Sleep Disorders

3. Sleep disorders
- Jet lag
  - Don’t travel across time zones
  - “Go west”, not east
  - Called desynchronosis
  - Alterations to circadian rhythms
  - Sleep disorder
    - May last several days
    - Figure 1 day per time zone
  - Out of synch w destination time
    - contrary to accustomed rhythms
    - times for eating, sleeping, hormone regulation and body temperature
  - How long to adjust
    - Varies greatly
    - Cross 1-2 time zones no prob.
  - Not linked to length of flight
    - 10 hr flight within time zone okay
      - Europe to southern Africa
    - Trans-meridian distance (west–east)
      - 5 hr flight from LA to NY
      - International Date Line
    - Maximum possible disruption is 12 hours plus or minus
  - Symptoms
    - Headaches, irritability
    - Fatigue, mild depression
    - Sleep problems
    - Digestive problems (constipation-diarrhea)
  - To minimize effects
    - Before the flight
      - Ask doctor about meds
      - Partially adapt
        
        Up an hour earlier
      - Light box
    - During flight
      - Travel in smaller segments
        
        Overnight midway
      - Set time to destination
        
        Sleep-wake
    - After flight
      - Sunlight
      - Eat on schedule
  - Most people have circadian period a little over 24 hours
    - Easier to stay up later
    - Harder to get up earlier
- Apnea
  - During sleep
    - Abnormal pauses in breathing (apnea)
    - Abnormal low breathing (hypopnea)
  - Each apnea can last
    - Seconds to minutes
  - 5-30 per hour
  - Sleep Study = polysomnogram
  - Most common in men; 2+x
    - Can affect children too
  - Symptoms
    - excessive daytime sleepiness
    - slower reaction time
    - daytime fatigue
    - vision problems
  - Treatment
    - CPAP machine
      - Continuous Positive Airway Pressure
      - pumps air into throat
    - Turbinate surgery
      - Grind down turbinates in nose
    - Oral Appliance Therapy (OAT)
    - Dental appliance; custom-made mouthpiece to shift lower jaw
- Insomnia
  - Incidence
    - 10% and 30% of adults
    - 6% for more than 1 month
  - More often in 65+
  - More often in women
  - Difficulty
    - initiating sleep
    - maintaining sleep
    - wake up often
    - can’t get back to sleep
    - Wake up too early
  - Clinical diagnosis
    - 3+ nights per week
    - 3+ months
    - adequate opportunity for sleep
    - not caused by other condition
  - Types
    - Transient insomnia
      - less than a week
      - often stress related
    - Acute
      - less than a month
    - Chronic
      - More than a month
  - Causes
    - can be: high levels of stress hormone
  - Symptoms
    - Muscle weakness
    - Hallucinations
    - Double vision
- Narcolepsy
  - Symptoms
    - Excessive sleepiness
    - Fall asleep at inappropriate times
      - Work
      - Driving
    - Cataplexy
      - Sudden muscular weakness
      - when emotional
    - Drop head, weak knees, collapse
    - Slurred speech but normal hearing
  - Often confused with insomnia
  - REM within 5 minutes
    - An hour before normal
  - Possible genetic cause
  - Treat with amphetamines
    - Provigil or Nuvigil
- RLS (restless leg syndrome)
  - Willis-Ekbom disease
  - Neurological disorder
  - irresistible urge to move
  - Involves
    - usually legs
    - can be arms, torso, head
    - phantom limbs
  - Temporary relief as long as move
  - Sensations
    - pain
    - aching
    - crawling feeling
  - Circadium rhythm to them
    - Time of day
    - When relaxing or reading
  - Usually also have
    - periodic limb movement disorder
  - Spectrum disorder
    - minor annoyance
    - major disruptions
  - Primary RLS
    - Idiopathic
      - No known cause
      - usually begins slowly
      - before age 40–45
      - can disappear for years
      - Often progressive
        
        Gets worse with age
      - Can occur in children
        
        misdiagnosed as growing pains
    - Genetics
      - 60%+ of cases
      - autosomal dominant
  - How it works
    - Dopamine & iron systems
    - low levels in cerebrospinal fluid
    - levodopa
    - cross blood-brain barrier
    - Iron is essential for making L-dopa
  - Four symptoms
    - Urge to move limbs with or without sensations
    - Improvement with activity
    - Worsening at rest
      - sitting for long time
    - Worsening in the evening or night
      - Clear circadian rhythm
      - restlessness in evening and night
  - No way to prevent it
  - Drugs
    - doesn’t cure
    - side effects
      - nausea, dizziness, orthostatic hypertension
  - Related to periodic limb movement disorder
    - Limbs jerk during sleep
    - disrupted sleep
  - Secondary RLS
    - Characteristics
      - Sudden onset
      - After age 40
      - Can be daily from beginning
      - Caused by specific medical conditions
        
        iron deficiency 25% of cases
        
        extra iron 75% of cases
        
        Diseases
        
        Varicose veins
        
        magnesium deficiency
        
        fibromyalgia
        
        sleep apnea
        
        thyroid disease
        
        diabetes
        
        peripheral neuropathy
        
        Rheumatoid arthritis
        
        Parkinson’s
        
        POTS
        
        Worse in pregnancy
        
        ADHD
        
        RLS & periodic limb movement
        
        Low levels of dopamine
        
        Medications can cause it
        
        Antihistamines
        
        Antidepressants
        
        Antipsychotics
        
        Benzodiazepine withdrawal
        
        Opioid withdrawal
    - Treatment
      - Rule out venous disorders
      - Stretching, walking & moving
      - vibrator
      - leg massage
      - hot baths & heating pads
      - ferritin
        
        60% will see improvement
      - Dopamine agonist
        
        might cause symptoms earlier in the day

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