Symptoms associated with sleep disorders:
Sleep-wake disorders represent a complex picture with a cluster of symptoms. For example sleep deprivation secondary to inadequate life style, stress, insomnia can yield to anxiety, depression, muscle tension, pain, all factors interacting and reinforcing each other ending often with multiple and long treatments.
Snoring is caused by the vibration of the soft tissues in the upper airway. When benign, it can cause annoyance or even marital discord. When more severe, snoring may reflect obstruction to the airflow at the back of the mouth.
Sleep apnea is associated with sleepiness during the daytime. If severe and not treated the condition yields to cardio-vascular, metabolic and hormonal problems not mentioning risk for injury secondary to excessive sleepiness. It is a condition in which the individual stops breathing between snores.
Daytime Sleepiness and Fatigue
The inability to remain alert, reduced concentration or impaired daytime performance may be due to obstructive sleep apnea, underlying medical disorders, movement disorders and unusual behaviour during sleep, disturbing sleep quality, sleep-wake rhythm disturbances, narcolepsy, medication etc.
Insomnia is a sleep disorder in which people experience poor sleep. It is defined by a repeated difficulty in falling asleep or/and maintaining sleep and/or frequent awakenings and/or early awakening in the morning and bad sleep quality despite adequate time and opportunity for sleep. Some people can have trouble falling asleep at night, others wake up during the night or awaken much too early in the morning. Insomnia is often related to emotional depression, stress or anxiety. It can be related to abnormal lifestyle, behavioural disorders while asleep or abnormal movements of the legs or other extremities, the patient being unaware.
Narcolepsy is a disorder primarily characterized by excessive daytime sleepiness and cataplexy.
- Sleepiness is very disabling yielding to repeated episodes of involuntary brief naps across the daytime. Patients wake up refreshed but within a couple of hours they feel sleepy again.
- Cataplexy is a sudden loss of muscle tones on both sides. The loss of muscle tones can range from a mild sensation of weakness to complete postural collapse, the subject being “paralyzed” but remaining conscious.
- Hallucinations which are vivid perception and awareness of the presence of someone or something, typically occurring at sleep onset, with often fear sensation.
- Sleep paralysis is a sudden and often frightening inability to move or speak when awakening – sometimes with a sensation of an inability to breathe. The paralysis can last several minutes.
Restless legs syndrome (RLS)
Restless legs is a disorder characterized by a uncomfortable, sometimes painful sensation, felt deep into the legs difficult to describe.
This sensation is engendered by rest, mainly while lying, and worsens in the evening or night.
It yields to strong, irresistible urge to move the limb. Walking, moving, scratching or having a massage to the legs can relieve immediately the sensation, at least temporarily.
Periodic limb movements (PLMs) and other movement disorders
PLM is characterized by repeated, brief, stereotyped and involuntary movements of the limbs such as jerking or twitching, flexion of the toe or the foot. It occurs mainly in the feet and the legs but other extremities can be involved. It can occur alone or be associated to RLS. The movements can disrupt the bed partner’s sleep.
Parasomnias are undesirable physical behavioural events that occur during sleep. They can develop at sleep onset, in the middle of the sleep or during arousals from sleep.
These events often involve complex, sometimes purposeful behaviors, the patient unaware of the events and unable to control them. They can affect children as well as adults.
Parasomnias include sleep-walking, sleep-talking, bedwetting, sleep terrors, frequent nightmares and nocturnal convulsions and sleep eating disorders.
Bruxism is the term used to describe jaw clenching and tooth grinding.
Bruxism usually occurs at night (nocturnal bruxism). This condition is very common and often accompanied by headaches on waking as well as pain/stiffness in the face and jaw joints. Bruxism if left untreated can lead to wearing of the protective enamel of the teeth rendering the teeth sensitive and in some cases mobile.
Whilst the exact cause of bruxism is unclear, it is exacerbated by stress, anxiety and sleep disorders which are often associated with temporomandibular joint dysfunction.
REM sleep behavior disorder (RBD)
RBD is parasomnias occurring during REM sleep. While in normal people the muscles are paralyzed during REM sleep, in some conditions this paralysis remains incomplete and the subject acts his dreams. Often these are action-filled, unpleasant and violent dreams or nightmares in which the patient is confronted or chased by unfamiliar people or wild animals. The subjects tries to escape or to fight, talks, shouts, swears, punches, kicks and this may yield to injury to the patient or the bed partner.
Abnormal Sleep-Wake Rhythm: The biological rhythm of sleep and wakefulness may be disrupted by many conditions or certain psychiatric conditions.
- Delayed sleep phase disorder
Subjects with this disorder fall asleep much later at night than is normal and also wake up later in the morning. This sleep pattern occurs often in young people and can interfere with their schedule of activities for the day. Light treatment should take place during the early morning hours.
- Advanced sleep phase disorder
The subject falls asleep much earlier at night than is normal and also wake up earlier in the morning. This condition is often encountered in elderly people. Exposure to bright light should take place early at night.
- Irregular sleep-wake rhythm
People with this disorder fall asleep at a different time each day. This condition most often occurs in blind people. Light therapy in the early morning hours may help blind people, even if they can't perceive visible light.
- Jet lag
Crossing many time zones on a flight can disturb sleep. Bright light in the evening may help when travelling west whereas light in the morning for an eastbound journey.
- Shift and night Work
Using light treatment in the evening should help someone who regularly works night shifts. Daylight should be avoided when coming off work and going to bed (using dark sunglasses can help).