Understanding Sleep Disorders

Sleep is essential for overall health, but millions suffer from sleep disorders that affect their well-being, productivity, and quality of life. This guide covers signs, symptoms, diagnosis, and management of common sleep disorders.

Common Sleep Disorders & Their Symptoms

1. Insomnia

• 🔹 Difficulty falling or staying asleep
• 🔹 Frequent nighttime awakenings
• 🔹 Early morning awakenings
• 🔹 Daytime fatigue, mood disturbances, memory issues

Types:

• ✔ Acute Insomnia: Short-term, often stress-related
• ✔ Chronic Insomnia: ≥3 nights per week for ≥3 months

2. Obstructive Sleep Apnea (OSA)

• 🔹 Loud snoring
• 🔹 Choking or gasping during sleep
• 🔹 Daytime sleepiness & fatigue
• 🔹 Morning headaches & irritability
• 🔹 Poor concentration & memory issues

Risk Factors: Obesity, male gender, age >40, large neck circumference, family history

3. Restless Legs Syndrome (RLS)

• 🔹 Uncomfortable leg sensations (tingling, burning, crawling)
• 🔹 Worsening at night & during rest
• 🔹 Temporary relief with movement

4. Narcolepsy

• 🔹 Sudden sleep attacks
• 🔹 Cataplexy (sudden loss of muscle tone due to emotions)
• 🔹 Sleep paralysis & hallucinations

5. Circadian Rhythm Sleep Disorders

• ✔ Delayed Sleep Phase Syndrome (DSPS) – Difficulty falling asleep early
• ✔ Shift Work Sleep Disorder – Sleep disturbances due to night shifts

Diagnostic Workup for Sleep Disorders

1. Clinical Evaluation

• 🩺 History & Symptoms: Sleep duration, quality, daytime fatigue, sleep hygiene, comorbidities
• 📝 Screening Questionnaires:
• ✔ Epworth Sleepiness Scale (ESS) – Assesses daytime sleepiness
• ✔ STOP-BANG Score – Screens for obstructive sleep apnea
• ✔ Insomnia Severity Index (ISI) – Evaluates insomnia severity

2. Sleep Studies

• 📡 Polysomnography (PSG): Gold standard for OSA, narcolepsy
• 📊 Home Sleep Apnea Testing (HSAT): Used for moderate to severe OSA screening
• 🕒 Actigraphy: Tracks sleep patterns (useful in circadian rhythm disorders)
• 💉 Multiple Sleep Latency Test (MSLT): Assesses daytime sleepiness & narcolepsy

3. Laboratory Tests

• 🩸 Ferritin levels (for RLS)
• 🧪 Thyroid function tests (for secondary causes of insomnia)

Management Protocols for Sleep Disorders

1. Insomnia Management

• ✅ Cognitive Behavioral Therapy for Insomnia (CBT-I): First-line treatment
• ✔ Sleep restriction therapy – Limiting time in bed to improve efficiency
• ✔ Stimulus control – Using the bed only for sleep
• ✔ Relaxation techniques – Meditation, deep breathing
• 💊 Pharmacologic Therapy (Short-Term Use):
• ✔ Melatonin (for circadian disorders)
• ✔ Z-drugs (Zolpidem, Eszopiclone) – Avoid in elderly
• ✔ Benzodiazepines (last resort, risk of dependence)

2. Obstructive Sleep Apnea (OSA) Management

• 🛑 First-Line Therapy:
• ✔ Continuous Positive Airway Pressure (CPAP) – Gold standard
• ✔ Weight loss & lifestyle modifications
• ✔ Positional therapy (avoid sleeping on back)
• 🩺 Alternative Therapies:
• 💊 Oral appliances (for mild to moderate cases)
• 💉 Surgical interventions (UPPP, hypoglossal nerve stimulation)

3. Restless Legs Syndrome (RLS) Management

• ✔ Dopamine agonists (Pramipexole, Ropinirole)
• ✔ Iron supplementation if ferritin <50 ng/mL
• ✔ Avoid caffeine, alcohol, and antihistamines

4. Narcolepsy Management

• 💊 Stimulants for EDS: Modafinil, Armodafinil
• 💊 Cataplexy Treatment: Sodium oxybate (Xyrem)

5. Circadian Rhythm Sleep Disorder Management

• ✔ Light therapy (morning for DSPS, evening for ASPS)
• ✔ Melatonin for sleep phase shifting
• ✔ Gradual shift scheduling for shift workers

Conclusion

Sleep disorders impact health and quality of life. Early identification, proper diagnosis, and tailored management can improve outcomes.

✅ Prioritize Sleep. Seek Help. Improve Your Well-being. ✅