Sleep Disorders

It is estimated that at least 1 in 10 adults, who live in developed countries, have an undiagnosed sleep disorder that could result in serious longer term health impacts. There are a wide range of sleep disorders, ranging from more common and well known conditions such as Insomnia or Obstructive Sleep Apnoea, to more rare disorders such as Narcolepsy.

To learn more about various sleep disorders, select from the options below.

OSA is the most common sleep disorder and is characterised by abnormal pauses in breathing during sleep or abnormally low breathing during sleep. The breathing pauses are called apnoea and the periods of low breathing are called hypopnea. These breathing pauses may last 10 seconds to up to one or two minutes and may occur several times each hour. With each breathing pause, oxygen levels are typically reduced and at the end of the pause, a person momentarily wakes from sleep to begin breathing normally again. OSA is often accompanied by snoring.

Due to low oxygen levels and frequent awakenings caused by OSA, a person will often have symptoms of excessive daytime sleepiness, morning headaches, restless sleep, decreased concentration and memory, lethargy, dry mouth upon awakening or low mood/depression. An individual with sleep apnoea is often unaware they are having breathing pauses during sleep and thus, the bed partner is often the one to recognise the problem. Untreated OSA that is moderate to severe in nature is associated with an increased risk of stroke or heart attack. It may also cause or contribute to other conditions such diabetes, hypertension, metabolic syndrome, mood disorders, sexual dysfunction, etc.

OSA is diagnosed by an inpatient sleep study or home sleep study. The most effective treatment for OSA is Continuous Positive Airway Pressure (CPAP). CPAP treatment consists of a small machine that administers positive air pressure through a tube that connects to a small mask that the patient wears over the nose, at the base of the nose, or over the nose and mouth.

The CPAP machine administers a gentle amount of air pressure whilst the patient breathes normally. This air pressure keeps the airway open and prevents collapse of upper airway tissue that causes snoring and obstructive sleep apnoea. Alternative treatment options for OSA include Mandibular Advancement Splints (dental appliances), Provent nasal micro valves, upper airway surgery, positional therapy and weight loss.

Complex sleep apnoea is characterised by a combination of Obstructive Sleep Apnoea (OSA) and Central Sleep Apnoea (CSA). OSA involves collapse of the upper airway during sleep, resulting in abnormal pauses in breathing. CSA involves inbalanced respiratory control centres in the brain that cause periods where there is no effort to breathe. If left untreated, complex sleep apnoea may disrupt sleep and may significantly increase the risk of cardiac related disease and death. Complex sleep apnoea may be diagnosed by an inpatient sleep study or home sleep study, although an inpatient sleep study is the preferred diagnostic exam for this sleep disorder.

Obesity hypoventiliation syndrome is a form of sleep disordered breathing. It is characterised by shallow breathing due to inability to fully expand the lungs. This condition is most often caused by obesity but may be a result of other restrictive lung disease. Obesity hypoventilation syndrome results in hypoxia (decreased blood oxygen) and subsequent increase in blood carbon dioxide (CO2) levels. Often times, obesity hypoventilation is accompanied by a degree of Obstructive Sleep Apnoea (OSA). If left untreated, obesity hypoventilation may disrupt sleep and cause increased risk of cardiac related disease and death. Obesity hypoventilation may be diagnosed by an inpatient sleep study or home sleep study, although an inpatient sleep study is the preferred diagnostic exam for this sleep disorder. BiPAP (Bi-level Positive Airway Pressure) is often used in treatment. The bi-level air pressure opens the airway, increases lung expansion and prevents hypoventilation. In some cases of obesity hypoventilation, Continuous Positive Airway Pressure (CPAP) is also an effective treatment.

RLS is a neurological disorder characterised by aching, creeping, or other unpleasant sensations in the legs associated with an uncontrollable urge to move the legs to relieve discomfort. With RLS, symptoms occur primarily at night when a person is at rest. Most people with RLS have difficulty falling to sleep and staying asleep, which may result in daytime fatigue.

Up to 10% of the population may have this RLS. This condition is identified by patient reporting and to some degree, it may be identified by an inpatient sleep study or comprehensive home sleep study. Treatment for RLS includes Magnesium supplementation and prescription medication. Many sufferers of RLS also have Periodic Limb Movement Syndrome (PLMS) where the legs excessively jerk or kick during sleep and cause brief awakenings.

PLMS is a neurological (movement) disorder characterised by leg twitching or jerking movement that occur during sleep approximately every 15-40 seconds. The leg jerks cause temporary awakenings that disrupt sleep and may cause daytime fatigue. PLMS is identified and diagnosed by an inpatient sleep study or comprehensive home sleep study. Treatment for PLMS includes Magnesium supplementation and prescription medication.

Chronic insomnia is characterised by difficulty getting to sleep and/or difficulty staying asleep for at least one month. Symptoms include difficulty initiating sleep (prolonged sleep latency), frequent and/or prolonged awakenings during the night, unrefreshing sleep and tiredness or fatigue during the day. Insomnia may be diagnosed by GP or specialist evaluation, often through use of questionnaires and patient history. Activity monitoring (actigraphy) may be used to classify the type of insomnia. In addition, consultation with a Sleep Specialist will help to rule out another sleep disorder (such as sleep apnoea or restless legs) as the cause of the insomnia. Insomnia is treated with Cognitive Behavioural Therapy for insomnia (CBTi). This is acknowledged as the gold standard treatment of insomnia and can be successful at eliminating the use of sleep medication.

Circadian rhythm disorders are a family of sleep disorders affecting the timing of sleep. They are characterised by sleep patterns that are in opposition to normal work, school and social functioning. Treatment may include light therapy and compounded melatonin to shift the body’s natural clock (circadian rhythm). Some components of Cognitive Behavioural Therapy for insomnia (CBTi) may also be helpful in treatment of a circadian rhythm disorder.

Narcolepsy is a neurological sleep disorder. Symptoms include excessive daytime sleepiness that may lead to uncontrollable urges to sleep at inappropriate times of the day. Narcoleptics often have disturbed night time sleep and may complain of insomnia. Some narcoleptics also have cataplexy, or episodes of sudden muscular weakness brought on by strong emotion. Other symptoms include dream-like hallucinations when drifting to sleep and sleep paralysis. Narcolepsy is diagnosed by an overnight inpatient sleep study followed by a daytime inpatient sleep study. The inpatient daytime sleep study consists of a series of naps throughout the day. Treatment for narcolepsy may include medication and lifestyle modification.