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Sleep Disorders

Sleep Apnea

Sleep apnea is a breathing disorder. People with sleep apnea actually stop breathing for 10 seconds to sometimes a full minute or longer – from five to as many as hundreds of time or more a night.

Definitions, please!
Apnea means “without breath.”

Symptoms of Sleep Apnea

A person with sleep apnea usually doesn’t know their breathing is stopping while they sleep. Initial concerns are usually raised by loved ones who see the apnea episodes occurring or by the victim who suffers from unusual fatigue.

Common symptoms of sleep apnea include:

  • Loud snoring
  • Daytime sleepiness
  • Frequent visits to the bathroom throughout the night
  • Severe mood swings
  • Low sex drive
  • General lack of energy
  • Headache, dry mouth, and sore throat in the morning
  • Forgetfulness
  • Poor concentration
  • Poor motor skills
  • Severe heartburn or acid reflux
  • High blood pressure

Causes of Sleep Apnea

In a healthy person, throat muscles keep the throat and airway open even during sleep. For someone with sleep apnea, though, the throat collapses during sleep, blocking the airway and stopping air from getting to the lungs. Why does this occur? Several factors can contribute:

  • A smaller than normal airway
  • Large tongue, tonsils, or adenoids
  • Excess weight or obesity
  • Alcohol or sedative use before bedtime
  • Irregular sleep hours
  • Smoking

Certain disorders and syndromes are also commonly associated with sleep apnea:

  • Hypothyroidism
  • Acromegaly
  • Amyloidosis
  • Vocal chord paralysis
  • Post-polio syndrome
  • Neuromuscular disorders
  • Marfan’s syndrome
  • Down’s syndrome

Who is likely to get sleep apnea?

People with sleep apnea are often overweight or obese and have breathing problems such as blocked air passages.

Diagnosing Sleep Apnea

If you think you might have sleep apnea, you should make an appointment with a health care professional. You will likely need to keep a sleep diary and participate in a sleep study. A complete diagnosis requires an overnight sleep test called a polysomnogram.

Treating Sleep Apnea

Sleep apnea responds well to treatment. Some treatments your physician may encourage you to try:

  • Losing weight. If you are overweight, losing even 10% of your weight can reduce sleep apnea incidents
  • Avoiding stimulants and depressants, especially before bedtime
  • Sleeping on your side instead of your back
  • Keeping consistent sleep hours

Medical treatments are also available for treating sleep apnea. The exact treatment your physician chooses will depend on the underlying causes of your sleep apnea. For example, if you have enlarged tonsils or adenoids, your physician may recommend surgery to remove them. Or if the shape of your jaw or size of your tongue are causing problems, a dental appliance may help keep your airway open during sleep.

For severe sleep apnea, the most common treatment is to use a CPAP machine. This machine blows pressurized air into a mask that you wear over your nose and keeps your airway open during sleep.

Some patients also respond well to an innovative solution called Provent, a nasal device requiring no machine and no hoses; click here to read more about it.


People who suffer from insomnia have difficulty falling asleep and/or staying asleep. 40% of adults report having insomnia occasionally, while 10-15% have chronic or severe insomnia. This translates to approximately 60 million Americans suffering from insomnia. Women are particularly prone to insomnia.

How Big a Problem is Insomnia? Consider these Facts:

  • Insomnia sufferers spend $14 billion on insomnia treatments each year
  • As much as $28 billion a year is lost to decreased work productivity, accidents, and illnesses related to insomnia
  • People with severe insomnia have a quality of life similar to people who have chronic conditions such as heart failure
  • Insomnia increases your risk of disorders such as major depression, anxiety disorder, and substance abuse

Causes of Insomnia

Finding the cause of insomnia is usually key to finding a cure. Typical factors include:

  • Stress
  • Anxiety
  • Medications
  • Caffeine
  • Depression
  • Physical pain

Unfortunately, there may sometimes be no apparent cause.

Symptoms of Insomnia

Everyone has an occasional night when it is hard to fall asleep. However, if you have symptoms such as these night after night for a month or more, you may have insomnia:

  • Difficulty falling asleep
  • Difficulty staying asleep
  • Waking up unrefreshed and feeling like you haven’t slept at all or that you have a hangover
  • Morning headaches
  • Difficulty remembering things
  • Poor motor skills
  • Difficulty concentrating
  • Rapid mood shifts
  • Irritability
  • Bloodshot eyes
  • Daytime sleepiness

Treating Insomnia

To treat your insomnia, your physician may prescribe one or a combination of the following treatments:

  • Behavior modification
  • Prescription medication
  • Over-the-counter sleep aids

Behavior Modification

Because insomnia can be caused by anxiety and stress, learning to manage your stress and to develop relaxation techniques can help bring an end to your insomnia. Relaxation techniques you might try include:

  • Progressive muscle relaxation. Tense and then relax the muscles in each area of your body one after the other.
  • Guided imagery. Close your eyes and imagine yourself in a peaceful place. What do you see, hear, and smell?
  • Abdominal breathing. Breathe deeply and slowly down into your abdomen. Hold each breath for a second or two and then relax to let the air escape.
  • Meditation. Concentrate on an object or thought without letting your mind wander.

Other behaviors that can help reduce your insomnia include using your bedroom only for sleep and sex and avoiding caffeine, alcohol, and food before bedtime.

Prescription Medication

In years past, doctors often prescribed barbiturates such as Nembutal and Seconal for insomnia. However, these medications can be addictive and have replaced by safer benzodiazepine drugs such as Halcion, Lunesta, and Ambien. Another drug, called Rozerem, is especially useful for people who have trouble falling asleep, as it targets the part of the brain responsible for keeping you awake.

Antidepressants and antipsychotics may also be prescribed to help you win the battle against insomnia.

Over-the-Counter Sleep Aids

Over-the-counter sleep aids use antihistamines to sedate the brain. While these may work initially, they lose their effectiveness over time. In addition, they can have unpleasant side effects, including:

  • Next-day grogginess
  • Constipation
  • Confusion
  • Delirium

Another option is to try dietary supplements such as melatonin and valerian root, which may help some people with insomnia.

Restless Leg Syndrome

Approximately 12 million Americans suffer from restless legs syndrome (RLS), a neurological condition that can lead to sleep deprivation. RLS symptoms can strike anytime, day or night, but are most common at night. People with RLS have an irresistible urge to move their legs and often feel like their legs are tingling or crawling. The sensation becomes worse when resting and are relieved, at least partially, by moving the legs.

While RLS symptoms can also occur during the day, it is classified as a sleep disorder because sufferers generally have a hard time falling asleep and staying asleep. Their legs jerk every 20-30 seconds throughout the night, waking them up and leading to sleep deprivation.

Causes of RLS

RLS is a disorder that is based in the brain or spinal column. Scientists have not yet discovered an exact cause, although they suspect it may have a genetic basis and may be linked to a brain chemical disorder.

Other conditions can trigger RLS, including:

  • Medical problems such as diabetes mellitus, kidney disease, Parkinson’s disease, or rheumatoid arthritis
  • Iron deficiency anemia
  • Pregnancy
  • Neurologic lesions
  • Medications, including tricyclic antidepressants, anti-nausea, and some cold and allergy drugs
  • Varicose veins

Diagnosing RLS

Although RLS is frequently misdiagnosed and left untreated it is a treatable condition. If you suspect you have RLS, talk to your physicians. They will take a medical history of you and your family members and see if you have any other medical conditions that could be triggering your RLS symptoms.

Treating RLS

There is no cure for RLS but you can find relief for your symptoms through behavior modification and medication. In addition, if your RLS is caused by another condition, your physicians will treat that underlying condition.

Behavior modification

Some habits and behavior changes you can make to treat your RLS symptoms include:

  • Starting an exercise program
  • Wrapping your legs in an ace bandage or wearing tight pantyhose
  • Taking iron supplements
  • Avoiding coffee, chocolate, and caffeine, especially in the evening
  • Maintaining a regular sleep schedule


Your physicians may prescribe depressants or anticonvulsants to give you relief from RLS. Common choices include:

  • Dopaminergic agents such as Levodopa and Carbidopa (Sinemet), which decrease leg sensations
  • Sedatives such as Temazepam (Restoril), Alprazolam (Xanax), and Clonazepam (Klonopin) to help you sleep
  • Anticonvulsants such as Gabapentin (Neurontin) to treat severe muscle spasms
  • Alpha2 agonists such as Clonidine Hydrochloride (Catapres) to reduce muscle movements and sensations

Opiates such as codeine and propoxyphene (Darvon, Dolene) may also be prescribed when other medications don’t work.


Narcolepsy is a chronic and incurable brain disorder in which the brain cannot regulate sleep-wake cycles. Narcoleptics do not sleep well at night and have abnormal REM sleep. On the other hand, they may fall asleep without warning during normal daytime activities including talking, walking, driving, and cooking.

Narcolepsy affects many areas of a sufferer’s life, including:

  • Physical safety
  • Mental health
  • Social relationships
  • Professional development
  • Family life

Narcoleptics should wear a medical ID to alert others to their condition in case they suddenly fall asleep or cannot move or speak.

Symptoms of Narcolepsy

An estimated 200,000 Americans suffer from narcolepsy. Most people begin to display the following symptoms between the ages of 10 and 25:

  • Excessive daytime sleepiness
  • Abnormal REM sleep
  • Vivid and frightening dreams while asleep and hallucinations upon waking
  • Cataplexy, or sudden loss of muscle control when laughing or experiencing other strong emotions
  • Nighttime wakefulness
  • Sleep paralysis

About 25 to 50% of narcolepsy sufferers are unable to move or talk at the beginning or end of sleep.

Causes of Narcolepsy

Scientists are still working to discover the root cause of narcolepsy. They have discovered that narcoleptics are lacking in a brain chemical called hypocretin, which regulates sleep. Exactly why this is so is likely a combination of genetics and an environmental trigger such as a virus.

Diagnosing Narcolepsy

Narcolepsy can be difficult to diagnose because its most common symptom is daytime sleepiness. Because this is also a symptom of depression and of other sleep disorders, narcolepsy is often misdiagnosed.

If your physicians suspect you have narcolepsy, they will order several tests to confirm the diagnosis:

  • A nocturnal polysomnogram to measure your brain, heart, muscle, and eye activity while you sleep
  • A multiple sleep latency test to measure how long it takes you to fall asleep during the day
  • A spinal fluid analysis to test hypocretin levels in your spinal fluid
  • An Epworth Sleepiness Scale questionnaire

Treating Narcolepsy

Narcolepsy can’t be cured, but it can be treated. Treatment usually consists of a combination of behavior modification and medication.

Behavior modification

People with narcolepsy can help control their symptoms by:

  • Taking a few 15-minute naps at the same time each day
  • Avoid caffeine, alcohol, and nicotine
  • Exercising regularly


Medications can help alleviate the symptoms of narcolepsy so you can stay awake during the day and sleep better at night. A combination of stimulants and antidepressants is often used: stimulants to help you stay awake and antidepressants to reduce cataplectic attacks.

  • Methylphenidate (Ritalin) and Modafinil (Provigil) reduce daytime sleepiness and improves alertness
  • Fluoxetine (Prozac), Clomipramine (Anafranil) and Imipramine (Tofranil) reduce the frequency of cataplexy
  • Sodium Oxybate (Xyrem), reduces both daytime sleepiness and cataplexy. However, it has a history of abuse as a recreational drug and is therefore only recommended for people who do not respond to other medications

These drugs may become ineffective if you use them continuously for a long period. Your healthcare provider may suggest you take a “drug holiday” one day each week.