SLEEP DISORDERS :- Sleep is a biological process and is required to maintain a normal health. However normally it varies widely from person to person. There are different disorders of sleen
(A) Dyssomnias (Insomnia)
Insomnia is a condition of not getting sleep in proper time and ways. This also includes early morning awaking and intermittent wakefulness.
CAUSES OF SLEEP DISORDERS
1. Psychic disturbances e.g. Depresion, anxiety, manic disorders.
2. Shift of REM sleep.
3. Alcohol abuse or withdrawal.
4. Withdrawal or continued use of sedative/hypnotics.
5. Excessive pain anywhere in the body.
6. Respiratory distress.
7. Chronic renal failure.
1. Psychologic procedures :
To go to bed at regular hours and when sleepy, reading books before sleep, to have sex, to have evening exercise, and to avoid night coffee/cocco or heavy cigerettes.
Lorazepam 0.5 mgm
Temazepam 7.5-15 mgm
Zolpidem 5-10 mgm
Diphenhydramine 25 mgm
The above drugs are very effective. Zolpedem may even be used in COPD cases.
(B) Hypersomnias (Excessive sleepiness)
1. Narcolepsy— This is a chronic recurrent form of hypersomnia. This is usually seen in teenagers where there is irresistible or uncontrollable sleep. It may be associated with:
a) Sleep attacks : Dextoamphetamine 10mgm in morning is useful. Imetramine is useful in cataplexy which may be sudden in onset lasting for 15 minutes in any period of activity associated with REM (Rapid eye movement).
b) Cataplexy or sudden development of muscular hypotonicity developing after emotion or surprise.
c) Sleep paralysis when the individual though conscious and realising all about him cannot move his limbs or speak, and
d) Hypnagogic hallucination which is a dreamlike experience midway between wakefulness and sleep.
Narcolepsy is inherited as an autosomal dominant trait. MAO inhibitors or Amphetamine may give relief.
2. Kleine-Levin Syndrome
Here sleepy attacks occur 3-4 times a year lasting for about 48 hours. It is seen in young men. There may be polyphagia, hypersexuality, iretation and confusion. It usually disappears after the age of 40 years. Clonazepam is sometimes useful.
3. Sleep Apnoea :
Here apnoeic attacks occur during night for about 25-30 times lasting for about 10 seconds or more. These are of three types-obstructive, central and mixed types. In obstructive type the ventilatory effort persists, in central type the ventilatory effort is nil while in mixed type ventilatory effort is absent and precedes upper airway obstruction.
Central and mixed types are seen in obese middle-aged and older individuals with hypertension. Symptoms are snoring, restlessness during sleep, day time sleepiness, headache, loss of memory, depression, cardiac arrhythmia, loss of judgement and blood gas abnormality. During apnoea sleep.becomes lighter or patient takes a deep breath and awakes. Day time sleepiness and excessive snoring during sleep are present. Usually there is history of moderate alcohol consumption at bed time. Moderate weight reduction, air administration under pressure in nasophaynx and acetazolamide or Trycyclic antidepressants may be of help. Medical treatment is not of much help. If there is upper respiratory obstruction surgical correction may be done. Oxygen or hypnotic drugs are risky. Obstructive and Mixed apnoea are common while control type is rare.
4. Noctrunal myoclonus
During sleep there will be periodic lower leg movement associated with day time sleepiness, anxiety, depression and cognitive defect.
(C) Parasomnias (Abnormal behaviour during sleep)
(i) Nightmares-This occurs during REM sleep
(i1) Night or sleep terror (Pavor nocturnus)-This occurs abruptly with arousal from sleep with terror. Fear, tachycardia, sweating, confusion with amnesia for the event are present.
(iii) Sleep walking (somnambulism)-It is common in children between 6-12 years. Adults are also affected when idsiosyncrasy to alcohol or drugs like marijuana and partial complex seizures are present. In older people dementia is responsible.
(iv) Sleep talking-During sleep patient talks though he forgets this after awaking. Clear or slurred talks are heard.
(v) Nocturnal enuresis This is common in children. There is bed wetting during sleep. Confusion and amnesia for the event are seen. Imipramine 25-50 mgm or ADH preparations are useful.
(vi) Restless leg syndrome-There is peculiar feeling in the legs during lying down for sleep so that relief is obtained after getting up and walking for some time. This causes insomnia. Carbamazepine 100-200 mg daily is very much effective. Clonazepam, Vitamin E, etc. have also been tried with some beneficial effect.