Insomnia

Insomnia is defined as a condition manifested by difficulty falling asleep and/or staying asleep. It needs to last for more than three (3) weeks at a time and is associated with negative daytime consequences of the disturbed nocturnal sleep. These daytime symptoms include fatigue, lethargy, impaired thought processes, mood disturbance and non-specific physical complaints including headache, gastrointestinal disturbance or multiple aches and pains. For the most part, insomnia is a symptom of an underlying medical and/or psychological problem; it is not a diagnosis by itself. Treatment is always more effective when the underlying problem is addressed rather than just treating the sleep complaints. An extremely useful regimen is for the person to maintain good sleep habits (see Guidelines for Better Sleep). Treatment can include behavioral therapy aimed at promoting mental relaxation as well as muscle tension release at bedtime. Therapy can be aimed at controlling the patient’s physical as well as their emotional environment that they are contending with at the time of sleep onset, or in special cases the patient can be treated by restricting the number of hours that they spend in bed (time spent waiting to fall asleep as well as time spent asleep) and as the person’s sleep improves the time in bed is increased. In some cases judicious use of sleeping medications are employed. This occurs when a temporary aid is needed to allow the person to get their sleep back on track. In most cases sleep will re-establish itself and in the long run regular use of sleeping pills will do more harm than good.

REM Sleep-Related Disturbances

Dream related abnormal sleep states include Recurring Nightmares, Sleep Paralysis, and REM Sleep Behavior Disorder (RBD). Nightmares and isolated sleep paralysis are common occurrences and do not constitute an abnormality unless they occur several times a week and disturb the patient’s sleep however RBD is a serious disorder that involves patients acting out their dreams and can include punching, kicking, leaping and running from their bed. The disorder is more common in middle aged and elderly males and there is a high statistical association with a large number of neurologic conditions such as Parkinson’s, Disease, Alzheimer’s Dementia, strike, and Multiple Sclerosis. RBD is due to the body’s inability to turn off the voluntary muscles during dream sleep which then manifests itself as the person “acting out” their dream mentation.

Narcolepsy

Narcolepsy is one of the most under diagnosed illnesses that medicine of the twenty first century deals with. It is estimated that only one quarter of those actually suffering from this disorder have been properly diagnosed and treated. This leaves approximately 120,000 sleepy people who have been misdiagnosed and improperly treated or undiagnosed completely. For these people, the impact on their lives is considerable and at times completely disabling or fatal (auto accidents account for the majority of the fatalities). With the advent of modern sleep monitoring techniques and recent developments in genetics this number should drop significantly. Although no cure for narcolepsy has been found, recent advances in medications allow most people to lead normal or nearly normal lives.

Narcolepsy can be defined as uncontrollable attacks of REM (Rapid Eye Movement) Sleep also called dream or paradoxical sleep during what is considered daytime or “normal” waking hours. Between these episodes the person feels sleepy on a continual basis unrelated to the amount or type of nighttime sleep.

Excessive daytime sleepiness is just one of the symptoms of narcolepsy. There are three other symptoms that are closely associated with narcolepsy and are known as the ancillary symptoms. These include cataplexy, which is the sudden loss of muscle strength usually brought on by a strong emotional stimulus e.g. laughter, anger, and fright. Sleep Paralysis is the sensation that all of your muscles are paralyzed and occurs in the transition into or out of sleep. Many “normal” people experience a feeling of free falling generally after a full night’s sleep and occurs when waking up out of the last REM period (dream state) of the night. Sleep paralysis becomes pathologic when it occurs at sleep onset rather than sleep offset.

The third associated symptom is called Hypnagogic and Hypnopompic Hallucinations. Hypnagogic hallucinations are vivid still image mental pictures that occur when one first falls asleep and hypnopompic hallucinations are similar vivid frozen motion mental imagery at the point of awakening.

Narcoleptic patients can have one, two or all three of the associated symptoms and sometimes there will be no other symptom, other than the daytime sleepiness. Most patients with narcolepsy start off with the daytime sleep attacks and then go on to develop the ancillary symptoms later on. The ancillary symptoms however such as cataplexy can be as troubling to the patient as the primary symptom of sleep attacks. Treatment of the sleep attacks and cataplexy for the most part require different medications. Other symptoms of narcolepsy include:

•Automatic behavior – performance of routine tasks while in a twilight sleep state for which the person has no memory “upon awakening”.

•Disturbed nighttime sleep.

•Poor concentration abilities.

•Poor short-term memory.

•Short temper and mood swings.

•Social isolation.

•Depression.

Narcolepsy typically starts during a person’s teenage years and for this reason many patients are labeled; slow, unmotivated, daydreamers, drug users, or ADD (Attention Deficit Disorder) sufferers.

The exact cause is not known but narcolepsy appears to be a disorder of that part of the central nervous system that controls sleep and wakefulness. An almost identical syndrome occurs in dogs and a very recent discovery has identified a mutant gene that codes for a specific neurotransmitter receptor. This is very exciting because it may allow medical science to modify the gene so that the correct receptor is made and “cure” the condition. The ancillary symptoms: cataplexy, sleep paralysis and hypnagogic hallucinations can be thought of as REM (rapid eye movement) intrusion into wakefulness. During REM sleep all muscles of the body become paralyzed and dreaming occurs. In narcoleptics however this behavior is not confined to sleep during the night but occurs periodically throughout the day causing all the signs and symptoms described above. Narcolepsy is not caused by psychiatric or psychological or emotional problems.

 

Parasomnias

Parasomnias are unpleasant feelings or behaviors that take place during the night when non-dream or non-REM sleep is taking place. This usually happens within the first two hours of sleep onset and includes Confusional arousals where there is an abrupt partial awakening from sleep manifested by disorientation, slow speech confusion and amnesia for the event upon full awakening. Sleepwalking and sleeptalking are other examples of parasomnias. More disturbing is the parasomnia known as sleep terrors which are more frightening than dreams or nightmares and include crying out, feelings of extreme anxiety and impending doom. These disorders are common during childhood and generally disappear during the teenage years. They rarely require treatment but sometimes medication is used if the parasomnia causes the person to place themselves in harm’s way.

Circadian Rhythm Disturbances

Some people have their internal biologic clocks out of alignment with the usual 24 hour cycle of light and dark. These people cannot fall asleep until very late in the night or into the early morning hours and then have difficulty waking up for school or work in the morning and would tend to stay asleep until late morning or early afternoon. Others go to sleep early in the evening and then wake up in the early morning well before daybreak unable to fall back asleep. These sleep problems fall under the category of circadian rhythm disturbances. They are treated using such measures as exposure to bright light at certain times of the day or night depending on the specific complaint and in some cases are used in conjunction with medications that help control the body’s internal clock. People who work Night Shifts and/or Rotating Shifts as well as people who travel across two (2) or more time zones (Time Zone Change) are especially prone to circadian rhythm disturbances.

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Orion Medical is an organization of physicians, physician extenders, ultrasound technologists and support staff that provide compassionate, prompt and state of the art medical care to patients. We specialize in comprehensive cardiovascular care, sleep medicine and related disorders, as well as venous diseases of the legs. Our primary office is located in Pasadena TX, conveniently accessible by residents of Baytown, Channelview, Deer Park, Friendswood, Galena Park, Highlands, Houston, Kemah, La Porte, League City, Pasadena, Pearland, Seabrook, South Houston, and Webster.

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5413 Crenshaw Road
Pasadena, TX 77505

1505 East Winding Way Drive, Suite 200
Friendswood TX 77546

10970 Shadow Creek Pkwy Ste 220
Pearland, TX 77584


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