Sleep disorders: Treatment, symptoms, advice and help

About sleep disorders

A sleep disorder (somnipathy) is a medical disorder in which there is disturbance of sleep.

Sleep disorder: Incidence, age and sex

The lifetime incidence of all types of sleep disorders put together is around 17% with the prevalence of insomnia being more in adults above 65 yrs and among males. Parasomnias are more common in children. Narcolepsy has a prevalence of about 1 in 4000.

Signs & symptoms of sleep disorder: Diagnosis

There are several types of sleep disorders. In parasomnias, automatic behaviour takes place during light sleep and is not recalled on waking up, e.g. sleep talking, sleep walking and night terrors. In daytime somnolence, excessive sleepiness occurs in the day. It occurs after meals and during dull monotonous activities, such as long car journeys. In narcolepsy, recurrent bouts of irresistible sleep are experienced. Sufferers tend to fall asleep when eating or talking, not just when under-stimulated. The periods of sleep are usually short and the person can be woken relatively easily. He or she usually feels refreshed after waking. In restless leg syndrome unpleasant sensations in the legs that are ameliorated by moving the legs occur when the patient is tired in the evenings and at the onset of sleep.

Causes and prevention of sleep disorders

Some sleep disorders may be caused by medical conditions such as chronic obstructive pulmonary disease, sleep-related gastroesophageal reflux, peptic ulcer, back problems, neck problems, Alzheimer's disease, endocrine changes, intake of certain drugs, obstructive sleep apnea and snoring. Most of the mental problems such as anxiety, depression, panic attacks, bipolar syndrome, paranoia and schizophrenia can cause sleep disorders. The sleep problems associated with menopause and pregnancy are very common.

The alteration in the circadian rhythm is a major causative for many sleep disorders. Shift workers usually experience sleep disorders due to their altered sleep pattern and jet lag is a reason for sleep disorder among plane travellers.

Lifestyle factors such as alcoholism and intake of caffeine may also contribute to the cause of sleep disorders. The environmental factors include light, noise, and change of bedding. Narcolepsy is genetic with an autosomal dominant inheritance with low penetrance.

Sleep disorder: Complications

The complications include depression, fatigue, hypertension, sleep deprivation, stroke and even sudden death.

Sleep disorder: Treatment

The choice of a specific treatment depends on the patient's diagnosis, medical and psychiatric history and preferences. Management of sleep disturbances that are secondary to mental or physical medical disorders should focus on the underlying conditions.

Some disorders, such as narcolepsy, are best treated pharmacologically. Others, such as chronic and primary insomnia, may be more amenable to behavioral interventions.

Narcoleptic attacks can be treated with CNS stimulants such as dexamfetamine (5-10 mg 8 hourly) or methylphenidate (10-60 mg per day) but fewer side – effects occur with modafinil (200-400 mg per day). Cataplexy responds to clomipramine (25-50 mg 8 hourly) or fluoxetine (20 mg per day).