Sleep Disorders Health Article

Sleep disorders related to other conditions

In addition to the primary sleep disorders, there are three categories of sleep disorders that are caused by or related to substance use or other physical or mental disorders.

SLEEP DISORDERS RELATED TO MENTAL DISORDERS. Many mental disorders, especially depression or one of the anxiety disorders, can cause sleep disturbances. Psychiatric disorders are the most common cause of chronic insomnia.

SLEEP DISORDERS DUE TO MEDICAL CONDITIONS. Some patients with chronic neurological conditions like Parkinson's disease or Huntington's disease may develop sleep disorders. Sleep disorders have also been associated with viral encephalitis, brain disease, and hypoor hyperthyroidism.

SUBSTANCE-INDUCED SLEEP DISORDERS. The use of drugs, alcohol, and caffeine frequently produces disturbances in sleep patterns. Alcohol abuse is associated with insomnia. The person may initially feel sleepy after drinking, but wakes up or sleeps fitfully during the second half of the night. Alcohol can also increase the severity

of breathing-related sleep disorders. With amphetamines or cocaine, the patient typically suffers from insomnia during drug use and hypersomnia during drug withdrawal. Opioids usually make short-term users sleepy. However, long-term users develop tolerance and may suffer from insomnia.

In addition to alcohol and drugs that are abused, a variety of prescription medications can affect sleep patterns. These medications include antihistamines, corticosteroids, asthma medicines, and drugs that affect the central nervous system.

Sleep disorders in children and adolescents

Pediatricians estimate that 20–30% of children have difficulties with sleep that are serious enough to disturb their families. Although sleepwalking and night terror disorder occur more frequently in children than in adults, children can also suffer from narcolepsy and sleep apnea syndrome.

Causes and symptoms

The causes of sleep disorders have already been discussed with respect to the classification of these disorders.

The most important symptoms of sleep disorders are insomnia and sleepiness during waking hours. Insomnia is by far the more common of the two symptoms. It covers a number of different patterns of sleep disturbance. These patterns include inability to fall asleep at bedtime, repeated awakening during the night, and/or inability to go back to sleep once awakened.

Diagnosis

Diagnosis of sleep disorders usually requires a psychological history as well as a medical history. With the exception of sleep apnea syndromes, physical examinations are not usually revealing. The patient's sex and age are useful starting points in assessing the problem. The doctor may also talk to other family members in order to obtain information about the patient's symptoms. The family's observations are particularly important to evaluate sleepwalking, kicking in bed, snoring loudly, or other behaviors that the patient cannot remember.

Sleep logs

Many doctors ask patients to keep a sleep diary or sleep log for a minimum of one to two weeks in order to evaluate the severity and characteristics of the sleep disturbance. The patient records medications taken as well as the length of time spent in bed, the quality of the sleep, and similar information. Some sleep logs are designed to indicate circadian sleep patterns as well as simple duration or restfulness of sleep.

Psychological testing

The doctor may use psychological tests or inventories to evaluate insomnia because it is frequently associated with mood or affective disorders. The Minnesota Multiphasic Personality Inventory (MMPI), the Millon Clinical Multiaxial Inventory (MCMI), the Beck Depression Inventory, and the Zung Depression Scale are the tests most commonly used in evaluating this symptom.

SELF-REPORT TESTS. The Epworth Sleepiness Scale, a self-rating form recently developed in Australia, consists of eight questions used to assess daytime sleepiness. Scores range from 0–24, with scores higher than 16 indicating severe daytime sleepiness.

Laboratory studies

If the doctor is considering breathing-related sleep disorders, myoclonus, or narcolepsy as possible diagnoses, he or she may ask the patient to be tested in a sleep laboratory or at home with portable instruments.

POLYSOMNOGRAPHY. Polysomnography can be used to help diagnose sleep disorders as well as conduct research into sleep. In some cases the patient is tested in a special sleep laboratory. The advantage of this testing is the availability and expertise of trained technologists, but it is expensive. As of 2001, however, portable equipment is available for home recording of certain specific physiological functions.

MULTIPLE SLEEP LATENCY TEST (MSLT). The multiple sleep latency test (MSLT) is frequently used to measure the severity of the patient's daytime sleepiness. The test measures sleep latency (the speed with which the patient falls asleep) during a series of planned naps during the day. The test also measures the amount of REM sleep that occurs. Two or more episodes of REM sleep under these conditions indicates narcolepsy. This test can also be used to help diagnose primary hypersomnia.

REPEATED TEST OF SUSTAINED WAKEFULNESS (RTSW). The repeated test of sustained wakefulness (RTSW) is a test that measures sleep latency by challenging the patient's ability to stay awake. In the RTSW, the patient is placed in a quiet room with dim lighting and is asked to stay awake. As with the MSLT, the testing pattern is repeated at intervals during the day.