Sleep Medicine

What is Sleep Medicine

Sleep medicine represents a burgeoning field of study across medicine, neuroscience, pulmonology, and psychology, aimed at unraveling the intricate nature of sleep and its profound effects on human well-being. This interdisciplinary pursuit demands expert collaboration, forging a comprehensive foundation for understanding and addressing sleep-related health issues.

Common Sleep Disorders

• Insomnia: It refers to a consistent difficulty in falling or staying asleep, leading to daytime sleepiness and impaired functioning. Chronic insomnia, experienced by up to two-thirds of adults intermittently, often correlates with older age, lower socioeconomic status, and anxiety or depression. 
• Narcolepsy: It is a disorder causing extreme daytime sleepiness despite sufficient rest, leading to sudden “sleep attacks” lasting minutes. Disruptions in the brain’s sleep-wake regulation cause these symptoms, posing risks of accidents. 
• Sleep apnea: It is a prevalent condition wherein breathing repeatedly halts and restarts during sleep, depriving the body of sufficient oxygen. It generally results from upper airway blockages, often due to obesity or enlarged tonsils. Central sleep apnea stems from brain signal disruptions.
• Restless Legs Syndrome (RLS): It is marked by an urge to move the legs due to uncomfortable sensations such as creeping, tingling, or burning. This sensation is more pronounced at night and disrupts sleep initiation.
• Nightmare Disorder: Nightmare disorders involve distressing, vivid dreams in the latter half of sleep, often involving evading threats. These lengthy, realistic nightmares provoke anxiety and distress, leading to quick alertness upon waking. They can begin in childhood but peak in severity during late teens or early adulthood.

Symptoms

Common symptoms of various sleep disorders include:

• Excessive daytime sleepiness
• Difficulty falling asleep at night
• Inappropriate episodes of falling asleep, like while driving
• Irregular breathing patterns
• Urges to move while trying to sleep
• Unusual movements or experiences during sleep
• Irregular sleep-wake cycles

Causes 

• Depression: It affects sleep regulation, causing insomnia or hypersomnia.
• PTSD: Trauma-related stress disrupts sleep patterns, leading to sleep disorders.
• Anxiety disorder: Persistent worry and fear interrupts sleep, causing severe sleep disturbances.
• Bipolar Disorder: Mood swings disrupt sleep-wake cycles, causing sleep irregularities.
• Opioid Abuse: Substance misuse leads to sleep disruptions and disorders.
• Alcoholism: Excessive alcohol consumption can affect sleep quality and patterns.
• Chronic Obstructive Pulmonary Disease (COPD): This respiratory condition can cause sleep apnea and disrupted breathing.
• Hyperthyroidism: An overactive thyroid obstructs the airway, causing sleep apnea symptoms.

Diagnosis

• Arterial Blood Gases: Checks oxygen levels, which is essential for assessing conditions like sleep apnea or respiratory disorders
• Thyroid Function Tests: Evaluate thyroid hormones, crucial in diagnosing hyperthyroidism, which can disrupt sleep patterns
• Drug and Alcohol Toxicity Screening: Identifies substance misuse affecting sleep quality and patterns
• Iron Studies and Ferritin Levels: Assess iron levels, which are crucial for detecting conditions like restless legs syndrome
• Cerebrospinal Fluid Hypocretin-1 Deficiency: Measures hypocretin-1 for diagnosing narcolepsy
• Actigraphy: Monitors movement to assess sleep-wake cycles, aiding in diagnosing circadian rhythm disorders like advanced or delayed sleep phase syndrome
• Multiple Sleep Latency Testing: Measures sleepiness through multiple naps, aiding in diagnosing disorders causing excessive daytime sleepiness.

Treatment

For individuals experiencing sleep disorders, treatment avenues vary based on the specific disorder. Sleep medicine specialists specializing in neurology, pulmonology, psychiatry, or otolaryngology provide tailored therapies and expertise in managing diverse sleep-related conditions.

• Medications: Sleep medicine professionals assess the need for drugs, prescribing sleeping pills (hypnotics) for short-term relief from insomnia, restless legs syndrome, narcolepsy, or REM sleep behavior disorder.
• Cognitive Behavioral Therapy for Insomnia (CBT-I): This therapy targets behaviors and thoughts contributing to insomnia, equipping patients with strategies to enhance their sleep quality.
• Continuous Positive Airway Pressure (CPAP): Vital for sleep apnea, CPAP machines maintain open airways with a constant airflow through a nighttime mask.
• Oral Appliances: Custom devices, resembling retainers or mouthguards, aid sleep apnea patients who cannot tolerate CPAP machines. These appliances position the tongue or jaw such that airway blockage can be prevented during sleep.
• Improved Sleep Hygiene: Establishing beneficial habits enhances sleep, such as creating a serene sleep environment, regular exercise, exposure to natural light, and avoiding stimulants like caffeine and nicotine near bedtime.
• Surgical Options:
• Hyoid Suspension: Connects the U-shaped hyoid bone to the jaw or Adam’s Apple, preventing airway blockage
• Hypoglossal Nerve Stimulator: Implants an electrode near the jaw nerve controlling tongue muscles, stimulating it during sleep to prevent airway obstruction
• Radiofrequency Volumetric Tissue Reduction: Shrinks throat tissues with radiofrequency energy. This technique is primarily used for problematic snoring
• Septoplasty: Corrects a deviated septum to improve nasal airflow
• Turbinate Reduction: Trims or removes nasal passage bones to improve airflow
• Uvulopalatopharyngoplasty: Removes excess throat tissue to widen the airway, often combined with other procedures for sleep apnea treatment
• Weight Loss Surgery (Bariatric Surgery): Aids weight loss, improves sleep apnea, and improves overall health in obese individuals 

Good Sleep Practices

Listed below are recommendations for maintaining good sleep hygiene:

• Maintain a Consistent Schedule: Establish a consistent bedtime and wake-up time each day to regulate your body’s natural rhythm.
• Use Bed for Sleep and Intimacy Only: Reserve the bed for sleep or intimate activities, avoiding screen time or stimulating activities before sleep.
• Regular Exercise, Timed Wisely: Engage in daily exercise, but avoid vigorous workouts close to bedtime, allowing the body to wind down.
• Limit Caffeine and Smoking: Minimize consumption of caffeine and avoid smoking, especially in the hours leading up to bedtime.
• Create a Serene Bedroom Environment: Ensure the bedroom is dark, quiet, and comfortable, conducive to relaxation and restful sleep.
• Avoid Struggling to Sleep: If you are unable to fall asleep after about 20 minutes, get up and engage in a relaxing activity. Return to bed when feeling sleepy.

Implementing these practices can promote better sleep quality and improve overall well-being.