Sleep disorders can delay sleep, prevent sleeping through the night, and hinder alertness and coordination during the daytime Table 02. Lack of sleep leads to drowsiness and diminished attention and performance. Primary care physicians should be alert to the possibility of sleep disorders in patients who complain of vague symptoms such as fatigue and tiredness.
Table 2. Symptoms of Sleep Disorders
Insomnia Excessive daytime sleepiness or hypersomnia Difficulty falling asleepFrequent awakeningsEarly morning awakeningInsufficient sleepDaytime fatigue or sleepinessIrritability or lack of concentratio.Anxiety, sometimes depressionForgetfulnessPsychomotor symptoms Excessive daytime sleepinessFalling asleep in inappropriate places and circumstancesLack of relief of symptoms after additional sleepDaytime fatigueInability to concentrateImpairment of motor skills and cognition
Sleep disorder symptoms range from an inability to sleep to excessive drowsines. While insomnia—the inability to fall asleep or to maintain sleep through the night—is an obvious sleep disorder, other symptoms are not so clear–cut, and at first glance may not appear to be related to a sleep disorder.
Some individuals may sleep for very long periods (hypersomnia), or may experience excessive drowsiness and fall asleep at inappropriate times during the day. Some individuals never really feel rested, although they do not recall any difficulty sleeping at night.
Snoring and moving can disrupt sleep. Patients with sleep apnea usually snore a great deal and repeatedly wake up throughout the night, although they may have no recollection of these activities.
Periodic limb movement disorder may lead to poor–quality sleep and daytime drowsiness.
Some patients with parasomnias may experience episodes of sleepwalking or sleep terrors. Another parasomnia, rapid eye movement sleep behavior disorder, involves aggressive movements, reflecting dream activity during REM sleep. This violent activity sometimes injures a bed partner. REM sleep behavior disorder is associated with neurological disorders in about half the cases. In elderly patients, REM sleep behavior disorder may be associated with cerebrovascular disease, Parkinson’s disease, or Alzheimer’s disease.
Narcolepsy, a disorder involving excessive sleepiness, is usually associated with abrupt loss of muscle tone (cataplexy) and REM sleep reactions. Symptoms of narcolepsy include sleep paralysis, the inability to move after awakening from sleep, and hallucinations.
Overweight, middle–aged men are at risk for sleep apnea. Obesity often contributes to reduced space in the upper airways by increasing deposition of fat in the soft tissues of the pharynx. Superficial fat masses in the neck may compress the pharynx. The upper airways are narrowed during sleep, a condition that sets the stage for obstructive sleep apnea. Because of the narrowed upper airway, most individuals with obstructive sleep apnea frequently snore.
Although not limited by age or sex, obstructive sleep apnea typically occurs in middle–aged and elderly men who are slightly overweight (with a body mass more than 20% of normal), have a history of snoring, and often have mild to moderate hypertension.
Enlarged tonsils or an enlarged tongue also may place an individual at risk for sleep apnea episodes.
People who abuse drugs and alcohol are at risk for sleep disorders. Although alcohol and sedatives may help some people relax enough to fall asleep easily, using these drugs often leads to poor–quality sleep. Alcohol use also makes obstructive sleep apnea worse because the drug adversely affects upper airway muscles. Individuals who take certain types of sedatives and antidepressants, or who are alcoholics, may be at risk for REM sleep behavior disorder.
The risk for some sleep disorders is genetic.
- Alcohol and AntidepressantsThe dos and don'ts of drinking when you take antidepressants are mostly don'ts.
- Antidepressant Treatment TimelineYou can expect to feel some relief from depression symptoms as early as the first week, but the full response could take months.
- Medications to Avoid While on AntidepressantsCould your antidepressant interact with something else you're taking?