Sleep Disorders in Humans

Main Idea:

Sleep medicine constitutes a spectrum of disorders, which combines the specialties of neurology, pulmonary medicine, psychiatry, psychology, otolaryngology, and pediatrics.? Sleep disorders may be divided based on symptoms into four types:

• Insomnia, or difficulty initiating and maintaining continuous sleep,
• Excessive sleepiness,
• Circadian sleep-wake rhythm disorders, in which the sleep-wake cycle is out of sync with the day-night cycle, and
• Parasomnias, in which undesirable motor, behavioral and autonomic activity occur before, during, or after sleep.

?The International Classification of Sleep Disorders, revised in 1997, lists 84 disorders which are divided into four categories:

• Dyssomnias which include causes of insomnia and excessive sleepiness,
• Parasomnias,
• Sleep disorders associated with medical or psychiatric disorders, and
• Proposed sleep disorders, for which there is suggestive, but not unambiguous data, for a sleep disorder.? This chapter will review the properties of normal sleep and sleep disorders based on the symptomatic classification.

?Normal Sleep? ??

Sleep is more than a respite from consciousness or sensory stimulation.? It is a complex and dynamic process.? Much of what we now know about the anatomy of sleep is based on lesion studies in animals.? Thehypothalamus is critical to the organization of sleep.? It is involved in a network of brain nuclei that regulate an intrinsic time clock, body temperature, and sleep-wake cycles, while concurrently relying on cues from light as perceived by the eyes and skin.? The thalamus is most closely involved in the control of the sleep-wake cycle.? Massive bilateral destruction of the thalamus is characteristic of fatal familial insomnia, which results in progressive insomnia and neurologic deterioration leading to death.? Both the hypothalamus and

thalamus extensively modulates the actions of the brainstem, the primary site of origin for REM sleep.? The reticular activating system, raphe nuclei and locus coeruleus, in particular, have key roles in the generation of REM sleep.

?Insomnia

?Insomnia is the inability to initiate or maintain continuous sleep.? About 40% of women, 30% of men, and half of the people over the age of 65 complain of insomnia.? A large number of patients complaining of insomnia have an unsuspected sleep disorder while an equally large number of patients have no detectable abnormality in the quality or quantity of sleep.? In the elderly, insomnia may be due to frequent arousals and displacement of sleep from night to day. In others, three major etiologic factors exist:

?Psycho physiologic factors.

• Organic factors.
• Psychiatric disorders.

?Excessive Sleepiness

?Excessive daytime somnolence is a more common complaint in sleep clinics than insomnia.? The major causes of this symptom are sleep apnea, narcolepsy or neurologic illness such as head injury, post viral infection, myotonic dystrophy, developmental disorders, Parkinson's disease, Alzheimer's disease and, occasionally, Parasomnias.? The diagnosis is determined by history, physical exam and objective testing for daytime sleepiness, such as the multiple sleep latency test (MSLT), which is almost always preceded by an overnight polysomnogram to document adequate sleep. The history is often best obtained or corroborated by a bed partner or family member who can provide witnessed accounts of daytime somnolence and the patient's nocturnal sleep patterns.

?Circadian Sleep-Wake Rhythm Disorders

? This group of disorders is characterized by a mismatch between the patient's sleep patterns and the time at which the patient wishes to fall asleep.? The most common scenario in which this complaint occurs is with shift work or jet lag.? With shift work, rotating shifts are more disruptive to the sleep-wake cycle than fixed evening or night shifts.? Patients older than 40 years of age experience greater difficulty in adapting to shift work than younger workers.? Jet lag has the same effect on sleep as shift work.? Its effect is exacerbated by alcohol and dehydration. In general, east to west travel across several time zones results in sleep disturbances that last about 4-5 days.? Travel from west to east can disrupt sleep for up to 10-14 days.? Melatonin and benzodiazepines may reduce jet lag in some people, but their use is not recommended because of inadequate data supporting their efficacy.? Furthermore, the long-term side effects of melatonin are unknown.

?There are three major circadian rhythm sleep disorders:

• Delayed sleep phase syndrome.
• Advanced sleep phase syndrome.
• Non-24 hour sleep-wake syndrome.

?Parasomnias

?Parasomnias collectively refer to undesirable motor or autonomic activity during sleep or upon arousal.? They include hypnic jerks, sleep myoclonus, periodic leg movements of sleep, head banging, sleep paralysis, REM sleep behavior disorder, sleepwalking, nightmares, night terrors, bruxism (teeth grinding), and bed-wetting.? It is more common in children than adults. ?They may be associated with:

• Abnormal sleep architecture such as REM behavior disorder.
• Familial predisposition such as sleepwalking or night terrors.
• Transition between sleep stages, a particular stage of sleep, such as head banging and REM behavior disorder, respectively,
• Multiple factors as in bed wetting.? Anxiety, sleep deprivation or changes in sleep habit may exacerbate the frequency or severity of parasomnias in children and adults.

Conclusion:

Now a days in 100 people minimum 30% people having sleep disorders. Everyone trying how to reduce those problems using some therapies.

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