An explanation of sleep disorder conditions, what causes them, their symptoms and what treatment options you have in Malaysia.
An explanation of sleep disorder conditions, what causes them, their symptoms and what treatment options you have in Malaysia.
This will subsequently affect your daytime activities, work and overall general health.
There are many types of sleep disorders, which include breathing disorders during sleep.
Example of breathing disorders during sleep include obstructive sleep apnoea and central sleep apnoea, where the breathing can suddenly stop during sleep.
Difficulty to sleep (insomnia), excessive sleepiness, jet lag and shift-work disorders are also part of the sleep disorders.
These sleep disorders need to be investigated and treated to ensure your overall good health quality.
Obstructive Sleep Apnoea is a potentially serious sleep disorder. It causes breathing to repeatedly stop and start during sleep.
There are several types of sleep apnoea, but the most common is obstructive sleep apnoea.
This type of apnoea occurs when your throat muscles intermittently relax and block your airway during sleep.
A noticeable sign of obstructive sleep apnoea is snoring.
Signs and symptoms of obstructive sleep apnoea include:
– Excessive daytime sleepiness
– Loud snoring
– Observed episodes of stopped breathing during sleep
– Abrupt awakenings accompanied by gasping or choking
– Awakening with a dry mouth or sore throat
– Morning headache
– Difficulty concentrating during the day
– Experiencing mood changes, such as depression or irritability
– High blood pressure
– Nighttime sweating
– Decreased libido
To diagnose your condition, an evaluation based on your signs and symptoms, physical examination, and a sleep study need to be done.
You’ll have a physical examination, and your doctor will examine the back of your throat, mouth and nose for extra tissue or abnormalities.
Your doctor may measure your neck and waist circumference and check your blood pressure.
Your doctor also may refer you to an ear, nose and throat doctor to rule out any anatomic blockage in your nose or throat.
For milder cases of obstructive sleep apnoea, your doctor may recommend lifestyle changes.
If these measures don’t improve your sleep or if your apnoea is moderate to severe, then your doctor may recommend other treatments.
Certain devices can help open up a blocked airway. In other cases, surgery may be necessary.
Central Sleep Apnoea is a disorder in which your breathing repeatedly stops and starts during sleep.
This condition is different from Obstructive Sleep Apnoea, in which you can’t breathe normally because of upper airway obstruction.
Central Sleep Apnoea is less common than Obstructive Sleep Apnoea.
Central Sleep Apnoea occurs when your brain fails to transmit signals to your breathing muscles.
It can be caused by a number of conditions that affect the ability of your brainstem — which links your brain to your spinal cord and controls many functions such as heart rate and breathing — to control your breathing.
Common signs and symptoms of Central Sleep Apnoea include:
– Observed episodes of stopped breathing or abnormal breathing patterns during sleep
– Abrupt awakenings accompanied by shortness of breath
– Shortness of breath that’s relieved by sitting up
– Difficulty staying asleep (insomnia)
– Excessive daytime sleepiness (hypersomnia)
– Chest pain at night
– Difficulty concentrating
– Mood changes
– Morning headaches
– Lower tolerance for exercise
Although snoring indicates some degree of airflow obstruction, snoring also may be heard in the presence of Central Sleep Apnoea.
However, snoring may not be as prominent with Central Sleep apnoea as it is with Obstructive Sleep Apnoea.
Your doctor may make an evaluation based on your signs and symptoms.
Further evaluation often involves overnight monitoring of your breathing and other body functions during a sleep study called polysomnography.
Doctors trained in nervous system diseases (neurologists), heart diseases (cardiologists) and others may be involved in evaluating your condition.
Doctors may also order imaging of your head or heart to look for contributing conditions.
Treatments for Central Sleep Apnoea may include:
– Addressing associated medical problems.
– Reduction of opioid medications.
– Continuous positive airway pressure (CPAP).
– Adaptive servo-ventilation (ASV).
– Bilevel positive airway pressure (BPAP).
– Supplemental oxygen.
– Surgery or other procedures
Narcolepsy is a sleep disorder characterized by excessive sleepiness, sleep paralysis, hallucinations, and in some cases episodes of cataplexy (partial or total loss of muscle control, often triggered by a strong emotion such as laughter).
Narcolepsy occurs equally in men and women and is thought to affect roughly 1 in 2,000 people.
The symptoms appear in childhood or adolescence, but many people have symptoms of narcolepsy for years before getting a proper diagnosis.
Narcolepsy with cataplexy is caused by a lack of the chemical hypocretin in the brain.
Hypocretin is an important chemical for regulating wakefulness and rapid eye movement (REM) sleep.
Narcolepsy without cataplexy includes most of the same symptoms, but its cause is unknown. Injuries to the hypothalamus and brain stem, tumors, and stroke are under investigation.
The most prominent symptom of narcolepsy is extreme daytime sleepiness.
This is often the first symptom to develop, and many people with narcolepsy suffer with this and other issues for years before receiving a proper diagnosis and treatment.
Some common symptoms of narcolepsy include:
– Excessive daytime sleepiness and sleep attacks during normal activities
– Cataplexy (sudden loss of muscle tone), triggered by emotions
– Hallucinations and sleep paralysis
– Disrupted nighttime sleep
– Vivid dreaming
Diagnosis of Narcolepsy can be done by taking complete medical and personal history, physical examination and further tests.
During the appointment your doctor will ask questions about your symptoms, when, and how they developed.
The doctor will ask you about sleepiness, possible episodes of cataplexy, your nighttime sleep patterns, and other symptoms like hallucinations, dreams, and sleep paralysis.
At the same time, the doctor will rule out other causes of sleepiness and investigate other health conditions that may be causing your symptoms.
The most common way to treat narcolepsy is often with a combination of medication and behavioral changes.
These lifestyle changes can include good sleep habits, napping, knowing how to stay alert, and developing self-awareness.
Hypersomnia is a condition in which you feel excessive sleepiness during the day. It may occur even after long stretches of sleep. Another name for hypersomnia is excessive daytime sleepiness (EDS).
Hypersomnia can be a primary condition or a secondary condition.
Secondary hypersomnia is the result of another medical condition.
People with hypersomnia have difficulty functioning during the day because they’re frequently tired, which can affect concentration and energy level.
The main symptom of hypersomnia is constant tiredness. People with hypersomnia may take naps throughout the day without ever relieving drowsiness.
They also have difficulty waking from long periods of sleep.
Other symptoms of hypersomnia include:
– low energy
– loss of appetite
– slow thinking or speech
– difficulty remembering
To diagnose hypersomnia, a doctor will review your symptoms and medical history.
A physical exam can test for alertness.
Doctors use several tests to diagnose hypersomnia, including:
– Sleep diary:
– Epworth Sleepiness Scale:
– Multiple sleep latency test
Treatments for this condition can vary, depending on the cause of your hypersomnia.
Many drugs intended for narcolepsy can treat hypersomnia. These drugs are stimulants that help you feel more awake.
Lifestyle changes are a critical part of the treatment process. A doctor may recommend getting on a regular sleeping schedule. Avoiding certain activities can also improve symptoms, especially around bedtime.
Most people with hypersomnia shouldn’t drink alcohol or use drugs.
A doctor may also recommend a high-nutrition diet to maintain energy levels naturally.
Insomnia is a sleep disorder in which you have trouble falling and/or staying asleep.
The condition can be short-term (acute) or can last a long time (chronic). It may also come and go.
Acute insomnia lasts from 1 night to a few weeks. Insomnia is chronic when it happens at least 3 nights a week for 3 months or more.
There are two types of insomnia: primary and secondary.
– Primary insomnia: This means your sleep problems aren’t linked to any other health condition or problem.
– Secondary insomnia: This means you have trouble sleeping because of a health condition (like asthma, depression, arthritis, cancer, or heartburn); pain; medication; or substance use (like alcohol).
Causes of primary insomnia include:
– Stress related to big life events, like a job loss or change, the death of a loved one, divorce, or moving
– Things around you like noise, light, or temperature
– Changes to your sleep schedule like jet lag, a new shift at work, or bad habits you picked up when you had other sleep problems
Causes of secondary insomnia include:
– Mental health issues like depression and anxiety
– Medications for colds, allergies, depression, high blood pressure, and asthma
– Pain or discomfort at night
– Caffeine, tobacco, or alcohol use
– Hyperthyroidism and other endocrine problems
– Other sleep disorders, like sleep apnea or restless legs syndrome
Symptoms of insomnia include:
– Sleepiness during the day
– Problems with concentration or memory
Your doctor will do a physical exam and ask about your medical history and sleep history.
They might tell you to keep a sleep diary for a week or two, keeping track of your sleep patterns and how you feel during the day.
They may talk to your bed partner about how much and how well you’re sleeping.
You might also have special tests at a sleep center.
Acute insomnia may not need treatment.
If it’s hard for you to do everyday activities because you’re tired, your doctor may prescribe sleeping pills for a short time. Medicines that work quickly but briefly can help you avoid problems like drowsiness the next day.
For chronic insomnia, you’ll need treatment for the conditions or health problems that are keeping you awake.
Your doctor might also suggest behavioral therapy. This can help you change the things you do that make insomnia worse and learn what you can do to promote sleep.
Periodic limb movement disorder (PLMD) is repetitive cramping or jerking of the legs during sleep. It is the only movement disorder that occurs only during sleep, and it is sometimes called periodic leg (or limb) movements during sleep.
“Periodic” refers to the fact that the movements are repetitive and rhythmic, occurring about every 20-40 seconds.
PLMD is also considered a sleep disorder, because the movements often disrupt sleep and lead to daytime sleepiness.
Periodic limb movement disorder can be primary or secondary.
Secondary PLMD is caused by an underlying medical problem.
Primary PLMD, on the other hand, has no known cause. It has been linked to abnormalities in regulation of nerves traveling from the brain to the limbs, but the exact nature of these abnormalities is not known.
Secondary PLMD has many different causes, including the following (many of these are also causes of restless legs syndrome):
• Diabetes mellitus
• Iron deficiency
• Spinal cord tumor
• Spinal cord injury
• Sleep apnea syndrome – Breathing difficulties that disrupt sleep, causing daytime sleepiness and a number of other problems.
• Narcolepsy – A sleep disorder involving excessive sleepiness and overpowering urge to sleep during waking hours
• Uremia – Build-up of waste products in the blood because of poor kidney function
• Anemia – Low level of hemoglobin, the substance that carries oxygen in the blood
• Medication – Neuroleptics and other antidopaminergic agents such as Haldol, dopaminergic agents such as Sinemet (despite the fact that Sinemet is often a treatment for PLMD), or tricyclic antidepressants such as amitriptyline (Elavil)
• Withdrawal from sedative medications such as barbiturates or benzodiazepines (such as Valium)
The most common symptoms noted by people with PLMD are not leg movements but poor sleep and daytime sleepiness.
Many people with PLMD are unaware of their leg movements unless their bed partner tells them.
Leg movements involve one or both limbs.
• Typically the knee, ankle, and big toe joints all bend as part of the movements.
• The movements vary from slight to strenuous and wild kicking and thrashing.
• The movements last about 2 seconds (and thus are much slower than the leg jerks of myoclonus).
• The movements are rhythmic and repetitive and occur every 20-40 seconds.
There is no lab test or imaging study that can prove that you have PLMD.
However, certain tests can identify underlying medical causes such as anemia, other deficiencies, and metabolic disorders that could cause PLMD.
• You may have blood drawn to check your blood cell counts and hemoglobin, basic organ functions, chemistry, and thyroid hormone levels. You also may be checked for certain infections that could cause secondary PLMD.
• A urine sample may be collected to check for traces of drugs that can cause sleep problems.
Polysomnography (sleep lab testing) is the only way to confirm that you have PLMD. As you sleep in the lab, your leg movements can be documented.
At any time during your evaluation, your health care provider may refer you to a neurologist (a specialist in disorders of the nervous system). This specialist can help rule out other neurological problems and confirm the diagnosis of PLMD.
Therapy does not cure PLMD but relieves symptoms.
Note that many of the medications used to treat PLMD are the same as those used to treat restless legs syndrome.
• Benzodiazepines: These drugs suppress muscle contractions. They are also sedatives and help you sleep through the movements. Clonazepam (Klonopin), in particular, has been shown to reduce the total number of periodic limb movements per hour. It is probably the most widely used drug to treat PLMD.
• Dopaminergic agents: These drugs increased the levels of an important neurotransmitter (brain chemical) called dopamine, which is important in regulating muscle movements. These medications seem to improve the condition in some people but not in others. Widely used examples are a levodopa/carbidopa combination (Sinemet) and pergolide (Permax).
• Anticonvulsant agents: These medications reduce muscle contractions in some people. The most widely used anticonvulsant in PLMD is gabapentin (Neurontin).
• GABA agonists: These agents inhibit release of certain neurotransmitters that stimulate muscle contractions. The result is relaxation of contractions. The most widely used of these agents in PLMD is baclofen (Lioresal).
Upon your first visit to the clinic we’ll conduct a thorough history taking, physical examination and lab investigation, to diagnose your actual lung disease quickly and accurately.
Choose the appropriate diagnostic plan and procedures such as Chest X Ray, CT scan, PET scan, Bronchoscopy, Pleuroscopy, Sleep study, TB, etc, to come to the correct diagnosis.
Working closely with my pharmacists, physiotherapists, or your personal physio, to suggest specific therapeutic options to allow the best and quickest relief from your condition.
Administer a customised treatment plan to suit your specific needs and effective recovery. Procedures may include: Anti-TB medications, inhalers, antibiotics, CPAP treatment, etc.
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Consultant Respiratory & Internal Medicine Physician. MBBS, MRCP, Respiratory Medicine Fellowship, International Sleep Disorders Specialist.
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