Sleep disorder is the common clinical condition, which is observed in many patients. It is a group of conditions and is associated with disturbance at physical, mental, social and emotional level.
Quality of life gets degraded due to improper sleep.
Normal sleep mechanism
Sleep is complex biological process. During sleep there is decrease metabolic and motor activities.
It has two phase: 1) REM (Rapid Eye Movement); 2) NREM (Non Rapid Eye Movement
REM is active dreaming and presence of motor activities. The cycle of REM to NREM repeats at every 90 minutes.
Sleep disorder category
a) Primary (Endogenous disturbance):
- Parasomnias - Patient shows unusual behavior during sleep such as;
- Sleep terror disorder
- Sleep walking
- Nightmare disorder
- Dyssomias: Patient shows abnormalities in amount, quality or timing of sleep such as;
- Primary insomnia
- Hypersomnia
- Narcolepsy
- Breathing related sleep disorders
- Circardian rhythm sleep disorder
b) Secondary ( defines by medical and psychiatric disturbance)
Etiology:
Wide range of causes lead to disturbance in sleeping pattern. It can be due;
- Cardiac cause: Heart failure, due to difficulty in breathing patient usually gets awakens in middle of night.
- Respiratory cause: Asthma, COPD, Obstructive sleep apnea
- Nervous system cause: Stroke, Restless leg syndrome, headache
- Musculoskeletal cause: Rheumatoid arthritis, Fibromyalgia
- Gastric cause: GERD
- Psychiatric causes:
- Depression: It causes either insomnia or hypersomnia.
- Anxiety: Anxiety disorder leads to insomnia or patient may not fresh after sleeping.
- Phobias
- Panic Attacks
- Anti depressant medication: Benzodiazepines causes rebound insomnia mostly in elderly.
- Shift work schedule
- Corticosteroids
- Alcohol withdrawal syndrome
- Traumatic childhood experience
Signs and Symptoms:
In case of narcolepsy (chronic neurological disorder):
- Excessive day time sleepiness
- Loss of muscular tone
Obstructive sleep apnea:
- Loud snoring
- Gasping
- Choking
- Excessive day time sleepiness
Advanced sleep phase syndrome:
REM sleep behavior disorder:
Night terror disorder:
Work up:
Keep sleep diary; for recording duration and time of sleep. Along with it keep note of number of awakening during sleep and nap time.
Electroencehalogram: It is useful in detecting sleep apnea events.
Laboratory work up: Complete blood count, Arterial blood gas, Thyroid function test, Drug and alcohol toxicity screening, Iron study and CRP.
Oxygen saturation measurement monitoring is mandatory during sleep.
Multiple sleep latency test or nap study
Differential diagnosis:
Treatment and management:
Pharmacological treatment:
Complications:
Due to insomnia or night terror disorder, as patient is not able to get enough amount of sleep; he/she may suffer at physical or emotional level as it disturb the hormonal and metabolic functioning.
- Mood swings and anxiety disorder
- Formation of false memory
- Decline in cognitive accidents
- Cerebrovascular accidents
- Brain damage
Prevention:
- Maintain schedule
- Don't use bed for watching T.V. or reading
- Avoid caffeine or smoking
- Exercise regularly
Key words: sleep, insomnia, anxiety, metabolic, depression
Reference:
1. https://www.ncbi.nlm.nih.gov/books/NBK560720/
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