Sleep-Wake Disorder: The Sleeping Trouble

Sleep-wake disorders are sleep disorders no more severe than to necessitate the intervention of a physician, and they encompass insomnia, sleep apnea and restless legs syndrome.

Sleep-wake disorders are an illness complex that disrupt the optimal possible equilibrium of wakefulness and sleep. Sleeping, sleep onset, wake-up, and wakefulness sleeping-wake disorders influence health, work, safety, and well-being to some extent. Sleeping-wake disorders, their pathogenesis, classification, symptoms, and treatment should be well known in the busy rhythm of the times.

Sleep-wake disorders are clinical syndromes characterized by periodic sleep timing, quality, or quantity problems that result in daytime distress and impairment in functioning. An occasional bad night of sleep is unavoidable, but periodic sleep-wake problems are serious and require care.

Primary Categories of Sleep-Wake Disorders

Know the categories and recognize each condition and treat it accordingly.

1. Insomnia

The most prevalent sleep disorder is insomnia, trouble falling asleep, sleeping, or waking up too early and staying awake the whole night. Insomniacs are drowsy, grumpy, and cannot work or study well. Insomnia is acute (intermittent) or chronic (recurring).

2. Sleep Apnea

Nocturnal interrupted breathing patterns with repeated attacks triggered by insomnia can result in sleep apnea and go on to snoring, choking, or gasping. Most prevalent forms of sleep apnea are:

• Obstructive Sleep Apnea (OSA): Obstruction of airway by body.
• Central Sleep Apnea (CSA): Spinal cord failure to pass command to breathe spontaneously to muscles.

Sleep apnea renders the individual irretrievably exhausted during the day, with associated extreme daytime sleepiness and vulnerability to cardiovascular disease and accident.

3. Narcolepsy

Narcolepsy is characterized by daytime sleepiness, sudden “sleep attacks,” and, in some patients, cataplexy—a loss of muscle strength with emotion. Narcolepsy disrupts normal sleep-wake control, and untreated, causes incalculable harm.

4. Restless Legs Syndrome (RLS)

RLS is a condition in which there is an intense urge to move the legs, often while at rest or at night. They are typically accompanied by aching itching or creeping and are actually disruptive to sleep.

5. Circadian Rhythm Disorders

Our body clock or circadian rhythm tells us to sleep or wake. Our body clock disorder comes into play when the clock is unsynchronized with the world and it takes on such a pattern as follows:

• Delayed Sleep Phase Disorder (night owls)
• Early Sleep Phase Disorder (early birds)
• Shift Work Disorder (since they work later at night)
• Non-24-Hour Sleep-Wake Disorder (most frequently in the blind)

These states lack the ability to control sleep-wake timing in a coordinated manner and are susceptible to becoming victims of hypersomnia or insomnia.

6. Parasomnias

Parasomnias are also referred to as inappropriate sleep behavior such as night walking, night talking, night terror, bed wetting, and teeth bruxism. The patient is unconscious but remembers or does not remember the attack on wake-up. Parasomnias are seen in children but sometimes in adults too.

7. Hypersomnia

Hypersomnia is more than sufficient sleep duration. The patients with hypersomnia are not able to remain awake throughout the day, experience sleep inertia (taking a while to get up from bed), and get incapacitated.

Causes of Sleep-Wake Disorder

The causes of sleep-wake disorder are as follows:

• Mental status: Anxiety, concern, depression are the frequent causes of insomnia and sleep disruption.
• Physical status: Asthma, neurological illness (e.g., Parkinson’s illness), or pain, coronary illness will interfere with sleep.
• Habitat: Poor night sleep, night habits, night shift work.
• Night screen, i.e., TV screens and computer screens.
• Drugs: Some drugs—e.g., some antidepressant and antihypertensive drugs, steroids—will break normal sleep.
• Respiratory illnesses: Upper respiratory illness or allergy will insert snoring and breathing, which will disturb sleep.healthline
• Environmental cause: Low mattress or inappropriately warm temperature also disturb sleep.

Symptoms of Sleep-Wake Disorders

The symptoms will vary depending upon the disorder but some of the common symptoms are:

• Not staying asleep or insomnia
• Daytime sleep and daytime somnolence
• Daytime excessive somnolence
• Night gasping, snoring, or apnea
• Sleep movement, behavior, or sensation disorder
• Disturbance of normal sleep/wake cycle
• School/work impairment, concentration difficulty, or memory loss
• Mood change, i.e., irritability, depression, or anxiety

Complications of Health

Untreated, sleep-wake disorders have a number of physical as well as psychiatric complications, as defined below:

• Immunocompromised and disease-prone
• Greater risk of obesity and metabolic syndrome
• Greater risk of heart disease and hypertension
• Impaired judgment, memory, and learning
• Increased risk of accident, i.e., driving or operation of heavy machinery

Diagnosis

Even fairly uncomplicated diagnostic testing is undertaken only after adequate history taking and sleep. Sleep diaries are also used by clinicians to monitor for weeks.

• Polysomnography: Sleep, brain wave pattern, effort to breathe, heart rate, and movement recorded overnight or all night.

• Actigraphy: Patient monitors for activity and sleep.

• Blood tests: To rule out other disorders causing thyroid disease or iron deficiency.

Treatment Approaches

Treatment is severity-and-type-of-disorder-specific:

• Behavioral & Lifestyle Interventions
• Stick to a regular sleep schedule, bedtime, and wake-up time.
• Establish “sleep hygiene”: blind-folding curtains, quiet bedroom, cold bed and nothing more stimulating than a book or magazine in reach.
•  light meal, no alcohol and caffeine late at night.
• Daily routine activity but not night.

Cognitive-Behavioral Therapy

CBT-I is great. It works by replacing sleep, cognition, and behavior with negative thought.

Horrible insomnia has short-term control of sleeping medications. Wake-promoting medication or hypersomnia or narcolepsy stimulants.

Treatment of Basic Medical Illnesses

Treatment of psychiatric, chronic, or other illness will have immensely significant impacts on sleep.

• Prevention of Sleep-Wake Disorders
• Maintain a schedule even on weekends.
• The bedroom must be a sleep and sex-alone room.
• Institute wind-down activities such as reading or warm baths.
• Offer treatment of concomitant depression, anxiety, or chronic illness.
• Manage environmental disruption—earplugs, black drapes, and white noise machines are sufficient.
• Deal with stress by therapy such as meditation, yoga, or therapy.

When to Seek Help

Sleeping the whole night through at an intermittent rate is not necessary. Consult a professional if:

• Sleep disturbance continues for months or weeks
• Daytime sleepiness or lethargy hampers functioning
• Abnormal sleep or behavior
• Affective disturbance (e.g., mood change or irritability) with sleep disorder

You will be provided with good care by a sleep specialist, who will have the proper diagnosis and will be in a position to put the proper treatment in your stead.

Living Well with a Sleep-Wake Disorder

Sleep-wake disorders are common, but sensitisation, motivation, and proper approach can make patients live with quality sleep and conquer disease and incapacitation. Timely curing of sleeping disorders can change nights and days for the better, and bring in a healthy and productive life.