Obstructive sleep apnea is a common and serious sleep disorder that causes you to stop breathing during sleep. The airway repeatedly becomes blocked, limiting the amount of air that reaches your lungs. When this happens, you may snore loudly or making choking noises as you try to breathe. Your brain and body becomes oxygen deprived and you may wake up. This may happen a few times a night, or in more severe cases, several hundred times a night.

In many cases, an apnea, or temporary pause in breathing, is caused by the tissue in the back of the throat collapsing. The muscles of the upper airway relax when you fall asleep. If you sleep on your back, gravity can cause the tongue to fall back. This narrows the airway, which reduces the amount of air that can reach your lungs. The narrowed airway causes snoring by making the tissue in back of the throat vibrate as you breathe.

Sleep apnea can make you wake up in the morning feeling tired or unrefreshed even though you have had a full night of sleep. During the day, you may feel fatigued, have difficulty concentrating or you may even unintentionally fall asleep. This is because your body is waking up numerous times throughout the night, even though you might not be conscious of each awakening.

The lack of oxygen your body receives can have negative long-term consequences for your health. This includes:

• High blood pressure
• Heart disease
• Stroke
• Pre-diabetes and diabetes
• Depression

There are many people with sleep apnea who have not been diagnosed or received treatment. A sleep medicine physician can diagnose obstructive sleep apnea using an in-lab sleep study or a home sleep apnea test. Sleep apnea is manageable using continuous positive airway pressure (CPAP) therapy, the front-line treatment for sleep apnea, oral appliance therapy or surgery.

Obstructive sleep apnea in adults is considered a sleep-related breathing disorder. Causes and symptoms differ for obstructive sleep apnea in children and central sleep apnea.

Risk Factors for OSA:

• Excess weight. People who are obese have four times the risk of sleep apnea that people who are a normal weight people do. Fat deposits around your upper airway may obstruct your breathing. But not everyone who has sleep apnea is overweight.
• Neck circumference. People with thicker necks may have narrower airways. For men, the risk increases if neck circumference is 17 inches (43 centimeters) and larger. In women, the risk increases if neck circumference is 15 inches (38 centimeters) or more.
• A narrowed airway. You may have inherited a naturally narrow throat. Or, tonsils or adenoids may become enlarged and block the airway, particularly in children with sleep apnea.
• Being male. Men are twice as likely to have sleep apnea. However, women increase their risk if they’re overweight, and their risk also appears to rise after menopause.
• Being older. Sleep apnea occurs significantly more often in older adults.
• Family history. If you have family members with sleep apnea, you may be at increased risk.
• Use of alcohol, sedatives or tranquilizers. These substances relax the muscles in your throat.
• Smoking. Smokers are three times more likely to have obstructive sleep apnea than are people who’ve never smoked. Smoking may increase the amount of inflammation and fluid retention in the upper airway. This risk likely drops after you quit smoking.
• Nasal congestion. If you have difficulty breathing through your nose — whether it’s from an anatomical problem or allergies — you’re more likely to develop obstructive sleep apnea.

From materials by American Academy of Sleep Medicine

Central sleep apnea occurs when your brain doesn’t send proper signals to the muscles that control breathing. Central sleep apnea is less common form of sleep apnea. This means you make no effort to breathe for a short period of time. You may awaken with shortness of breath or have a difficult time getting to sleep or staying asleep.

Central sleep apnea is a breathing disorder that causes your body to decrease or stop the effort of breathing during sleep. This occurs in an off-and-on cycle. It is a result of a problem in the brain or heart. It is different from obstructive sleep apnea (OSA) because the problem is not caused by a blockage of the airway.

The brain and heart normally interact to direct, monitor, and change the amount of air that we breathe. The problem in central sleep apnea syndromes (CSA) is that the brain and heart move an abnormal amount of air into the lungs. CSA syndromes in adults are divided into these five categories:

Primary Central Sleep Apnea — Cause is not known. The breathing pattern consists of the repetitive absence of breathing effort and air flow.

Cheyne-Stokes Breathing Pattern — Cause is heart failure, stroke, and possibly kidney failure. The breathing pattern consists of a rhythmic increase and decrease of the breathing effort and the amount of air flow.

Medical Condition Not Cheyne-Stokes — CSA caused by medical conditions, but without the typical Cheyne-Stokes breathing pattern. It is caused by heart and kidney problems. It may also result from a problem in the base of the brain where breathing is controlled.

High-Altitude Periodic Breathing — Caused by sleeping at altitudes higher than about 15,000 feet. The breathing pattern is similar to the Cheyne-Stokes Breathing Pattern. The difference is that there is no history of heart failure, stroke, or kidney failure. Also, the cycle time is shorter.

Due to Drug or Substance — Caused by the use of drugs, mainly pain medicines in the opioid category. Breathing may stop completely or increase and decrease in a regular pattern. Breathing can also be quite irregular. It can even have elements of obstruction such as the breathing that is seen in OSA.

Risk Factors for CSA:

• Being older. Middle-aged and older people have a higher risk of central sleep apnea.
• Heart disorders. People with congestive heart failure are more at risk of central sleep apnea.
• Using narcotic pain medications. Opioid medications, especially long-acting ones such as methadone, increase the risk of central sleep apnea.
• Stroke. People who’ve had a stroke are more at risk of central sleep apnea or treatment-emergent central sleep apnea.

From materials by American Academy of Sleep Medicine

Insomnia is the most common sleep complaint. It occurs when you have trouble falling asleep or staying asleep even though you had the opportunity to get a full night of sleep. 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.

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

• Short-term insomnia: This type of brief insomnia lasts for up to three months. It occurs in 15 to 20 percent of people.
• 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.

A board certified sleep medicine physician diagnoses chronic insomnia. Our specialists can provide ongoing care. Please contact us to arrange consultation.

SYMPTOMS AND CAUSES

Symptoms and causes of insomnia are different for every patient. Insomnia symptoms may include:

• Fatigue
• Problems with attention, concentration or memory (cognitive impairment)
• Poor performance at school or work
• Moodiness or irritability
• Daytime sleepiness
• Impulsiveness or aggression
• Lack of energy or motivation
• Errors or accidents
• Concern or frustration about your sleep

Insomnia is most often associated with another problem. Insomnia that is not caused or worsened by other factors is rare. These factors may include:

Stress

This varies from relatively minor things like work or personal stress, to more severe changes such as death, divorce or job loss.

Other sleep disorders

Some sleep disorders can cause insomnia or make it worse. For instance, people with restless legs syndrome may have a hard time falling asleep.

Medical conditions

Many physical illnesses can cause insomnia. People who experience pain, discomfort or limited mobility from medical problems may have difficulty falling asleep or staying asleep. Insomnia due to medical conditions is most common in older adults because people tend to have more chronic health problems as they age. Conditions such as pregnancy, particularly the third trimester, and menopause can cause sleep problems. The severity and duration of insomnia often varies with the related health condition.

Mental disorders

The relationship between sleep and mental health is complex. Insomnia is sometimes caused by a mental health disorder. Often a mental health disorder will be found after a complaint of insomnia. Depression is one of the most common mental illnesses in the United States and a frequent cause of insomnia. People with depression often have trouble falling asleep or staying asleep. Difficulty falling asleep is also common in people with anxiety disorders. Other mood disorders such as bipolar disorder may also cause sleep problems.

Medication or substance use or abuse

Insomnia can be an unwanted side effect of many prescription or over-the-counter medications. Common cold and allergy medicines contain pseudoephedrine and can make it difficult to fall asleep. Antidepressants and medications to treat ADHD, high blood pressure or Parkinson’s disease can also cause insomnia.

Drinking alcohol before bedtime can cause frequent awakenings during the night. Insomnia also can occur if you suddenly stop using a sleeping pill.

Caffeine and other stimulants can prevent you from falling asleep. Stimulants also cause frequent awakenings during the night.

Some people are sensitive to certain foods and may be allergic to them. This can result in insomnia and disrupted sleep.

Environmental factors

The environment where you sleep can cause insomnia. Disruptive factors such as noise, light or extreme temperatures can interfere with sleep. Sleeping with a bed partner who snores also can cause sleep disruption. Extended exposure to environmental toxins and chemicals may prevent you from being able to fall asleep or stay asleep.

Habits or lifestyles

Irregular sleep schedules (see shift work disorder) can cause insomnia in workers who try to sleep during the day.

From materials by American Academy of Sleep Medicine

Narcolepsy is a lifelong sleep disorder that makes you feel overwhelmingly tired, and in severe cases, have sudden uncontrollable sleep attacks. Narcolepsy can impact nearly every aspect of your life. It is dangerous because you can have excessive sleepiness or a sleep attack at any time of the day, in the middle of any activity including eating, walking or driving. Operating a vehicle with untreated narcolepsy can be very dangerous and some states even have laws against it.

Many people with narcolepsy do not know they have the sleep disorder. About one in 2,000 people have some form of narcolepsy. Narcolepsy may run in some families, but most cases are not genetic. The disorder is extremely rare in children. The cause of narcolepsy is still unknown, but recent research suggests that many people with narcolepsy with cataplexy have low levels of the neurotransmitter hypocretin, a chemical that regulates arousal, wakefulness and appetite.

There are two types of narcolepsy:

• Narcolepsy Type 1 – This type of narcolepsy involves a combination of excessive daytime sleepiness and one or both of the following:
  • Cataplexy is when you have attacks that cause a sudden loss of muscle tone while you are awake. It may lead to slurred speech and buckling knees, or in more severe cases complete paralysis. These events are usually triggered by strong emotions such as joy, surprise, laughter or anger.
  • Low or absent CSF hypocretin-1 levels. Narcolepsy type 1 is caused by a deficiency of hypocretin (orexin). A patient with low hypocretin has narcolepsy type 1, even if they don’t exhibit cataplexy.
• Narcolepsy Type 2 – This type of narcolepsy occurs when you have continuous excessive sleepiness but no cataplexy. You may take a nap for a couple of hours and wake up feeling refreshed. But after a short time, you feel tired again.

When you add up the hours of total sleep time, people with narcolepsy don’t necessarily sleep any more than people who don’t have the sleep disorder. This is especially true when you consider that many people with narcolepsy often have difficulty sleeping through the night because of unwanted awakenings.

Some people assume that because they are consistently tired during the day, that they may have narcolepsy. Other sleep disorders that cause daytime sleepiness are often mistaken for narcolepsy. These include sleep apnea, circadian rhythm sleep disorders and restless legs syndrome. Medical conditions, mental health disorders and use of certain medications or substances can also cause symptoms similar to narcolepsy.

Symptoms of narcolepsy usually begin between the ages of 15 to 25, but it is possible start experiencing symptoms at a much younger or older age. The symptoms usually worsen after the first few years. You may experience the following:

Excessive daytime sleepiness

The primary symptom of narcolepsy is excessive daytime sleepiness. You may feel tired during the day even though you had a full night’s sleep. This sleepiness is difficult to prevent and may vary over the course of the day. After a brief nap, you may feel alert, but the sleepiness will return after an hour or two.

Hallucinations

Some patients with narcolepsy have vivid hallucinations at sleep onset. These hypnagogic hallucinations are usually visions that someone or something is present in your bedroom. It can feel very real, and trigger feelings of fear or dread. Other common visions may include being caught in a fire or flying through the air. These experiences are mainly visual, though they may also involve your senses of sound, touch, taste and smell.

Sleep paralysis

You might lose the ability to move and feel paralyzed when you are falling asleep or waking up. This usually lasts a few seconds or minutes. This can be frightening, but it is not associated with an inability to breathe. Sleep paralysis can sometimes be paired with hallucinations, which are especially upsetting.

Disturbed nighttime sleep

About half of people with narcolepsy have problems sleeping through the night. You may wake up frequently and have difficulty falling back to sleep.

Memory problems

You may have trouble remembering things that people tell you because you were not fully awake at the time. Memory lapses also happen when sleepiness sets in as you are doing activities that do not require much thought.

Sudden loss in muscle tone (cataplexy)

This only occurs if you have narcolepsy with cataplexy. Cataplexy occurs when you have a sleep attack that is triggered by a strong emotion. This can happen when you are surprised, elated or even intimate with a partner. You may slur your speech or lose control of your limbs, or you may become completely paralyzed.

Narcolepsy with cataplexy is frequently linked to increased weight, sometimes obesity. It is possible to have narcolepsy along with another sleep disorder, such as sleep apnea or REM sleep behavior disorder.

From materials by American Academy of Sleep Medicine

Restless legs syndrome is a neurological sleep disorder that make you have an overwhelming urge to move your legs. Restless legs syndrome makes it difficult to get comfortable enough to fall asleep. The symptoms are usually worse at night. The sensation is difficult for some people to describe. You may lie down and begin to feel burning or itching inside your legs. If you move your legs or get up and walk around, these symptoms may go away. The discomfort may return when you try again to go to sleep.

In some restless legs syndrome cases, you may have trouble sitting still for long periods of time. Long car rides or airplane travel may be difficult.

Many people wait years to seek treatment because they do not view it as a serious concern. If left untreated, you may notice that your symptoms become more frequent and severe.

Restless legs syndrome may cause you to get fewer hours of sleep each night. Many people with severe cases get less than five hours of sleep per night. Milder cases do not disturb your sleep as much, though the sleep may be of poorer quality.

The accumulated sleep loss from restless legs syndrome can make you excessively sleepy during the daytime, cause you to be irritable and make concentration difficult. This may have a major impact on your professional and personal life. People with restless legs syndrome are more likely to have depression or anxiety.

Restless legs syndrome is almost always manageable through medication and a number of lifestyle changes.

Most people develop restless legs syndrome after age 45. Women are nearly twice as likely as men to develop the disorder. If you have a family member with restless legs syndrome, you are more likely to develop the symptoms before you are 45 years old. More than half of people with restless legs syndrome have a pattern of it in their family, as the risk is about three to six times greater.

Causes

What causes of restless legs syndrome varies from person to person. In some cases the cause is unknown, or it can be caused by or made worse by other health issues or medication. This may include:

Low iron levels

This can cause problems with brain cell communication that can lead to restless legs syndrome. If you think you have restless legs syndrome caused by low iron, talk with your physician and do not attempt to take supplements on your own.

Diabetes

This lifelong condition can damage blood vessels and nerves that affect leg muscles causing restless legs syndrome. By properly managing your diabetes, you may help prevent or improve your restless legs syndrome.

Pregnancy

Many women have restless legs syndrome when they are pregnant. It usually goes away within a month of giving birth.

Medications

Some medications can cause restless legs syndrome or make it worse:

• Allergy medications
• Many antidepressants
• Antihistamines and over-the-counter sleep aids
• Nearly all centrally active dopamine-receptor antagonists, including anti-nausea medications

Symptoms

The primary symptom of restless legs syndrome is a sensation of discomfort in the legs that often defies description. The feeling is different than leg cramps or numbness from circulation problems. Patients have used the following words to describe this sensation:

• Itchy
• Crawling
• Burning
• Creepy
• Throbbing

Usually this feeling is paired with the urge to move your legs. The desire usually worsens when you lie down or rest.

The symptoms of restless legs syndrome are frequently worse at night than in the morning.

A related problem is that your leg muscles might tighten or flex while you are still. These movements can be out of your control. In extreme cases, they may be periodic limb movements.

From materials by American Academy of Sleep Medicine

Shift work disorder occurs when you have difficulties adjusting to a work schedule that takes place during a time which most people sleep. When you have shift work disorder, there is a conflict between your body’s circadian rhythms and your work schedule. You may have to be at work when your body wants to sleep. Then when you have to sleep, you body expects to be awake.

People with shift work disorder may sleep up to four hours less than the average worker. Shift work disorder causes you to have trouble sleeping or be severely tired. The quality of sleep may be poor, and you may wake up feeling unrefreshed. You may feel fatigued or exhausted. This can hurt your performance at work, and can put you at risk for making a costly mistake or getting injured on the job.

Not everyone who does shift work has shift work disorder. Many people have difficulty initially adjusting to a new shift. If after several weeks you have difficulty falling asleep or staying asleep or you feel tired even after sleeping 7-8 hours, you may have shift work disorder.

The symptoms of shift work disorder usually last as long as you keep the shift work schedule. The sleep problems tend to go away once you begin sleeping at a normal time again. Some people may have sleep problems even after the shift work schedule ends.

Shift work disorder is a circadian rhythm sleep disorder. Your circadian rhythms are your body’s internal clock that signals when you are supposed to feel sleepy or alert. Your circadian rhythms operate on a roughly 24-hour schedule. Your body uses sunlight to determine how much of the sleep-promoting hormone melatonin it produces. In shift work disorder, melatonin production may occur when you need to be awake and alert for your job. Exposure to sunlight may prevent you from producing melatonin when you are supposed to sleep.

There are several variations of shift work schedules that can cause difficulties. This includes:

• Early-morning shifts
• Night shifts
• Overnight shifts
• Rotating shifts

Some people have a more difficult time with certain shift work schedules. Night owls may adjust more easily to working an evening shift than morning-types. Likewise, morning larks may have an easier time with early morning shifts. Many people have difficulty adjusting to overnight or rotating shifts.

Shift work disorder makes it difficult to get enough sleep each day. As a result, you may experience:

• Excessive sleepiness
• Difficulty falling asleep or staying asleep
• Lack of energy
• Difficulty concentrating
• Headaches
• Poor mood & irritability

Shift work disorder can also increase the risk for:

• Work-related injuries
• Costly mistakes at work
• Increased use of sick time
• Accidents related to drowsy driving
• Substance abuse due to use of drugs or alcohol to improve sleep

Increased long term health risks include:

• Frequent infections, colds and the flu
• Breast and prostate cancer
• High cholesterol levels
• Heart disease
• Obesity

From materials by American Academy of Sleep Medicine

This category of disorders includes conditions in which the sleep times are out of alignment. A patient with one of these disorders does not follow the normal sleep times at night.

Delayed Sleep-Wake Phase

This circadian rhythm disorder is a sleep pattern that is delayed by two or more hours so that a person goes to sleep later at night and sleeps later in the morning.

Advanced Sleep-Wake Phase

This circadian disorder causes people to fall asleep several hours before a normal bedtime and wake up hours earlier than most people wake in the morning.

Irregular Sleep-Wake Rhythm

This disorder causes a person’s circadian rhythms to be so disorganized that there is no clear sleep or wake pattern. People with this sleep disorder may sleep off and on in a series of naps over a 24-hour period.

Non-24-Hour Sleep-Wake Rhythm

Non-24 is a sleep disorder that causes a person’s sleep time to shift a little later every day. Sleep times may go in and out of alignment with other people over time.

Jet Lag

Jet lag occurs when you travel across multiple time zones and have difficulty adjusting to the new schedule.

From materials by American Academy of Sleep Medicine