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.
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| 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.
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| 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.
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| 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.
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| 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.
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| 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.
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| 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.
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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.
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| 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).
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| 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.
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| 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.
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| 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.
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| 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.
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| 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.
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| 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.
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| 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.
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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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