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Sleep disturbance

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Sleep disturbance

Sleep disorder
Classification and external resources
ICD-10 9 DiseasesDB MedlinePlus eMedicine MeSH D012893

A sleep disorder, or somnipathy, is a medical disorder of the sleep patterns of a person or animal. Some sleep disorders are serious enough to interfere with normal physical, mental and emotional functioning. Polysomnography is a test commonly ordered for some sleep disorders.

Disruptions in sleep can be caused by a variety of issues, from teeth grinding (bruxism) to night terrors. When a person suffers from difficulty falling asleep and staying asleep with no obvious cause, it is referred to as insomnia.[1] Dyssomnia refers to a group of sleep disorders with the symptoms of trouble falling asleep or maintaining sleep, which may cause an elevated sense of sleepiness during the day. Insomnia is characterized by an extended period of symptoms including trouble with retaining sleep, fatigue, decreased attentiveness, and dysphoria. To diagnose insomnia, these symptoms must persist for a minimum of 4 weeks. The DSM-IV categorizes insomnias into primary insomnia, insomnia associated with medical or mental diseases, and insomnia associated with the consumption or abuse of substances. Individuals with insomnia often worry about the negative health consequences, which can lead to the development of anxiety and depression.[2]

In addition, sleep disorders may also cause sufferers to sleep excessively, a condition known as hypersomnia. Management of sleep disturbances that are secondary to mental, medical, or substance abuse disorders should focus on the underlying conditions.

Common disorders

The most common sleep disorders include:

Types

Tests used to diagnose insomnia

The following tests are used to diagnose insomnia.

  • Sleep diary: Tracking sleep patterns may help a doctor reach a diagnosis.
  • Epworth Sleepiness Scale: a validated questionnaire that is used to assess daytime sleepiness
  • Polysomnogram: a test measuring brain and muscle activity including breathing during sleep
  • Multiple Sleep Latency Test: a test for daytime sleepiness, usually administered the day after overnight polysomnography
  • Actigraphy: a test to assess sleep-wake patterns, usually for a week or more. Actigraphs are wrist-worn devices, about the size of a wristwatch, that measure movement.
  • Mental health exam: Because insomnia may be a symptom of depression, anxiety, or another mental health disorder, a mental status exam, mental health history, and basic mental evaluations may be part of the assessment for a person complaining of insomnia.

General principles of treatment


Treatments for sleep disorders generally can be grouped into four categories:

  • Rehabilitation and management
  • Medication

None of these general approaches is sufficient for all patients with sleep disorders. Rather, the choice of a specific treatment depends on the patient's diagnosis, medical and psychiatric history, and preferences, as well as the expertise of the treating clinician. Often, behavioral/psychotherapeutic and pharmacological approaches are not incompatible and can effectively be combined to maximize therapeutic benefits. Management of sleep disturbances that are secondary to mental, medical, or substance abuse disorders should focus on the underlying conditions.

Medications and somatic treatments may provide the most rapid symptomatic relief from some sleep disturbances. Certain disorders like narcolepsy, are best treated with prescription drugs such as Modafinil.[2] Others, such as chronic and primary insomnia, may be more amenable to behavioral interventions, with more durable results.

Chronic sleep disorders in childhood, which affect some 70% of children with developmental or psychological disorders, are under-reported and under-treated. Sleep-phase disruption is also common among adolescents, whose school schedules are often incompatible with their natural circadian rhythm. Effective treatment begins with careful diagnosis using sleep diaries and perhaps sleep studies. Modifications in sleep hygiene may resolve the problem, but medical treatment is often warranted.[10]

Special equipment may be required for treatment of several disorders such as obstructive apnea, the circadian rhythm disorders and bruxism. In these cases, when severe, an acceptance of living with the disorder, however well managed, is often necessary.

Some sleep disorders have been found to compromise glucose metabolism.[11]

Hypnosis treatment

Research suggests that hypnosis may be helpful in alleviating some types and manifestations of sleep disorders in some patients.[12] "Acute and chronic insomnia often respond to relaxation and hypnotherapy approaches, along with sleep hygiene instructions."[13] Hypnotherapy has also helped with nightmares and sleep terrors. There are several reports of successful use of hypnotherapy for parasomnias[14][15] specifically for head and body rocking, bedwetting and sleepwalking.[16]

Hypnotherapy has been studied in the treatment of sleep disorders in both adults[16] and children.[17]

Sleep medicine

Main article: Sleep medicine


Due to rapidly increasing knowledge about sleep in the 20th century, including the discovery of REM sleep and sleep apnea, the medical importance of sleep was recognized. The medical community began paying more attention than previously to primary sleep disorders, such as sleep apnea, as well as the role and quality of sleep in other conditions. By the 1970s in the USA, clinics and laboratories devoted to the study of sleep and sleep disorders had been founded, and a need for standards arose.

Sleep Medicine is now a recognized subspecialty within internal medicine, family medicine, pediatrics, otolaryngology, psychiatry and neurology in the United States. Certification in Sleep Medicine shows that the specialist:
"has demonstrated expertise in the diagnosis and management of clinical conditions that occur during sleep, that disturb sleep, or that are affected by disturbances in the wake-sleep cycle. This specialist is skilled in the analysis and interpretation of comprehensive polysomnography, and well-versed in emerging research and management of a sleep laboratory."[19]

Competence in sleep medicine requires an understanding of a myriad of very diverse disorders, many of which present with similar symptoms such as excessive daytime sleepiness, which, in the absence of volitional sleep deprivation, "is almost inevitably caused by an identifiable and treatable sleep disorder", such as sleep apnea, narcolepsy, idiopathic hypersomnia, Kleine–Levin syndrome, menstrual-related hypersomnia, idiopathic recurrent stupor, or circadian rhythm disturbances.[20] Another common complaint is insomnia, a set of symptoms which can have a great many different causes, physical and mental. Management in the varying situations differs greatly and cannot be undertaken without a correct diagnosis.

Sleep dentistry (bruxism, snoring and sleep apnea), while not recognized as one of the nine dental specialties, qualifies for board-certification by the American Board of Dental Sleep Medicine (ABDSM). The resulting Diplomate status is recognized by the American Academy of Sleep Medicine (AASM), and these dentists are organized in the Academy of Dental Sleep Medicine (USA).[21] The qualified dentists collaborate with sleep physicians at accredited sleep centers and can provide oral appliance therapy and upper airway surgery to treat or manage sleep-related breathing disorders.[22]

In the UK, knowledge of sleep medicine and possibilities for diagnosis and treatment seem to lag. Guardian.co.uk quotes the director of the Imperial College Healthcare Sleep Centre: "One problem is that there has been relatively little training in sleep medicine in this country – certainly there is no structured training for sleep physicians."[23] The Imperial College Healthcare site[24] shows attention to obstructive sleep apnea syndrome (OSA) and very few other sleep disorders.

See also

References

External links

  • Sleep Problems - information leaflet from mental health charity The Royal College of Psychiatrists
  • [1] Sleep Disorders Health Center
  • [2] The Sleep Paralysis Project - an online resource and film exploring the phenomenon of sleep paralysis

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