlays or crowns to entirely reshape the chewing surfaces of your teeth. Behavior therapy. Once you discover that you have bruxism, you may be able to change the behavior by practicing proper mouth and jaw position. Concentrate on resting your tongue upward with your teeth apart and your lips closed. This should keep your teeth from grinding and your jaw from clenching. If you're having a hard time changing your habits, you may benefit from biofeedback, a form of complementary and alternative medicine that uses a variety of monitoring procedures and equipment to teach you to control involuntary body responses. During a biofeedback session, a therapist applies electrical sensors to different parts of your body. These sensors monitor your body's physiological responses to stress — such as teeth grinding — and then feed the information back to you via auditory and visual cues. These cues may take the form of a beeping sound or a flashing light. With this feedback, you'll start to associate teeth grinding or clenching with stress and learn to change your behavior. You may also be given a portable biofeedback device that you use at home. Your therapist will explain how it works. Medications. In general, medications aren't very effective for treatment of bruxism. In some cases, your doctor may suggest taking a muscle relaxant before bedtime. If you develop bruxism as a side effect of an antidepressant medication, your doctor may change your medication or prescribe another medication to counteract your bruxism. Botulinum toxin (Botox) injections may help some people with severe bruxism that hasn't responded to other treatments. Hypersomnia_______________________________________________________________ Hypersomnia is excessive sleepiness. It is an excessively deep or prolonged major sleep period. It may be associated with difficulty in awakening. It is believed to be caused by the central nervous system and can be associated with a normal or prolonged major sleep episode and excessive sleepiness consisting of prolonged (1-2 hours) sleep episodes of non-REM sleep. What are the Symptoms? Long sleep periods Excessive sleepiness or excessively deep sleep The onset is insidious (gradually, so you are not aware of it at first) Typically appears before age 25 Has been present for at lest six months How does a doctor determine that I have hypersomnia? The first step is to consult a sleep specialist. The specialist will probably order a polysomnography test (sleep study) where you stay overnight while Technologists monitor your muscle movement, heartbeat, eye movement, leg movements and respiration. The specialist may also want to do a Multiple Sleep Latency Test (MSLT) that tests how sleepy you are. How can it be treated? Since the cause is still unknown, treatment consists of behavioral changes, good sleep hygiene and taking stimulants to help you be more alert. Limit your naps to one (preferably in the afternoon) lasting no longer than 45 minutes. Get at least 81/2 hours of sleep. Avoid shiftwork, alcohol and caffeine. Your doctor will determine the amount and type of stimulant you should take. Sleep Deprivation___________________________________________________________ What is sleep deprivation? Many Americans don't get enough sleep to remain healthy and feel alert during the day. Recent studies have shown that Americans sleep an average of 7 hours each night rather than the 8 hours recommended by sleep experts. People who work long hours, those who have a hectic family schedule or a new baby, teens who stay up late and have to get up early for school, and even people whose pets sleep with them may get less sleep than their body needs to be at its best. Over time, this lack of sleep, also called sleep deprivation, can have serious effects on health and relationships. It may even be deadly. What are the effects of sleep deprivation? It isn't clear why we need sleep, but we do know that sleep is as important as food and water. Some experts think sleep helps the brain recharge its energy and store memories for the long term. Sleep also seems to help the body fight off infection. People who don't get enough sleep may lack energy, be depressed or irritable, have trouble remembering everyday things, and get sick more often than people who get enough sleep. They seem to age faster and they may have problems concentrating at work or school. Some scientists believe a lack of sleep may have a role in diabetes, high blood pressure, heart problems, and even obesity. Poor sleep also leads to accidents. More than 200,000 auto accidents happen each year because drivers fall asleep at the wheel. The 1989 Exxon Valdez oil spill was at least partially caused by the actions of a tired tanker operator. On the other hand, too much sleep can be as harmful as too little. Recent studies have shown that adults who get 7 to 8 hours of sleep a night live longer and are less likely to get heart disease than those who sleep less or more.