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Utah Sleep and Pulmonary Specialists | 9103 South 1300 West | Suite 103 | West Jordan, UT 84088
Phone: 801-432-8690       Fax: 801-432-8681

Sleep Disorders
 

Common Sleep Disorders
 
Adult
 

Obstructive Sleep Apnea Syndrome occurs when the soft tissues in the back of the throat close off the airway and your body fights for breath. These “apneic” events (“apnea” means “not breathing”) usually cause an arousal (a “mini-awakening”). The patient then starts breathing normally and returns to sleep with no memory of the event. Sleep apnea can cause dozens or even hundreds of arousals every hour, making sleep non-refreshing. Overweight individuals are at a higher risk, but thin individuals can have sleep apnea as well.

Restless Leg Syndrome is often described as a tingling or crawling feeling in the legs. The patient has the urge to move their legs to relieve the unpleasant sensation, which makes relaxing and falling asleep exceedingly difficult. Restless legs syndrome is most common in the late evenings but can occur any time when at rest.

Periodic Limb Movement Disorder often goes hand-in hand with restless leg syndrome. Occurring after the onset of sleep, the legs or arms will twitch or move, sometimes causing arousals or decreased quality of sleep.

Narcolepsy patients can have uncontrolled sleepiness several times during the day, sometimes hallucinating immediately before or after an attack. Cataplexy happens in some patients; this is a form of temporary paralysis (a mild weakness up to an inability to stand or talk for a few seconds or minutes) that can be brought on by strong emotions or laughter.

Insomnia is difficulty falling asleep or staying asleep. Sleeping pills are often helpful with acute or intermittent insomnia, but chronic insomnia (over three months) deserves a thorough investigation by a sleep specialist.

Pediatric


The most common sleep problems in children include:

Sleeplessness – These are difficulties falling asleep, maintaining sleep (staying asleep) and napping.

Sleep Schedule Abnormalities – This concerns difficulties associated with the timing of sleep throughout the day and night; sleep schedule issues can include an inconsistent bedtime and wake time; a delay in sleep time, associated with a delay in waking (most commonly seen in teenagers); or long awakenings during the night, associated with typical wake time behavior; it can be a result of insufficient limit setting or sleep onset association disorder – behavioral insomnias of childhood.

Excessive Sleepiness - This includes trouble waking, excessive sleep (number of hours/24 hours – depends  on age), daytime sleepiness and narcolepsy.

Parasomnias - These are periods of incomplete waking, with crying, screaming, thrashing, walking, eating, cooking; it includes confusional arousals, sleep walking, night terrors, nocturnal eating and bedwetting; if occurring in Rapid Eye Movement sleep, are nightmares

Sleep-Associated Breathing Difficulties - This includes snoring and sleep apnea: noisy breathing – snoring, gasping, choking, coughing, heavy breathing; it also includes central or periodic breathing: pauses in breathing or an irregular breathing pattern.

Sleep Related Movement Disorders - These include restlessness, agitation or pain affecting the legs, ankles or feet, that makes falling asleep difficult (Restless Legs Syndrome); wakings or arousals associated with twitching, jerking or kicking of the legs (Periodic Limb Movement Disorder); rocking or head-banging occurring at sleep onset, or during the night after an awakening – may be accompanied by humming or moaning (Rhythmic Movement Disorder).

Specific Diagnoses


OSA (Obstructive Sleep Apnea) - Obstructive sleep apnea in children is a disorder in which a child’s breathing is blocked (obstructed) during sleep.  This obstruction is usually only partial, as compared to adult OSA. During these episodes, the child tries to breathe, often resulting in snoring, pauses in breathing, working hard to breathe, and gasping.  Periods of obstruction may lead to 1). temporary decreases in oxygen levels in the blood, as well as 2). disrupted or fragmented sleep, due to arousals (disruption of sleep, without awakening) or frank awakenings.

Most common signs and symptoms:

  • Loud snoring or noisy, heavy breathing during sleep
  • Periods of inadequate and difficult breathing, often ending with a gasp, snort, snore or sigh
  • Mouth breathing (especially with enlarged adenoids)
  • Restlessness during sleep – frequent body position changes, unusual sleeping positions
  • Excessive Daytime Sleepiness
  • Irritability/Moodiness during the day
  • Hyperactivity, difficulty focusing

The most common cause for OSA in children is:

  • Adenoid and tonsillar enlargement
  • Obesity
  • Down Syndrome (and a large number of other genetic disorders)
  • Other disorders affecting the structure of the face and jaw, such as Pierre-Robin, Apert, Crouzon and other syndromes)
  • Disorders affecting muscle tone and function (such as, cerebral palsy, Duchenne’s Muscular dystrophy, other myopathies and neuromuscular dystrophies)

Treatment includes:

  • Adenotonsillectomy (removal of adenoids and tonsils)
  • CPAP (wearing a special mask over the nose/nose and mouth at night, which pushes air through the airway to keep it from collapsing during sleep
  • Weight loss
  • Other airway or facial surgery

Common Terms in Pediatric Sleep Medicine:

Bruxism - Grinding or clenching the teeth. This can lead to damaged teeth, headaches or jaw disorders

Insufficient Sleep Syndrome - Chronic sleep deprivation, without an underlying disease process; the patient, often a teenager, tries to decrease their sleep debt during the week by sleeping later during the weekends

Narcolepsy - A neurological disorder causing excessive daytime sleepiness as its main symptom. Can be associated with cataplexy, which is a sudden muscle weakness, usually brought on by laughter or strong emotion

Nightmares - Dreams (occurring in REM sleep) that upset the child enough to result in an awakening. Nightmares are well remembered in the morning. Increased in post traumatic stress disorder (PTSD)

NREM Sleep - Stages 1-4 of sleep. The period of sleep during which most rest or restoration of both the brain and body occurs. It is greatest during the first third of the night. The child has no, or very little recollection of the night’s events the following morning. Growth hormone is produced during NREM sleep. Heart rate, breathing and blood pressure are very regular. NREM parasominias occur during this period of sleep.

Nocturnal Enuresis - Bedwetting

OSA - Narrowing of the back of the throat, leading to snoring and periods of inadequate breathing, and often, poor and disrupted sleep

Parasomnias - Partial waking from deep, NREM sleep. Sleepwalking, sleep terrors, confusional arousals. Sleep terrors are associated with the child appearing terrorized, with increased heart rate and sweating, but not fully awake or coherent. Can be the result of insufficient or fragmented sleep. Although parasomnias affect otherwise healthy children, and tend to decrease as adolescence approaches, children with parasomnias are also frequently found to display higher rate of sleep onset delay, night awakenings, bedtime resistance, and reduced sleep duration, compared to a children without parasomnias.

Periodic Limb Movement Disorder (PLMD) - Involuntary leg twitching or jerking movements during sleep.  Movements occur about every 10-40 seconds and occur repeatedly; PLMs can result in poor sleep, with arousals and awakenings

REM Sleep - The period of sleep during which dreams occur. During REM sleep there are bursts of rapid eye movements, small body twitches and heart and breathing patterns become very irregular; vulnerable stage for sleep disordered breathing

Restless Leg Syndrome (RLS) - Unpleasant sensation in the legs (creepy crawly, heebie-geebies, pain, cramping, stretching); accompanied by a need to move the legs, or press them against something. Symptoms start or are worse when lying down; may interfere with falling asleep.

Sleep and Behavioral or Psychiatric Conditions

Attention deficit hyperactivity disorder (ADHD), pervasive developmental disorder (PDD), ASD (autistic spectrum disorder), mental retardation (MR) depressive disorders, anxiety disorders, bipolar  and manic disorders frequently are associated with sleep disturbances.

ADHD in particular is associated with a higher incidence of RLS and PLMD

Sleep and Other Medical Conditions 

Gastroesophageal reflux (GERD), atopic dermatitis, asthma, juvenile rheumatoid arthritis, seizures, chronic fatique syndrome

Headaches and blindness are associated with sleep disturbances

In addition

Down syndrome, Prader-Willi syndrome, Rett syndrome, Tourett syndrome, neuromuscular disorders are associated with sleep disorders, usually because of sleep disordered breathing 

Adult and pediatric sleep disorders