Sleep Disorders

• Disturbed sleep is one of the most common health problems.
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  Average requirement of sleep is 7-8 hours per night.

   

  • States and stages of sleep are defined by character­istic patterns in EEG (electro-encephalogram), EOG (Electrooculogram), EMG (Electromyogram) measured on the chin and neck.

• Polysomnography

  • The continuous recording of electrophysiologic param­eters of sleep and wakefulness is termed poly­somnography.

There are two states of sleep:

• Rapid Eye Movement Sleep (REM)
• A Non Rapi Eye Movement Sleep (NREM) There are 4 stages of NREM sleep.
• After onset of sleep there is NREM sleep stages 1 to 4 in one hour. NREM stages 3 and 4 continue for 1/3rd of the night.
• First REM sleep occurs in the 2nd hour of sleep.
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  Sleep-wake cycle is affected by

   

  • endocrine, ther­moregulatory, cardiac, pulmonary, renal, gastrointes­tinal and neural functions.
  • This follows a circadian rhythm.

• Narcolepsy

  • Sudden weakness of muscles, hallucinations and sleep paralysis

• Sleep apnea

  • There is occlusion of airway, or absence of respira­tory effort.

• Somnambulism

  • Patients leave the bed and walk about and even do certain activities.
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  Aruxism

   

  • There is involuntary grinding of teeth.
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  sleep enuresis

   

  • Bed-wetting.

Sleep disorders are  :

• Obstructive sleep apnea
• Narcolepsy-Cataplexy syndrome .y Periodic limb movements
• Insomnia.
• The narcolepsy tetrad consists of excessive day time sleepiness, loss of muscle tone without loss of con­sciousness (cataplexy), hallucinations, sleep paraly­sis on awakening.

Obstructive sleep apnea syndrome (OSAS) and Cardiovascular disease:

• Snoring is a loud sound produced during sleep due to vibration of colla sible art of airwa between poste­rior c onae and the e i lottis articularl oro..eha­ryngeal isthumus. Extreme cases of snoring associ­a ed with apnea and h 0 neas are described as sleep
• Isor er breathin or OSAS.
• OSAS has a high prevalence in the cardiovascular dis­ease patients.
• OSAS affects as many s 30% of coronary artery dis­ease patients, 50% of congestive heart failure pa­tients, 60% of stroke patients, 80% of drug resistant hypertensive patients. OSAS has been associated with’ an almost 5 fold increase in risk of development of cardiovascular disease independent of age, body mass index, systolic blood pressure, diastolic blood pres-‘ sure and smoking. ‘

Clinical features of Sleep Disorders :

• Patient is usually obese
• Snoring
• Hypertension
• Hallucinations
• Restless legs syndrome
• Renal failure
• Anaemia and Asthma.

Treatment of Sleep Disorders

• Continuous positive airway pressure Uvulopalatopharyngoplasty by ENT surgeon Weight loss
• Clonazepam and Zolpidem.