Understanding Sleeping Disorders

Common Sleep Disorders

With 1/3 of our lives dedicated to sleep, it is not surprising that sleep disorders are one of the most debilitating issues that face people. Whether it is getting too much sleep, too little sleep, or something that affects the quality of sleep, anything that interferes with the body’s natural balance between sleep and wakefulness has the potential of affecting the day-to-day life of an individual.

The most common sleep-related disorder is insomnia. Clinically defined as the inability to sleep, insomnia can affect the ability to fall asleep, the ability to maintain sleep, the ability to remain asleep in the morning, or any combination of the three. Acute insomnia is usually short-term, and is related to stress. Chronic insomnia lasts for a month or more, and is no as easily defined. In fact, according to the National Sleep Foundation, chronic insomnia may even be a primary disorder, rather than a secondary disorder caused by some other primary complaint.

At the other end of the spectrum is hypersomnia. Commonly experienced by teenagers and young adults, hypersomnia is characterized by excessive sleepiness during the day, and oversleeping (over ten hours) at night. This disorder is often overlooked by those affected because they mistakenly assume that it is normal to require a mid-day nap, or to feel sleepy during the day.

Why do Sleep Disorders Occur?

There are many different reasons for the sleep disorders that affect us. Some are primarily physical, while others can be psychological in nature.

Acute insomnia is often secondary to something else that is affecting a patient’s life. This could be a severe illness, a change in environment, or excessive stress. Because acute insomnia generally lasts less than a week, it is not generally necessary to treat, but sometimes it is recurrent, making it important to discover the causes of the insomnia and work to alleviate the primary trigger.

Chronic insomnia is a bit more complicated, with at least three possible causes. The first is a physical medical disorder. This could be something simple such as headaches or asthma, or it could be something more serious such as Parkinson’s or a degenerative neurological disorder. The second possibility is a sleep disorder that contributes to insomnia such as psychophysiological insomnia, sleep apnea, sleep onset association disorder, or drug/alcohol dependant sleep disorder. The third cause is a psychiatric disorder, which may be a chicken-or-the-egg situation where it is unclear whether the insomnia or the psychiatric disorder came first. For a more comprehensive look at the causes of insomnia visit The Sleep Disorder Channel.

Hypersomnia can sometimes be attributed to other sleep disorders that reduce the amount of quality sleep at night. For example, with sleep apnea the patient suffers repeated periods in which he or she stops breathing for several brief periods throughout the night. Other causes include neurological diseases that prevent the brain from transitioning properly to and from sleep, prescription medication, and sleep deprivation.

Treating Sleep Disorders

While every sleep disorder has a cause, the treatment is often symptom driven. This means that while the symptom of inadequate or excessive sleep is being treated through medication, the underlying cause is left untreated. This is particularly true when treatment is initiated by the patient through the use of sleeping pills, or stimulants to maintain wakefulness during the day.

The American Insomnia Association outlines the most common treatments used today to treat insomnia. Most over-the-counter medications are sedating antihistamines. Prescription medications include benzodiazepines, benzodiazepine receptor agonists, and some other sedating drugs. Benzodiazepine receptor agonists such as zolpidem (Ambien) and zaleplon (Sonata) are considered to be more effective than the older benzodiazepines, with fewer side-effects and less chance of drowsiness the next morning.

Similarly, hypersomnia is treated most often through medication. Generally stimulants such as Methylphenidate (Ritalin), Modafinil (Provigil), or other amphetamines are prescribed.

While medication is safe enough to use, it does not do anything about the underlying cause of insomnia or hypersomnia, and thus does not actually cure the disorders. It is really important to get to the bottom of the problem, because the disorders may be secondary to a more serious condition.

As an alternative to medication, or even as a complementary program, many patients and doctors turn to behavioral therapy and methods such as neurofeedback, one of the services described on this website and offered by Dr. Rothman.

Relaxation therapy is often used to teach patients to relax their mind and body in preparation for sleep.

Modifying a patient’s lifestyle by instilling set sleep schedules and revising the nighttime routines also helps to rebuild a suitable state of mind for sleep. Another method that has shown good results is stimulus control. By recreating the pre-sleep routine, stimulus control seeks to re-educate the body and mind in correct sleep behaviors.

Sleep Restriction Therapy calculates the patient’s natural sleep cycle, and works to slowly build the total sleep time through regulated sleep/rest periods. Finally, some cases are treated through cognitive-behavioral therapy, where patients are re-taught about their actual sleep needs, and how to get a good night’s sleep.

To learn more about sleep disorders and how to treat them, try visiting the following websites:

Sleepdex
Sleep Disorders Guide
Sleep Disorders Centre – Sequoia Health Services