Dyssomnia

Dyssomnias are a broad classification of sleeping disorder that make it difficult to get to sleep, or to stay sleeping. Dyssomnias are primary sleep disorders of initiating or maintaining sleep or of excessive sleepiness and are characterized by a disturbance in the amount, quality, or timing of sleep. Patients may complain of difficulty getting to sleep or staying asleep, intermittent wakefulness during the night, early morning awakening, or combinations of any of these. Transient episodes are usually of little significance. Stress, caffeine, physical discomfort, daytime napping, and early bedtimes are common factors. The most well known dyssomnia is obstructive sleep apnea. Obstructive sleep apnea is a potentially serious sleep disorder. It causes breathing to repeatedly stop and start during sleep. Treatments for obstructive sleep apnea are available. One treatment involves using a device that uses positive pressure to keep your airway open while you sleep. Another option is a mouthpiece to thrust your lower jaw forward during sleep. In some cases, surgery may be an option too.

On the other hand, parasomnias are a group of sleep disorders that involve unwanted events or experiences that occur while you are falling asleep, sleeping or waking up. Parasomnias may include abnormal movements, behaviors, emotions, perceptions or dreams. Although the behaviors may be complex and appear purposeful to others, you remain asleep during the event and often have no memory that it occurred. If you have a parasomnia, you may find it hard to sleep through the night.

Parasomnias examples are:

• Confusional arousals: This parasomnia causes you to act in a very strange and confused way as you wake up or just after waking. It may appear that you don’t know where you are or what you are doing.
• Sleepwalking: Sleepwalking involves getting up from bed and walking around when you are still asleep in another room or outside your home and not remember how you got there.
• Sleep Terrors: Sleep terrors (or night terrors) cause you to wake up in intense fear with barely any memory, if any, of a terrifying dream. These episodes may cause you to wake up with the look of intense fear, kicking, thrashing and your heart racing.
• Sleep Eating Disorder: These episodes occur when you rapidly binge eat while you are only partially awake. You may only have a slight memory or no memory of the binge, and the food may be highly caloric or in strange combinations.
• REM Sleep Behavior Disorder: This potentially dangerous sleep disorder causes you to act out vivid dreams as you sleep. You may kick, punch or flail in response to your dream and episodes get worse over time.
• Sleep Paralysis: Sleep paralysis causes you to be unable to move your body when you are falling asleep or when you are waking up. These episodes typically last seconds or minutes.
• Nightmares: Frequent nightmares that prevent you from getting a good night’s sleep are considered a sleep disorder. People with nightmare disorder may fear going to sleep or have difficulty falling back asleep because of intense nightmares.
• Bedwetting: Bedwetting can occur as a primary or secondary condition in both adults and children. Primary bedwetting results from a failure to wake up when the bladder is full. Secondary bedwetting happens in children who face strong social or mental stress or as a sign of another medical problem such as diabetes or a urinary tract infection.
• Sleep Hallucinations: Sleep related hallucinations are imagined events that seem very real. They are usually visual but may also involve your senses of sound, touch, taste and small. You may not be sure if you are awake or asleep.
• Exploding Head Syndrome: This parasomnia causes you to hear a loud imaginary noise just before you fall asleep or awaken. It can sound like a bomb exploding, cymbals crashing or a painless loud bang. Episodes can be distressing and people often mistakenly think they are having a stroke or brain problem. Try to get more sleep each night to alleviate the symptoms.
• Sleep Talking: Sleep talking is common and tends to be harmless. The subject matter is often loud and fairly nonsensical. Sleep talking can occur by itself or it may also be a feature of another sleep disorder.

Obstructive sleep apnea

Obstructive sleep apnea occurs when the muscles in the back of your throat relax too much to allow normal breathing. These muscles support structures including the back of the roof of your mouth (soft palate), the triangular piece of tissue hanging from the soft palate (uvula), the tonsils and the tongue. When the muscles relax, your airway narrows or closes as you breathe in and breathing may be inadequate for 10 seconds or longer. This may lower the level of oxygen in your blood and cause a buildup of carbon dioxide. Your brain senses this impaired breathing and briefly rouses you from sleep so that you can reopen your airway. This awakening is usually so brief that you don’t remember it. You can awaken with shortness of breath that corrects itself quickly, within one or two deep breaths. You may make a snorting, choking or gasping sound. This pattern can repeat itself five to 30 times or more each hour, all night long. These disruptions impair your ability to reach the desired deep, restful phases of sleep, and you’ll probably feel sleepy during your waking hours. People with obstructive sleep apnea may not be aware that their sleep was interrupted. In fact, many people with this type of sleep apnea think they slept well all night.

Risk factors for developing obstructive sleep apnea

Anyone can develop obstructive sleep apnea. However, certain factors put you at increased risk, including:

• Excess weight. Most but not all people with obstructive sleep apnea are overweight. Fat deposits around the upper airway may obstruct breathing. Medical conditions that are associated with obesity, such as hypothyroidism and polycystic ovary syndrome, also can cause obstructive sleep apnea. However, not everyone with obstructive sleep apnea is overweight and vice versa. Thin people can develop the disorder, too.
• Narrowed airway. You may inherit naturally narrow airways. Or your tonsils or adenoids may become enlarged, which can block your airway.
• High blood pressure (hypertension). Obstructive sleep apnea is relatively common in people with hypertension.
• Chronic nasal congestion. Obstructive sleep apnea occurs twice as often in those who have consistent nasal congestion at night, regardless of the cause. This may be due to narrowed airways.
• Smoking. People who smoke are more likely to have obstructive sleep apnea.
• Diabetes. Obstructive sleep apnea may be more common in people with diabetes.
• Sex. In general, men are twice as likely as premenopausal women to have obstructive sleep apnea. The frequency of obstructive sleep apnea increases in women after menopause.
• A family history of sleep apnea. If you have family members with obstructive sleep apnea, you may be at increased risk.
• Asthma. Research has found an association between asthma and the risk of obstructive sleep apnea.

Obstructive sleep apnea complications

Obstructive sleep apnea is considered a serious medical condition. Complications may include:

• Daytime fatigue and sleepiness. The repeated awakenings associated with obstructive sleep apnea make normal, restorative sleep impossible. People with obstructive sleep apnea often experience severe daytime drowsiness, fatigue and irritability. They may have difficulty concentrating and find themselves falling asleep at work, while watching TV or even when driving. They may also be at higher risk of work-related accidents. Children and young people with obstructive sleep apnea may do poorly in school and commonly have attention or behavior problems.
• Cardiovascular problems. Sudden drops in blood oxygen levels that occur during obstructive sleep apnea increase blood pressure and strain the cardiovascular system. Many people with obstructive sleep apnea develop high blood pressure (hypertension), which can increase the risk of heart disease. The more severe the obstructive sleep apnea, the greater the risk of coronary artery disease, heart attack, heart failure and stroke. Obstructive sleep apnea increases the risk of abnormal heart rhythms (arrhythmias). These abnormal rhythms can lower blood pressure. If there’s underlying heart disease, these repeated multiple episodes of arrhythmias could lead to sudden death.
• Complications with medications and surgery. Obstructive sleep apnea also is a concern with certain medications and general anesthesia. These medications, such as sedatives, narcotic analgesics and general anesthetics, relax your upper airway and may worsen your obstructive sleep apnea. If you have obstructive sleep apnea, you may experience worse breathing problems after major surgery, especially after being sedated and lying on your back. People with obstructive sleep apnea may be more prone to complications after surgery. Before you have surgery, tell your doctor if you have obstructive sleep apnea or symptoms related to obstructive sleep apnea. If you have obstructive sleep apnea symptoms, your doctor may test you for obstructive sleep apnea prior to surgery.
• Eye problems. Some research has found a connection between obstructive sleep apnea and certain eye conditions, such as glaucoma. Eye complications can usually be treated.
• Sleep-deprived partners. Loud snoring can keep those around you from getting good rest and eventually disrupt your relationships. Some partners may even choose to sleep in another room. Many bed partners of people who snore are sleep deprived as well.

People with obstructive sleep apnea may also complain of memory problems, morning headaches, mood swings or feelings of depression, and a need to urinate frequently at night (nocturia).

Insomnias

Insomnia is the most common sleep disorder that can make it hard to fall asleep, hard to stay asleep, or cause you to wake up too early and not be able to get back to sleep. You may still feel tired when you wake up. Insomnia can sap not only your energy level and mood but also your health, work performance and quality of life. Daytime fatigue and other effects of insomnia can impact nearly every aspect of your life.

How much sleep is enough varies from person to person, but most adults need seven to eight hours a night.

There are two types of insomnia based on the regularity and duration of the sleep disturbance and daytime symptoms:

1. Short-term insomnia: This type of brief insomnia lasts for up to three months. It occurs in 15 to 20 percent of people.
2. Chronic insomnia: This type of insomnia occurs at least three times per week and lasts for at least three months. About 10 percent of people have chronic insomnia.

At some point, many adults experience short-term (acute) insomnia, which lasts for days or weeks. It’s usually the result of stress or a traumatic event. But some people have long-term (chronic) insomnia that lasts for a month or more. Insomnia may be the primary problem, or it may be associated with other medical conditions or medications.

You don’t have to put up with sleepless nights. Simple changes in your daily habits can often help.

The causes, symptoms and severity of insomnia vary from person to person. Insomnia may include:

• Difficulty falling asleep
• Difficulty staying asleep throughout the night
• Waking up too early in the morning

Insomnia involves both a sleep disturbance and daytime symptoms. The effects of insomnia can impact nearly every aspect of your life. Studies show that insomnia negatively affects work performance, impairs decision-making and can damage relationships. In most cases, people with insomnia report a worse overall quality of life.

Everyone has the occasional night of poor sleep. In many cases this is due to staying up too late or waking up too early. This does not mean you have insomnia, it means you didn’t get enough sleep.

As many as 30 to 35 percent of adults complain of insomnia. It is more common in groups such as older adults, women, people under stress and people with certain medical and mental health problems such as depression.

If insomnia makes it hard for you to function during the day, see your doctor to identify the cause of your sleep problem and how it can be treated. If your doctor thinks you could have a sleep disorder, you might be referred to a sleep center for special testing. A board certified sleep medicine physician diagnoses chronic insomnia. The sleep team at an accredited sleep center can provide ongoing care.

Insomnias causes

Insomnia may be the primary problem, or it may be associated with other conditions.

Chronic insomnia is usually a result of stress, life events or habits that disrupt sleep. Treating the underlying cause can resolve the insomnia, but sometimes it can last for years.

Common causes of chronic insomnia include:

• Stress. Concerns about work, school, health, finances or family can keep your mind active at night, making it difficult to sleep. Stressful life events or trauma — such as the death or illness of a loved one, divorce, or a job loss — also may lead to insomnia.
• Travel or work schedule. Your circadian rhythms act as an internal clock, guiding such things as your sleep-wake cycle, metabolism and body temperature. Disrupting your body’s circadian rhythms can lead to insomnia. Causes include jet lag from traveling across multiple time zones, working a late or early shift, or frequently changing shifts.
• Poor sleep habits. Poor sleep habits include an irregular bedtime schedule, naps, stimulating activities before bed, an uncomfortable sleep environment, and using your bed for work, eating or watching TV. Computers, TVs, video games, smartphones or other screens just before bed can interfere with your sleep cycle.
• Eating too much late in the evening. Having a light snack before bedtime is OK, but eating too much may cause you to feel physically uncomfortable while lying down. Many people also experience heartburn, a backflow of acid and food from the stomach into the esophagus after eating, which may keep you awake.

Chronic insomnia may also be associated with medical conditions or the use of certain drugs. Treating the medical condition may help improve sleep, but the insomnia may persist after the medical condition improves.

Primary insomnia is not caused by outside events. It can be hard to identify the cause of primary insomnia.

• Types of primary insomnia:
  • Psycho-physiological insomnia occurs when someone under emotional stress becomes anxious, concentrates too intently on trying to sleep, and is unable to sleep because of the level of stress and anxiety.
  • Paradoxical insomnia, formerly known as sleep-state misperception, is a sleep disorder characterized by a significant difference between the time a person thinks he or she has been asleep and how much time he or she has actually slept. People with this problem may complain that they can’t fall asleep and feel sleepy during the day because of lack of sleep, but they are actually sleeping and have no evidence of a sleep disorder.

Additional common causes of insomnia include:

• Mental health disorders. Anxiety disorders, such as post-traumatic stress disorder, may disrupt your sleep. Awakening too early can be a sign of depression. Insomnia often occurs with other mental health disorders as well.
• Medications. Many prescription drugs can interfere with sleep, such as certain antidepressants and medications for asthma or blood pressure. Many over-the-counter medications — such as some pain medications, allergy and cold medications, and weight-loss products — contain caffeine and other stimulants that can disrupt sleep.
• Medical conditions. Examples of conditions linked with insomnia include chronic pain, cancer, diabetes, heart disease, asthma, gastroesophageal reflux disease (GERD), overactive thyroid, Parkinson’s disease and Alzheimer’s disease.
• Sleep-related disorders. Sleep apnea causes you to stop breathing periodically throughout the night, interrupting your sleep. Restless legs syndrome causes unpleasant sensations in your legs and an almost irresistible desire to move them, which may prevent you from falling asleep.
• Caffeine, nicotine and alcohol. Coffee, tea, cola and other caffeinated drinks are stimulants. Drinking them in the late afternoon or evening can keep you from falling asleep at night. Nicotine in tobacco products is another stimulant that can interfere with sleep. Alcohol may help you fall asleep, but it prevents deeper stages of sleep and often causes awakening in the middle of the night.

Insomnia and aging

Insomnia becomes more common with age. As you get older, you may experience:

• Changes in sleep patterns. Sleep often becomes less restful as you age, so noise or other changes in your environment are more likely to wake you. With age, your internal clock often advances, so you get tired earlier in the evening and wake up earlier in the morning. But older people generally still need the same amount of sleep as younger people do.
• Changes in activity. You may be less physically or socially active. A lack of activity can interfere with a good night’s sleep. Also, the less active you are, the more likely you may be to take a daily nap, which can interfere with sleep at night.
• Changes in health. Chronic pain from conditions such as arthritis or back problems as well as depression or anxiety can interfere with sleep. Issues that increase the need to urinate during the night ―such as prostate or bladder problems ― can disrupt sleep. Sleep apnea and restless legs syndrome become more common with age.
• More medications. Older people typically use more prescription drugs than younger people do, which increases the chance of insomnia associated with medications.

Insomnia in children and teens

Sleep problems may be a concern for children and teenagers as well. However, some children and teens simply have trouble getting to sleep or resist a regular bedtime because their internal clocks are more delayed. They want to go to bed later and sleep later in the morning.

Risk factors for developing insomnia

Nearly everyone has an occasional sleepless night. But your risk of insomnia is greater if:

• You’re a woman. Hormonal shifts during the menstrual cycle and in menopause may play a role. During menopause, night sweats and hot flashes often disrupt sleep. Insomnia is also common with pregnancy.
• You’re over age 60. Because of changes in sleep patterns and health, insomnia increases with age.
• You have a mental health disorder or physical health condition. Many issues that impact your mental or physical health can disrupt sleep.
• You’re under a lot of stress. Stressful times and events can cause temporary insomnia. And major or long-lasting stress can lead to chronic insomnia.
• You don’t have a regular schedule. For example, changing shifts at work or traveling can disrupt your sleep-wake cycle.

Insomnias prevention

Good sleep habits can help prevent insomnia and promote sound sleep:

• Keep your bedtime and wake time consistent from day to day, including weekends.
• Stay active — regular activity helps promote a good night’s sleep.
• Check your medications to see if they may contribute to insomnia.
• Avoid or limit naps.
• Avoid or limit caffeine and alcohol, and don’t use nicotine.
• Avoid large meals and beverages before bedtime.
• Make your bedroom comfortable for sleep and only use it for sex or sleep.
• Create a relaxing bedtime ritual, such as taking a warm bath, reading or listening to soft music.

Insomnias complications

Sleep is as important to your health as a healthy diet and regular physical activity. Whatever your reason for sleep loss, insomnia can affect you both mentally and physically. People with insomnia report a lower quality of life compared with people who are sleeping well.

Complications of insomnia may include:

• Lower performance on the job or at school
• Slowed reaction time while driving and a higher risk of accidents
• Mental health disorders, such as depression, an anxiety disorder or substance abuse
• Increased risk and severity of long-term diseases or conditions, such as high blood pressure and heart disease

Insomnias diagnosis

Depending on your situation, the diagnosis of insomnia and the search for its cause may include:

• Physical exam. If the cause of insomnia is unknown, your doctor may do a physical exam to look for signs of medical problems that may be related to insomnia. Occasionally, a blood test may be done to check for thyroid problems or other conditions that may be associated with poor sleep.
• Sleep habits review. In addition to asking you sleep-related questions, your doctor may have you complete a questionnaire to determine your sleep-wake pattern and your level of daytime sleepiness. You may also be asked to keep a sleep diary for a couple of weeks.
• Sleep study. If the cause of your insomnia isn’t clear, or you have signs of another sleep disorder, such as sleep apnea or restless legs syndrome, you may need to spend a night at a sleep center. Tests are done to monitor and record a variety of body activities while you sleep, including brain waves, breathing, heartbeat, eye movements and body movements.

Restless legs syndrome

Restless legs syndrome is a neurological condition that causes an uncontrollable urge to move your legs, usually because of an uncomfortable sensation. Restless legs syndrome causes leg pain, a crawling feeling in the legs, or an urge to move the legs when you’re trying to go to sleep. The symptoms tend to occur when you sit or lie down. They are relieved by walking or moving the legs. Restless legs syndrome symptoms happen in the evening or nighttime hours when you’re sitting or lying down. Moving eases the unpleasant feeling temporarily. Restless legs syndrome may make it hard to fall asleep or stay asleep. It also causes excessive sleepiness during the daytime.

Restless legs syndrome, now known as restless legs syndrome or Willis-Ekbom disease, can begin at any age and generally worsens as you age. It can disrupt sleep, which interferes with daily activities.

Some people with restless legs syndrome or Willis-Ekbom disease never seek medical attention because they worry they won’t be taken seriously. But restless legs syndrome or Willis-Ekbom disease can interfere with your sleep and cause daytime drowsiness and affect your quality of life. Talk with your doctor if you think you may have restless legs syndrome or Willis-Ekbom disease.

Simple self-care steps and lifestyle changes may help you. Medications also help many people with restless legs syndrome.

Restless legs syndrome causes

Often, there’s no known cause for restless legs syndrome or Willis-Ekbom disease. Researchers suspect the condition may be caused by an imbalance of the brain chemical dopamine, which sends messages to control muscle movement.

Heredity: Sometimes restless legs syndrome or Willis-Ekbom disease runs in families, especially if the condition starts before age 40. Researchers have identified sites on the chromosomes where genes for restless legs syndrome or Willis-Ekbom disease may be present.

Pregnancy: Pregnancy or hormonal changes may temporarily worsen restless legs syndrome or Willis-Ekbom disease signs and symptoms. Some women get restless legs syndrome or Willis-Ekbom disease for the first time during pregnancy, especially during their last trimester. However, signs and symptoms usually disappear after delivery.

Risk factors for restless legs syndrome

Restless legs syndrome or Willis-Ekbom disease can develop at any age, even during childhood. The disorder is more common with increasing age and more common in women than in men.

Restless legs syndrome usually isn’t related to a serious underlying medical problem. However, restless legs syndrome or Willis-Ekbom disease sometimes accompanies other conditions, such as:

• Peripheral neuropathy. This damage to the nerves in your hands and feet is sometimes due to chronic diseases such as diabetes and alcoholism.
• Iron deficiency. Even without anemia, iron deficiency can cause or worsen restless legs syndrome or Willis-Ekbom disease. If you have a history of bleeding from your stomach or bowels, experience heavy menstrual periods, or repeatedly donate blood, you may have iron deficiency.
• Kidney failure. If you have kidney failure, you may also have iron deficiency, often with anemia. When kidneys don’t function properly, iron stores in your blood can decrease. This and other changes in body chemistry may cause or worsen restless legs syndrome or Willis-Ekbom disease.
• Spinal cord conditions. Lesions on the spinal cord have been linked to restless legs syndrome or Willis-Ekbom disease. Having had anesthesia to the spinal cord, such as a spinal block, also increases the risk of developing restless legs syndrome or Willis-Ekbom disease.

Restless legs syndrome complications

Although restless legs syndrome or Willis-Ekbom disease doesn’t lead to other serious conditions, symptoms can range from barely bothersome to incapacitating. Many people with restless legs syndrome or Willis-Ekbom disease find it difficult to fall or stay asleep.

Severe restless legs syndrome or Willis-Ekbom disease can cause marked impairment in life quality and can result in depression. Insomnia may lead to excessive daytime drowsiness, but restless legs syndrome or Willis-Ekbom disease may interfere with napping.

Restless legs syndrome diagnosis

Your doctor will take your medical history and ask for a description of your symptoms. A diagnosis of restless legs syndrome or Willis-Ekbom disease is based on the following criteria, established by the International Restless Legs Syndrome Study Group and International Classification of Sleep Disorders:

• You have a strong, often irresistible urge to move your legs, usually accompanied by uncomfortable sensations typically described as crawling, creeping, cramping, tingling or pulling.
• Your symptoms start or get worse when you’re resting, such as sitting or lying down.
• Your symptoms are partially or temporarily relieved by activity, such as walking or stretching.
• Your symptoms are worse at night.
• Symptoms can’t be explained solely by another medical or behavioral condition.

Your doctor may conduct a physical and a neurological exam. Blood tests, particularly for iron deficiency, may be ordered to rule out other possible causes for your symptoms.

In addition, your doctor may refer you to a sleep specialist. This may involve an overnight stay at a sleep clinic, where doctors can study your sleep if another sleep disorder such as sleep apnea is suspected. However, a diagnosis of restless legs syndrome or Willis-Ekbom disease usually doesn’t require a sleep study.

Periodic limb movements

Periodic limb movements are when you have episodes of simple, repetitive muscle movements. You are unable to control them. They usually do not keep you from falling asleep. Instead, they severely disrupt your sleep during the night. This can cause you to be very tired during the day. They do not involve a change in body position, stretching a muscle, or a cramp. Instead, the movements tend to involve the tightening or flexing of a muscle. They occur most often in the lower legs.

Periodic limb movements can occur at two different times:

1. Periodic limb movements while you sleep (PLMS): Periodic limb movements in sleep occur when your arms and legs move frequently and involuntarily during sleep.
2. Periodic limb movements while you are awake (PLMW)

Periodic limb movements in sleep are much more common. Periodic limb movements in sleep can cause the arms and legs to twitch, jerk, or flex. When they occur often through the night, they can disrupt your sleep many times. Normally, you are unaware of the movements or of waking up. A typical movement is for the big toe to extend. Often the ankle, knee or hip will also bend slightly. Though it is less common, this can also happen in your upper arms. The degree to which these movements occur can change from night to night. They usually happen during non-Rapid Eye Movement (NREM) sleep in the first half of the night. When these movements are very severe, then they may also happen while you are awake (periodic limb movements while you are awake).

An episode will normally last from a few minutes to an hour. Within that time, movements tend to occur every 20 to 40 seconds. They may affect only one of the legs. More often, they will affect both legs. periodic limb movements in sleep are quite common. For most people, the movements do not disturb their sleep in a severe way. This means that it is not a sleep disorder. The sleep of the bed partner tends to be affected more often than that of the patient. The movements reach the level of a disorder, periodic limb movement disorder (PLMD), when they disrupt the patient’s sleep and daily life.

Periodic limb movement disorder may be a factor in causing you to have any of the following:

• Depression
• Bad memory
• Short attention span
• Fatigue

Risk factors for periodic limb movements in sleep

Periodic limb movements in sleep occur in both children and adults. The chance of having it increases with age, making it very common in the elderly. It occurs in up to 34% of people over 60 years old. Studies have not yet shown how common it is in other age groups. No difference has been noticed in the rate of males and females who have it. The family pattern has not been studied in detail.

Periodic limb movements in sleep can be influenced and caused by a number of factors. They are commonly found in people who have one of three other sleep disorders:

• Restless legs syndrome
• REM sleep behavior disorder
• Narcolepsy

Low brain iron may play a role in making periodic limb movements in sleep worse.

High rates of periodic limb movements in sleep have been found in some people with:

• Spinal cord injury
• Multiple system atrophy (a rare neurological disorder)
• Sleep related eating disorder

The following medications are thought to cause periodic limb movements in sleep or make them worse:

• Some antidepressants
• Lithium
• Dopamine-receptor antagonists (e.g., some anti-nausea medications)

Data is not certain about a link between periodic limb movements in sleep and the following:

• Kidney disease
• Parkinson disease
• ADHD (attention-deficit/hyperactivity disorder)
• Pregnancy
• Posttraumatic stress disorder
• Multiple sclerosis (MS)

Periodic limb movements in sleep diagnosis

For most people, the movements do not disturb their sleep in a severe way. They do not need to seek medical help. In other cases, severe movements can greatly disturb your sleep and life. In this case, you will want to see a sleep specialist. You will need someone with the proper training and experience to help treat it.

You should complete a sleep diary for two weeks. This will give the doctor clues as to what might be causing your problems. You can also rate your sleep with the Epworth Sleepiness Scale. This will help show how your sleep is affecting your daily life. The doctor will need to know your complete medical history. Be sure to inform him of any past or present drug and medication use. Also tell him if you or a relative have ever had a sleep disorder.

Your doctor will likely have you do an overnight sleep study. This is called a polysomnogram. The polysomnogram charts your brain waves, heart beat, and breathing as you sleep. It also records how your arms and legs move. Not only will it keep track of your movements, it will also help detect any other sleep disorder that you may have.

Dyssomnia symptoms

Dyssomnia sleep disorders cause trouble falling asleep or staying asleep.

Obstructive sleep apnea

Signs and symptoms of obstructive sleep apnea include:

• Excessive daytime sleepiness
• Loud snoring
• Observed episodes of stopped breathing during sleep
• Abrupt awakenings accompanied by gasping or choking
• Awakening with a dry mouth or sore throat
• Morning headache
• Difficulty concentrating during the day
• Experiencing mood changes, such as depression or irritability
• High blood pressure
• Nighttime sweating
• Decreased libido

Restless legs syndrome

The chief symptom of restless legs syndrome is an urge to move the legs. Common accompanying characteristics of restless legs syndrome or Willis-Ekbom disease include:

• Sensations that begin after rest. The sensation typically begins after you’ve been lying down or sitting for an extended time, such as in a car, airplane or movie theater.
• Relief with movement. The sensation of restless legs syndrome or Willis-Ekbom disease lessens with movement, such as stretching, jiggling your legs, pacing or walking.
• Worsening of symptoms in the evening. Symptoms occur mainly at night.
• Nighttime leg twitching. Restless legs syndrome or Willis-Ekbom disease may be associated with another, more common condition called periodic limb movement of sleep, which causes your legs to twitch and kick, possibly throughout the night, while you sleep.

People typically describe restless legs syndrome or Willis-Ekbom disease symptoms as abnormal, unpleasant sensations in their legs or feet. They usually happen on both sides of the body. Less commonly, the sensations affect the arms.

The sensations, which generally occur within the limb rather than on the skin, are described as:

• Crawling
• Creeping
• Pulling
• Throbbing
• Aching
• Itching
• Electric

Sometimes the sensations are difficult to explain. Affected people usually don’t describe the condition as a muscle cramp or numbness. They do, however, consistently describe the desire to move their legs.

It’s common for symptoms to fluctuate in severity. Sometimes, symptoms disappear for periods of time, then come back.

Periodic limb movements

Periodic limb movements symptoms

Normally, you are unaware of the movements. This can make it very hard for you to know if you have periodic limb movements. Someone who sleeps in the same bed with you would be more likely to notice the movements. You might have periodic limb movement disorder (PLMD) if:

• Someone else told you that your body makes unusual, repetitive movements while you sleep
• These movements tend to occur in your lower legs
• You feel like you are never well-rested, even after a full night of sleep
• You are often very tired during the day

It is also important to know if there is something else that is causing your sleep problems. They may be a result of one of the following:

• Another sleep disorder
• A medical condition
• Medication use
• A mental health disorder
• Substance abuse

Insomnias

Insomnia symptoms are different for every patient and may include:

• Difficulty falling asleep at night
• Waking up during the night
• Waking up too early
• Not feeling well-rested after a night’s sleep
• Daytime tiredness or sleepiness
• Fatigue
• Irritability, depression or anxiety
• Difficulty paying attention, focusing on tasks (concentration) or remembering/memory (cognitive impairment)
• Increased errors or accidents
• Poor performance at school or work
• Ongoing worries or frustration about sleep
• Moodiness or irritability
• Daytime sleepiness
• Impulsiveness or aggression
• Lack of energy or motivation.

Dyssomnia diagnosis

To diagnose your condition, your doctor may make an evaluation based on your signs and symptoms, an examination, and tests. Your doctor may refer you to a sleep specialist in a sleep center for further evaluation.

You’ll have a physical examination, and your doctor will examine the back of your throat, mouth and nose for extra tissue or abnormalities. Your doctor may measure your neck and waist circumference and check your blood pressure.

A sleep specialist may conduct additional evaluations to diagnose your condition, determine the severity of your condition and plan your treatment. The evaluation may involve overnight monitoring of your breathing and other body functions as you sleep.

Tests to detect dyssomnias include:

• Polysomnography. During this sleep study, you’re hooked up to equipment that monitors your heart, lung and brain activity, breathing patterns, arm and leg movements, and blood oxygen levels while you sleep. You may have a full-night study, in which you’re monitored all night, or a split-night sleep study. In a split-night sleep study, you’ll be monitored during the first half of the night. If you’re diagnosed with obstructive sleep apnea, staff may wake you and give you continuous positive airway pressure for the second half of the night. Polysomnography can help your doctor diagnose obstructive sleep apnea and adjust positive airway pressure therapy, if appropriate. This sleep study can also help rule out other sleep disorders that can cause excessive daytime sleepiness but require different treatments, such as leg movements during sleep (periodic limb movements) or sudden bouts of sleep during the day (narcolepsy).
• Home sleep apnea testing. Under certain circumstances, your doctor may provide you with an at-home version of polysomnography to diagnose obstructive sleep apnea. This test usually involves measurement of airflow, breathing patterns and blood oxygen levels, and possibly limb movements and snoring intensity.

Your doctor also may refer you to an ear, nose and throat doctor to rule out any anatomic blockage in your nose or throat.

Dyssomnia treatment

Dyssomnia treatment involves treating the underlying cause.

Obstructive sleep apnea treatment

Lifestyle changes

For milder cases of obstructive sleep apnea, your doctor may recommend lifestyle changes:

• Lose weight if you’re overweight.
• Exercise regularly.
• Drink alcohol moderately, if at all, and don’t drink several hours before bedtime.
• Quit smoking.
• Use a nasal decongestant or allergy medications.
• Don’t sleep on your back.
• Avoid taking sedative medications such as anti-anxiety drugs or sleeping pills.

If these measures don’t improve your sleep or if your apnea is moderate to severe, then your doctor may recommend other treatments. Certain devices can help open up a blocked airway. In other cases, surgery may be necessary.

Positive airway pressure therapy

If you have obstructive sleep apnea, you may benefit from positive airway pressure. In this treatment, a machine delivers air pressure through a piece that fits into your nose or is placed over your nose and mouth while you sleep. Positive airway pressure reduces the number of respiratory events that occur as you sleep, reduces daytime sleepiness and improves your quality of life.

The most common type is called continuous positive airway pressure (CPAP). With CPAP treatment, the pressure of the air breathed is continuous, constant and somewhat greater than that of the surrounding air, which is just enough to keep your upper airway passages open. This air pressure prevents obstructive sleep apnea and snoring.

Although CPAP is the most consistently successful and most commonly used method of treating obstructive sleep apnea, some people find the mask cumbersome, uncomfortable or loud. However, newer machines are smaller and less noisy than older machines and there are a variety of mask designs for individual comfort.

Also, with some practice, most people learn to adjust the mask to obtain a comfortable and secure fit. You may need to try different types to find a suitable mask. Several options are available, such as nasal masks, nasal pillows or face masks.

If you’re having particular difficulties tolerating pressure, some machines have special adaptive pressure functions to improve comfort. You also may benefit from using a humidifier along with your CPAP system.

CPAP may be given at a continuous (fixed) pressure or varied (autotitrating) pressure. In fixed CPAP, the pressure stays constant. In autotitrating CPAP, the levels of pressure are adjusted if the device senses increased airway resistance.

Bilevel positive airway pressure (BPAP), another type of positive airway pressure, delivers a preset amount of pressure when you breathe in and a different amount of pressure when you breathe out.

CPAP is more commonly used because it’s been well studied for obstructive sleep apnea and has been shown to effectively treat obstructive sleep apnea. However, for people who have difficulty tolerating fixed CPAP, BPAP or autotitrating CPAP may be worth a try.

Don’t stop using your positive airway pressure machine if you have problems. Check with your doctor to see what adjustments you can make to improve its comfort.

In addition, contact your doctor if you still snore despite treatment, if you begin snoring again or if your weight goes up or down by 10% or more.

Mouthpiece (oral device)

Though positive airway pressure is often an effective treatment, oral appliances are an alternative for some people with mild or moderate obstructive sleep apnea. These devices may reduce your sleepiness and improve your quality of life.

These devices are designed to keep your throat open. Some devices keep your airway open by bringing your lower jaw forward, which can sometimes relieve snoring and obstructive sleep apnea. Other devices hold your tongue in a different position.

If you and your doctor decide to explore this option, you’ll need to see a dentist experienced in dental sleep medicine appliances for the fitting and follow-up therapy. A number of devices are available. Close follow-up is needed to ensure successful treatment.

Surgery or other procedures

Surgery is usually considered only if other therapies haven’t been effective or haven’t been appropriate options for you. Surgical options may include:

• Surgical removal of tissue. Uvulopalatopharyngoplasty (UPPP) is a procedure in which your doctor removes tissue from the back of your mouth and top of your throat. Your tonsils and adenoids may be removed as well. Uvulopalatopharyngoplasty usually is performed in a hospital and requires a general anesthetic. Doctors sometimes remove tissue from the back of the throat with a laser (laser-assisted uvulopalatoplasty) or with radiofrequency energy (radiofrequency ablation) to treat snoring. These procedures don’t treat obstructive sleep apnea, but they may reduce snoring.
• Upper airway stimulation. This new device is approved for use in people with moderate to severe obstructive sleep apnea who can’t tolerate CPAP or BPAP. A small, thin impulse generator (hypoglossal nerve stimulator) is implanted under the skin in the upper chest. The device detects your breathing patterns and, when necessary, stimulates the nerve that controls movement of the tongue. Studies have found that upper airway stimulation leads to significant improvement in obstructive sleep apnea symptoms and improvements in quality of life.
• Jaw surgery (maxillomandibular advancement). In this procedure, the upper and lower parts of your jaw are moved forward from the rest of your facial bones. This enlarges the space behind the tongue and soft palate, making obstruction less likely.
• Surgical opening in the neck (tracheostomy). You may need this form of surgery if other treatments have failed and you have severe, life-threatening obstructive sleep apnea. During a tracheostomy, your surgeon makes an opening in your neck and inserts a metal or plastic tube through which you breathe. Air passes in and out of your lungs, bypassing the blocked air passage in your throat.
• Implants. This minimally invasive treatment involves placement of three tiny polyester rods in the soft palate. These inserts stiffen and support the tissue of the soft palate and reduce upper airway collapse and snoring. This treatment is recommended only for people with mild obstructive sleep apnea.

Other types of surgery may help reduce snoring and sleep apnea by clearing or enlarging air passages, including:

• Nasal surgery to remove polyps or straighten a crooked partition between your nostrils (deviated septum)
• Surgery to remove enlarged tonsils (tonsillectomy) or adenoids (adenoidectomy)

Restless legs syndrome treatment

Sometimes, treating an underlying condition, such as iron deficiency, greatly relieves symptoms of restless legs syndrome. Correcting an iron deficiency may involve receiving iron supplementation orally or intravenously. However, take iron supplements only with medical supervision and after your doctor has checked your blood-iron level.

If you have restless legs syndrome or Willis-Ekbom disease without an associated condition, treatment focuses on lifestyle changes. If those aren’t effective, your doctor might prescribe medications.

Medication therapy

Several prescription medications, most of which were developed to treat other diseases, are available to reduce the restlessness in your legs. These include:

• Medications that increase dopamine in the brain. These medications affect levels of the chemical messenger dopamine in your brain. Ropinirole (Requip), rotigotine (Neupro) and pramipexole (Mirapex) are approved by the Food and Drug Administration for the treatment of moderate to severe restless legs syndrome or Willis-Ekbom disease. Short-term side effects of these medications are usually mild and include nausea, lightheadedness and fatigue. However, they can also cause impulse control disorders, such as compulsive gambling, and daytime sleepiness.
• Drugs affecting calcium channels. Certain medications, such as gabapentin (Neurontin), gabapentin enacarbil (Horizant) and pregabalin (Lyrica), work for some people with restless legs syndrome or Willis-Ekbom disease.
• Opioids. Narcotic medications can relieve mild to severe symptoms, but they may be addicting if used in high doses. Some examples include codeine, oxycodone (OxyContin, Roxicodone), combined oxycodone and acetaminophen (Percocet, Roxicet), and combined hydrocodone and acetaminophen (Norco, Vicodin).
• Muscle relaxants and sleep medications. Known as benzodiazepines, these drugs help you sleep better at night, but they don’t eliminate the leg sensations, and they may cause daytime drowsiness. A commonly used sedative for restless legs syndrome or Willis-Ekbom disease is clonazepam (Klonopin). These drugs are generally only used if no other treatment provides relief.

It may take several trials for you and your doctor to find the right medication or combination of medications that work best for you.

Caution about medications

Sometimes dopamine medications that have worked for a while to relieve your restless legs syndrome or Willis-Ekbom disease become ineffective, or you notice your symptoms returning earlier in the day. This is called augmentation. Your doctor may substitute another medication to combat the problem.

Most drugs prescribed to treat restless legs syndrome or Willis-Ekbom disease aren’t recommended during pregnancy. Instead, your doctor may recommend self-care techniques to relieve symptoms. However, if the sensations are particularly bothersome during your last trimester, your doctor may approve the use of certain drugs.

Some medications may worsen symptoms of restless legs syndrome or Willis-Ekbom disease. These include some antidepressants, some antipsychotic medications, some anti-nausea drugs, and some cold and allergy medications. Your doctor may recommend that you avoid these medications, if possible. However, if you need to take these medications, talk to your doctor about adding drugs to help manage your restless legs syndrome or Willis-Ekbom disease.

Lifestyle and home remedies

Making simple lifestyle changes can help alleviate symptoms of restless legs syndrome or Willis-Ekbom disease:

• Try baths and massages. Soaking in a warm bath and massaging your legs can relax your muscles.
• Apply warm or cool packs. Use of heat or cold, or alternating use of the two, may lessen your limb sensations.
• Establish good sleep hygiene. Fatigue tends to worsen symptoms of restless legs syndrome or Willis-Ekbom disease, so it’s important that you practice good sleep hygiene. Ideally, have a cool, quiet, comfortable sleeping environment; go to bed and rise at the same time daily; and get adequate sleep.
• Exercise. Getting moderate, regular exercise may relieve symptoms of restless legs syndrome or Willis-Ekbom disease, but overdoing it or working out too late in the day may intensify symptoms.
• Avoid caffeine. Sometimes cutting back on caffeine may help restless legs. Try to avoid caffeine-containing products, including chocolate and caffeinated beverages, such as coffee, tea and soft drinks, for a few weeks to see if this helps.

Periodic limb movements in sleep treatment

When it is necessary to treat periodic limb movements in sleep, the same drugs that are used for restless legs syndrome also work for periodic limb movements in sleep. These include drugs that replace a chemical in the brain called dopamine. These drugs are also used to treat Parkinson’s disease. However, if you have periodic limb movements in sleep, you are not at an increased risk of getting Parkinson’s disease. Other medications used include the following:

• Sleeping tablets
• Some anti-seizure medications
• Narcotic pain killers

Insomnia treatment

The treatment for insomnia depends on its underlying cause. When insomnia is caused by a medical condition, your medical provider may refer you to a specialist who can treat the underlying condition. The course of insomnia is likely to change as your medical condition improves. Your doctor also may want to change medications that you take to limit potential side effects.

Although insomnia is common, it can be treated effectively with the help of the sleep team at an accredited sleep center.

For chronic insomnia, your medical provider may recommend any combination of the following treatments:

Sleep hygiene

In many cases, by practicing good sleep hygiene and changing your sleep habits you can improve your sleep. Sleep hygiene is a set of bedtime habits and rituals you can do every night to improve how you sleep.

Changing your sleep habits and addressing any issues that may be associated with insomnia, such as stress, medical conditions or medications, can restore restful sleep for many people. If these measures don’t work, your doctor may recommend cognitive behavioral therapy, medications or both, to help improve relaxation and sleep.

Cognitive behavioral therapy for insomnia

Cognitive behavioral therapy for insomnia (CBT-I) can help you control or eliminate negative thoughts and actions that keep you awake and is generally recommended as the first line of treatment for people with insomnia. Typically, cognitive behavioral therapy for insomnia (CBT-I) is equally or more effective than sleep medications.

The cognitive part of cognitive behavioral therapy for insomnia (CBT-I) teaches you to recognize and change beliefs that affect your ability to sleep. It can help you control or eliminate negative thoughts and worries that keep you awake. It may also involve eliminating the cycle that can develop where you worry so much about getting to sleep that you can’t fall asleep.

The behavioral part of cognitive behavioral therapy for insomnia (CBT-I) helps you develop good sleep habits and avoid behaviors that keep you from sleeping well. Strategies include, for example:

• Stimulus control therapy. This method helps remove factors that condition your mind to resist sleep. For example, you might be coached to set a consistent bedtime and wake time and avoid naps, use the bed only for sleep and sex, and leave the bedroom if you can’t go to sleep within 20 minutes, only returning when you’re sleepy.
• Relaxation techniques. Progressive muscle relaxation, biofeedback and breathing exercises are ways to reduce anxiety at bedtime. Practicing these techniques can help you control your breathing, heart rate, muscle tension and mood so that you can relax.
• Sleep restriction. This therapy decreases the time you spend in bed and avoids daytime naps, causing partial sleep deprivation, which makes you more tired the next night. Once your sleep has improved, your time in bed is gradually increased.
• Remaining passively awake. Also called paradoxical intention, this therapy for learned insomnia is aimed at reducing the worry and anxiety about being able to get to sleep by getting in bed and trying to stay awake rather than expecting to fall asleep.
• Light therapy. If you fall asleep too early and then awaken too early, you can use light to push back your internal clock. You can go outside during times of the year when it’s light outside in the evenings, or you can use a light box. Talk to your doctor about recommendations.

Your doctor may recommend other strategies related to your lifestyle and sleep environment to help you develop habits that promote sound sleep and daytime alertness.

Prescription medications

Prescription sleeping pills can help you get to sleep, stay asleep or both. Doctors generally don’t recommend relying on prescription sleeping pills for more than a few weeks, but several medications are approved for long-term use.

Examples include:

• Eszopiclone (Lunesta)
• Ramelteon (Rozerem)
• Zaleplon (Sonata)
• Zolpidem (Ambien, Edluar, Intermezzo, Zolpimist)

Prescription sleeping pills can have side effects, such as causing daytime grogginess and increasing the risk of falling, or they can be habit-forming, so talk to your doctor about these medications and other possible side effects.

WARNING: Complex sleep behaviors such as sleepwalking or sleep driving can occur when you take a sleeping pill. Read this Consumer Update from the FDA to learn about these safety risks.

Over-the-counter sleep aids

Nonprescription sleep medications contain antihistamines that can make you drowsy, but they’re not intended for regular use. Talk to your doctor before you take these, as antihistamines may cause side effects, such as daytime sleepiness, dizziness, confusion, cognitive decline and difficulty urinating, which may be worse in older adults.