Sleep Medicine

Sleep medicine is a recognized specialty that addresses sleep health, sleep disorders, and other issues related to sleep. The healthcare professionals that deal with sleep medicine are known as somnologists. Somnologists specialize in internal medicine, pulmonary medicine, psychiatry, otorhinolaryngology, or pediatrics.

Sleep disorder – causes:

Sleep is an important factor of good health which affects both physical and emotional aspects that matter for old and young alike. Sleep disorder is defined as any difference or change in the normal sleep patterns. The causes of these sleep disorders can vary from persistent difficulty in falling asleep, low quality sleep for long periods of time, lack of sufficient sleep to more serious problems depending on physical, emotional, medical, and environmental factors.

Classification of sleep disorders

Sleep disorders can be classified into:

  • Insomnia: A condition that occurs due to decrease in the quantity or quality of sleep although there is adequate opportunity and time for sleep. Insomnia can also be characterized with difficulty in staying asleep. In chronic cases, insomnia can last for months or years which may be caused due to physical or emotional stress, or due to disturbances in the brain function.

  • Sleep-related breathing disorders: Breathing difficulties during sleep can result in decrease of oxygen levels in the body which causes sleep disruptions. This condition is known as sleep apnea. It is usually associated with irregular, loud snoring. Respiratory disorders such as asthma and chronic obstructive pulmonary disease, in which bronchospasm attacks may occur in the early hours and reduced oxygen levels at night, respectively can play a role to cause sleep apnea.

  • Narcolepsy: It is a condition of excessive sleepiness, sleep paralysis (unable to move after awakening), and hallucinations (just prior to sleep and/or on awakening) which occur due to sudden uncontrollable sleep attacks. Sometimes, it can be accompanied by sudden loss of muscle control, often triggered by strong emotions or laughter (cataplexy). Individuals with narcolepsy have a heightened feeling of sleepiness and may sometimes fall asleep during normal activities with no capacity to differentiate between asleep and awake.

  • Parasomnias: It is a group of conditions which refers to all the abnormal activities that can happen while sleeping. These include sleep walking, sleep-related eating disorders, nightmares, sleep talking, sleep paralysis, sleep aggression and performing sexual acts while sleeping. Parasomnias may have negative effects of increased sleepiness during the day.

  • Circardian rhythm sleep disorders: When the biological clock fails to follow the 24-hour cycle, causing the sleep cycle slowly rotating with decreased sleep at night and sleepiness during the day.

  • Restless leg syndrome: A condition characterized with an uncomfortable sensation in the limbs or an overwhelming need to move your limbs, which can worsen at night causing lack or reduction of sleep. It is seen often in the elderly due to a sedentary lifestyle.

  • Idiopathic Hypersomnolence: It is a rare neurological sleep disorder in which staying awake and being alert becomes hard during the day causing excessive daytime sleepiness. Individuals may be observed falling asleep unintentionally at inappropriate times which interfere with their daily normal activities.

Sleep disorders - Symptoms

The basic symptoms of sleep disorders include:

  • Snoring
  • Daytime sleepiness
  • Breathing difficulties
  • High blood pressure
  • Morning headaches
  • Difficulty in staying alert
  • Mood changes
  • Irritability or anxiety
  • Restless sleep
  • Daytime fatigue

Sleep disorders - Diagnosis

A somnologist performs a series of sleep studies (or polysomnogram) to completely assess sleep problems. Some sleep-related conditions can be determined only when an individual is asleep.

Sleep studies: These are overnight studies conducted in a private room of a sleep lab and the normal nighttime medications are taken. Electrodes and monitors are placed on different parts of the body. These equipment measure and record various factors to diagnose sleep disorders, which include brain waves, heart rhythm, oxygen and carbon dioxide levels, breathing, muscle activity and other diagnostic events. These factors help evaluate the nature and severity of sleep disorders.

Electroencephalogram: This is an additional test that is used along with sleep studies. It evaluates the electrical activity in the brain and determines the potential problems associated with sleep.

Sleep disorders - Treatment options

The treatment of sleep disorders is largely related to the cause of the disorder. Treatment options and recommendations are made only after a thorough complete medical evaluation and the sleep study which is based on the individual’s situations. The treatment of sleep disorders most often include a combination of medical treatments and lifestyle changes.

Medical treatment options that are used to treat sleep disorders include sleeping pills, melatonin supplements, medication for an underlying condition that is causing sleep disturbances, breathing devices (generally for sleep apnea), and a dental guard to prevent teeth grinding during sleep.

Sleep hygiene

Maintaining a good sleep hygiene can be a good start for any treatment regime. Sleep hygiene is a term which means to maintain good habits that can ensure a good night’s sleep. Some of these activities include:

  • Maintain a regular bedtime schedule every day.
  • Avoid activities which increase stress and vigorous exercise for at least two hours prior to the bedtime. Whereas regular exercise during the day can improve the quality of sleep.
  • Sleep in a quiet, dark and cool room.
  • Avoid consumption of caffeine and aerated beverages for a minimum of four hours prior to bedtime.
  • Relaxation exercises such as deep breathing, yoga or meditation before bedtime to improve the quantity and quality of sleep.
  • Consumption of low carbohydrate meal before bedtime.
  • Include more vegetables in the diet and reduce the intake of sugars.
  • Go to bed and wake up at the same time every day.