Sleep Disorders Overview

Sleep is crucial to a healthy lifestyle and disease prevention. In today’s hectic world, many people have trouble working in the amount of sleep they need each night. The term “sleep disorders” can refer to a wide variety of disorders that either prevent or disrupt sleep. But sleep disorders do more than just prevent sleep — they can also increase the risk of serious and chronic health conditions, such as obesity, depression, diabetes and heart disease. Thousands of auto accidents each year are attributed to drowsy driving. Its clear lack of sleep can affect not just you, but those around you.

Yet many people who consistently have trouble sleeping do not even realize they have a sleep disorder. Please read the symptoms below, and if you think you may have a sleep issue, you can also take our sleep quiz (link to quiz)

Beyond yawns: Signs you may need a sleep study::
If you need copious amounts of caffeine just to get through the day, and you feel persistently exhausted, you already know there’s something amiss with your sleep. But a lack of good sleep can manifest itself in other ways too. If you’ve ever experienced any of the following problems found below, it could be an underlying sleep disorder.

• Respiratory
  Snoring, snorting, gasping or choking during the night
• Metabolic & Circulatory
  Weight issues or obesity, acid reflux, heartburn, type 2 diabetes, hypertension, heart problems, sudden cardiac arrest, stroke
• Mood Disorders
  Depression, anxiety, stress, lack of concentration, irritability, other mood disturbances
• Exhaustion
  Excessive daytime sleepiness, fatigue, insomnia
• Other physical signs
  Restless limbs, low immune system, morning headaches, reduced libido, poor job or school performance

• Snoring
• Excessive daytime sleepiness
• Sleep Apnea
• Insomnia
• Restless leg syndrome
• Narcolepsy
• Periodic limb movements
• Sleep walking
• Abnormal dream behavior

A full service sleep health center, we provide sleep medicine physician consultations, diagnostic testing and treatment services for more than 80 sleep disorders.

Say hello to sleep again!

Snoring

If your snoring is affecting your sleep, it’s affecting your waking hours. No one thinks, acts or looks their best when they haven’t gotten enough sleep. And if you share your snoring with a bedmate that goes double.

Loud, frequent snoring is often a sign of untreated sleep apnea (link to sleep apnea section), a potentially serious health concern, the most common being obstructive sleep apnea caused by the obstruction of the upper airway, and your breathing is interrupted while sleeping.

Studies show that between 30-50 percent of adults snore. We’re all more than familiar what snoring sounds like — but what causes it?

To put it simply, snoring occurs when your breathing is obstructed while sleeping, causing the walls of the throat to vibrate and produce the sound we call “snoring.” Snoring can be caused by obstructed nasal airways, bulky throat tissue, poor muscle tone in the throat and tongue, and long soft palates or uvulas.

Our board-certified sleep medicine physicians are available for consultation appointments at our sleep health centers, and can check for any blockages, and determine if a sleep study will be the next best step, or they may refer you to an ENT physician for further evaluation.
Sleep Apnea

Sleep apnea is a sleep disorder in which a person’s breathing is interrupted during sleep. Approximately 18 million Americans have sleep apnea, though many are not diagnosed with the sleep disorder. Oftentimes the person who suffers from sleep apnea is not even aware their breathing is stopped or slowed during sleep; rather, they are told about their condition by others who witness it. They may also suffer from symptoms of sleep apnea without knowing that is what they derive from. People with sleep apnea often exhibit “excessive daytime sleepiness,” moodiness, depression and a decrease in altertness. A polysomnogram (or sleep study) allows a sleep doctor or technician to diagnose the condition.

What is sleep apnea?

Sleep apnea can be classified in three different forms:

• Obstructive sleep apnea
• Central sleep apnea
• Complex or mixed sleep apnea

Of the three, obstructive sleep apnea is the most common form of sleep apnea. Obstructive sleep apnea occurs when the windpipe collapse during sleep, blocking airflow. Once the brain recognizes that the blood oxygen level is falling, the person wakes up enough to tighten up the muscles and open the airway. Those with soft tissue and low muscle tone around the windpipe (often due to obesity) are at a high risk for obstructive sleep apnea. Daytime sleepiness, interrupted sleep and snoring are all symptoms of this form of sleep apnea.

Central sleep apnea occurs when there is an imbalance in the brain’s respiratory control centers during sleep, causing an uneven respiratory rate which in turn causes the sleeper to cycle between apnea and hyperpnea. They start and stop breathing with no sign that they are struggling to breathe. When they regain their breath, their breathing may be faster in an effort to absorb more oxygen and rid the body of excess waste gases. This is sometimes referred to as Cheyne-Stokes respiration.

When people exhibit both of these forms of sleep apnea, it is referred to as “complex or mixed sleep apnea.” Central apnea can sometimes develop if a case of obstructive sleep apnea is severe or chronic.

Who is likely to get sleep apnea?

Sleep apnea occurs in about 25 percent of men and nearly 10 percent of women. Sleep apnea can affect people of all ages, including babies and children and particularly people over the age of forty and those who are overweight. Certain physical traits and clinical features are common in patients with obstructive sleep apnea. These include excessive weight, large neck, and structural abnormalities reducing the diameter of the upper airway, such as nasal obstruction, a low-hanging soft palate, enlarged tonsils, or a small jaw with an overbite.

What are the symptoms of sleep apnea?

Often the first signs of OSA are recognized not by the patient, but by the bed partner. Many of those affected have no sleep complaints. The most common symptoms of OSA include:

• Snoring
• Daytime sleepiness or fatigue
• Restlessness during sleep
• Sudden awakenings with a sensation of gasping or choking
• Dry mouth or sore throat upon awakening
• Intellectual impairment, such as trouble concentrating, forgetfulness, or irritability
• Night sweats
• Sexual dysfunction
• Headaches

People with central sleep apnea more often report recurrent awakenings or insomnia, although may also experience a choking or gasping sensation upon awakening.

Are the symptoms of sleep apnea different in children?

Symptoms in children may not be as obvious and include:

• Poor school performance
• Sluggishness or sleepiness, often misinterpreted as laziness in the classroom
• Daytime mouth breathing and swallowing difficulty
• Inward movement of the ribcage when inhaling
• Unusual sleeping positions, such as sleeping on the hands and knees, or with the neck hyper-extended
• Excessive sweating at night
• Learning and behavioral disorders
• Bedwetting

What are the effects of sleep apnea?

If left untreated, sleep apnea can result in a number of health problems including:

• Stroke
• Cardiac arrhythmias
• Cardiac cardiomyopathy (enlargement of the muscle tissue of the heart)
• Congestive heart failure
• Heart attacks
• Diabetes
• Obesity
• Depression/Anxiety
• Sexual dysfunction
• Cognitive defects
• Vascular changes
• Gastric reflux
• Morning headaches

In addition, untreated sleep apnea may be responsible for job impairment, work-related accidents, and motor vehicle crashes as well as academic underachievement in children and adolescents.

How is sleep apnea diagnosed?

If you think you might have sleep apnea, please schedule an appointment with your healthcare provider or call to schedule a consultation with our sleep medicine physicians. A sleep study (link to sleep study info) will most likely be required as a complete diagnosis requires an overnight sleep test called a polysomnogram.

How is sleep apnea treated?

We offer a wide range of treatment options (link to services treatment pages) which means you’ll find the treatment, or combination of treatments, that works best for both you and your bedmate. These options include lifestyle changes, such as losing weight, changing sleep position, or avoiding alcohol or sleeping pills for the more mild sleep apneas, to oral appliances and to the latest CPAP equipment for the treatment of sleep apnea.

Our CPAP specialist will introduce you to CPAP, and make sure you are comfortable with this form of treatment. Oral appliances are an alternative to CPAP for mild to moderate sleep apnea, and our center is the only center in the DC metro area to provide on-site dentists and offer full medical insurance coverage for the treatment of sleep apnea with oral appliance therapy.

Surgical treatment may also be a possibility.
Insomnia

When most people think of insomnia, they think of someone who struggles to sleep and thus stays up through all hours of the night.

What is Insomnia

Insomnia is a sleep disorder in which people have one or more of the following symptoms:

• Difficulty falling asleep
• Waking up often during the night and having trouble going back to sleep
• Waking up too early in the morning
• Having sleep that is not refreshing

Who gets insomnia?

Approximately 50% of adults experience occasional bouts of insomnia, and 1 in 10 complain of chronic insomnia. Insomnia is approximately twice as common in women as in men, and is more common in older than younger people.

What kinds of insomnia are there?

There are two kinds of insomnia:

• Primary insomnia means that a person is having sleep problems that are not directly associated with any other health condition or problem.
• Secondary (co-morbid) insomnia means that a person is having sleep problems because of something else, such as a health condition (for example, asthma, depression, arthritis, cancer, or heartburn); pain, medicine they are taking; or a substance they are using (such as alcohol).

Insomnia also varies in how long it lasts and how often it occurs. Insomnia can be short-term (acute insomnia) or can last a long time (chronic insomnia). It can also come and go, with periods of time when a person has no sleep problems. Acute insomnia can last from one night to a few weeks. Insomnia is called chronic when a person has insomnia at least three nights a week for a month or longer.

There are still other ways to classify insomnia. One of the most common forms of insomnia is called psychophysiological (“mind-body”) insomnia. This is a disorder of learned, sleep-preventing associations, such as not being able to sleep because either your body or your mind is not relaxed. People with this insomnia usually have excessive, daily worries about not being able to fall or stay asleep when desired and worry that their efforts to fall asleep will be unsuccessful. Many people with this condition are concerned that they will never have a good night of sleep again.

What are the causes of insomnia?

Stress is the most common cause of psychophysiological insomnia. While sleep problems are common when going through a stressful event, some people continue to have sleep problems long after the stressful event is over. Sometimes the stress and sleep problems create an ongoing, worsening cycle of each problem.

Causes of acute insomnia can include:

• Other significant types of life stressors (job loss or change, death of a loved one, moving)
• Illness
• Medications
• Emotional or physical discomfort
• Environmental factors such as noise, light, or extreme temperatures (hot or cold) that interfere with sleep
• Things that interfere with a normal sleep schedule (jet lag or switching from a day to night shift, for example)

Causes of chronic insomnia include:

• Depression
• Chronic stress
• Pain or discomfort at night

What are the symptoms of insomnia?

Symptoms of insomnia include sleepiness during the day, general tiredness, irritability, and problems with concentration or memory.

How is insomnia diagnosed?

If you think you have insomnia, talk to your health care provider or schedule a sleep consultation with our board-certified sleep medicine physicians. An evaluation may include a physical exam, a medical history, and a sleep history. You may be asked to keep a sleep diary for a week or two, keeping track of your sleep patterns and how you feel during the day.

How is insomnia treated?

Acute insomnia may not require treatment. Mild insomnia often can be prevented or cured by practicing good sleep habits (see below). If your insomnia makes it hard for you to function during the day because you are sleepy and tired, our physicians may prescribe medication.

Treatment for chronic insomnia includes first treating any underlying conditions or health problems that are causing the insomnia. Additionally, our physicians may suggest behavioral therapy. Behavioral approaches help you to change behaviors that may worsen insomnia and to learn new behaviors to promote sleep. Behavior therapy is commonly used to treat psychophysiological insomnia. Other techniques such as relaxation exercises, biofeedback, sleep restriction therapy, and reconditioning can be tried. Although these techniques require some effort and take time to work, they do provide a means of coping with insomnia that help people return to more normal sleep patterns.

What habits promote a good night’s sleep?

Good sleep habits, also called sleep hygiene, can help you get a good night’s sleep. For example:

• Think positive. Avoid going to bed with a negative mindset, such as “If I don’t sleep for 8 hours, I will feel terrible tomorrow.”
• Try to go to sleep at the same time each night and get up at the same time each morning. Try not to take naps during the day because naps may make you less sleepy at night.
• Avoid caffeine, nicotine, and alcohol late in the day. Caffeine and nicotine are stimulants and can keep you from falling asleep. Alcohol can cause waking in the night and interferes with sleep quality.
• Get regular exercise. Try not to exercise close to bedtime because it may stimulate you and make it hard to fall asleep. Experts suggest not exercising for 4 hours before the time you go to sleep.
• Don’t eat a heavy meal late in the day. A light snack before bedtime, however, may help you sleep.
• Make your sleeping place comfortable. Be sure that it is dark, quiet, and not too warm or too cold. If light is a problem, try a sleeping mask. If noise is a problem, try earplugs or a fan.
• Relax before going to bed by reading a book, listening to music, taking a bath, or enjoying another activity you find relaxing.
• Avoid using your bed for anything other than sleep or sex.
• If you can’t fall asleep and don’t feel drowsy, get up and read or do something that is not overly stimulating until you feel sleepy.
• If you have trouble lying awake worrying about things, try making a to-do list before you go to bed. This may help you to not focus on those worries overnight.
• Stop clockwatching. Turn the clock around and only use the alarm.

Narcolepsy

What is Narcolpesy?

Narcolepsy is a chronic sleep disorder characterized by overwhelming daytime drowsiness and sudden attacks of sleep. People with narcolepsy often find it difficult to stay awake for long periods of time, regardless of the circumstances. Narcolepsy can cause serious disruptions in your daily routine.

Contrary to what some people believe, narcolepsy isn’t related to depression, seizure disorders, fainting, simple lack of sleep or other conditions that may cause abnormal sleep patterns.

Narcolepsy is a chronic condition, and while there is no cure, medications and lifestyle changes can help you manage the symptoms.

What are the symptoms of Narcolepsy?

The symptoms of narcolepsy most commonly begin between the ages of 10 and 25. They may worsen for the first few years, and then continue for life. They include:

• Excessive daytime sleepiness
  People with narcolepsy fall asleep without warning, anywhere, anytime. For example, you may suddenly nod off while working or talking with friends. You may sleep for a few minutes or up to a half-hour before awakening and feeling refreshed, but eventually you fall asleep again.
• Experience decreased alertness throughout the day
  Excessive daytime sleepiness usually is the first symptom to appear and is often the most troublesome, making it difficult for you to concentrate and fully function.
• Sudden loss of muscle tone
  This condition, called cataplexy (KAT-uh-plek-see), can cause a number of physical changes, from slurred speech to complete weakness of most muscles, and may last for a few seconds to a few minutes.
  • Cataplexy is uncontrollable and is triggered by intense emotions, usually positive ones such as laughter or excitement, but sometimes fear, surprise or anger. For example, your head may droop uncontrollably or your knees may suddenly buckle when you laugh. Some people with narcolepsy experience only one or two episodes of cataplexy a year, while others have numerous episodes daily. Not everyone with narcolepsy experiences cataplexy.
• Sleep paralysis
  People with narcolepsy often experience a temporary inability to move or speak while falling asleep or upon waking. These episodes are usually brief — lasting one or two minutes — but can be frightening. You may be aware of the condition and have no difficulty recalling it afterward, even if you had no control over what was happening to you.
• Hallucinations
  These hallucinations are called hypnagogic hallucinations if occurring as you fall asleep and hypnopompic hallucinations if occurring upon waking. Because you may be semi-awake when you begin dreaming, you experience your dreams as reality, and they may be particularly vivid and frightening
• Other characteristics
  People with narcolepsy may have other sleep disorders, such as obstructive sleep apnea, a condition in which breathing starts and stops throughout the night, restless legs syndrome and even insomnia. People with narcolepsy may also act out their dreams at night by flailing their arms or kicking and screaming.Some episodes of sleep attacks are brief, lasting seconds. Some people with narcolepsy experience automatic behavior during these brief episodes. For example, you may fall asleep while performing a task you normally perform, such as writing, typing or driving, and you continue to function while asleep. When you awaken, you can’t remember what you did, and you probably didn’t do it well.

What is the impact of untreated Narcolepsy?

• Public misunderstanding of the condition
  May cause serious problems for you professionally and personally. Others might see you as lazy, lethargic or rude. Your performance may suffer at school or work.
• Interference with intimate relationships.
  Extreme sleepiness may cause low sex drive or impotence, and people with narcolepsy may even fall asleep while having sex. The problems caused by sexual dysfunction can be further complicated by emotional difficulties. Intense feelings, such as anger or joy, can trigger some signs of narcolepsy such as cataplexy, causing affected people to withdraw from emotional interactions.
• Physical Harm
  Sleep attacks may result in physical harm to people with narcolepsy. You’re at increased risk of a car accident if you have an attack while driving. Your risk of cuts and burns is greater if you fall asleep while preparing food.
• Obesity
  People with narcolepsy are twice as likely to be overweight. The weight gain may be related to inactivity, binge eating, hypocretin deficiency or a combination of factors.

How is Narcolepsy diagnosed?

• Consultation
  Consultation with one of our sleep medicine physicians, and if recommended one or both of the following may be the next step
• Polysomnogram
  This test measures a variety of signals during sleep using electrodes placed on your scalp. For this test, you must spend a night at a medical facility. The test measures the electrical activity of your brain (electroencephalogram) and heart (electrocardiogram) and the movement of your muscles (electromyogram) and eyes (electro-oculogram). It also monitors your breathing.
• Multiple sleep latency test
  This examination measures how long it takes you to fall asleep during the day. You’ll be asked to take four or five naps, each nap two hours apart. Specialists will observe your sleep patterns. People who have narcolepsy fall asleep easily and enter into rapid eye movement (REM) sleep quickly.These tests can also help doctors rule out other possible causes of your signs and symptoms. Other sleep disorders, such as sleep apnea, can cause excessive daytime sleepiness.

What are the treatments for Narcolepsy?

There is no cure for narcolepsy, but medications and lifestyle modifications can help you manage the symptoms.

Possible medications for narcolepsy include:

• Stimulants
  Drugs that stimulate the central nervous system are the primary treatment to help people with narcolepsy stay awake during the day. Doctors often try modafinil (Provigil) or armodafinil (Nuvigil) first for narcolepsy because it isn’t as addictive as older stimulants and doesn’t produce the highs and lows often associated with older stimulants.
• Selective serotonin reuptake inhibitors (SSRIs) or serotonin and norepinephrine reuptake inhibitors (SNRIs)
  Doctors often prescribe these medications, which suppress REM sleep, to help alleviate the symptoms of cataplexy, hypnagogic hallucinations and sleep paralysis. They include fluoxetine (Prozac, Sarafem, others) and venlafaxine (Effexor XR).
• Tricyclic antidepressants
  These older antidepressants, such as protriptyline (Vivactil), imipramine (Tofranil) and clomipramine (Anafranil), are effective for cataplexy, but many people complain of side effects, such as dry mouth and lightheadedness.

Certain over-the-counter drugs, such as allergy and cold medications, can cause drowsiness. If you have narcolepsy, your doctor will likely recommend that you avoid taking these medications.

What lifestyles changes may be recommended?

Lifestyle modifications are important in managing the symptoms of narcolepsy. You may benefit from these steps:

• Stick to a schedule
  Go to sleep and wake up at the same time every day, including weekends.
• Take Naps
  Schedule short naps at regular intervals during the day. Naps of 20 minutes at strategic times during the day may be refreshing and reduce sleepiness for one to three hours. Some people may need longer naps.
• Avoid nicotine and alcohol
  Use of these substances, especially at night, can worsen your signs and symptoms.
• Get regular exercise
  Moderate, regular exercise at least four to five hours before bedtime may help you feel more awake during the day and sleep better at night.

Restless Leg Syndrome 

What is restless legs syndrome?

Restless legs syndrome (RLS) is a neurological disorder characterized by throbbing, pulling, creeping, or other unpleasant sensations in the legs and an uncontrollable, and sometimes overwhelming, urge to move them. Symptoms occur primarily at night when a person is relaxing or at rest and can increase in severity during the night. Moving the legs relieves the discomfort. Often called paresthesias (abnormal sensations) or dysesthesias (unpleasant abnormal sensations), the sensations range in severity from uncomfortable to irritating to painful.

The most distinctive or unusual aspect of the condition is that lying down and trying to relax activates the symptoms. Most people with RLS have difficulty falling asleep and staying asleep. Left untreated, the condition causes exhaustion and daytime fatigue. Many people with RLS report that their job, personal relations, and activities of daily living are strongly affected as a result of their sleep deprivation. They are often unable to concentrate, have impaired memory, or fail to accomplish daily tasks. It also can make traveling difficult and can cause depression.

Who is at risk for RLS?

As many as 10 percent of the U.S. population may have RLS. Several studies have shown that moderate to severe RLS affects approximately 2-3 percent of adults (more than 5 million individuals). An additional 5 percent appears to be affected by a milder form. Childhood RLS is estimated to affect almost 1 million school-age children, with one-third having moderate to severe symptoms. Some people with RLS will not seek medical attention, believing that they will not be taken seriously, that their symptoms are too mild, or that their condition is not treatable. Some physicians wrongly attribute the symptoms to nervousness, insomnia, stress, arthritis, muscle cramps, or aging.

RLS occurs in both men and women, although the incidence is about twice as high in women. It may begin at any age. Many individuals who are severely affected are middle-aged or older, and the symptoms typically become more frequent and last longer with age.
RLS is classified as a movement disorder, as individuals are forced to move their legs in order to gain relief from symptoms.

How is Periodic limb movement related to RLS?

More than 80 percent of people with RLS also experience a more common condition known as periodic limb movement of sleep (PLMS). PLMS is characterized by involuntary leg twitching or jerking movements during sleep that typically occur every 15 to 40 seconds, sometimes throughout the night. The symptoms cause repeated awakening and severely disrupted sleep. Although many individuals with RLS also develop PLMS, most people with PLMS do not experience RLS. People who have PLMS and do not have RLS or another cause for the PLMS may be diagnosed with periodic limb movement disorder (PLMD). PLMD may be a variant of RLS and thus respond to similar treatments.

What are common signs and symptoms of restless legs?

People with RLS often feel:

• Uncomfortable sensations in their legs, especially when sitting or lying down, accompanied by an irresistible urge to move the affected limb. Although the sensations can occur on just one side of the body, they most often affect both sides.
• Because moving the legs (or other affected parts of the body) relieves the discomfort, people with RLS often keep their legs in motion to minimize or prevent the sensations. They may pace the floor, constantly move their legs while sitting, and toss and turn in bed.
• Symptoms are worse at night with a distinct symptom-free period in the early morning, allowing for more refreshing sleep at that time. Other triggering situations are periods of inactivity such as long car trips, sitting in a movie theater, long-distance flights, immobilization in a cast, or relaxation exercises. Many individuals also note a worsening of symptoms if their sleep is further reduced by events or activity.

RLS symptoms may vary from day to day and in severity and frequency from person to person. Individuals with mild RLS may have some disruption of sleep onset and minor interference in daytime activities. In moderately severe cases, symptoms occur only once or twice a week but result in significant delay of sleep onset, with some disruption of daytime function. In severe cases of RLS, the symptoms occur more than twice a week and result in burdensome interruption of sleep and impairment of daytime function.

What causes restless legs syndrome?

In most cases, the cause of RLS is unknown. However, it may have a genetic component; RLS is often found in families where the onset of symptoms is before age 40. Specific gene variants have been associated with RLS. Evidence indicates that low levels of iron in the brain also may be responsible for RLS.

Considerable evidence suggests that RLS is related to a dysfunction in the brain’s basal ganglia circuits that use the neurotransmitter dopamine, which is needed to produce smooth, purposeful muscle activity and movement. Disruption of these pathways frequently results in involuntary movements. Individuals with Parkinson’s disease, another disorder of the basal ganglia’s dopamine pathways, often have RLS as well.

RLS also appears to be related to the following factors or conditions, although researchers do not yet know if these factors actually cause RLS:

• Chronic diseases such as kidney failure, diabetes, and peripheral neuropathy. Treating the underlying condition often provides relief from RLS symptoms
• Certain medications that may aggravate symptoms. These medications include antinausea drugs (prochlorperazine or metoclopramide), antipsychotic drugs (haloperidol or phenothiazine derivatives), antidepressants that increase serotonin, and some cold and allergy medications-that contain sedating antihistamines.
• Pregnancy, especially in the last trimester. In most cases, symptoms usually disappear within 4 weeks after delivery.
• Alcohol and sleep deprivation also may aggravate or trigger symptoms in some individuals. Reducing or completely eliminating these factors may relieve symptoms, but it is unclear if this can prevent RLS symptoms from occurring at all.

How is RLS and PLMD diagnosed?

• Laboratory tests may be performed to rule out other conditions. Blood tests can identify iron and vitamin deficiencies as well as other medical disorders associated with RLS.
• Sleep studies such as polysomnography (a test that records the individual’s brain waves, heartbeat, breathing, and leg movements during an entire night) may identify the presence of other causes of sleep disruption (e.g., sleep apnea), which may impact management of the disorder.

Diagnosing RLS in children may be especially difficult, since it may be hard for a child to describe where it hurts, when and how often the symptoms occur, and how long symptoms last. Pediatric RLS can sometimes be misdiagnosed as “growing pains” or attention deficit disorder.

How is restless legs syndrome treated?

RLS can be treated, with the goal of relieving symptoms.

Certain lifestyle changes and activities that may reduce symptoms in persons with mild to moderate symptoms include decreased use of caffeine, alcohol, and tobacco; supplements to correct deficiencies in iron, folate, and magnesium; changing or maintaining a regular sleep pattern; a program of moderate exercise; and massaging the legs, taking a hot bath, or using a heating pad or ice pack. Medications are usually helpful, and common medications that may be considered include:

• Dopaminergic agents (drugs that increase dopamine), largely used to treat Parkinson’s disease; have been shown to reduce symptoms of RLS and PLMS. Additionally, gabapentin, for the treatment of moderate to server RLS.

Parasomnias

Our board-certified sleep medicine physicians specialize in sleep disorders including, parasomnia. The term parasomnia encompasses a wide range of unwanted behaviors during sleep. Parasomnias can occur as someone is falling asleep or at any point during the sleep cycle.

What are Parasomnias?

The term “parasomnia” refers to all the abnormal things that can happen to people while they sleep, apart from sleep apnea . Some examples are sleep-related eating disorder, sleepwalking, nightmares, sleep paralysis, REM sleep behavior disorder, and sleep aggression. Sexsomnia, sometimes called “sleepsex,” is also a parasomnia. It refers to sexual acts that are carried out by a person who is sleeping. Parasomnias can have negative effects on people during the daytime, including sleepiness.

What are the types of parasomnias?

• Sleep Paralysis
  Many people experience the sensation of sleep paralysis while falling asleep. Their body feels unable to move for seconds or even minutes. Sleep paralysis can be quite frightening and may be accompanied by hallucinations.
• Sleep Walking
  Somnambulism, or sleep walking as it is commonly called, occurs when a person appears to be awake and moving around but is actually asleep. A person who is sleep walking may have their eyes opened and even engage you in conversation. This condition most often occurs during delta (stage 3 and stage 4) sleep. It is most common when an individual is young (ages 8-12 or so) and tends to run in families.
• Night Terrors
  A person experiencing a night terror or sleep terror abruptly awakes from sleep in a terrified state. The person may appear to be awake, but is confused and unable to communicate. They do not respond to voices and are difficult to fully awaken.
• Nightmares
  Vivid nighttime events that can cause feelings of fear, terror, and/or anxiety. Usually the person wakes from REM sleep and experiences fear and anxiety making it difficult to return to sleep.
• Somniliquy (sleep talking)
  This usually occurs during sleep-wake transition. Most of the time sleep talking is harmless except for annoying the bed partner. This includes speaking words, making sounds and any other verbal outbursts.
• Confusional Arousals
  Arousals that usually occur when a person is awakened from a deep sleep during the first part of the night. People experiencing confusional arousals react slowly to commands and may have trouble understanding questions that they are asked. In addition, people with confusional arousals often have problems with short-term memory and have no memory of doing these things the following day.
• REM Behavior Disorder (RBD)
  People with RBD act out dramatic, vigorous and/or violent dreams during REM sleep. Usually, RBD occurs in men age 50 and older, but the disorder also can occur in women and in younger people. It differs from sleep walking and sleep terrors in that the sleeper can be easily awakened and can recall vivid details of the dream. Sleep Eating Disorder: This disorder is characterized by sleep walking and excessive nocturnal overeating (compulsive hyperphagia). Sleep eaters are unaware and unconscious of their behavior and usually have no recollection of their eating afterward. Sleep eating disorder can be very dangerous, the risk of choking and hurting one’s self with cooking utensils is quite high. Most people with this disorder also experience an unexplained weight gain along with daytime sleepiness.

What causes a parasomnia?
Parasomnias often run in families and so there is probably a genetic factor in many cases. Brain disorders may be responsible for some parasomnias, such as many cases of REM sleep behavior disorder. Parasomnias may also be triggered by other sleep disorders such as obstructive sleep apnea, and by various medications.

How is parasomnia diagnosed?
As part of the initial consultation with our sleep medicine physician, a thorough history and additionally a physical examination may be performed. Our sleep medicine specialist may recommend an overnight sleep study called a polysomnogram (PSG). These studies are used to identify sleep disorders.

How is parasomnia treated?
The broad expertise of our sleep doctors allows parasomnia treatment to be individualized. Our sleep disorder clinic and its staff will consult with you and prescribe medications and behavioral treatments to help reduce parasomnia behaviors.