Diagnosis and management of sleep disorders in pregnancy

There are many different ways in which sleep data can be collected, the gold standard, however, is to measure sleep using polysomnography (PSG) as this provides an objective assessment of the sleep-wake cycle over the entire sleep period (Baker et al, 1999).

Much of the data regarding sleep in pregnancy is limited to self-administered questionnaires and to diaries: very few recent studies have used PSG. However, it is recognised that undertaking multiple sleep studies at different time points during pregnancy is difficult. Despite this there is evidence to suggest that sleep disorders in pregnancy can in certain individuals have adverse outcomes for the mother or baby and therefore it would be useful to develop a screening tool that could be administered quickly by health professionals during routine pregnancy consultations.

A simple and cost-effective alternative to PSG is to use actigraphy and sleep diaries. There are now many wrist-watch style actigraphs available. They are activated by movement and can differentiate when a person is awake or asleep, many also now have light monitors incorporated in them as well. They are useful in identifying night time awakenings and for determining their subsequent duration. When used in conjunction with self-recorded sleep diaries, actigraphs can help to establish a very detailed sleep pattern.

Questionnaires administered to a bed partner can also help to establish a diagnosis of sleep disordered breathing. OSA is a common but often unrecognised condition in women of childbearing age. The likelihood is increased however in women with a past or current history of polycystic ovary syndrome, depression, hypertension, diabetes, hypothyroidism, metabolic syndrome, obesity (Champagne et al, 2010). The diagnostic test of choice would be a PSG, and referral to a sleep specialist to confirm and treat primary sleep disorders may be required. Further research is also required to establish if the management thresholds for treatment of OSA in non-pregnant women are applicable to pregnant women.

Pharmacological treatment of sleep disorders in pregnancy needs to be viewed with caution, given the potential for harm to the foetus. Similar caution needs to extend to women who are breastfeeding.

Diagnosis and management of sleep disorders in pregnancy

Sleep disorders in pregnancy

Sleep-Disordered breathing (SDB) is the term used to describe a group of disorders which are characterized by abnormalities of respiratory pattern (pauses in breathing) or the quantity of ventilation during sleep. A recent study evaluated the frequency of sleep disordered breathing in women with gestational hypertension compared to healthy women with uncomplicated pregnancies. They observed that women with gestational hypertension may have a significantly higher frequency of sleep disordered breathing than do healthy women with uncomplicated pregnancies of similar gestational age. The frequencies of sleep disordered breathing in the more obese gestational hypertension group and the healthy group were 53% and 12% (p<0 .001="" 2011="" al="" br="" eid="" et="">
 
Obstructive sleep apnoea (OSA) is the most common of these sleep disorders and is characterized by the complete or partial collapse of the pharyngeal airway during sleep. To resume ventilation, feedback mechanisms arouse the individual, which leads to sleep disruption. OSA is associated with an increased CVD risk. Although, men are twice as likely to develop OSA as women, the risk is increased in women if they are overweight. Moreover, data from recent studies indicates that snoring and OSA increase during pregnancy. The prevalence of OSA is very low in normotensive women low-risk pregnancies but is increased among normotensive pregnant women with high risk pregnancies and, in those with gestational hypertension (pregnancy-induced hypertension (PIH)/pre-eclampsia) during pregnancy, the prevalence is even higher.

PIH is characterised by high blood pressure with a flat circadian rhythm and in particular does not have the normal nocturnal dip associated with sleep. Risk factors for PIH include first time pregnancy, long periods (>10years) between pregnancies, multiple pregnancies,women younger than 20 or older than 35 or women who are overweight, have a history or hypertension or kidney disease or diabetes. Recent studies indicate that OSA per se is an independent risk factor for gestational hypertension/pre-eclampsia and may contribute to other poor obstetrical outcomes. Good blood pressure control in pregnancy is important. Continuous Positive Airway Pressure (CPAP), which is used to treat OSA, may also have beneficial effects on blood pressure (Champagne et al, 2010). It may therefore be very useful in patients with PIH as this condition is associated with both increased blood pressure and a significantly narrowed upper airways and limited airflow during sleep (Izci et al, 2003). Continuation of treatment for OSA following the pregnancy may also be required.

Insomnia is a sleep disorder which is characterised by a difficulty in initiating or maintaining sleep in combination with adverse daytime consequences. The daytime effects may include excessive fatigue, impairment of performance or emotional changes. Data from self-reported questionnaires suggests that sleep complaints are more frequent in pregnancy and that sleep disturbances increases as the pregnancy progresses. In a recent study of 300 women (100 women in each trimester of pregnancy) it was observed that there was a significant increase in insomnia in the 2nd trimester, excessive daytime sleepiness (EDS) was also increased in pregnancy and the rate for specific awakenings increased by 63% in the first trimester, by 80% in the second trimester and by 84% in the third trimester (p<0 .001="" 2004="" al="" br="" et="" opes="">
Restless leg syndrome is a neurosensory sleep disorder which begins in the evening. The associated symptomatic leg movements can prevent a person from falling asleep and contribute to poor sleep quality. Pregnant women have at least two or three times higher risk of experiencing restless legs syndrome (RLS) than the general population and women affected by pre-existing RLS often complain of worsening symptoms during pregnancy. It is associated with iron deficiency anaemia. 

The women who are most at risk are those with low folate, ferritin or haemoglobin prior to conception. Data from the existing epidemiological studies suggests that the rates may be as high as 27% in the third trimester(Lee et al, 2001; Manconi et al, 2004). Whilst RLS is a reversible syndrome in pregnancy and is typically limited to the third trimester it has been associated with adverse pregnancy outcomes and therefore needs to be taken seriously. The standard medications for RLS that contain dopaminergics or opioids should be avoided but preventative measures to increase the amount of folate should be encouraged at the first prenatal visit.

Complaints of heartburn increase during pregnancy and if these progress to severe nocturnal oesophageal reflux may also contribute to sleep disruption.

Sleep disorders in pregnancy

Sleep deprivation: Adverse sleep changes in pregnancy quantity and quality

Due to the lack of good longitudinal studies there is still little information on what constitutes normal sleep quality and quantity both during pregnancy and in the period following delivery. In a recent study however Signal et al quantified the change and variability in sleep duration and quality across pregnancy and post-partum in 8 healthy nulliparous and 11 healthy multiparous women (Signal et al, 2007).

The women wore an actigraph and completed a sleep diary for seven nights during the second trimester, one week prior to delivery, and at one and six weeks post-partum. They observed that compared to multiparous women, nulliparous women generally had less efficient sleep, spent more time in bed and had greater wake after sleep onset in the second trimester, and spent less time in bed and had fewer sleep episodes a day at one week post-partum.

The largest change in sleep however occurred during the first week after delivery with the women obtaining 1.5h less sleep than during pregnancy. In a more recent and larger study sleep was assessed using the Pittsburgh Sleep Quality Index (PSQI) in 260 women during the second and third trimester of pregnancy (Naud et al, 2010). Of the 260 women, 192 (73.6%) had a term delivery without any adverse outcome. The investigators reported that there were no differences in sleep parameters between pregnancies with adverse outcome and without adverse outcome. The PSQI scores however indicted that sleep quality deteriorated from the second (5.26 +/- 3.16) to the third trimester (6.73 +/- 4.02; P < 0.01).

This deterioration was displayed in five of seven sleep components (P < 0.01). Scores in the "poor sleeper" range were recorded by 36% of women in the second trimester and 56%, of women in the third (P < 0.01). "Poor sleep" in both trimesters was associated with low or high weight gain, low annual family income, and single motherhood (P < 0.01). A weak but not significant effect of season on sleep scores was recorded: The mean PSQI scores were 6.06 (+/-3.96) in winter, 5.21 (+/-3.21) in spring) 5.33 (+/-3.04) in summer and 5.53 (+/-2.41) in autumn); (P=0.076). In a similar study of 189 nulliparous women Facco et al demonstrated that compared with the baseline assessment (mean gestational age (13.8 (+/-3.8)) the mean sleep duration was significantly shorter at 30.0 (+/-2.2) weeks gestation (p<0 .01="" br="">
 
They also observed that in the third trimester the proportion of patients who reported frequent snoring (at least three nights per week) was significantly increased, and that there was an increase in those who met the diagnostic criteria for the recognised sleep disorder ‘restless leg syndrome’. Furthermore, poor sleep quality, as defined by a Pittsburgh Sleep Quality Index score greater than 5, became significantly more common as pregnancy progressed (Facco et al, 2010).

In a separate study Wilson et al also found that sleep efficiency was decreased in late pregnancy and was associated with an increase in cortical arousals when compared to women in early pregnancy and non-pregnant women. Compared to a control group, they found that women in the third trimester of pregnancy had more awakenings and had had poorer sleep efficiency. They had less stage 4 sleep and more stage 1 sleep and spent less time in rapid eye movement (REM) sleep (Wilson et al, 2010).

Sleep quality also decreases as a woman approaches labour (Evans et al, 1995) but whilst little is known of the effect of sleep disturbance on labour or delivery outcome it has been common practice to administer morphine sulphate to women in either early or non progressing latent phase labour to induce sleep. It has been observed that on awakening the contractions are more regular and active.

Sleep deprivation: Adverse sleep changes in pregnancy quantity and quality

Sleep and pregnancy

Pregnancy is associated with many maternal physiological and psychological changes both of which may have an effect on sleep. In the first trimester, hormonal changes may disrupt sleep and in the third trimester the large baby and the anxiety regarding delivery may have associated effects on sleep. Likewise post-partum, a newborn may disrupt sleep patterns.

The review by Lee in 1998 demonstrated that there was a paucity of studies, which addressed the alterations of sleep in pregnant women, moreover many of these studies lacked sufficient power to allow consistent interpretation and replication of the results (Lee, 1998). Since then a number of studies have now been conducted but more research is still required to establish whether for example, a woman’s pre-pregnancy sleep pattern can affect outcome and to determine whether there is any effect of parity on sleep related maternal and foetal outcomes.

The changes in circadian rhythm of various hormones and the associated changes to sleep architecture that occur throughout pregnancy are discussed by Wolfson and Lee (2005) in ‘The Principles and Practice of Sleep Medicine’ (Kryger, Roth and Dement (Eds)).

Sleep and pregnancy

What Is Childhood Sleep Apnea?

Childhood obstructive sleep apnea syndrome (OSAS) is a condition in which the air passage in the child’s throat becomes blocked during sleep. This potentially serious condition occurs in 1 to 3 percent of otherwise healthy preschool children. It is most prevalent in children ages 2 to 6, but can also strike infants and adolescents.

Patient history and physical examination alone cannot detect OSAS. However, observation while sleeping, or polysomnography, can play an important role in assessing the condition. Children with OSAS always snore and have difficulty breathing when sleeping. They sleep restlessly, may thrash about, and often sleep in unusual or contorted positions. However, these indicators alone are not absolutes. Many children who snore do so as a natural consequence of sleep and do not need treatment.

About 10% of children snore. Approximately 20-30% of snoring children have OSAS and it is very difficult to determine which of the snoring children actually have OSAS simply by examining the child's history and physical results. Any child that has daytime sleepiness may have OSAS. Sometimes, the daytime symptoms may be subtle, such as an unexplained change in behavior or decline in school performance. OSAS can also be a cause of poor growth. Any child who has poor growth or is not growing normally or has growth impairment, and has snoring, should be considered as a possible sleep apnea candidate.

What Is Childhood Sleep Apnea?

Lack of sleep raises the risk of diabetes in the elderly

By FIONA MACRAE

Poor quality sleep could raise the risk of diabetes in the elderly, a study suggests.

Research shows that interruption of deep sleep has a dramatic effect on the body's metabolism and the conversion of sugar into energy, heightening the risk of diabetes.

Just three nights of disrupted sleep can have the same effect on the body's ability to control sugar levels as putting on more than two stone in weight, the study found.

The finding is likely to be particularly relevant to the elderly, whose sleep is usually shorter and of poorer quality than that of younger people.

In addition, the risk of type-2 diabetes, the most common form of the disease, rises with age.

The U.S. researchers said it would be wise for older people to take measures to improve their sleep quality.

The University of Chicago study looked at the effect of sleep quality on the body's ability to produce insulin, the hormone needed to control blood glucose or sugar levels.

Nine healthy young men and women were monitored during five nights of sleep.

During the first two nights, they were allowed to sleep normally. After that, their sleep was regularly disrupted by noises calculated to be loud enough to draw them out of deep sleep without fully waking them.

The disruption to deep sleep was equivalent to that seen during the ageing process, with the young volunteers experiencing a quality of sleep more usually seen in people in their 60s.

After normal sleep and interrupted sleep the volunteers were given injections of glucose and their blood was sampled to measure how well the sudden influx of sugar was being controlled.

Analysis showed that sleep quality had a big effect on the body's ability to use insulin to control blood sugar levels, with levels rising by an alarming 23 per cent after just three nights of interrupted sleep.

Such an inability to use insulin - or insulin resistance - is thought to be the main cause of type-2 diabetes, which is linked to obesity and affects more than one million Britons.

The researchers, who report their results in the journal Proceedings of the National Academy of Sciences, said that while previous studies have linked quantity of sleep with diabetes, this was the first to make the association with quality of sleep.

They added: "Since reduced amounts of deep sleep are typical of ageing and of common obesity-related sleep disorders such as obstructive sleep apnea, these results suggest that strategies to improve sleep quality, as well as quantity, may help to prevent or delay the onset of type-2 diabetes in populations at risk."

Obstructive sleep apnea is a common disorder in which breathing regularly stops or becomes very shallow during sleep.

Previous studies have linked lack of sleep to a host of health problems, including high blood pressure, obesity and memory loss.

Lack of sleep raises the risk of diabetes in the elderly

New mothers DO get enough sleep - but it's of poor quality, finds study

By FIONA MACRAE

It may come as a surprise to new parents but a study has found that mothers do get enough sleep in their babies' first few months - it's just not good quality.

Researchers from West Virginia University followed a group of new mothers and found, on average, the women got just over seven hours of sleep a night during their babies' first four months.

That amount is generally what is recommended for adults, and, based on past studies, more than the average Briton gets.

But the study found that sleep is also frequently disrupted with the women typically being awake for a total of two hours a night which was worrying as sleep problems and exhaustion may contribute to postpartum depression and impact work performance.

Researcher Dr Hawley E. Montgomery-Downs, said the study challenges a central assumption about new mothers' typical sleep patterns.

She said that the general assumption had been that most new mothers are not getting enough hours of sleep so the advice on how to combat daytime fatigue has focused on countering sleep deprivation, such as nap when your baby naps.

The current results, reported in the American Journal of Obstetrics & Gynecology, suggest that new mothers' highly fragmented sleep is the cause of daytime fatigue.

That sleep pattern, Dr Montgomery-Downs said, is similar to what is seen with certain sleep disorders, such as sleep apnea, where people log enough hours in bed, but get little restorative, good-quality sleep.

Sleep occurs in repeated cycles that each last 90 minutes to two hours. Depending on how often a new mother is waking up, she may get few or no full cycles of sleep, Dr Montgomery-Downs noted.

'We need to think about what kinds of strategies can help consolidate sleep' for these mothers, Dr Montgomery-Downs said.

One tactic, she suggested, could be for breastfeeding mothers to find time to pump milk and store it in bottles so that they do not have to be the one to always get up with the baby.

While quick naps might not do much, Dr Montgomery-Downs noted that 'if you're one of the lucky parents' whose infants typically nap for at least two straight hours, taking that time to sleep could be helpful.

The findings are based on 74 new mothers who were followed between either the second and 13th week of their infants' lives, or between the 9th and 16th week.

The women kept track of their sleep patterns using sleep 'diaries,' and also wore a wristwatch-like device called an actigraph that recorded their movements during the night.

New mothers DO get enough sleep - but it's of poor quality, finds study

How Is Sleep Apnea Treated?

Goals of Treatment

The goals of treating obstructive sleep apnea are to:

• Restore regular breathing during sleep
• Relieve symptoms such as loud snoring and daytime sleepiness

Treatment may help other medical problems linked to sleep apnea, such as high blood pressure. Treatment also can reduce your risk for heart disease, stroke, and diabetes.

Specific Types of Treatment

Lifestyle changes, mouthpieces, breathing devices, and/or surgery are used to treat sleep apnea. Currently, there are no medicines to treat sleep apnea.

If you have sleep apnea, talk to your doctor or sleep specialist about the treatment options that are most appropriate for your specific condition.

Lifestyle changes and/or mouthpieces may be enough to relieve mild sleep apnea. People who have moderate or severe sleep apnea may need breathing devices or surgery.

Lifestyle Changes

If you have mild sleep apnea, some changes in daily activities or habits may be all that you need.

• Avoid alcohol and medicines that make you sleepy. They make it harder for your throat to stay open while you sleep.
• Lose weight if you're overweight or obese. Even a little weight loss can improve your symptoms.
• Sleep on your side instead of your back to help keep your throat open. You can sleep with special pillows or shirts that prevent you from sleeping on your back.
• Keep your nasal passages open at night with nose sprays or allergy medicines, if needed. Talk to your doctor about whether these treatments might help you.
• Stop smoking.

Mouthpiece

A mouthpiece, sometimes called an oral appliance, may help some people who have mild sleep apnea. Your doctor also may recommend a mouthpiece if you snore loudly but don't have sleep apnea.

A dentist or orthodontist can make a custom-fit plastic mouthpiece for treating sleep apnea. (An orthodontist specializes in correcting teeth or jaw problems.) The mouthpiece will adjust your lower jaw and your tongue to help keep your airways open while you sleep.

If you use a mouthpiece, it's important that you check with your doctor about discomfort or pain while using the device. You may need periodic office visits so your doctor can adjust your mouthpiece to fit better.

Breathing Devices

Continuous positive airway pressure (CPAP) is the most common treatment for moderate to severe sleep apnea in adults. A CPAP machine uses a mask that fits over your mouth and nose, or just over your nose. The machine gently blows air into your throat.

The air presses on the wall of your airway. The air pressure is adjusted so that it's just enough to stop the airways from becoming narrowed or blocked during sleep.

Treating sleep apnea may help you stop snoring. But stopping snoring doesn't mean that you no longer have sleep apnea or can stop using CPAP. Sleep apnea will return if CPAP is stopped or not used correctly.
Usually, a technician will come to your home to bring the CPAP equipment. The technician will set up the CPAP machine and adjust it based on your doctor's orders. After the initial setup, you may need to have the CPAP adjusted on occasion for the best results.

CPAP treatment may cause side effects in some people. These side effects include a dry or stuffy nose, irritated skin on your face, sore eyes, and headaches. If your CPAP isn't properly adjusted, you may get stomach bloating and discomfort while wearing the mask.

If you're having trouble with CPAP side effects, work with your sleep specialist, his or her nursing staff, and the CPAP technician. Together, you can take steps to reduce these side effects. These steps include adjusting the CPAP settings or the size/fit of the mask, or adding moisture to the air as it flows through the mask. A nasal spray may relieve a dry, stuffy, or runny nose.

There are many different kinds of CPAP machines and masks. Be sure to tell your doctor if you're not happy with the type you're using. He or she may suggest switching to a different kind that may work better for you.
People who have severe sleep apnea symptoms generally feel much better once they begin treatment with CPAP.

Surgery

Some people who have sleep apnea may benefit from surgery. The type of surgery and how well it works depend on the cause of the sleep apnea.

Surgery is done to widen breathing passages. It usually involves removing, shrinking, or stiffening excess tissue in the mouth and throat or resetting the lower jaw.

Surgery to shrink or stiffen excess tissue in the mouth or throat is done in a doctor's office or a hospital. Shrinking tissue may involve small shots or other treatments to the tissue. A series of such treatments may be needed to shrink the excess tissue. To stiffen excess tissue, the doctor makes a small cut in the tissue and inserts a small piece of stiff plastic.

Surgery to remove excess tissue is only done in a hospital. You're given medicine that makes you sleep during the surgery. After surgery, you may have throat pain that lasts for 1 to 2 weeks.

Surgery to remove the tonsils, if they're blocking the airway, may be very helpful for some children. Your child's doctor may suggest waiting some time to see whether these tissues shrink on their own. This is common as small children grow.

How Is Sleep Apnea Treated?

What Are the Signs and Symptoms of Sleep Apnea?

Major Signs and Symptoms

One of the most common signs of obstructive sleep apnea is loud and chronic (ongoing) snoring. Pauses may occur in the snoring. Choking or gasping may follow the pauses.

The snoring usually is loudest when you sleep on your back; it may be less noisy when you turn on your side. Snoring may not happen every night. Over time, the snoring may happen more often and get louder.

You're asleep when the snoring or gasping occurs. You will likely not know that you're having problems breathing or be able to judge how severe the problem is. Your family members or bed partner will often notice these problems before you do.

Not everyone who snores has sleep apnea.

Another common sign of sleep apnea is fighting sleepiness during the day, at work, or while driving. You may find yourself rapidly falling asleep during the quiet moments of the day when you're not active.

Other Signs and Symptoms

Others signs and symptoms of sleep apnea may include:

• Morning headaches
• Memory or learning problems and not being able to concentrate
• Feeling irritable, depressed, or having mood swings or personality changes
• Urination at night
• A dry throat when you wake up

In children, sleep apnea can cause hyperactivity, poor school performance, and aggressiveness. Children who have sleep apnea also may have unusual sleeping positions, bedwetting, and may breathe through their mouths instead of their noses during the day.

What Are the Signs and Symptoms of Sleep Apnea?

Who Is At Risk for Sleep Apnea?

It's estimated that more than 12 million American adults have obstructive sleep apnea. More than half of the people who have this condition are overweight.

Sleep apnea is more common in men. One out of 25 middle-aged men and 1 out of 50 middle-aged women have sleep apnea.

Sleep apnea becomes more common as you get older. At least 1 out of 10 people over the age of 65 has sleep apnea. Women are much more likely to develop sleep apnea after menopause.

African Americans, Hispanics, and Pacific Islanders are more likely to develop sleep apnea than Caucasians.
If someone in your family has sleep apnea, you're more likely to develop it.

People who have small airways in their noses, throats, or mouths also are more likely to have sleep apnea. Smaller airways may be due to the shape of these structures or allergies or other medical conditions that cause congestion in these areas.

Small children often have enlarged tonsil tissues in the throat. This can make them prone to developing sleep apnea.

Other risk factors for sleep apnea include smoking, high blood pressure, and risk factors for stroke or heart failure.

Who Is At Risk for Sleep Apnea?

What Is Sleep Apnea?

Sleep apnea is a common disorder in which you have one or more pauses in breathing or shallow breaths while you sleep.

Breathing pauses can last from a few seconds to minutes. They often occur 5 to 30 times or more an hour. Typically, normal breathing then starts again, sometimes with a loud snort or choking sound.

Sleep apnea usually is a chronic (ongoing) condition that disrupts your sleep 3 or more nights each week. You often move out of deep sleep and into light sleep when your breathing pauses or becomes shallow.

This results in poor sleep quality that makes you tired during the day. Sleep apnea is one of the leading causes of excessive daytime sleepiness.

Overview

Sleep apnea often goes undiagnosed. Doctors usually can't detect the condition during routine office visits. Also, there are no blood tests for the condition.

Most people who have sleep apnea don't know they have it because it only occurs during sleep. A family member and/or bed partner may first notice the signs of sleep apnea.

The most common type of sleep apnea is obstructive sleep apnea. This most often means that the airway has collapsed or is blocked during sleep. The blockage may cause shallow breathing or breathing pauses.

When you try to breathe, any air that squeezes past the blockage can cause loud snoring. Obstructive sleep apnea happens more often in people who are overweight, but it can affect anyone.

The animation below shows how obstructive sleep apnea occurs. Click the "start" button to play the animation. Written and spoken explanations are provided with each frame. Use the buttons in the lower right corner to pause, restart, or replay the animation, or use the scroll bar below the buttons to move through the frames.

Central sleep apnea is a less common type of sleep apnea. It happens when the area of your brain that controls your breathing doesn't send the correct signals to your breathing muscles. You make no effort to breathe for brief periods.

Central sleep apnea often occurs with obstructive sleep apnea, but it can occur alone. Snoring doesn't typically happen with central sleep apnea.

This article mainly focuses on obstructive sleep apnea.

Outlook

Untreated sleep apnea can:

• Increase the risk for high blood pressure, heart attack, stroke, obesity, and diabetes
• Increase the risk for or worsen heart failure
• Make irregular heartbeats more likely
• Increase the chance of having work-related or driving accidents

Lifestyle changes, mouthpieces, surgery, and/or breathing devices can successfully treat sleep apnea in many people.

Other Names for Sleep Apnea

• Sleep-disordered breathing
• Cheyne-Stokes breathing

What Is Sleep Apnea?

Sleep Apnea

Obstructive sleep apnea is a condition in which a person has episodes of blocked breathing during sleep. This article discusses obstructive sleep apnea in adults.
See also:

• Central sleep apnea
• Sleep disorders

Symptoms

A person who has obstructive sleep apnea often is not aware of the apnea episodes during the night. Often, family members, especially spouses, witness the periods of apnea.

A person with obstructive sleep apnea usually snores heavily soon after falling asleep. The snoring continues at a regular pace for a period of time, often becoming louder. It is then interrupted by a long silent period during which there is no breathing. This is followed by a loud snort and gasp, and the snoring returns. This pattern repeats frequently throughout the night.

The main symptoms are usually associated with excessive daytime sleepiness:

• Abnormal daytime sleepiness, including falling asleep at inappropriate times
• Awakening unrefreshed in the morning

Other symptoms may include:

•  Depression (possibly)
• Memory difficulties
• Morning headaches
• Personality changes
• Poor concentration
• Restless and fitful sleep
• Frequent waking up during the night to urinate
• Insomnia

Other symptoms that may occur with this disease:

Hyperactive behavior, especially in children
Leg swelling (if severe)

Sleep Apnea

What Are the Symptoms of Sleep Disorders?

Insomnia
 
Insomnia is itself often a symptom of other problems. Typical patterns of insomnia include the inability to fall asleep or stay asleep at night, waking up earlier than usual, and daytime fatigue. Most people with insomnia don't fall asleep in inappropriate situations, like driving. If this does occur, it may signal that a medical disorder (such as sleep apnea) is the cause of insomnia.

Sleep Apnea
 
Excessive daytime sleepiness is the primary symptom. Some people will deny sleepiness but feel fatigued. Other symptoms are snoring, snorting, and gasping sounds when you sleep -- often first noticed by a sleeping partner. Restless or unrefreshing sleep is also typical, as are headaches in the morning.

Narcolepsy
 
Excessive sleepiness during the day, alleviated by naps, is a symptom of narcolepsy. Dreaming during naps and experiencing dream-like hallucinations as you fall asleep are also warning signs. Loss of muscle control (called cataplexy) that occurs with emotion, such as laughing or anger, and the inability to move as you're going to sleep or waking up (called sleep paralysis) are also symptoms.

Restless Leg Syndrome
 
The primary warning sign is the irresistible urge to move your legs shortly after you get into bed, in the middle of the night after awakening, or even when wide awake during the day. It usually feels better if you get up to walk around or rub your leg. "Creepy-crawly" or twitching feeling in your calves, feet, thighs, or arms are symptoms of restless leg syndrome -- the sensations of discomfort can be quite varied. Kicking or twitching leg movements during sleep, and sometimes while awake, may be warning signs.

Call Your Doctor If:

• Your sleep does not improve with self-help techniques, such as establishing good sleep hygiene, cutting down on caffeine, exercising, and using relaxation techniques.
• You think your sleep problems may be related to an underlying condition, such as depression or heart failure.
• You snore loudly or make snorting or gasping noises while you sleep -- or your partner observes these things while you're asleep.
• You fall asleep doing normal activities, such as talking or driving.
• You regularly feel unrefreshed on awakening and are constantly fatigued. Sleep disorders are among the many possible causes for fatigue.
• You suspect your medication is causing your sleep problems.

What Are the Symptoms of Sleep Disorders?