We spend almost a third of our lives asleep*. Sleep serves the purpose to refresh the body for the next day activities through rest and repair processes. Hence, unrefreshing sleep is a problem and can have detrimental consequences to one’s physical, mental, emotional and even social life.
However, this vital daily activity has been relatively neglected by the medical profession as a subject of scientific enquiry although since the 1970’s there has been increased attention and understanding of sleep disorders and their effects. We will briefly look at them here.
Sleep disorders can be categorised into two main types: the dyssomnias (primary disorders of initiating or maintaining sleep) and parasomnias (disorders that occur while in any sleep state.)
Parasomnias are the wide range of abnormal behaviours and feelings that can occur during sleep such as nightmares, sleep walking, bed-wetting and even bruxism (teeth grinding in sleep.) Treatment for these disorders usually involves behavioural adaptations to manage and control the problem.
The dyssomnias present a more complex challenge. They can be further categorised into three different disorder types: intrinsic (from within) such as sleep apnoea, extrinsic (from outside) such as a bad sleep habit and circadian rhythm (body clock) such as advanced or delayed sleeping disorders.
Sleep apnoea is arguably the most important sleep disorder as it is associated with poor attention and reaction times when awake alongside an increased long-term risk of blood pressure, diabetes, heart disease and stroke. It can occur to anyone at all ages, although the stereotypical patient is an obese male.
Sleep apnoea results from a narrowed airway which gets blocked when the muscles relax in sleep, causing a build up of carbon dioxide levels and a subsequent body response of waking to obtain more oxygen. This occurs at a background level so the sufferer can often be oblivious to it. Contrary to popular belief, snoring is not directly linked to sleep apnoea.
Investigation of potential cases comes in the form of an overnight sleep study. Greater than 5 apnoeic episodes per hour is sufficient for a diagnosis of a mild case, although severe cases can have up to 30 episodes per hour.
Once diagnosed, treatment involves a mask of CPAP (continuous positive airway pressure) to be worn at night that forces the airways open and delivers oxygen. Alternatives are dental supports and surgery to open up more space in the nose and throat.
Restless legs syndrome –the urge keep moving the legs at night- understandably making it hard to sleep and often wakes up the sufferer. Since it can often have an underlying medical cause such as low iron, low vitamin B12, kidney failure or second to some medications, it is important to see your doctor for a full assessment.
Primary insomnia is perhaps the most common disorder. It covers difficulty in getting to sleep, waking up in the middle of the night, or early morning waking. It is often the manifestation of a deeper physical or more commonly mental root cause such as anxiety and depression. Stress and some medications can also lead to insomnia. Therefore, it is vital insomniacs see their doctor to get the right diagnosis and find the most appropriate individual management regimen for refreshing sleep.
Poor sleep habits are also common. They can be better controlled by following good sleep hygiene measures. This includes sensible advice such as avoiding alcohol and caffeine late at night and avoiding screen use just before going to bed, whilst making the sleeping environment more welcoming to invite the onset of sleep.
Finally are circadian rhythm disorders, where the natural body clock is set in a pattern less compatible with our life routines like work and school times. The cause is frequently genetic. It includes advanced sleep phase disorder of falling asleep and waking up early aswell as delayed sleep phase disorder of falling asleep and waking up late. Jet lag from travelling is a temporary form of this disorder. Treatment is difficult, given that it is natural, but timely doses of melatonin (caution that it can cause sleep disorders in some) and/or light therapy can be helpful in getting some control of sleep times.
*The often quoted 8 hour recommendation is not completely true. Everyone has an individual sleep pattern and requirement- the amount that leaves them refreshed and functional the next day. It can vary from anything upwards of 4-5 hours to 10 hours.