The Science of Living Better, Longer

Medical Symptoms and Indications of Sleep Disorders

• Daytime somnolence
• Weight gain
• Morbid obesity
• Chronic Obstructive Pulmonary Disease
• Heavy and chronic snoring
• Congestive Heart Failure
• Neck size > 16 inches
• Gastroesophageal Reflux
• Hypertension
• Enuresis (pediatrics)
• Morning headaches
• Epworth Sleepiness Scale Score of 8-24
• Sleepwalking
• Witness apnea and gasping
• Insomnia
• Coronary Artery Disease
• Complaint of unrefreshed sleep
• Difficulty fall or staying asleep
• Abnormal behaviors during sleep
• Excessive sleeping

Combined with directed history and physical exam, the above symptoms and medical conditions are suggestive of a sleep disorder.

OBSTRUCTIVE SLEEP APNEA HYPOPNEA SYNDROME (OSAHS)
Obstructive Sleep Apnea Hypopnea Syndrome is an array of sleep related breathing disorders that is commonly referred to as “sleep apnea.” These include obstructive, central and mixed apnea and hypoventilation (hypopnea).

Sleep apnea is a common disorder affecting approximately 20% of men and 9% of women, which can be very serious; 85% of patients referred to sleep labs are to rule out OSAHS. During sleep, your breathing stops or gets shallow with pauses typically lasting 10-20 seconds or more, which can occur 20-30 times or more an hour, then normal breathing resumes with a loud snort, gasp or choking sound.

OSAHS is associated with often severe desaturation. This results in an arousal, which disrupts sleep architecture, thus leading to unrefreshed sleep and the numerous known adverse physiological affects associated with cardio-pulmonary instability (hypertension, heart attack or stroke) and sleep deprivation. The severity OSAHS is reported as the Apnea Hypopnea Index (AHI).

Because of advances in clinical practice as evidenced by the sleep literature combined with new technologies, several options now exist to both diagnose and manage OSAHS. If it goes untreated it can also increase the risk of diabetes, risk of work-related accidents and driving accidents.

NARCOLEPSY
Narcolepsy is a chronic neurological disorder caused by the brain’s inability to regulate sleep-wake cycles normally. People with narcolepsy experience urges to sleep. If the urge becomes overwhelming, individuals will fall asleep for periods lasting a few seconds to a few minutes. In addition to excessive daytime sleepiness (EDS), there are three other major symptoms: cataplexy, sudden loss of voluntary muscle tone; vivid hallucinations during sleep onset or awakening; and brief episodes of total paralysis at the beginning or end of sleep.

RESTLESS LEG SYNDROME
Restless legs syndrome (RLS) is a neurological disorder characterized by unpleasant sensations in the legs and an uncontrollable urge to move them for relief. Individuals affected with the disorder describe the sensations  “burning”, “creeping”, “tugging”, “itching”, “tingling” and “crawling” inside the legs.

PERIODIC LIMB MOVEMENT
Periodic limp movement disorder (PLMD) is another neurological movement disorder. Movement disorders often prevent or disrupt sleep. PLMD only affects people during sleep. It is a repetitive cramping or jerking of the legs during sleep. “Periodic” refers to the fact that the movements are repetitive and rhythmic, occurring about every 20-40 seconds. It is often linked to Restless Legs Syndrome, but they are not the same thing. It is more common in middle-aged and older patients.

INSOMNIA
Insomnia is defined as an inability to fall asleep or an inability to stay asleep. It affects one third of the population at some point in their lives, with roughly one third of these people experiencing chronic insomnia. A variety of psychological and physiological factors can cause insomnia. The disorder may be worsened by consuming alcohol or stimulants such as caffeine, or by certain drugs or medications.

Other Sleep Disorders:
Other sleep disorders include night terrors, sleepwalking, REM Behavior Disorders and
other far less prevalent sleep-related disorders.