Can’t Sleep? Many Sleep Disorders Can Signal Serious Underlying Conditions

November 5, 2010

Given the busy, always-on-the-go lifestyles most of us lead, complaints of daytime sleepiness or trouble sleeping at night seem almost commonplace, certainly not cause for alarm. But Azmi Draw, MD, and Nuzhat Hasan, MD, sleep disorders specialists with the Floyd Memorial Sleep Disorders Center, insist that sleep problems should not be ignored, and can actually signal some very serious underlying conditions that need to be addressed.

What Qualifies as a Sleep Disorder?

“Sleep disorders are actually incredibly common, in fact, insomnia is not only the most common sleep disorder, it’s also the most common medical complaint in the world, with 69 percent of the population experiencing it at some point in their lives,” explained Dr. Hasan. “However, I think this works against us sometimes. Because sleep disorders are so prevalent, we tend to brush them off and not take them seriously. In reality though, adequate, restful sleep is as essential to keeping our bodies functioning as the water we drink and the air we breathe.”

Dr. Draw added, “The definition of a sleep disorder is actually very broad, essentially though, a sleep disorder is any condition that interferes with sleep. This can be characterized by disturbance in the amount of sleep, in the quality or timing of sleep, or in the behaviors or physiological conditions associated with sleep.”

Insomnia-the Most Common of All Sleep Disorders

Dr. Hasan defined insomnia and what it entails. “Insomnia occurs when a person does not sleep well at night. This can include taking longer than 20 minutes to fall asleep, waking during the night with difficulty falling back to sleep, consistently waking up earlier than planned, and generally experiencing unrestorative sleep that results in a feeling of fatigue and decreased functioning during the day.”

“Many times underlying medical or psychological conditions can show themselves as sleep disorders, making it critical to seek medical attention so that your physician can diagnose and begin to treat the underlying disease process. An excellent example of this is insomnia. Many times insomnia is actually a symptom of a more serious condition such as depression, anxiety disorders, arthritis or severe breathing issues.”

Nuzhat Hasan, MD
Board Certified Pulmonologist, Critical Care & Sleep Disorders Specialist
Floyd Memorial Sleep Disorders Center

Types of Insomnia

There are two types of insomnia, acute and chronic. The acute occurrence of insomnia is short-term and usually triggered by a stressful event. This type of insomnia is very common; in fact, studies show that 50 percent of people have experienced an episode of acute insomnia at some point in their lives. Chronic insomnia, on the other hand, is less common, affecting approximately 19 percent of the population at some point in their lives. It entails a longterm inability to sleep, many times brought on by a variety of underlying triggers that must be properly dealt with before the insomnia can subside.

Causes & Treatment

“Insomnia can be a very complex sleep disorder to treat because it can be linked to medical, behavioral, lifestyle, psychological or environmental triggers, and more often than not a combination of those. Treating insomnia involves identifying those underlying causes and addressing them appropriately so that the patient can return to a normal sleep schedule,” noted Dr. Hasan. “For example, some disease processes can perpetuate insomnia, necessitating treatment of the underlying condition before the insomnia can subside. These conditions can include, but are not limited to, arthritis, depression, anxiety disorders, restless leg syndrome, obstructive sleep apnea, chronic back pain and severe breathing problems such as asthma or Chronic Obstructive Pulmonary Disorder (COPD).”

Lifestyle choices such as strenuous exercising before bedtime, smoking before bedtime, drinking large amounts of caffeine, and frequent traveling can also instigate insomnia. “In these cases, I suggest patients not smoke at all, but if they must, they should abstain from smoking four to six hours prior to bedtime. It’s also wise to abstain from caffeinated beverages four to six hours before bedtime, and to avoid exercise four hours before going to bed,” advised Dr. Hasan.

“You should ideally aim for six to seven hours of sleep per night. And if you find yourself unable to sleep several nights per week, seek medical attention so your physician can rule out any serious underlying conditions and help you treat whatever is causing the insomnia. Sometimes sleep medications may be prescribed, and they can help on a short term basis, but chronic insomnia sufferers will not find relief with medication alone. Identifying the cause and treating it is the key.”

Obstructive Sleep Apnea – a Classic Example of the Negative Effects of Stress on Our Bodies

“In my opinion, Obstructive Sleep Apnea (OSA) is the most concerning sleep disorder of all, because of its devastating health implications, and because of its largely undiagnosed prevalence in the population,” explained Dr. Draw. “It’s estimated that nearly 20 million Americans have sleep apnea, and 87 percent of those are currently undiagnosed and not receiving treatment. Many people who suffer from OSA stop and start breathing over and over during the night, but are not aware of it. Unless a bed partner or other household member notices what’s happening, the person may not recognize that their daytime symptoms are tied to their sleep.”

Causes of OSA

People who suffer from obstructive sleep apnea may go without breathing for 10 or more seconds per episode, and may have episode after episode throughout the night, which can lead to a reduction in airflow, and dropped levels of oxygen in the blood. In OSA, the throat briefly collapses, causing pauses in breathing. This collapse may occur for several reasons, including:

  • The throat muscles and tongue relax more than usual during sleep
  • The tonsils and adenoids are too large, blocking the airway
  • Excess weight results in extra soft tissue in the throat, making it harder to keep the airway open
  • Abnormal body structure, in which the shape of the head and neck results in a smaller airway size in the mouth and throat area

Signs & Symptoms

OSA symptoms can sometimes be difficult to recognize as symptoms of a sleep disorder, because they can commonly be attributed to many other conditions. However, if you suffer from any combination of these symptoms, it’s a good idea to discuss them with your doctor, and possibly undergo a sleep study for a definitive diagnosis.

  • Excessive daytime sleepiness
  • Difficulty concentrating and remembering
  • Mood swings
  • Weight gain
  • Morning headaches
  • Fatigue during the day
  • Loud snoring at night
  • Sore throat in the morning

“Too many people today see sleep as a luxury and not a medical necessity. In fact, many sleep disorders, such as Obstructive Sleep Apnea (OSA), have major implications on your overall health. For example, the risk of heart attack or stroke increases by two to three times in patients with untreated moderate to severe OSA. Making sure you’re getting adequate, restful sleep couldn’t be more important.”

Azmi Draw, MD, FCCP
Board Certified Pulmonologist, Critical Care & Sleep Disorders Specialist
Floyd Memorial Sleep Disorders Center

Effects on the Body

Dr. Draw explained the overall implications of OSA. “Because OSA deprives the body of adequate oxygen and restful sleep, it is essentially in a heightened state of stress throughout the night. The result of this is an increase in stress hormone production, which stimulates the brain, heart and cardiovascular system precisely when it’s supposed to be at rest.” This leads to a host of serious medical conditions, including:

Diagnosis & Treatment

“The only way to definitively diagnose OSA is during a sleep study at a sleep lab such as the one located in Floyd Memorial’s Sleep Disorders Center,” added Dr. Draw. “Once a patient has been diagnosed, treatment typically involves using a Continuous Positive Airway Pressure device (CPAP) while sleeping. A CPAP device is a mask that fits over the nose and/or mouth and gently blows air into the airway to help keep it open during sleep. A Bilevel Positive Airway Pressure device (BiPAP) is also sometimes used. BiPAP is similar to CPAP therapy, however the BiPAP device features dual pressure settings, allowing patients to get more air into, and out of the lungs without the normal muscular activity needed to do so.”

“Another option is the use of oral devices made by a dentist to move the jaw forward and keep the airway from collapsing during sleep. Surgery to remove excess tissue from the upper airway is also a common treatment of OSA. This is known as Uvulopalatopharyngoplasty (UPPP), which involves removing tissue from the rear of the mouth and top of the throat, while also removing the tonsils and adenoids.”

Call (812) 949-5550 to learn more about treatment options available at the Floyd Memorial Sleep Disorders Center or visit us on the web at floydmemorial.com/sleep-center/.