Sleep Disorders

We are Austin's first Sleep Center Accredited by the American Academy of Sleep Medicine! Call us today at 512.533.9400 or read below for information about common sleep disorders.

SLEEP APNEA | INSOMNIA | LIMB MOVEMENT DISORDERS
CHILDREN’S SLEEP DISORDERS
OTHER SLEEP DISORDERS
SLEEP BRUXISM | FIBROMYALGIA | HYPERSOMNIA

SLEEP APNEA
Obstructive Sleep Apnea is characterized by repetitive episodes of upper airway obstruction that occur during sleep, usually associated with a reduction in blood oxygen saturation. In other words, the airway becomes obstructed at several possible sites. The upper airway can be obstructed by excess tissue in the airway, large tonsils, a large tongue and usually includes the airway muscles relaxing and collapsing when asleep. Another site of obstruction can be the nasal passages. Sometimes the structure of the jaw and airway can be a factor in sleep apnea.
There is also Central Sleep Apnea. It also is characterized by the cessation of breath due to a lack of effort in breathing during sleep. Central Sleep Apnea is not as common as OSA and is more difficult to diagnose. Typically it is do to some neuromuscular problem but other sources could be the cause.

Symptoms?

Very sleepy during the day
Breathing stops frequently during sleep. (usually unaware).
Some Effects of OSA:
Loud snoring
Morning headaches
Chest pulls in during sleep in young children
High blood pressure
Overweight, but not always
A dry mouth upon awakening
Depression
Difficulty concentrating
Excessive perspiring during sleep
Heartburn
Reduced libido
Insomnia
Frequent trips to the bath room during the night
Restless sleep
Rapid weight gain

Is this a serious condition?

It is a potentially life-threatening condition that requires immediate medical attention. The risks of undiagnosed obstructive sleep apnea include heart attacks, strokes, irregular heartbeat, high blood pressure and heart disease. In addition, obstructive sleep apnea causes daytime sleepiness that can result in accidents, lost productivity, impotence, and interpersonal relationship problems. The severity of the symptoms may be mild, moderate or severe.

How does the doctor determine if you have Obstructive Sleep Apnea?
A sleep test, called polysomnography is usually done to diagnose sleep apnea. There are two kinds of polysomnograms. An overnight polysomnography test involves monitoring brain waves, muscle tension, eye movement, respiration, oxygen level in the blood and audio monitoring (For snoring, gasping, etc.). The second kind of polysomnography test is a home monitoring test. A Sleep Technologist hooks you up to all the electrodes and instructs you on how to record your sleep with a computerized polysomnograph that you take home and return in the morning. They are painless tests that are usually covered by insurance.

How is Sleep Apnea treated?
Mild Sleep Apnea is usually treated by some behavioral changes. Losing weight, sleeping on your side is often recommended. There are oral mouth devices (that help keep the airway open) on the market that may help to reduce snoring in three different ways. Some devices (1) bring the jaw forward or (2) elevate the soft palate or (3) retain the tongue (from falling back in the airway and blocking breathing). Sleep Apnea is a progressive condition (gets worse as you age) and should not be taken lightly. Moderate to severe Sleep Apnea is usually treated with a C-PAP (continuos positive airway pressure). C-PAP is a machine that blows air into your nose via a nose mask, keeping the airway open and unobstructed. For more severe apnea, there is a Bi-level (Bi-PAP) machine. The Bi-level machine is different in that it blows air at two different pressures. When a person inhales, the pressure is higher and in exhaling, the pressure is lower. Your sleep doctor will "prescribe" your pressure and a home healthcare company will set it up and provide training in its use and maintenance. Some people have facial deformities that may cause the sleep apnea. I t simply may be that their jaw is smaller than it should be or they could have a smaller opening at the back of the throat. Some people have enlarged tonsils, a large tongue or some other tissues partially blocking the airway. Enlarged tonsils and adenoids are common in children. Fixing a deviated septum may help to open the nasal passages. Removing the tonsils and adenoids or polyps may help also. There are several other surgical treatments. Usually a surgeon will ask the patient to be on CPAP for at least month to see if they get better. If CPAP is not tolerated, then surgery is probably another alternative.

What is Snoring?
I'm sure just about everyone is somewhat familiar with snoring. You probably know at least one person who snores. It could be your bed partner, your parents, and grandparents, even Uncle Ned or Aunt Sophie who may snore at various sound levels. Some laugh and make jokes about it, but it can be a symptom of a serious disorder called obstructive sleep apnea. And if it is obstructive sleep apnea, then it is no laughing matter, and that individual needs to get evaluated by a sleep specialist. Information on apnea is available at the above link. Snoring is a noise produced when an individual breathes during sleep (usually produced when breathing in) that in turn, causes vibration of the soft palate and uvula (the appendage in the back of the throat). The word "apnea" means the abscence of breathing.

All snorers have incomplete obstruction (a block) of the upper airway. Many habitual snorers have complete episodes of upper airway obstruction where the airway is completely blocked for a period of time, usually 10 seconds or longer. This silence is usually followed by snorts and gasps as the individual fights to take a breath. When an individual snores so loudly that it disturbs others, obstructive sleep apnea is almost certain to be present.

There is snoring that is an indicator of obstructive sleep apnea and there is also primary snoring.
Primary Snoring, also known as simple snoring, snoring without sleep apnea, noisy breathing during sleep, benign snoring, rhythmical snoring and continuous snoring is characterized by loud upper airway breathing sounds in sleep without episodes of apnea (cessation of breath).

How Does Primary Snoring Differ from Snoring that Indicates Obstructive Sleep Apnea?

• A complaint of snoring by an observer
• No evidence of insomnia or excessive sleepiness due to the snoring
• Dryness of the mouth upon awakening
A polysomnogram (sleep study) that shows:
• Snoring and other sounds often occurring for long episodes during the sleep period
• No associated abrupt arousals, arterial oxygen desaturation (lowered amount of oxygen in the blood) or cardiac disturbances
• Normal sleep patterns
• Normal respiratory patterns during sleep
• No signs of other sleep disorders

What can be done about primary snoring?
First of all, it is absolutely necessary to rule out obstructive sleep apnea or other sleep disorders. Be wary of any doctor who says it is not necessary. Behavioral and lifestyle changes may be suggested. Losing weight, sleeping on your side, refraining from alcohol and sedatives are often recommended.
There are mouth/oral devices (that help keep the airway open) on the market that may help to reduce snoring in three different ways.
Some devices:

1. Bring the jaw forward or
2. Elevate the soft palate or
3. Retain the tongue (from falling back in the airway and thus decreasing snoring).

There is also surgery. There is uvulopalatopharyngoplasty (UPPP) or Laser-Assisted Uvulopalatoplasty (LAUP), that involves removing excess tissue from the throat.

The newest surgery, approved by the FDA in July 1997 for treating snoring is called somnoplasty and uses radio frequency waves to remove excess tissue.

INSOMNIA

Insomnia comes in many different flavors

Difficulty falling asleep
No problem falling asleep but difficulty staying asleep (many awakenings)
Waking up too early

How much sleep does a person need?

Enough to feel alert during the day. Typically 7 to 9 hours (varies from person to person) of good quality sleep.Three basic types of Insomnia

• Transient insomnia - lasting for a few nights
• Short-term insomnia - two or three weeks of poor sleep
• Chronic insomnia - poor sleep that last three weeks or longer

Difficulty sleeping at night is only one of the symptoms. Daytime symptoms include:

Fatigue
Anxiety
Impaired concentration
Irritability
Impaired memory
Sleepiness

Am I getting enough sleep? A simple test for sleepiness:
Do you need an alarm to wake up in the morning?
If so do you usually press the snooze button?
Do you feel like you need a nap during the day, but are unable to go to sleep?
Do you fall asleep while watching TV?
Does reading a book make you feel sleepy?
Answering yes to any of these questions could mean you are not getting enough quality sleep a result of a shortened sleep period or from a sleep disorder. Talking to your physician is advised.

Narcolepsy

Some people, no matter how much they sleep, continue to experience a irresistible need to sleep. People with narcolepsy can fall asleep while at work, talking, and driving a car for example. These "sleep attacks" can last from 30 seconds to more than 30 minutes. They may also experience periods of cataplexy (loss of muscle tone) ranging from a slight buckling at the knees to a complete, "rag doll" limpness throughout the body.

Narcolepsy is a chronic disorder affecting the brain where regulation of sleep and wakefulness take place. Narcolepsy can be thought of as an intrusion of dreaming sleep (REM) into the waking state.

The prevalence of narcolepsy has been calculated at about 0.03% of the general population. Its onset can occur at any time throughout life, but its peek onset is during the teen years. Narcolepsy has been found to be hereditary along with some environmental factors.

Symptoms

Excessive sleepiness.
Temporary decrease or loss of muscle control, especially when excited.
Vivid dream-like images when drifting off to sleep or waking up.
Waking up unable to move or talk for a brief time.
Test for Narcolepsy:
Do you feel like you could sleep for days and still wake up sleepy?
Do you ever collapse or feel weak when laughing?
Do you ever collapse or feel weak when angry?
Are you afraid you may fall asleep while swimming?
Are you afraid you may fall asleep while taking a bath?
Did one of your parents or close relatives have the "sleeping sickness"?
Answering yes to any of these questions may be an indication of narcolepsy. You should discuss this with your physician.

LIMB MOVEMENT DISORDERS

Restless Leg Syndrome

Restless legs syndrome (RLS) is a discomfort in the legs which is relieved by moving or stimulating the legs. This feeling is difficult to describe and commonly referred to as a crawling, tingling or prickling sensation. Medications have been found useful.

Most likely situations for symptoms to occur
Riding in a car
Reading
Inactivity, sitting
Lying in bed trying to fall asleep

Techniques to provide temporary relief of symptoms
Getting up and walking around
Taking a hot shower
Rubbing the legs

Periodic Limb Movements
One variation of RLS is Periodic Limb Movements in Sleep (PLMS). PLMS are characterized by leg movements or jerks, that typically occur every 20 to 40 seconds during sleep. PLMS causes sleep to be disrupted. These movements are typically reported by the patient’s bed partner. These movements fragment sleep leaving the person with excessive daytime sleepiness.

Simple test for Restless Legs/Periodic Limb Movements
Do you feel that in some way your sleep is not refreshing or restful?
Do your legs ache prior to bed or when getting up?
Does your bed partner report that you kick them during the night?
PLMs/RLs may be caused by medical conditions such as iron deficiency or periferal neuropathy. Certain drugs are know to aggravate this disease. If you answer yes to one of these questions you should probably consult with your physician.

CHILDREN’S SLEEP DISORDERS

What is Sleepwalking (Somnambulism)?
Sleepwalking (Somnambulism) is a combination of complex behaviors that are initiated during slow wave sleep and result in walking during sleep. The onset typically occurs in prepubertal children.
Associated features include:

Difficulty in arousing the patient during an episode
Amnesia following an episode
Episodes typically occur in the first third of the sleep episode
Polysomnographic monitoring demonstrates the onset of an episode during stage 3 or 4 sleep
Other medical and psychiatric disorders can be present but do not account for the symptom
The ambulation is not due to other sleep disorders such as REM sleep behavior disorder or sleep terrors

How Common is Sleepwalking?
Medical reports show that about 18% of the population are prone to sleepwalking. It is more common in children than in adolescents and adults. Boys are more likely to sleepwalk than girls. The highest prevalence of sleepwalking was 16.7% at age 11 to 12 years of age. Sleepwalking can have a genetic tendency. If a child begins to sleepwalk at the age of 9, it often lasts into adulthood.

How serious is Sleepwalking?
For some, the episodes of sleepwalking occur less than once per month and do not result in harm to the patient or others. Others experience episodes more than once per month, but not nightly, and do not result in harm to the patient or others. In its most severe form, the episodes occur almost nightly or are associated with physical injury. The sleepwalker may feel embarrassment, shame, guilt, anxiety and confusion when they are told about their sleepwalking behavior.
If the sleepwalker exits the house, or is having frequent episodes and injuries are occurring -- DO NOT delay, it is time to seek professional help from a sleep disorder center in your area. There have been some tragedies with sleepwalkers, don't let it happen to your loved one!

What can be done about sleepwalking?
There are some things a sleepwalker can do:

Make sure you get plenty of rest; being overtired can trigger a sleepwalking episode.
Develop a calming bedtime ritual. Some people meditate or do relaxation exercises; stress can be another trigger for sleepwalking.
Remove anything from the bedroom that could be hazardous or harmful.
The sleepwalker's bedroom should be on the ground floor of the house. The possibility of the patient opening windows or doors should be eliminated.
An assessment of the sleepwalker should include a careful review of the current medication so that modifications can be made if necessary.
Hypnosis has been found to be helpful for both children and adults.
An accurate psychiatric evaluation could help to decide the need for psychiatric intervention.
Benzodiazepines have been proven to be useful in the treatment of this disorder. A small dose of diazepam or lorazepam eliminates the episodes or considerably reduces them.

What are Sleep Terrors?
Sleep Terrors are characterized by a sudden arousal from slow wave sleep with a piercing scream or cry, accompanied by autonomic (Controlled by the part of the nervous system that regulates motor functions of the heart, lungs, etc.) and behavioral manifestations of intense fear. Also known as Pavor Nocturnus, incubus, severe autonomic discharge, night terror.

What are the symptoms of Sleep Terrors?

A sudden episode of intense terror during sleep
The episodes usually occur within the first third of the night
Partial or total amnesia occurs for the events during the episode.
Associated features include:
Polysomnographic monitoring demonstrates the onset of episodes during stage 3 or 4 sleep
Tachycardia usually occurs in association with the episodes.
Other medical disorders are not the cause of the episode, e.g., epilepsy
Other sleep disorders can be present, e.g., nightmares.

How serious are Sleep Terrors?
Some people have episodes of sleep terror that may occur less than once per month, and do not result in harm to the patient or others. While some people experience episodes less than once per week, and do not result in harm to the patient or others. In its severest form, the episodes occur almost nightly, or are associated with physical injury to the patient or others. Consult a sleep specialist if you are concerned.

Nightmares
Children often suffer from repeated vivid dreams which cause them to awaken suddenly. Also called dream anxiety attacks, these episodes usually occur in the mid-to-late portion of the night, when REM sleep periods are abundant and intensive. Dream recall is usually vivid and detailed.

Confusional Arousals
Confusional arousals consist of confusion during and after arousals from sleep, most typically from deep sleep in the first part of the night. The child is disoriented in time and space, slow of speech and responds poorly to requests or verbal communication.

OTHER SLEEP DISORDERS

What is Sleepwalking (Somnambulism)?
Sleepwalking (Somnambulism) is a series of complex behaviors that are initiated during slow wave sleep and result in walking during sleep.

What are the symptoms of Sleepwalking (Somnambulism)?
Ambulation (walking or moving about) that occurs during sleep. The onset typically occurs in prepubertal children.

Associated features include:

difficulty in arousing the patient during an episode
amnesia following an episode
episodes typically occur in the first third of the sleep episode
polysomnographic monitoring demonstrates the onset of an episode during stage 3 or 4 sleep
other medical and psychiatric disorders can be present but do not account for the symptom
the ambulation is not due to other sleep disorders such as REM sleep behavior disorder or sleep terrors

What can be done about sleepwalking?
There are some things a sleepwalker can do:

Make sure you get plenty of rest; being overtired can trigger a sleepwalking episode.
Develop a calming bedtime ritual. Some people meditate or do relaxation exercises; stress can be another trigger for sleepwalking.
Remove anything from the bedroom that could be hazardous or harmful.
The sleepwalker's bedroom should be on the ground floor of the house. The possibility of the patient opening windows or doors should be eliminated.
An assessment of the sleepwalker should include a careful review of the current medication so that modifications can be made if necessary.
Hypnosis has been found to be helpful for both children and adults.
An accurate psychiatric evaluation could help to decide the need for psychiatric intervention.
Benzodiazepines have been proven to be useful in the treatment of this disorder. A small dose of diazepam or lorazepam eliminates the episodes or considerably reduces them.

What are the symptoms of Sleep Terrors?

A sudden episode of intense terror during sleep
The episodes usually occur within the first third of the night
Partial or total amnesia occurs for the events during the episode.

Associated features include:

Polysomnographic monitoring demonstrates the onset of episodes during stage 3 or 4 sleep
Tachycardia usually occurs in association with the episodes.
Other medical disorders are not the cause of the episode, e.g., epilepsy
Other sleep disorders can be present, e.g., nightmares.

SLEEP BRUXISM

Sleep Bruxism is a stereotyped movement disorder characterized by grinding or clenching of the teeth during sleep. The disorder has also been identified as nocturnal bruxism, nocturnal tooth-grinding and nocturnal tooth-clenching.

What are the Symptoms?
The symptoms of Sleep Bruxism are tooth-grinding or tooth-clenching during sleep that may cause:

Abnormal wear of the teeth
Sounds associated with bruxism (It's about as pleasant as fingernails on a chalkboard!)
Jaw muscle discomfort

How serious is the disorder?
Some people have episodes that occur less than nightly with no evidence of dental injury or impairment of psychosocial functioning. And others experience nightly episodes with evidence of mild impairment of psychosocial functioning. Yet others have nightly episodes with evidence of dental injury, tempomandibular (jaw) disorders, other physical injury or moderate or severe impairment of psychosocial functioning.

When someone with suspected sleep bruxism has a polysomnographic test there is evidence of jaw muscle activity during the sleep period and the absence of abnormal movement during sleep. Other sleep disorders may be present at the same time, e.g., obstructive sleep apnea, restless legs syndrome.

FIBROMYALGIA

Fibromyalgia is a disorder involving chronic pain in your muscles, ligaments and tendons. Fibromyalgia is also known as Fibromyositsis, rheumatic pain modulation disorder or Fibrositis Syndrome.

What are the symptoms of Fibromyalgia?

Unrefreshing sleep
Muscular pain
Firm, tender zones are found within the muscles, particularly those of the neck and shoulders

Polysomnography shows alpha activity during non-REM sleep, particularly stage 3 and 4 sleep. A Multiple Sleep Latency Test (MSLT) shows a normal amount of time in falling asleep.

What is the treatment for Fibromyalgia?
A low dose of tri-cyclic antidepressants seem to help. Exercise and relaxation techniques are suggested. Sometimes an analgesic is prescribed.

HYPERSOMNIA

Hypersomnia is excessive sleepiness. It is an excessively deep or prolonged major sleep period. It may be associated with difficulty in awakening. It is believed to be caused by the central nervous system and can be associated with a normal or prolonged major sleep episode and excessive sleepiness consisting of prolonged (1-2 hours) sleep episodes of non-REM sleep.

What are the Symptoms?

Long sleep periods
Excessive sleepiness or excessively deep sleep
The onset is insidious (gradually, so you are not aware of it at first)
Typically appears before age 25
Has been present for at lest six months

How does a doctor determine that I have hypersomnia?
The first step is to consult a sleep specialist. The specialist will probably order a polysomnography test (sleep study) where you stay overnight while Technologists monitor your muscle movement, heartbeat, eye movement, leg movements and respiration. The specialist may also want to do a Multiple Sleep Latency Test (MSLT) that tests how sleepy you are.

How can it be treated?
Since the cause is still unknown, treatment consists of behavioral changes, good sleep hygiene and taking stimulants to help you be more alert. Limit your naps to one (preferably in the afternoon) lasting no longer than 45 minutes. Get at least 8 1/2 hours of sleep. Avoid shift work, alcohol, and caffeine. Your doctor will determine the amount and type of stimulant you should take.

Further Reading:

The Complete Book of Sleep, by Dianne Hales (Addison-Wesley, Reading, MA. 1981)

Insomnia and Other Sleeping Problems, by Peter Lambley (Pinnacle Books, New York. 1982)

A Good Night's Sleep, by Elliott Richard Philips (Prentice-Hall, Englewood Cliffs, NJ. 1983)

Getting to Sleep, by Ellen Catalano (New Harbinger Publications, Oakland, CA 19__)

Much of the above information was provided by dipping into Dr. William C. Dement's SleepWell.