How Sleep Disorders Affect You

Sleep Disorders

— the most common medical disorders in American adults.

Over half of our population suffers from a significant sleep disorder. These disorders can take a variety of forms that not only interfere with your daily life but also can increase the risk of many serious health problems.

Ask yourself…

Do you have difficulty falling asleep or staying asleep?

Do you wake up tired?

Have you been told that you snore?

Even these seemingly small things point to potentially bigger concerns or issues that may develop as a result of poor quality sleep or undiagnosed sleep disorders.

Health Issues Associated with Sleep

Sleep disorders are believed to influence neurological health. You create opportunities for degenerative cognitive conditions to take hold when you don’t get enough sleep.  There are numerous reasons for this, perhaps you aren’t properly planning and staying up too late and waking up to an alarm before your body is fully rested. Perhaps you suffer from restless legs syndrome or insomnia and it’s keeping you from falling asleep at night. Maybe you aren’t getting into deep sleep because you suffer from untreated obstructive sleep apnea). Deep sleep is restorative sleep.  It’s when your body repairs the brain.

In recent years medical research has shown that sleep disorders are major causes or risk factors of serious health issues such as:

  • High blood pressure
  • Type 2 diabetes
  • Heart disease
  • Stroke
  • Depression and Anxiety
  • Obesity
  • Gastro-esophageal Reflux Disease (GERD)
  • Erectile dysfunction
  • Mental Impairment
  • ADD / ADHD
  • PTSD
  • Nocturia
  • Fibromyalgia symptoms
  • Headaches
  • Fatigue

Most Common Sleep Disorders

There are over 90 documented sleep disorders, and we treat them all.  Insomnia and obstructive sleep apnea are the most common cases we see at our sleep center.  Circadian rhythm disorders, restless legs syndrome, narcolepsy, and parasomnias (i.e. REM sleep behavior disorder) are also common sleep disorders.

Obstructive Sleep Apnea

Obstructive sleep apnea (OSA) has been well researched with documented adverse effects on your health.

It’s easy to diagnose and easy to treat. Despite this fact, 80% of moderate to severe cases go undiagnosed. Separate studies in the United States and Australia showed that up to 40% of people with severe obstructive sleep apnea who went untreated died within 12-15 years.

If you suspect you have sleep apnea, seeking diagnosis and possible treatment will not only improve your sleep, it will improve your health. It can also help prevent disease and future health issues like cardiovascular disease, diabetes and hypertension, as well as, save you from costly health care expenses in the future.  

Learn more about why and how obstructive sleep apnea leads to heart disease, diabetes, and other health issues here.

Narcolepsy

If you suffer from the sleep disorder narcolepsy...

…you may feel excessively sleepy, fall asleep during normal activities, and for some experience cataplexy (which is a partial loss of muscle control) while you’re awake.  This is strongly associated with an emotional reaction, usually laughter.

Men and women are both equally affected. Narcolepsy is where the boundary between the awake and sleep states are blurred, and many people have symptoms for years before diagnosis. True narcolepsy, however, is very rare and is often improperly diagnosed.

There is no cure for narcolepsy, but with behavioral treatments and medication, people are able to function well and have normal lives. 

REM Sleep Behavior Disorder

REM sleep behavior disorder (RBD) is  a neurological sleep disorder most common in older adults, especially men over 50.  It results in abnormal movements during dream sleep. If you suffer from this disorder, you may enact your dreams.  Typically during REM sleep the body is naturally paralyzed from the chin down, so you shouldn’t normally be able to move any muscles. Unfortunately with RBD you may act out your dreams in a violent and aggressive manner.  This enactment points to a neurological disconnect between your brain and your body when you sleep.

If you have REM sleep behavior disorder:

  • You may be aware of your dreams as you act them out
  • Feel you are both awake and asleep at the same time
  • Vividly recall dream details

Accurate diagnosis is essential, because of the severe and long term consequences of this disorder. It can be an early indicator of neurodegenerative disease, like Parkinson’s disease.

A thorough evaluation is performed along with a nocturnal sleep study (polysomnogram). A sleep study is an important step in the diagnosis process. You may suspect you have REM sleep behavior disorder, but a thorough examination is necessary to eliminate other possible culprits such as medications, like antidepressants.  Acting out dreams can also occur with sleep apnea and occasionally with antidepressant medication. 

Restless Legs Syndrome

Up to 10% of the US population is suspected to suffer from restless legs syndrome. Men and women are affected, although more women than men, and it is most severe for middle-aged or older populations.

If you have restless legs syndrome (RLS) you may experience:

  • An urge to move the limbs
  • An unpleasant or uncomfortable sensation in the limbs
  • A worsening of the symptoms during rest or inactivity
  • A worsening of the symptoms in the evening or at nighttime
  • An improvement of the symptoms after getting up or moving

Restless legs syndrome is classified as a sleep disorder because the symptoms are initiated when you rest or try to sleep.  Moving helps relieve the discomfort, but that relief is temporary and will return when movement stops.

Symptoms of restless legs syndrome may include:

  • Exhaustion and daytime sleepiness
  • Poor concentration
  • Impaired memory
  • Depression or other mood disorders

Sleep studies are not needed to diagnose or treat restless legs syndrome.

Insomnia

Insomnia is one of the most visible sleep disorders and intermittently affects many people.

What is Insomnia?

Insomnia is characterized by the inability to initiate or maintain sleep. It occurs when you have difficulty falling asleep or staying asleep even though you’ve had the opportunity for a full night of rest.

Adults need seven or more hours of sleep per night for the best health and wellbeing [1]. If you’re suffering from insomnia, you may find it difficult to meet that nightly sleep recommendation.

Signs You May Have Insomnia

This common ailment often involves one or more of the following sleep disturbances:

  • difficulty falling asleep
  • difficulty staying asleep
  • waking too early in the morning

Do you often feel excessively sleepy during the day?  

If yes, it could be insomnia.

Insomnia is most common in older adults, women, individuals under stress, and those with certain medical and mental health problems such as depression.  The American Academy of Sleep Medicine states that as many as 30% – 35% of adults may complain of insomnia at some point in their lives.

Causes of Insomnia

There are many reasons you may develop insomnia, which include:

  • Stress
  • Poor sleep hygiene
  • Medical conditions
  • Hormone changes
  • Sleep-related breathing disorders
  • Limb Movements

Types of Insomnia

Insomnia is classified as either short-term or chronic.  This determination is based on the regularity and duration of the sleep disturbance and daytime symptoms.

Short-term insomnia. This type is generally limited in duration – lasting for up to three months.  It’s often a result of some stressful event like the loss of a loved one. The American Academy of Sleep Medicine (AASM) estimates it occurs in 15% – 20% of people.  

Chronic insomnia. If you suffer from chronic insomnia you’re having difficulty falling asleep and staying asleep and occurs at least three times per week for a minimum of three months. It affects approximately 10% of people.

Why Treating Insomnia Matters

It is important to treat insomnia because the lack of sufficient sleep may result in:

  • Impaired cognitive function
  • Low energy levels
  • Inability to concentrate
  • Memory issues
  • Relationship trouble
  • Work difficulties
  • More frequent errors or accidents

If you’re interested in learning more about the effects of insomnia you can learn more here.

Insomnia Treatment

Our Advanced Practice Providers (APP) Sleep Specialists can diagnose and provide ongoing care for insomnia. They’re trained in the most effective forms of treatment, including the first line of recommended treatment for insomnia. Cognitive Behavioral Therapy (CBT) [2], is most often the initial treatment protocol.  It addresses the attitudes, behaviors, and beliefs that negatively impact your sleep. CBT is a good treatment choice because it offers lasting benefits and no negative side effects.

In certain cases, your provider may recommend sleep medication in addition to CBT. Sleep medications can also be an effective choice for short-term treatment of insomnia. For example, medication can provide immediate relief of symptoms during periods of elevated grief and stress.

Each case is different, but effective treatment options are available. A short term treatment option is medication to prevent chronic or long term insomnia.

Don’t let insomnia prevent you from sleeping well and living life to the fullest. Our Sleep Medicine Advanced Practice Providers are here to help you feel your best. Get help today.

[1]  Watson NF, Badr MS, Belenky G, et al.; Consensus Conference Panel. Joint consensus statement of the American Academy of Sleep Medicine and Sleep Research Society on the recommended amount of sleep for a healthy adult: methodology and discussion. Sleep. 2015;38:1161–1183.

[2] Bonnet MH, et al. Treatment of insomnia. http://www.uptodate.com/home

Symptoms and Side Effects of Sleep Disorders

In addition to diabetes, cognitive decline, heart disease, and other health issues related to obstructive sleep apnea, insomnia, and other sleep disorders, there are numerous symptoms such as pain, dry mouth, and bedwetting that are also related.  We’ve listed several below.

Anxiety

Symptoms of anxiety can be a sign of a psychological disorder (such as an anxiety disorder), or can occur in some cases due to medical problems or medications. Sleep is highly associated with symptoms of anxiety. Any disruption in the sleep pattern negatively impacts the brain’s ability to replenish certain types of neurochemicals (such as serotonin) during deep sleep. These neurochemicals are largely responsible for regulating mood/anxiety symptoms and cognitive function (related to such things as memory, focus, concentration). As such, the neurochemical deficiency that results from sleep disruption often results in anxiety symptoms. Anxiety is often a causal factor for insomnia, thus creating an endless cycle of sleep problems and anxiety.

Bedwetting

Bedwetting, also known as enuresis, can occur as a primary disorder or as part of another disorder. Primary bedwetting occurs most frequently in children, and may be due to a lack of development of the brain’s “alarming” system that wakes us prior to urinating at night. This problem can be fixed using medication or various types of alarming devices. Secondary bedwetting can occur as part of a medical problem or another sleep disorder. Bedwetting can be strongly associated with obstructive sleep apnea (OSA) in both children and adults.

Body Jerks

Jerking of the body (often times the whole body) can occur as we initiate sleep. These movements, known as hypnogogic jerks, often involve a sensation of falling as we transition from wake to sleep. They are a normal phenomenon occurring in most humans. They can sometimes interfere with one’s ability to get to sleep. Body jerks can also occur during sleep as part of another sleep disorder, such as obstructive sleep apnea (OSA), periodic limb movements (PLM’s), parasomnias (such as sleepwalking, night terrors), and others.

Daytime Fatigue

Like excessive daytime sleepiness (EDS), daytime fatigue can be caused by a long list of sleep problems, medical problems, medications, and behavioral issues. Daytime fatigue is often characterized by a generalized lack of energy, feeling “tired” or “drained”, or lethargy during the day. Daytime fatigue often interferes with one’s ability to function well. Those with daytime fatigue do not usually report fighting sleep or dozing during the day. One of the most common sleep disorders that causes daytime fatigue is obstructive sleep apnea (OSA). Other sleep-related problems that may contribute to daytime fatigue include periodic limb movements (PLM’s), parasomnias (such as sleepwalking, night terrors), insomnia, circadian rhythm disorders (such as jet lag, delayed sleep phase syndrome), and behaviorally induced insufficient sleep syndrome

Depression

Symptoms of anxiety can be a sign of a psychological disorder (such as an anxiety disorder), or can occur in some cases due to medical problems or medications. Sleep is highly associated with symptoms of anxiety. Any disruption in the sleep pattern negatively impacts the brain’s ability to replenish certain types of neurochemicals (such as serotonin) during deep sleep. These neurochemicals are largely responsible for regulating mood/anxiety symptoms and cognitive function (related to such things as memory, focus, concentration). As such, the neurochemical deficiency that results from sleep disruption often results in anxiety symptoms. Anxiety is often a causal factor for insomnia, thus creating an endless cycle of sleep problems and anxiety.

Difficulty Sleeping

Patients with trouble getting to sleep, staying asleep, or both may be suffering from insomnia. Insomnia is best treated using cognitive behavioral treatment (CBT) techniques. Medications may also be appropriate to treat insomnia in some cases. Before deciding on treatment for insomnia, it is important to discuss the problems with difficulty sleeping with a sleep doctor to rule out other sleep disorders (such as circadian rhythm disorders, OSA, RLS/PLM’s), medical problems, or medication issues.

Dry Mouth

Waking from sleep with a dry mouth or a dry throat is frequently reported by patients with untreated obstructive sleep apnea (OSA). The symptom of dry mouth occurs because patients with OSA are usually “mouth breathers” during sleep.

Daytime Sleepiness

Those who suffer from excessive daytime sleepiness (EDS) often find it difficult to get through the day without fighting sleep or dozing. EDS is measured subjectively by way of screening tests (such as the Epworth Sleepiness Scale) and can be measured objectively by way of sleep laboratory testing. One such laboratory test is a Multiple Sleep Latency Test (MSLT), during which a patient undergoes an overnight sleep study followed by a series of nap trials the following day. EDS can be the result of a host of different problems related to sleep, medical conditions, medications, or behavioral issues. One of the most common sleep disorders that causes EDS is obstructive sleep apnea (OSA). Other sleep-related problems that may contribute to EDS include periodic limb movements (PLM’s), parasomnias (such as sleepwalking, night terrors), insomnia, circadian rhythm disorders (such as jet lag, delayed sleep phase syndrome), and behaviorally induced insufficient sleep syndrome. If a patient suffers from significant EDS despite all of the above listed types of sleep problems being ruled out, a diagnosis of narcolepsy or idiopathic hypersomnia may be made.

Frequent Nighttime Urination

Urinating frequently at night, also known as nocturia, is highly associated with obstructive sleep apnea (OSA). Untreated OSA often results in increased production of atrial natriuretic peptide (ANP), which is one of our body’s natural diuretics – a hormone that works to remove fluid from the body. The end result is frequent urination during nighttime hours while OSA is occurring. Frequent nighttime urination can also be the result of certain medical problems, such as prostate problems in men.

Gasping/Shortness of Breath at Night

Waking from sleep with gasping or shortness of breath is often a sign of obstructive sleep apnea (OSA). This sensation, also reported as a feeling of “choking”, occurs when the muscles around the upper airway (or throat area) relax and collapse during sleep. The end result is a sensation of gasping or shortness of breath, often associated with a drop in the body’s oxygen level.

Gastroesophageal Reflux

Gastroesophageal reflux can have many different causes, including certain types of bacteria, hernia, or diet. Gastroesophageal reflux can also occur secondary to untreated obstructive sleep apnea (OSA). In patients with OSA a negative pressure or “vacuum effect” is created in the thorax during apneic events, and the acid from the stomach is drawn up the esophagus to the back of the throat. Over time, exposure of the esophagus to stomach acid causes erosion of the esophageal lining, and the end result is gastroesophageal reflux. This reflux occurs most often at night, and can result in waking with a sore throat, bad taste in the mouth upon waking, or a choking/gagging sensation.

Erectile Dysfunction

Difficulty achieving or sustaining penile erections can occur as part of obstructive sleep apnea (OSA). Patients with untreated OSA experience repeated drops in the oxygen level (hypoxemia) during sleep, and research suggests that this phenomenon negatively impacts erectile functioning. Moreover, some of the medications frequently used to treat problems with erectile functioning work by relaxing certain types of muscles in the body. One muscle group that may relax in response to these types of medications is located around the upper airway (or throat) area. The relaxation of the muscles around the upper airway can increase the upper airway’s propensity to collapse, causing an obstruction (or apnea) in the airway. As such, OSA may in some cases be worsened by the medications used to treat erectile dysfunction.

Heart Arrhythmias

Patients with sleep problems will sometimes report a feeling of heart arrhythmias during sleep. They will frequently describe waking from sleep with a “racing heart”, or feeling that their heart is “skipping beats”. This could be a sign of a cardiac problem, or this could occur as part of a sleep disorder. The sleep disorder most commonly associated with heart arrhythmias is obstructive sleep apnea (OSA).

High Blood Sugar

Problems with elevated blood sugar can have many different causes, one of which is untreated obstructive sleep apnea (OSA). As part of OSA, our oxygen level is compromised at night. Our brain senses the drops in oxygen and releases a “stimulating” neurotransmitter (norepinephrine) into our bloodstream. The release of this neurotransmitter helps to arouse us from sleep to take a breath and raise our oxygen level back to normal. However, norepinephrine is counterregulatory to insulin, and the end result of these repeated releases of norepinephrine into the bloodstream is elevation in blood sugar – particularly hemoglobin A1c. The elevation in hemoglobin A1c is often discovered as part of routine bloodwork, and patients will often get diagnosed as “insulin resistant” or “borderline diabetic” based in this finding. For patients with untreated OSA who have been diagnosed with diabetes, the elevations in hemoglobin A1c can result in poor diabetic control.

Leg Movements

Leg Movements at Bedtime

Patients who experience an urge to move the legs at bedtime sometimes get diagnosed with restless legs syndrome (RLS). This disorder can be caused by multiple medical problems, issues related to our body’s iron stores, or medications. The urge to move the legs may also occur when at rest during the afternoon or evening hours. It should be noted that some patients move their legs at bedtime as part of a “self-soothing” technique to help them fall asleep, which is normal.

 

Leg Movements During sleep

Leg movements or leg “jerks” during sleep may be a sign of periodic limb movements (PLM’s). These limb movements during sleep are usually in the legs, and can also occur during wake. PLM’s are often associated with restless legs syndrome (RLS), and are frequently seen as part of a sleep study. PLM’s can be caused by multiple medical problems, issues related to our body’s iron stores, or medications.

Memory Loss

Memory loss can be a sign of a serious neurological problem, a psychological disorder (such as a mood disorder), or can occur in some cases due to medical problems or medications. Problems with memory also can occur secondary to sleep disorders. Any disruption in the sleep pattern negatively impacts the brain’s ability to replenish certain types of neurochemicals (such as serotonin) during deep sleep. These neurochemicals are largely responsible for various different processes, including cognitive function. Cognitive function is related to factors such as our ability to store things into memory, and our ability to plan, focus, and concentrate. As such, the neurochemical deficiency that results from sleep disruption often results in memory problems (amongst other things) – a common complaint in those suffering from untreated sleep disorders. There is hope, however, in that those who suffer from memory problems as part of their sleep disorder often report a substantial improvement in memory, once their sleep disorder is treated.

Nasal Congestion

Problems with nasal congestion can have many different causes, ranging from allergies to non-allergic rhinitis. Nasal congestion can worsen obstructive sleep apnea (OSA), in that patients suffering from problems breathing through the nose often resort to “mouth breathing” during sleep. This type of breathing increases the propensity of the base of the tongue to collapse over the upper airway (or throat) area, thus causing an obstruction (or apnea) in the airway. Problems with nasal congestion can also result from the use of positive airway pressure (PAP) therapy for OSA. Addressing the issues with nasal congestion can improve a patient’s response to PAP therapy, and in some rare cases can improve OSA.

Pain

Acute (short term) or chronic (long term) pain makes life difficult. Those suffering from pain issues often have many medical problems, are on medications, and are at risk for developing depression and/or anxiety due to their day to day struggles with pain. But did you know pain can be directly related to sleep? Research has shown that there is a bi-directional relationship between pain and sleep. First, pain can disrupt sleep, causing problems getting to steep or staying asleep. And since the brain is active during sleep replenishing certain types of neurochemicals and hormones that aid the body in healing itself, poor sleep can result in making pain issues much worse. Of course, it is important to be closely followed by a pain specialist to optimally address issues with pain. It is also important to note, however, that a sleep specialist may be able to improve the quality of sleep, thus ending the negative cycle occurring between pain and poor quality sleep.

Snoring

Snoring is a noise produced from a collapse in the upper airway (usually the throat area) during sleep. It is the result of the muscles around the upper airway relaxing as we drift off to sleep, and the tissue around the airway vibrating to produce a snoring sound. Snoring (in particular, loud snoring) is usually a sign of obstructive sleep apnea. Snoring is more common in men, but occurs in both men and women. Snoring often worsens with age, and increases with weight gain.

Sore Throat

Waking from sleep with a sore throat is frequently reported by patients with untreated snoring or obstructive sleep apnea (OSA). The sore throat occurs due to the continuous vibration of the tissue in the upper airway (mostly the throat area) during sleep that occurs as part of snoring or OSA. The continuous vibration of this upper airway tissue results in inflammation of this tissue, which is usually reported to be worse just after waking.

Tossing & Turning

Many different problems can contribute to or cause tossing and tuning during sleep, including pain issues, environmental problems, or medications. Sleep disorders such as obstructive steep apnea (OSA), periodic limb movements (PLM’s), parasomnias (such as sleepwalking, night terrors), or insomnia also may contribute to this problem. Patients who toss and turn frequently during sleep often report feeling fatigued or sleepy during the day, and they often disrupt their bed partner’s sleep.

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