Why can't you sleep?

What is Obstructive Sleep Apnea?

Obstructive sleep apnea (OSA) is a sleep related breathing disorder that causes your body to stop breathing during sleep.  It’s caused when the tissue in the back of the throat collapses and blocks the airway, preventing air from getting into the lungs. 

It happens because the muscles inside your throat relax while you sleep and gravity causes your tongue to fall back, blocking your airway. 

Symptoms of Obstructive Sleep Apnea

• Accidently falling asleep during the day
• General daytime sleepiness
• Un-refreshing sleep
• Fatigue
• Insomnia

If you experience any of the symptoms above or answer yes to either of the following questions, you may have obstructive sleep apnea.

1. Do you awake from sleep with a choking sound or gasping for breath?
2. Has your partner noticed you snore loudly or stop breathing while you sleep?

Tests for Obstructive Sleep Apnea

If you have a problem with breathing during your sleep, an overnight sleep study may be required.  Called a polysomnogram, it charts your brain waves, heartbeat, and breathing as you sleep while recording any movement of your arms and legs.  All these things will verify if you have OSA and to what extent.

If you have OSA, you may be asked to participate in a second polysomnogram.  This time, a continuous positive airway pressure (CPAP) treatment will be given to you as you sleep (called a CPAP study).

Treatments for Obstructive Sleep Apnea

Depending on the severity of your OSA, there are many treatment options and your doctor will determine what will work best for you. The most common treatment is CPAP (mentioned above).  The treatment is delivered through a mask worn over the nose or face.  Air is blown into the back of your throat, keeping the airway open so you are able to keep breathing as you sleep.  The amount of air pressure is different for each person and the CPAP study (mentioned above) will show what level is right for you.

Other treatments include the following.

• Position therapy may reduce the symptoms, such as staying off your back while sleeping and raising the head of the bed.
• Weight loss-decreases the amount of obstruction in the throat.
• Sleeping with an oral appliance in your mouth-similar to a sports mouth guard, it moves your jaw forward and keeps the airway open.
• Surgery-increase the size of the upper airway

What is Insomnia?

For most people, insomnia only last a day or two and goes away on its own.  Stress and depression can cause an elevated level of insomnia that can last for weeks and may not go away on its own.

4 main kinds of insomnia

1. Difficulty falling asleep
2. Difficulty staying asleep
3. Waking up too early
4. Poor quality of sleep

Symptoms of Insomnia

• Feeling tired and grumpy during the day
• Having trouble concentrating at work
• Falling asleep during the day

Tests for Insomnia

A written test may be given to analyze your mental and emotional well-being.  Most often, a medical test will not be needed unless the doctor suspects you may have a sleep apnea or another sleep disorder.  In that case, an overnight sleep study will be performed. 

Treatments for Obstructive Sleep Apnea

The most common treatment is making changes to your sleep habits so you develop a healthy sleep pattern.  Here are some tips to improve your sleep hygiene.

• Don’t go to bed unless you’re sleepy
• If you’re not asleep after 20 minutes, get out of bed.
• Begin rituals to help you relax before bed each night
• Avoid taking naps
• Keep a regular schedule
• Keep your bedroom dark, quiet and on the cool side

If the above tips don’t work, the doctor may prescribe sleeping pills called hypnotics to help you sleep or suggest behavioral therapy to teach you relaxation exercises.  If the doctor suspects medication to be causing your insomnia, a change will be made in your medicine. 

What is Narcolepsy?

Narcolepsy is a term used to describe people who are affected by excessive sleepiness and also includes features of dreaming that occur when you’re awake.  People with narcolepsy can fall asleep suddenly (known as “sleep attacks”) while they are driving, eating or walking.

2 kinds of narcolepsy

1. Narcolepsy with cataplexy
2. Narcolepsy without cataplexy

(Cataplexy is when the muscles in your arm, leg or face become weak and is normally caused by strong emotions.)

Symptoms of Narcolepsy

• Sleep paralysis-being unable to move for a few seconds or minutes as you are falling asleep or waking up
• Hypnagogic hallucinations-seeing things that aren’t there-usually when you are falling asleep
• Disturbed night time sleep-wake up frequently and have trouble falling back to sleep
• Memory problems-trouble remembering things since you may not be fully awake they you hear them

If you are unable to move when you first fall asleep or wake up, then you mostly likely have narcolepsy.

Tests for Obstructive Narcolepsy

You will need to do 2 sleep studies.

1. Overnight sleep study (called a polysomnogram) will record a full night of sleep
2. Multiple sleep latency test (MSLT) is a daytime test that records at least 4 naps

The overnight sleep study will chart your brain waves, heart beat and breathing while recording any movement of your arms and legs. This will determine if other problems are causing your sleep attacks.

Since people with narcolepsy fall asleep at unusual times during the day, the MSLT will measure how fast you fall asleep and show what kind of sleep you have when you are napping.

Treatments for Narcolepsy

The most common treatment is medication, usually a stimulant that will help you stay awake during the day.  If you have narcolepsy with cataplexy, you will most likely be given another drug to treat your muscle weakness.

What is Idiopathic Hypersomnia?

Idiopathic hypersomnia is a disorder of severe sleepiness which causes you to have disabling daytime sleepiness.

2 types of Idiopathic Hypersomnia

1. Idiopathic hypersomnia with long sleep time-sleep longer than 10 hours a night
2. Idiopathic hypersomnia without long sleep time-sleep 8 to 10 hours a night

With both types, you sleep with few interruptions and it’s very hard to wake up.  Even awake, you may appear to be partially asleep, confused or drunk (referred to sleep drunkenness).  No matter how much sleep you get, you are still sleepy.  It differs with narcolepsy in that you are even sleepier during the day and naps are not refreshing.

Symptoms of Idiopathic Hypersomnia

• Are you really sleepy even though you sleep 8 or more hours a night without interruption?
• Has this been going on daily for more than 3 months?
• Sleepy even after naps and these naps are not refreshing?
• You do not have narcolepsy symptoms such as cataplexy.
• You sleepiness cannot be explained by another sleep disorder, other medical, psychiatric or neurological conditions or alcohol/drug abuse.

If you answered yes to these questions, then you might have idiopathic hypersomnia.

Tests for Idiopathic Hypersomnia

Your doctor will probably do blood and urine drug testing to make sure your sleepiness is not due to medication or drug use.  An extended sleep study that lasts all night and then all the next day will be done. 

The first part is called a polysomnogram.  It charts your brain waves, heartbeat, muscle activity and breathing as you sleep while recording any movement of your arms and legs. 

The testing will continue with a daytime sleep study called a Multiple Sleep Latency Test (MSLT).  This test is a series of daytime nap opportunities and usually lasts until late afternoon or early evening.

Treatments for Idiopathic Hypersomnia

The causes of idiopathic hypersomnia are unknown so treatment is focused on relieving the symptoms.  The same medications that treat narcolepsy are used for this disorder.

Following these tips will improve your treatment

• Keep regular sleep times.
• Avoid alcohol and other medications that affect sleep and sleepiness.
• Treat other disorders that may be present.

What is Restless Leg Syndrome?

People with RLS (restless leg syndrome) often have a hard time describing what it feels like.  It’s often a tingling, prickling or burning sensation, sometimes painful which becomes worse when sitting or lying still.  It can be temporary relieved then you walk or move your legs.  The urge to move your legs grows worse at night and eases in the morning.

A related problem is periodic limb movements where your leg muscles tighten or flex while you are still.  This can happen while you are awake or when sleeping and may be out of your control.

Symptoms of Restless Leg Syndrome

If you answer yes to any of these questions, you may have RLS:

• Do you have an urge to move your legs?
• Does this get worse when you’re at rest?
• Do you have uncomfortable sensations in your legs (especially at night)?
• Do your legs feel better when you walk or move them?
• Are these feelings worse (or occur only) in the evening or at night?

Tests for Restless Leg Syndrome

An overnight sleep study (called a polysomnogram) may be done but this test is not usually needed to detect RLS.  Your doctor may want to do blood tests, including measuring iron.

Treatments for Restless Leg Syndrome

Regular exercise may help restless legs, along with reducing caffeinated drinks, alcohol use and smoking.  Keeping mentally active while sitting down can help and if restless legs do occur, try walking, massaging your legs or soaking in a hot tub.

There are many medications on the market that treat RLS.  The most common ones replace a chemical in the brain called dopamine.  Other medications used are sleeping pills, narcotic pain killers and some anti-seizure medication.

What is Central Sleep Apnea

Central sleep apnea is a breathing disorder that causes your body to decrease or stop the effort of breathing during sleep.  It occurs in an off-and-on cycle and is a result of a problem in the brain or heart.

The problem with CSA is that the brain and heart move an abnormal amount of air into your lungs.  It differs from obstructive sleep apnea (OSA) in that it’s not caused by a blockage of your airway.

Symptoms of Central Sleep Apnea

Most people with CSA have the following problems

• Disrupted sleep with frequent awakenings
• Difficulty in falling asleep
• Daytime sleepiness
• Other problems
• Snoring
• Pauses in breathing
• Waking up short of breath

A person with CSA is likely to be sleepy during the day and may be sleepy, even after a nap.  You may stop breathing hundreds of times during the night and may not even be aware of it since your body wakes up once you stop breathing.  Your spouse or partner should be able to tell how often you snore and whether or not you stop breathing.

Tests for Central Sleep Apnea

If you have a problem with breathing during your sleep, an overnight sleep study may be required.  Called a polysomnogram, it charts your brain waves, heartbeat, and breathing as you sleep while recording any movement of your arms and legs.  All these things will verify if you have CSA and to what extent.

Treatments for Central Sleep Apnea

Positive airway pressure (PAP) is the treatment most often used for CSA.  PAP is delivered through a mask you wear over your nose and face which gently blows air into the back of your throat.  This flow of air keeps your airway open so you are able to keep breathing and stay asleep.

Of course, the amount of air pressure needed for each person varies so a CPAP study will determine the right level for you.