Sleep Disorders

Sleep disorders are a group of conditions that affect the quality of sleep and is increasingly becoming common among the population. Disturbances in sleep may be occasional, as is seen in most of the people.

Stress and a hectic schedule may temporarily affect sleep. Some people have sleep issues regularly which affects their ability to carry on with their daily activities. Some sleep disorders affect the ability to fall asleep, and thus increases daytime fatigue.

This affects their concentration, mood, and general health. In some cases, sleep issue is a symptom of an underlying condition, treating which helps to alleviate the sleep problem. It is important to diagnose the cause of sleep disorder and treat the same to avoid further health consequences.

There are different types of sleep disorders:

• Insomnia – this condition is characterized by an inability to fall asleep or to remain asleep for a long duration.
• Hypersomnia – group of disorders in which the person is excessively sleepy is referred to as hypersomnia.
• Sleep-related breathing disorders – this group of disorders involve difficulty in breathing. This includes different variations of sleep apnea.
• Circadian rhythm sleep-wake disorders – in this condition, the sleep time is not aligned with the normal timings, and the patient fails to follow the usual sleep timings as others.
• Parasomnia – in this group of disorders, some experiences prior to or during sleep affect the quality of sleep.
• Sleep movement disorders – conditions that cause movement while falling asleep or during sleep lead to sleep issues.

Symptoms of sleep disorders differ with the type of disorder and the severity of the condition. Some of the general symptoms of sleep disorder are difficulty in falling asleep, increased sleepiness during daytime, urge to take naps in the day, anxiety, irritability, lack of concentration, and depression.

Sleep disturbances may be caused by many factors. In most of the cases, it develops as a symptom of an underlying medical condition. Respiratory disorders, allergies, nocturia or frequent urination, chronic pain, stress, and anxiety may all lead to disturbance in sleep.

Review of medical history associated symptoms and physical examination help in the identification of the underlying cause of the symptom. Different tests including polysomnography, EEG, and blood test are also used in confirmation of the cause.

The treatment method of a sleep disorder depends on the type and the underlying cause. Medications for treating the underlying medical condition, sleeping pills, melatonin supplements, allergy medication, breathing device, surgery, and dental guard are different types of treatment methods adopted based on the type of disorder.

Lifestyle modifications can also greatly improve sleep, particularly when used in combination with medications. Reducing stress, having a healthy diet, reducing fluid intake before bedtime, having a regular sleeping schedule, limiting caffeine and alcohol, are lifestyle changes that will be of help in improving the quality of sleep.

Long-term sleep disorders may take the time to resolve, and compliance with medication and sleep schedule is very important to have a good prognosis. Sticking with the treatment plan will help in getting relief from the symptom.

Sleep disorders are caused by many disorders and diseases.

Some of the causes of sleep disorders are: 

Stress – the cause of sleep disturbance may range from minor stress like work stress to more serious issues in life including personal loss like divorce or death of a dear one. Emotional stress was found to cause sleepwalking in some people.

Medical conditions – many types of physical illnesses may lead to sleep problems. The underlying health issue may be

Respiratory problems – upper respiratory tract infections, allergies, and common cold make breathing difficult, affecting sleep. Sleep is disturbed as breathing through the nose is hard.

• Nocturia – frequent urination in the night is a common cause of waking up in the night. Diseases of the urinary tract and hormonal imbalances cause nocturia.
• Chronic pain – sleep is disturbed in people with chronic pain. Even when the person becomes successful in falling asleep, he/she may wake up due to pain. Chronic fatigue syndrome, fibromyalgia, inflammatory bowel disease, headache, lower back pain, and arthritis may all cause chronic pain. On the other hand, sleep disorders may increase chronic pain.
• Hyperthyroidism – overproduction of thyroid hormones may cause sleepwalking, one of the sleep disorder.
• Migraine headaches – this condition is a cause for sleep terror and sleepwalking.
• Parkinson’s disease – Parkinson’s disease increases the risk of REM sleep disorder.
• Diabetes – this condition causes restless leg syndrome, characterized by discomfort in legs that affects sleep.

Mental disorders – mental disorders are often found to cause sleep disturbances. Depression is a common cause of sleep disorders like insomnia. People with depression often find it difficult to fall asleep or to remain asleep for a long duration.

Anxiety disorders and other mental disorders like bipolar disorder also affect sleep. Dementia and brain damage increases the risk of irregular sleep-wake rhythm, a type of circadian rhythm disorder.

It is also common in people with other mental disorders. Personality disorders may cause non-24-hour sleep-wake rhythm, another subtype of circadian rhythm disorder.

Certain medications – some prescription and over-the-counter medications are known to have sleep disturbance as a side effect. Antidepressants and medications used in the treatment of common cold and allergy are known to cause sleep issues.

Psychotropic drugs cause confusional arousals. Antihistamines and allergy medication may cause restless leg syndrome. Some antidepressants, lithium, and dopamine receptor antagonists increase the risk of periodic limb movement disorder, a type of sleep movement disorder.

Caffeine and other stimulants – these substances are known to affect the ability to fall asleep. Stimulants may also affect the ability to stay asleep, as they cause frequent awakenings during sleep. Allergy to certain food may cause disrupted sleep.

Substance abuse – drug abuse is known to cause parasomnia. Alcohol use and abuse is a known risk factor for sleepwalking and sleep terrors. Alcohol withdrawal increases the risk of rapid eye movement (REM) sleep disorder.

Lifestyle habits – irregular sleep routine and habits affect sleep and cause insomnia. Rotating shift work, night shifts, worry, and not enough sleep increase the chances of developing confusional arousals, a type of parasomnia.

Excess body weight, hypertension, family history, middle age, and male gender increases the risk of obstructive sleep apnea. Blindness increases the risk of non-24-hour sleep-wake rhythm. The weak circadian clock also affects the normal sleep pattern in a person.

Physical examination is performed after the review of medical history and associated symptoms. Other common tests suggested for the identification of cause are polysomnography, electroencephalogram (EEG), and genetic blood testing.

Polysomnography is a type of sleep study in which oxygen levels, body movements, and brain waves are evaluated during sleep. This enables to find the cause of sleep disruption. EEG analyzes the electrical activity in the brain and provides important clues on any abnormalities in the functioning of the brain that disrupt sleep.

Genetic blood testing is used to diagnose narcolepsy and some health conditions that lead to sleep disorders. Oximetry is suggested to check the levels of oxygen in the blood which may suggest sleep or any other breathing disorder that affect sleeping.

Some of the laboratory tests used in the diagnosis of sleep disorder are: 

• Hemoglobin
• Hematocrit
• Arterial blood gasses
• Thyroid function test
• Drug screening
• Alcohol toxicology screening

Under normal conditions, imaging tests are not recommended in the diagnosis of sleep disorders. But, this may depend on the underlying cause of the disorder, and one of the imaging technique may be used, if called for.

The treatment method is decided after evaluating the patient for primary sleep disorders like sleep apnea, the effect of medications, and the presence of any underlying medical condition.

Good sleep practices are often suggested before recommending medication for any of the sleep disorder. Losing excess body weight and using continuous positive airway pressure are useful in controlling sleep apnea.

Light-phase shift therapy is used in the treatment of sleep disruption associated with impaired circadian rhythm. Insomnia may be treated with cognitive behavioral therapy.

To restore the normal pattern of sleep drug therapy is suggested, but for a short-term. Hypnotic drugs are used for two weeks. Longer duration of drug use is suggested only for chronic insomnia.

Benzodiazepine receptor agonists are the conventional medication for treating insomnia. Non-benzodiazepine hypnotics are used for an acute form of insomnia. Melatonin receptor agonists are suggested for people who find it difficult to fall asleep. Some antidepressants are also suggested for treating sleep issues.

Orexin receptor antagonists are indicated for the treatment of sleep disorders characterized by difficulty in staying asleep. Good sleep practices are the most important in the treatment of sleep disorders.

• Watching television or reading should be avoided in bed
• Avoid caffeine or other stimulants before going to bed
• Practice relaxation techniques to avoid stress
• Develop regular exercise habit
• Have a regular routine for sleeping and waking up
• Avoid large meals and spicy foods before bedtime

Have tryptophan-containing food like milk before going to bed to induce sleep. Exercise early in the day may promote sleep, but strenuous exercise three hours before bedtime may affect falling asleep.

Any form of stimulating activities should be avoided before bedtime. Hospitalization is generally not required for the treatment of sleep disorder. Inpatient treatment is suggested only if the disorder is caused by severe medical condition or substance abuse disorder.

The smell of breath from nose and mouth is used in the diagnosis of the underlying cause of bad breath. The dentist usually rates the smell from the two regions on an odor intensity scale. Scrapings from the back of the tongue may also be taken for identifying the cause of bad breath.

Specialized detectors are now available to identify the causative chemical of bad breath, this includes:

• BANA test – this test is used to measure the amount of enzyme produced by the bacteria accumulated in the mouth.
• Halimeter – this detector is used to measure the levels of Sulphur in a breath. Gas chromatography detects three different volatile compounds of Sulphur including hydrogen sulfide and methyl mercaptan.
• Beta-galactosidase – beta-galactosidase enzyme is related to bad odor in the mouth. This test measures the level of enzyme in the mouth.

Good oral hygiene is the best way to treat bad breath. Good oral practices reduce the chances of cavities and gum diseases. Other treatment options for controlling bad breath may depend on the underlying cause of the symptom.

If the bad breath is caused by a medical condition, specific treatment may be recommended to reduce the foul smell in a breath. The dentist may refer to a primary physician or a specialist for treating the underlying condition.

If the bad breath is caused by a medical condition, specific treatment may be recommended to reduce the foul smell in a breath. The dentist may refer to a primary physician or a specialist for treating the underlying condition.

Routine oral hygiene should include brushing teeth and cleaning the space between teeth. Teeth should be cleaned twice a day using a soft brush. Special care should be taken to clean the area where teeth meet the gum.

Brushing just before eating or one hour after eating helps to prevent erosion of tooth. Cleaning the space between teeth, twice a day helps to prevent the formation of plaque. Flossing is the best way to clean the space between teeth. This helps to remove the debris that gets stuck in the space.

Food and drinks are common causes of bad breath, to avoid this:

• Reduce the number of sugary drinks and foods
• Reduce fizzy drinks and fruit juices as they increase the acid contact of teeth. Drinks that are low on acids like milk, tea, and coffee are better.
• While drinking fruit juices, drink without swishing the content inside the mouth to reduce acid contact.
• Avoid brushing within an hour of vomiting. This is because vomiting may contain a part of stomach acid in them and brushing may help to spread the same within the mouth.
• Quit smoking as it increases the chance of bad breath and gum disease
• Use sugar-free medicines
• Have regular dental check ups

Persisting bad breath may be treated with mouth washes and tongue cleaning. Mouth washes with antibacterial agents help to prevent the buildup of bacteria in mouth. Clean the back of tongue every day to remove the bacterial coat at the back.

Chewing sugar-free gum is also found to be good in reducing bad breath. It increases the flow of saliva which flushes the mouth of any debris. Dentures should be cleaned properly to avoid a foul smell in the breath.