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Diagnosis and Treatment of Sleep Disorders

Sleep walking

Sleep disorder is a general term and describes either a disturbance in sleep pattern of a person or alteration in total time of sleep. It is estimated that every 7th American is suffering from a sleep disorder and more than sixty five percent of these are elderly people. Sleep disorders are classified as primary and secondary; in primary sleep disorders there is endogenous disturbance in sleep-wake cycle while secondary sleep disorders are due to psychiatric or medical problems.

 

Emotional stress is a common cause of acute sleep disorders while the genetic basis for excessive sleepiness has also been found by researchers. Moreover, people who work in night shifts and noisy environment have more chances to get a sleep disorder. Psychiatric and medical ailments leading to sleep disorders include sleeping sickness, psychosis including schizophrenia, panic disorders and mood disorders including depression or anxiety.

Dyssomnia & Parasomnia

Sleep disorders are also categorized as dyssomnias or parasomnias. Dyssomnias result in increased or decreased sleep, which are medically termed as hypersomnia or insomnia respectively. Parasomnias refer to abnormal emotions, movements, perceptions and behaviors related to sleep. Most common presentations of dyssomnias include insomnia or narcolepsy; primary insomnia presents as difficulty in initiating or maintaining sleep without any obvious reason whereas narcolepsy refers to excessive daytime sleepiness.

Parasomnias also have wide presentations which include bruxism, hypo-apnea, nocturia, sleep walking, sleep paralysis, sleep apnea and night terror. Amongst the most common include bruxism in which patient grinds or clenches his teeth involuntary while sleeping and hypo-apnea syndrome which is associated with an abnormally slow respiratory rate or shallow breathing while sleeping. Others are night terror, nocturia which is frequent urination during night times, sleep walking, sleep paralysis, sleep apnea associated with obstruction of airway leading to snoring, restless leg syndrome, rapid eye movement syndrome.

Diagnosis and Treatment of Sleep Disorders

Different diagnostic modalities are used to diagnose sleep disorders. A patient can maintain a sleep diary which may help the doctor in diagnosing his ailment. Others include Epworth Sleepiness Scale: a standardized questionnaire which evaluates daytime sleepiness and Polysomnogram: a test which helps in measurement of brain and muscle activity during sleep. Multiple sleep latency test is done to evaluate daytime sleepiness. Actigraphy can evaluate sleep wake patterns for a week or more simply by the application of a wrist worn device which is termed as actigraphs.

Home and behavioral remedies include keeping regular sleep timings, avoidance from stressors, switching off the lights before sleeping, making sure that TV, mobiles or laptops are powered off and the room is cool and quiet and opting for day-time jobs. Therapeutic options for sleeping disorders are categorized into four groups; psychotherapy and behavior adaptation, medication, rehabilitation and other somatic treatments. Psychotherapy includes counseling by a psychologist or a psychiatrist. Medicines include sedatives and hypnotics along with others. Selection of treatment modality depends on the pattern of sleep disorder e.g. narcolepsy is best treated by medicines whereas chronic and primary insomnia respond better to behavioral and psychotherapy. Medicines provide an earlier response than other treatments whereas a combination of therapies is useful in refractory cases.

 

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