Sleep Disorders Health Article

Dyssomnias

Dyssomnias are primary sleep disorders in which the patient suffers from changes in the amount, restfulness, and timing of sleep. The most important dyssomnia is primary insomnia, which is defined as difficulty in falling asleep or remaining asleep that lasts for at least one month. It is estimated that 35% of adults in the United States experience insomnia during any given year. Primary insomnia usually begins during young adulthood or middle age.

Hypersomnia is a condition marked by excessive sleepiness during normal waking hours. The patient has either lengthy episodes of daytime sleep or episodes of daytime sleep on a daily basis even though he or she is sleeping normally at night. The number of people with primary hypersomnia is unknown, although 5–10% of patients in sleep disorder clinics have the disorder. Primary

hypersomnia usually affects young adults between the ages of 15 and 30.

Nocturnal myoclonus and restless legs syndrome (RLS) can cause either insomnia or hypersomnia in adults. Patients with nocturnal myoclonus, sometimes called periodic limb movement disorder (PLMD), awaken because of cramps or twitches in the calves and feel sleepy the next day. RLS patients have a crawly or aching feeling in their calves that can be relieved by moving or rubbing the legs. RLS often prevents the patient from falling asleep until the early hours of the morning.

Narcolepsy is a dyssomnia characterized by recurrent "sleep attacks" (abrupt loss of consciousness) lasting 10–20 minutes. The patient feels refreshed by the sleep, but typically feels sleepy again several hours later. Narcolepsy has three major symptoms in addition to sleep attacks: cataplexy (sudden loss of muscle tone and stability), hallucinations, and sleep paralysis. About 40% of patients with narcolepsy have or have had another mental disorder. Although narcolepsy is considered an adult disorder, it has been reported in children as young as three years old. Almost 18% of patients with narcolepsy are 10 years old or younger. It is estimated that 0.02–0.16% of the general population suffers from narcolepsy.

Breathing-related sleep disorders are syndromes in which the patient's sleep is interrupted by problems with his or her breathing. There are three types of breathingrelated sleep disorders:

• Obstructive sleep apnea syndrome is the most common form, marked by episodes of blockage in the upper airway during sleep. It is found primarily in obese people. Patients with this disorder typically alternate between periods of snoring or gasping (when their airway is partly open) and periods of silence (when their airway is blocked). Very loud snoring is characteristic of this disorder.
• Central sleep apnea syndrome is primarily found in elderly patients with heart or neurological conditions that affect their ability to breathe properly.
• Central alveolar hyperventilation syndrome is found most often in extremely obese people. The patient's airway is not blocked, but his or her blood oxygen level is too low.
• Mixed-type sleep apnea syndrome combines symptoms of both obstructive and central sleep apnea.

Circadian rhythm sleep disorders are dyssomnias resulting from a discrepancy between the person's daily sleep/wake patterns and the demands of social activities, shift work, or travel. There are three circadian rhythm sleep disorders: delayed sleep phase (going to bed and arising later than most people); jet lag (traveling to a new time zone); and shift work.