Sleep disorders

Overview of common sleep disorders

Next, Dr. Solet described common complaints that patients give and could be indicative of sleep disorders. Individuals may report they can’t fall asleep or can’t stay asleep; they are sleeping too much or at the wrong times; they are moving around during sleep or feel that they are not breathing right during sleep.

Untreated sleep disorders may explain and contribute to fatigue and must be carefully excluded. A summary of common sleep disorders may include:

- Insomnias or hypersomnias (i.e., can’t sleep or sleeping too much)
- Restless leg syndrome (RLS) and periodic limb movements disorder (PLMD)
- Sleep apnea: two types, one is associated with an obstruction of the respiratory system and the other, central apnea, is a neurological problem
- Parasomnia: sleep-walking, talking, bruxism
- REM sleep behavior disorder (i.e, acting out what the individual is dreaming)
- Psychiatric: depression/dysthymia, anxiety, post-traumatic stress disorder (PTSD)
- As mentioned earlier, the sleep environment including partners, pets, environmental disruptions should also be evaluated

Sleep screening considerations

•  Life cycle stage—Different problems that people have with sleep, in part, relate to their life cycle and developmental stage: adolescence, pregnancy, menopause, and aging.
•  Health Status—Check for other health problems that could impact sleep, like fatigue, pain, allergies, depression, anxiety, PTSD, diabetes, weight, and medications.
•  Special Stressors— Find out if the patient is going through a difficult situation (e.g., grief, job loss, relocation, divorce, or an existential crisis) that could affect sleep.
•  Personal and family sleep history issues—Assess a patient’s heritage or family history, which may provide evidence of a predisposition for certain problems.
•  Sleep hygiene and habits—Ask patients about their exercise, eating, activities in bed, erratic schedule, caffeine and/or alcohol consumption.
•  Sleep environment—Review sleep setting/disturbances (e.g., partners, noise, light).
•  History of accidents—Inquire about patient being drowsy while driving or having excessive daytime sleepiness, which may suggest sleep apnea or other sleep disorders.
•  Sleep apnea—Evaluate for sleep apnea. There are two types: obstructive, which is associated with an obstruction of the respiratory system and central apnea, which is a neurological problem. Snoring, choking, and gasping during sleep are signposts of obstructive sleep apnea. Often, a sleep partner will report these problems while the patient might be unaware of their numerous arousals of interrupted breathing. Treatments may include the use of a CPAP machine, dental prosthesis, surgery to correct structural problems, and weight loss.
•  Restless Legs Syndrome (RLS)—Tingly, abnormal sensations in the legs is indicative of RLS. It is found to be more prevalent in individuals of northern European heritage and to have an association with low iron reserves.
•  Periodic Limb Movements Disorder (PMLD)—PMLD presents with movement of limbs during sleep.