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Q: Sleep Disorders with particular attention to Sleep Apnea ( Answered 4 out of 5 stars,   0 Comments )
Subject: Sleep Disorders with particular attention to Sleep Apnea
Category: Health > Conditions and Diseases
Asked by: wbthom-ga
List Price: $35.00
Posted: 11 Jul 2005 14:22 PDT
Expires: 10 Aug 2005 14:22 PDT
Question ID: 542307
Need an up to date overview of sleep disorders with general
information about each type and links to websites/articles that can
explain each disorder in depth if required (*NOTE - information needs
to be written in a friendly informative style for non-medical
personnel such as patients & families).
With the specific sleep disorder category "sleep apnea" I need a
slightly more in depth review citing information such as - symptoms,
causes, diagnosis, and current treatment options - again I need
website/article links and a list of resources that patients & families
can use for follow up.
Subject: Re: Sleep Disorders with particular attention to Sleep Apnea
Answered By: nenna-ga on 11 Jul 2005 16:30 PDT
Rated:4 out of 5 stars
Good afternoon wbthom-ga  and thank you for your question.  I have
done a lot of reading on sleeping disorders and tried to put it in the
easiest terms possible without losing the intended meanings.  I hope
what I have listed below is helpful!

The National Institutes of Health define a ?sleep disorder? as any
difficulties related to sleeping, including:

    1. Difficulty falling or staying asleep,
    2. Falling asleep at inappropriate times,
    3. Excessive total sleep time, or
    4. Abnormal behaviors associated with sleep.

Physicians and sleep specialists typically categorize sleep disorders
into four main categories specified by the International
Classification of Sleep Disorders. These include:

    1. Dyssomnias,
    2. Parasomnias,
    3. Medical/psychiatric disorders, and
    4. Proposed sleep disorders.

* * * * * * * * * *

DYSSOMNIAS are disturbances in the amount, timing, or quality of sleep
resulting in excessive daytime sleepiness or insomnia. The
International Classification of Sleep Disorders lists three
subcategories of dyssomnias:

    1.  INTRINSIC sleep disorders originate inside the body and are
due to a variety of possible causes such as:

          a.	Psychophysiologic insomnia
          b.	Idiopathic insomnia
          c.	Narcolepsy
          d.	Obstructive sleep apnea
          e.	Central sleep apnea
          f.	Restless legs syndrome
          g.	Periodic limb movements in sleep

    2.   EXTRINSIC sleep disorders originate outside the body and are
due most commonly to behavioral or environmental factors. Common
extrinsic sleep disorders include:

         a.	Inadequate sleep hygiene:  This insomnia can also be
called ?bad sleep habits.? It involves the things that you normally do
every day. These habits keep your sleep from being refreshing. They
can also keep you from feeling alert during the day. These activities
are all things that you should be able to control. These specific
behaviors fall into the following two general categories:

            i.  Practices that keep you awake

            ii. Practices that bring disorder to your sleep schedule

Many common factors may keep you awake at night:  Alcohol may make you
sleepy, but it is also more likely to wake you up during the night. 
Drinking coffee or colas that contain caffeine can make you more
alert.   The nicotine in a cigarette can have the same effect.  People
often use these substances to ?keep their edge? during the day. This
?edge? is not always gone by the time they try to go to sleep.  Other
factors that cause you to stay awake when they occur too close to
bedtime include the following:

    * worry
    * excitement
    * mental stress
    * physical exercise

Many other practices can keep you from having a regular pattern of
sleeping and waking up. Perhaps you are unable to fall asleep because
you spend too much time in bed. Maybe you don?t go to bed and wake up
at the same times everyday. Or maybe you nap too often, too long, or
too close to your bedtime. These bad habits can confuse your body.
This will cause you to stay awake when you should really be asleep.

This disorder can affect you in the following negative ways:

    * mood changes
    * depression
    * short attention span
    * poor concentration
    * daytime sleepiness
    * frustration with sleeping
    * caffeine dependence
    * alcohol abuse or dependence

It is typically not found in young children. It may develop as early
as the teen years.  It may also begin at any time throughout

          b.	Environmental sleep disorder

          c.	Insufficient sleep syndrome

          d.	Stimulant-dependent sleep disorder

          e.	Alcohol-dependent sleep disorder

          f.	Hypnotic-dependent sleep disorder.

    3.  CIRCADIAN RHYTHM sleep disorders describe the disruption of
the sleep cycle in a 24-hour period. Common circadian rhythm sleep
disorders include:

          a.   Jet lag

          b.	Shift-work sleep disorder

          c.	Irregular sleep-wake pattern

          d.	Delayed sleep phase syndrome

          e.	Advanced sleep phase syndrome.

* * * * * * * * * *

PARASOMNIAS are disorders of partial arousal or disorders that
interfere with sleep stage transitions. Abnormal events occur during
sleep. The International Classification of Sleep Disorders lists four
subcategories of dyssomnias:

     1.  AROUSAL disorders are disorders of partial arousal. Common
arousal disorders include:

          a.	Confusional arousals takes place when you are waking up,
or just after. You act in a way that is very strange and confused. It
appears that you don?t know where you are or what you are doing. Your
behavior includes the following:

    * slow speech
    * confused thinking
    * poor memory
    * blunt responses to questions or requests

There are two variations of this disorder in teens and adults:

          1. Severe Morning Sleep Inertia:  At times this is called
?sleep drunkenness.? It occurs in the morning when you are waking up.
The signs of it are the same as those for typical confusional
arousals. The difference is that it occurs in the morning and not
early at night. It usually occurs every morning for many years without
going away.

         2. Sleep-Related Abnormal Sexual Behavior:  The set of
abnormal behaviors that occur during an episode includes violent or
forceful sexual activities and vocalizations of a sexual nature during
sleep. This disorder is rare.

          b.	Sleepwalking
          c.	Sleep terrors (please also see ( ) for information on night terrors in

     2.  SLEEP-WAKE TRANSITION disorders are disorders that interfere
with sleep stage transitions. Common examples include:

          a.	Rhythmic movement disorder
          b.	Sleep starts

          c.	Sleeptalking
          d.	Nocturnal leg cramps.

      3.  Other parasomnias include common sleep disorders such as:

          a.	Sleep bruxism: This involves the grinding or clenching of
teeth during sleep. In most severe cases, hundreds of events can occur
during the night. In milder cases, the grinding may vary from night to
night.  Severe bruxism may briefly disturb your sleep. Only at rare
times will it cause you to fully wake up. Loud sounds caused by the
grinding of teeth can be very unpleasant. This can also disturb the
sleep of a bed partner. It can occur during all stages of sleep. It is
most common in stages one and two of non-REM sleep.

The following are signs of bruxism:

    * tooth pain
    * jaw muscle pain
    * mouth and facial pain
    * limited jaw movement
    * damaged or worn teeth
    * sore gums
    * headaches

          b.	Sleep enuresis (?bedwetting?.  A frequent need to get up
and go to the bathroom to urinate at night is called nocturia. It
differs from  bed-wetting, in which the person does not arouse from
sleep, but the bladder empties anyway. Nocturia is a common cause of
sleep loss, especially among older adults. In fact, nearly two-thirds
(65%) of those responding to NSF's 2003 Sleep in America poll of
adults between the ages of 55 and 84 reported this disturbance at
least a few nights per week.  You can view this poll at

          c.	Primary snoring

          d.	Infant sleep apnea

          e.	Sudden infant death syndrome (SIDS).

Often, a person does not recall their experience of the parasomnic
event the fol lowing day. Parasomnias are often attributed to stress,
depression, or other psychological and medical conditions. Treatment
for parasomnias may involve lifestyle changes, medication, hypnosis,
guided imagery, or some combination thereof.

* * * * * * * * * *

Sleep disorders are often attributed to medical or psychiatric
disorders. The International Classification of Sleep Disorders lists
three subcategories of medical/psychiatric sleep disorders:

     1.  Sleep disorders associated with MEDICAL DISORDERS. Common
examples include:

          a.	Alcoholism

          b.	Chronic obstructive pulmonary disease

          c.	Asthma
          d.	Sleep-related gastroesophageal reflux, peptic ulcer

          e.	Fibrositis syndrome.

     2.  Sleep disorders associated with NEUROLOGICAL DISORDERS.
Common examples include:

          a.	Degenerative brain disorders

          b.	Dementia

          c.	Sleep-related epilepsy

          d.	Sleep-related headaches.

     3.  Sleep disorders associated with PSYCHIATRIC DISORDERS can
result in excessive sleepiness, insomnia, or other disruptions in the
sleep cycle.  Examples are:

          a.	Psychoses

          b.	Anxiety

          c.	Depression

          d.	Panic disorders.

* * * * * * * * * *

PROPOSED SLEEP DISORDERS encompass sleep problems for which there is
not enough information available to positively establish them as
distinct disorders. Examples in this category include:

     1.  Short sleepers (someone who regularly sleeps less than 75% of
the sleep time typically required for his or her age group but feels
no negative effects from this shortened sleep)

     2.  Long sleepers (someone who regularly sleeps more than 10 hours a night)

     3.  Subwakefulness syndrome (lack of daytime alertness with no
apparent sleep disruption),

     4.  Fragmentary myoclonus (brief, involuntary jerks or twitches) 

     5.  Menstrual-associated sleep disorder

     6.  Pregnancy-associated sleep disorder

     7.   Terrifying hypnagogic hallucinations

     8.  Sleep-related laryngospasm

     9.  Sleep choking syndrome.

     10.  Sleep hyperhydrosis (night sweats)

     11.  Sleep-Related Neurogenic Tachypnea - increase in respiratory
rate during sleep

* * * * * * * * *

Common sleeping disorders:

INSOMNIA - The treatment is related to the cause, if the cause can be
determined. If there is an obvious physical or psychological disorder
causing insomnia, it should be treated. Depression is a very common
cause of insomnia and can usually be treated with medication,
cognitive behavioral therapy, or interpersonal therapy. Attempts to
control environmental and lifestyle factors such as too much light,
noise, caffeine or other stimulants or erratic hours of wakefulness
should be made. Sleeping drugs should be used only when prescribed by
a health care provider.

* * * * * * * * * *

SLEEP APNIA - First described in 1965, sleep apnea is a breathing
disorder characterized by brief interruptions of breathing during
sleep. It owes its name to a Greek word, apnea, meaning ?want of

During the night, the number of involuntary breathing pauses or
?apneic events? may be as high as 20 to 60 or more per hour. These
breathing pauses are accompanied by snoring between apnea episodes,
although not everyone who snores has this condition. Sleep apnea can
also be characterized by choking sensations. The frequent
interruptions of deep, restorative sleep often leads to excessive
daytime sleepiness and may be associated with an early morning
headache. Distinctive signs of sleep apnea include:

     1.  Frequent waking episodes at night

     2.  Disrupted breathing, gasping, gagging, or choking for air during sleep

There are 3 types of sleep apnea:

     1.  OBSTRUCTIVE SLEEP APNEA (OSA): Obstructive sleep apnea is the
most common type of sleep apnea and is caused by an obstruction in the
airway, which actually stops the air flow in the nose and mouth.
Throat and abdominal breathing continue normally. Obstructive sleep
apnea is commonly accompanied by snoring and causes the sleeper to
wake up, gasping or snorting, and then go back to sleep again.

     2.  CENTRAL SLEEP APNEA (CSA): Central sleep apnea is much less
common.  It  is due to a brain signal problem.  The brain signal that
instructs the body to breathe is delayed.   Oral breathing, throat and
abdominal breathing all cease at the same time. The periods of
breathing interruption may last a few seconds, and breathing may be
too shallow to provide oxygen to the blood and tissues. Central sleep
apnea may be associated with:

          a.  Irregular heartbeat,
          b.  High blood pressure,
          c.  Heart attack
          d.  Stroke.

     3.  MIXED SLEEP APNEA: This is a combination of Obstructive sleep
apnea and Central sleep apnea.  Mixed sleep apnea is most commonly
found in infants or young children who have abnormal breathing

Sleep apnea occurs in all age groups and both sexes but is more common
in men and possibly young African Americans. It has been estimated
that as many as 18 million Americans have sleep apnea. Four percent of
middle-aged men and 2 percent of middle-aged women have sleep apnea
along with excessive daytime sleepiness.

Sleep apnea seems to run in some families, suggesting a possible
genetic basis.  In some people, apnea occurs when the throat muscles
and tongue relax during sleep and partially block the opening of the
airway. When the muscles of the soft palate at the base of the tongue
and the uvula (the small fleshy tissue hanging from the center of the
back of the throat) relax and sag, the airway becomes blocked, making
breathing labored and noisy and even stopping it altogether.

Sleep apnea also can occur in obese people when an excess amount of
tissue in the airway causes it to be narrowed. With a narrowed airway,
the person continues his or her efforts to breathe, but air cannot
easily flow into or out of the nose or mouth. Unknown to the person,
this results in heavy snoring, periods of no breathing, and frequent
arousals (causing abrupt changes from deep sleep to light sleep).  
Overweight persons can benefit from losing weight. Even a 10 percent
weight loss can reduce the number of apneic events for most patients.

Ingestion of alcohol and sleeping pills increases the frequency and
duration of breathing pauses in people with sleep apnea.

People with sleep apnea often feel very sleepy during the day and
their concentration and daytime performance suffer. They are often
depressed, irritable, have sexual dysfunction, learning and memory
difficulties, and fall asleep while at work, on the phone, or driving.
Untreated sleep apnea patients are 3 times (or more) likely to have
automobile accidents;

It has been estimated that up to 50 percent of sleep apnea patients
have high blood pressure. Sleep apnea also contributes to high blood
pressure. Risk for heart attack and stroke may also increase in those
with sleep apnea.

Diagnosis and treatment of seep apnea include the following:

     1.  POLYSOMNOGRAPHY - a test that records a variety of body
functions during sleep, such as the electrical activity of the brain,
eye movement, muscle activity, heart rate, respiratory effort, air
flow, and blood oxygen levels. These tests are used both to diagnose
sleep apnea and to determine its severity.

     2.  MULTIPLE SLEEP LATENCY TEST (MSLT) measures the speed of
falling asleep. In this test, patients are given several opportunities
to fall asleep during the course of a day when they would normally be
awake. For each opportunity, time to fall asleep is measured.
Individuals who fall asleep in less than 5 minutes are likely to
require some type of treatment for sleep disorders.

Medications are generally not effective in the treatment of sleep
apnea. Oxygen is sometimes used in patients with central apnea caused
by heart failure. It is not used to treat obstructive sleep apnea.

effective treatment for sleep apnea. In this procedure, the patient
wears a mask over the nose during sleep, and pressure from an air
blower forces air through the nasal passages. The air pressure is
adjusted so that it is just enough to prevent the throat from
collapsing during sleep. The pressure is constant and continuous.
Nasal CPAP prevents airway closure while in use, but apnea episodes
return when CPAP is stopped or it is used improperly.

     2.  DENTAL APPLIANCES can reposition the lower jaw and the
tongue.  These have been helpful to some patients with mild to
moderate sleep apnea or who snore but do not have apnea. A dentist or
orthodontist is often the one to fit the patient with such a device.

     3.  SURGERY - although several surgical procedures are used to
increase the size of the airway, none of them is completely successful
or without risks. More than one procedure may need to be tried before
the patient realizes any benefits.  Some of the more common procedures

          a.  UVULOPALATOPHARYNGOPLASTY (UPPP) is a procedure used to
remove excess tissue at the back of the throat (tonsils, uvula, and
part of the soft palate). The success of this technique may range from
30 to 60 percent. The long-term side effects and benefits are not
known, and it is difficult to predict which patients will do well with
this procedure.

snoring but has not been shown to be effective in treating sleep
apnea. This procedure involves using a laser device to eliminate
tissue in the back of the throat. It may decrease or eliminate snoring
but not eliminate sleep apnea itself.

          c.  SOMNOPLASTY is a procedure that uses radiowaves to
reduce the size of some airway structures such as the uvula and the
back of the tongue.

          d.  TRACHEOSTOMY is used in persons with severe,
life-threatening sleep apnea. In this procedure, a small hole is made
in the windpipe and a tube is inserted into the opening. This tube
stays closed during waking hours, and the person breathes and speaks
normally. It is opened for sleep so that air flows directly into the
lungs, bypassing any upper airway obstruction. Although this procedure
is highly effective, it is an extreme measure that is rarely used.

For more information, please visit the American Sleep Apnea
Association at ( ) or ( )

* * * * * * * * *

RESTLESS LEGS SYNDROME (RLS) - a neurological disorder characterized
by uncomfortable, tingly or creeping sensations in your legs, which
create an uncontrollable urge to keep them moving.

Symptoms of RLS include:

     1.  Irritating sensations in your legs that give you an
overwhelming urge to walk around and move them

     2.  Little movements of the toes, feet or legs may be visible when you rest

     3.  Very restless sleep

* * * * * * * * * *

PERIODIC LIMB MOVEMENT IN SLEEP (PLMS) - a neurological disorder
characterized by rhythmic jerking of the feet or legs, which
interrupts sleep.

* * * * * * * * * *

NARCOLEPSY - a chronic neurological disorder that impairs the ability
of the central nervous system to regulate sleep. People with
narcolepsy experience:

     1.  Excessive daytime sleepiness and

     2.  Intermittent, uncontrollable episodes of falling asleep
during the daytime.

Other symptoms typically associated with narcolepsy include:

     1.  Cataplexy (short-lived intermittent muscle weakness),

     2.  hypnagogic hallucinations (hallucinations while falling asleep or waking),

     3.  Sleep paralysis (paralysis while falling asleep or waking), and

Narcolepsy usually begins when a person is in their teens or early
twenties. Doctors typically recommend a combination of medication and
behavioral treatments for the condition.

* * * * * * * * * *

KLEINE-LEVIN SYNDROME is a rare disorder that causes recurring periods
of excessive drowsiness and sleep (up to 20 hours per day). Symptoms,
which may last for days to weeks, include excessive food intake,
irritability, disorientation, lack of energy, and hypersensitivity to
noise. Some patients may also experience hallucinations and an
abnormally uninhibited sex drive.

Affected persons are normal between episodes, although depression and
amnesia may be noted temporarily after an attack. It may be weeks or
more before symptoms reappear. Onset is typically around adolescence
to the late teens. The disorder is 4 times more common in males than
in females.

* * * * * * * * * *

If you are experiencing sleepiness during the day, loud snoring or
pauses in breathing during sleep or any other sleeping difficulties,
make an appointment to discuss these problems with your doctor. Sleep
disorders are treatable. Your doctor can evaluate your sleep problem
and may refer you to a sleep specialist who has special training in
sleep medicine. Many of these specialists work at sleep centers where
overnight sleep studies can help determine whether you have a sleep
disorder.   To find a sleep center near you, you can visit

( )

= = = = = = = = = =

Some good reference articles to print off for patients:

What is Sleep Apnea
( )

Facts About Restless Leg Syndrome:
( )

Problem Sleepiness
( )

Facts About Narcolepsy
( )

Fats About Insomnia
( )

This is a great site for kids:

Star Sleepers
( )

Interactive Sleeo Quiz:
( )

Interactive Sleep Disorders tutorial
( )

List of Clinical Trials re: sleeping disorders:



    * American Academy of Sleep Medicine:  ( )

    * American Sleep Apnea Association:  ( )
    * National Center on Sleep Disorders Research:  ( )
    * National Heart, Lung, and Blood Institute: ( )
   * National Sleep Foundation:  ( )

= = = = = = = = = = 

I hope this answers your question.  If you would like clarification
before rating my answer, please do not hesitate to ask!

Google Researcher


International Classification of Sleep Disorders
( )

American Academy of Sleep Medicine
( )

Medical Encyclopedia
( )
( )

National Institute of Neurological Disorders & Stroke
( )

Google Search Terms:

Sleeping Disorder Types

( :// )
wbthom-ga rated this answer:4 out of 5 stars
Thanks nenna-ga - Good Overview

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