Sleep medicine involves evaluation and management of variety of sleep disorders which includes insomnia, sleep-related breathing disorders, sleep-related movement disorders, parasomnia, hypersomnia, sleep problems secondary to other medical conditions etc.
Obstructive sleep apnea: Obstructive sleep apnea is most common sleep related breathing disorder, happens due to intermittent upper airway closure at night due to relaxation of throat muscles. Snoring is invariably present in patients with OSA, other symptoms include non-refreshing sleep, waking up with morning headaches, excessive fatigue, or sleepiness during the day etc. Risk of OSA increases with age, male sex, smoking, obesity and with positive family history. Patients with untreated sleep apnea are at increased risk of cardiovascular disorders including hypertension, diabetes, heart attack, stroke, and heart rhythm problems. Diagnosis of sleep apnea requires sleep study, which can be performed as either in home or in lab, depending on comorbid risk factors. Treatment involves positive airway pressure therapy, dental appliance, positional therapy, and surgical options etc.
Please refer to following video from ResMed
https://www.youtube.com/watch?v=xEuFw_nu8oA
Insomnia: – Insomnia is the most commonly reported sleep problem, affecting at least 10% of adults in United States. Insomnia is defined as difficulty to initiate or maintain sleep on 3 or more nights per week for at least 3 months. Untreated Insomnia can adversely affect both physical and mental wellbeing. Patients with chronic Insomnia have been found to have increased risk of hypertension, diabetes, obesity, and cardiovascular mortality. Prevalence of mental health problems including depression and anxiety etc. tends to be higher in patients with insomnia. Insomnia also effects performance at work or school, cause poor memory and concentration and increased proneness to accidents. It requires detailed evaluation, as many times insomnia is associated with other sleep or mental health disorders. Both behavioral and pharmacological interventions are utilized to treat insomnia.
Hypersomnia: In this condition, patient generally presents with excessive daytime fatigue or sleepiness, it is a challenging diagnosis as fatigue or sleepiness can be caused by multiple factors including medical conditions, medications, eating behaviors, exercising behaviors, illicit drugs etc. Most common disorders fall under this category are narcolepsy and idiopathic hypersomnia. It may require variety of diagnostic testing including blood work, brain imaging and sleep studies to arrive at the accurate diagnosis. Treated with improving sleep quality at night and utilizing wake promoting agents during the day if needed.
Parasomnia – Parasomnias are group of disorders exclusive to sleep or awake to sleep transition including sleep walking, sleep talking, nightmares or night terrors or acting out in dreams (REM sleep behavior disorder) etc. Parasomnias have been reported in approximately 4% of adult population. It is also 1 of the common sleep complaints in patients with psychiatric disorders, for example in PTSD, nightmares and acting out in dreams are very commonly seen. It can cause a lot of stress in relationship between patient and spouse because spouse is afraid of patient acting out in dreams, have seen many examples of patient hitting them in the sleep or choking them. To the patients – it is very real, that they are in combat and fighting with enemy but that is not the case in reality. Many times, it is an injury or concerns for physical injury to patient or bed partner which bring them for an evaluation.
Example of REM sleep behavioral disorder
https://www.youtube.com/watch?v=rFXYRQ9xPUA
If you suffer from any sleep disorder, please contact us so we can evaluate you and help you achieve good quality sleep.
