women

Sleep Disorders : Insomnia, Narcolepsy and Abnormal Daytime Sleepiness

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Insomnia

Q: What is insomnia?
A: Insomnia is the term used to describe inadequate or poor-quality sleep that may be due to one or more of the following: difficulty falling asleep, difficulty staying asleep, waking up too early in the morning and being unable to get back to sleep, and unrefreshing sleep.
Q: How does insomnia affect daytime functioning?
A: Insomnia results in unrefreshing sleep and can lead to daytime problems of fatigue, lack of energy, difficulty concentrating, and irritability.
Q: Are there different types of insomnia?
A: Periods of sleep difficulty lasting between one night and a few weeks are referred to as acute (transient) insomnia. Chronic insomnia refers to sleep difficulty during at least 3 nights a week for 1 month or more.
Q: How common is insomnia?
A: Insomnia is the most common complaint that is related to sleep and wakefulness. About 30–40 adults out of 100 have some degree of insomnia within any given year and about 10–15 in 100 indicate that the insomnia is chronic or severe. Insomnia increases with age and is more common in women. Women are about 1.3 times more likely to report insomnia-like sleep problems than men are. People over 65 years of age generally have approximately 1.5 times higher rates of difficulty sleeping compared with adults below the age of 65. Children can also have problems with insomnia and the rates for adolescents are similar to adults. Sleep onset insomnia is most common in young people.
Q: What causes insomnia?
A: Insomnia is nearly always related to a medical, psychiatric, circadian, sleep, behavioral, lifestyle, or environmental disorder. Acute insomnia is closely related to a major life event, such as pregnancy, significant stress at work, or bereavement. Once the event loses its intensity, the insomnia should also lessen. The development of chronic insomnia is often complex. An important factor appears to be a tendency to hyperarousal, or increased alertness during the day and night. People with hyperarousal have increased anxiety, and a higher heart rate while sleeping.
Q: What are the consequences of insomnia?
A: Insomnia can result in excessive sleepiness during the day, which can impact on activities such as driving and the operation of machinery, as well as decrease in concentration and ability to learn. Other consequences can relate to mood. Many people with ongoing insomnia become depressed or generally agitated. Insomnia can also worsen an underlying medical condition.
Q: How is insomnia treated?
A: Acute insomnia can be treated with short-term use of sedative medications such as benzodiazepines. Good sleep hygiene is mandatory, and some herbal preparations may be useful. People with chronic insomnia must combine treatments such as relaxation techniques, using the bedroom only for sleeping, setting regular sleep patterns, environmental change, treatment of medical/mood problems, and the judicious use of medication. People with chronic insomnia may benefit from counseling or cognitive-behavioral therapy. Not all treatments apply to or are effective in every individual with insomnia. If you have insomnia, discuss your treatment with your doctor.

Narcolepsy and Abnormal Daytime Sleepiness

Q: What is narcolepsy?
A: Narcolepsy was first described in 1880. It is characterized by an abnormal need to sleep, often in inappropriate situations. Nocturnal sleep is often disturbed.
Q: What are the symptoms of narcolepsy?
A: The main symptoms are excessive daytime sleepiness, attacks of muscle weakness called cataplexy, sleep paralysis (transient inability to move as you fall asleep or wake up), and visual hallucinations (see The symptoms of narcolepsy).
Q: How common is narcolepsy?
A: Classic narcolepsy is rare but it has many variations that are more common. Some 20–50 people in 100,000 have the condition. Between 1 and 4 in 10 people with narcolepsy have a family member who is also affected. Rarely, narcolepsy can be passed on through the genes. It can be a major social disability. Almost all patients with narcolepsy have a special genetic marker in the blood which can be tested for. Narcolepsy is now known to be due to a deficiency of the substance hypocretin (orexin) in the brain and spinal cord. Very rarely, the symptoms of narcolepsy may appear following a brain injury or in association with diseases of the central nervous system.
Q: At what age does narcolepsy start?
A: Narcolepsy usually appears between the ages of 15 and 30; sometimes it can start before the age of 10, or may not be recognized until after 50 years of age or even older. It is a lifelong condition.
Q: How is narcolepsy diagnosed?
A: Narcolepsy can be confirmed by doing an overnight sleep study followed by a special test called the multiple sleep latency test (MSLT). This test involves having 4–5 separate naps over the course of the day, assessing the time it takes for a person to get to sleep, and also whether dreaming sleep occurs. A special blood test is used to look at the genetic make up of the person to support a diagnosis of narcolepsy. A diagnosis of narcolepsy is made on the basis of the symptoms that the patient reports and the results of more objective testing as mentioned above.
Q: Is narcolepsy a severe condition?
A: If mild, the symptoms of narcolepsy may cause no more than minor inconveniences. If severe, however, symptoms can cause significant disruptions in one’s social and professional life, and may become profoundly disabling. Parents, teachers, spouses, and employers may often mistake sleepiness for lack of interest, or as a sign of hostility, rejection, or laziness.
Q: How is narcolepsy treated?
A: The sleepiness associated with narcolepsy can generally be greatly improved by the regular use of stimulant medication, such as modafinil. At present, these stimulant medications are the only drugs available. For cataplexy, antidepressant medication (such as clomipramine and imipramine) can be very helpful. The drug sodium oxybate can also be useful in instances of severe cataplexy.
Q: Can narcoleptics drive a vehicle?
A: If symptoms are well under control, narcoleptics can continue driving under normal conditions, and if they are being seen by a doctor at least once a year to discuss their symptoms and their medication. It is the responsibility of the person with narcolepsy to notify their insurance company and the appropriate licensing authority of their condition.
Q: What are the other disorders of excessive daytime sleepiness?
A: A few other disorders can make you sleep a lot during the day, like idiopathic hypersomnolence (idiopathic means “without a cause,” hypersomnolence means “excessive sleepiness”). Most are rare and the diagnosis can only be made by a sleep specialist or physician. Some people who sleep in excess are naturally “long sleepers” but this diagnosis is made only if all other disorders are excluded.

The symptoms of narcolepsy

Excessive daytime sleepiness.

People with narcolepsy can have anywhere from 2 to 30 episodes of uncontrollably falling asleep during the day. These attacks can occur at any time, even if a person is working. Each sleep attack can be as short as a few seconds and up to 20 minutes in duration. Following a sleep attack, they feel refreshed.

Cataplexy.

Cataplexy is muscular weakness caused by strong emotions such as laughter. Cataplexy attacks commonly occur in situations involving perfectly normal emotions, such as humor (hearing or telling a joke), competitiveness (bidding in a game of bridge), excitement (viewing, or especially participating in, a sports event), and stress or self-assertion.

Sleep paralysis.

This is a short period of inability to move during sleep, and it can last from a few seconds to half an hour. It is due to loss of postural muscle tone.

Hypnagogic hallucinations.

A hypnagogic hallucination is best described as visual hallucinations or dreamlike images (“awake dreaming”) that can occur at the start of sleep.


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