Sleep Disorders

Sleep Disorders

Sleep is as essential for wellbeing as food and water. Sleep needs vary with individual and are biologically determined. An average adult needs 8 or 9 hour of sleep a night to function optimally, most only get 7 or fewer hours. 

While many problems related to sleep are minor, the number of major clinical problems is greater than most people expect. Many of these involve difficulty in going to sleep or in staying asleep.

Persons with sleep problems are concerned not only about the immediate distress and discomfort caused by inability to sleep, but also about the effects of their sleep deficit on family life, employment status, and general social adjustment.

Dyssomnia & Parasomnia 

These are the two most widely studied types of sleep disorders. Dyssomnias involve abnormalities in amount, quality, or timing of sleep, and parasomnia are characterized by abnormal behavior of physiological events occurring in association with sleep, specific sleep stages or sleep wake-transitions.

DSM-IV-TR described these two sets of conditions as primary sleep disorders. There are many types of Dyssomnias, ranging from the relatively common insomnia to the less common hypersomnia, in which there is excessive sleepiness marked by prolonged sleep at night(12 hours or more) and/or long daytime periods of sleep.

1. Insomnia

Almost everyone occasionally suffers from short-term insomnia. Many people have difficulty initiating or maintaining sleep and complain of not feeling restored or rested upon awakening.

About 10 % of adults experience persistent difficulty getting to sleep or staying asleep. If the condition persists for at least a month, these people may have insomnia as defined by DSM-IV-TR. Insomnia is the most common type of sleep disorder. Insomnia often has a sudden onset related to a set of stressful circumstances, but it also persists after the upsetting experience has ended. It tends to be more prevalent with increasing age and among women.

The course of insomnia is variable-ranging from a month or two to a lifelong pattern- and often occurs in the context of other problems, such as anxiety and depression.

Insomnia reflects the perception of inadequate sleep duration, continuity, or quality, or of difficulty of sleep initiation (inability to get to sleep in a reasonable period of time e.g. 30 minutes), others have difficulty maintaining sleep (getting up in the middle of the night). In varying degrees, emotional arousal, mood, sleep habits, circadian rhythms, and physiological processes can play roles in sleep disorders.

2. Narcolepsy

It is a condition of marked daytime sleepiness that seems to involve the sudden onset of REM (reasons are poorly understood). Symptoms of Narcolepsy are Cataplexy (a sudden and transient episode of muscle weakness or paralysis), sleep paralysis, hypnogogic hallucinations.

When they fall asleep at night, they go almost directly to REM sleep without going through all the stages of the sleep that normally precedes it. They also may often experience sleep paralysis in which they cannot move or speak for a period of time. Theses sleep attacks can occur at any time, during any activity e.g. in the middle of a conversation, while eating, while playing sports or most dangerously-while driving.

3. Sleep Apnea: (apnea-Greek word means “with no breath”)

It is breathing related sleep disorder in which individuals experience brief disruptions in breath, which can last for10 to 30 seconds, that may interrupts their sleeping several times a night.

4. Sleep Related Hallucinations

Sleep related hallucinations are imagined events that seem very real.  These experiences are much rarer. They are mainly visual but may also involve your senses of sound and touch. It is very easy to confuse them with a state of dreaming. They may be similar to nightmare. Person may not be very sure if he/she is awake or asleep. These images may be distorted in shape and size.  They may remain present for many minutes. These generally are of two types:

Hypnagogic Hallucinations occur during night time between waking & sleeping, when you about to fall asleep.

Hypnopompic Hallucinations occur at morning between sleeping & waking, when you are just waking up in the morning.

If they occur during the day, then they may be sign of narcolepsy.

5. Sleep Inertia: Longer than 10 minutes sleeping may cause “sleep inertia”-the groggy feeling which takes considerable time to ease off before the power nap’s restorative benefits shine through.

II. Parasomnia: The unusual behavioral or psychological events occurring during sleep.

1. Sleepwalking Disorder: In this there are repeated episodes of complex motor behavior initiated during sleep and individual rises from his or her bed and walk about. This is most likely to happen in the first third of the sleep cycle. The activities performed during sleepwalking are usually of routine, and the individual may have no recollection of them in the morning.

2. Nightmare Disorder: In this, frightening dreams awaken the person, the nightmares often involve lengthy, elaborate dream sequences that are terrifying and leave the individual fully awake and very anxious. These are common in children.

3. Sleep Terror Disorder: Whereas nightmares tend to occur later in the night during REM sleep and produce vivid dream imagery and awakening, sleep terrors especially occur earlier in the sleep cycle and produce no dream recall or only single images that are not embedded in a dream narrative. Sleep terror leads to partial awakening, confusion, disorientation and a high level of autonomic activation. During typical episodes individuals abruptly sit up in bed screaming and crying, but the unresponsive to the efforts of others to awaken or comfort them.