The Sleep Disorders Center at Fort Sanders Sevier Medical Center

865.429.8042

Sleep disorders can affect overall health, and some may be life threatening. In addition to daytime sleepiness and fatigue, certain disorders may cause high blood pressure and serious heart problems. Sufferers often experience more illness, more accidents, reduced job performance, and strained relationships. Common symptoms of sleep disorders include:

• Excessive daytime sleepiness
• Morning headache
• Depression
• Irritability
• Sexual dysfunction
• Learning and memory difficulties
• Falling asleep while at work, on the phone, or while driving (Untreated sleep apnea patients are 3 times more likely to have car accidents)
• Increased risk for irregular heartbeat, high blood pressure, heart attack, and stroke (High blood pressure is present in 50 percent of those who suffer from sleep apnea)

Types Of Sleep Disorders

There are more than 84 different types of sleep disorders, most of which can be diagnosed and treated with the aid of a sleep study. Following are a few of the most common:

• Chronic fatigue: a disorder that produces an ongoing feeling of tiredness, malaise, sleepiness, boredom, or depression; has various causes and is sometimes associated with a sleep disorder.

• Insomnia: the most common sleep disorder; described as the inability to initiate or maintain sleep and is associated with daytime fatigue and sleepiness; often the result of stress, illness, environmental factors, or other conditions that throw off a normal sleep schedule

• Narcolepsy: a disorder that manifests itself through excessive daytime sleepiness, uncontrollable sleep attacks and muscle weakness triggered by sudden emotional reactions such as laughter or fear; sometimes accompanied by vivid dreamlike scenes or paralysis upon falling asleep or waking.

• Parasomnias: a disorder that may include nightmares, chest pain, night terrors, sleepwalking and sleep talking; most common in childhood and sometimes worsens during adolescence and adulthood.

• Restless legs syndrome (RLS): neurological movement disorder characterized by abnormal, uncomfortable stinging in the legs that typically occurs or worsens when a person is at rest; a near-constant "pins and needles" feeling that results in constant moving of the legs and prevents a restful sleep.

• Sleep apnea: a disorder that occurs when air cannot flow in or out of a person's nose or mouth although efforts to breathe continue; caused by mechanical and structural problems in the airway that cause interruptions in breathing (i.e., throat muscles and tongue relax, excessive amount of tissue in the airway); results in choking sensations during sleep and is almost always accompanied by snoring between apnea episodes.

• Sleep/Wake Cycle Disorders: a disorder accompanied by symptoms of insomnia or sleepiness at inappropriate times; associated with patients who work rotating schedules, suffer from jet lag, or have insufficient sleep syndrome; can become progressive and chronic, but can be treated with medication and therapy.

Sleep Studies

Sleep studies measure factors such as the amount of oxygen in the blood during sleep, the amount of restless movement during sleep, and the time it takes for a person to fall asleep during the day. The following tests are performed at Fort Sanders Sevier Sleep Disorders Center and will help your doctor determine the appropriate treatment:

A polysomnography is a test that records a variety of body functions during sleep, such as the electrical activity of the brain, eye movement, muscle activity, heart rate, respiratory effort, air flow, and blood oxygen levels.

An overnight polysomnography test involves monitoring brain waves, muscle tension, eye movement, respiration, oxygen level in the blood and audio monitoring.

A Multiple Sleep Latency Test (MSLT) is a test that measures the excess of daytime sleepiness in an individual. Individuals who fall asleep in less than five minutes are likely to require some type of treatment for sleep disorders.

Most insurance companies provide coverage for evaluation of sleep disorders. Contact your insurance company for details on your policy's specific conditions.

Treatment

Once a test has been performed to determine the type of sleep disorder, clinicians determine the appropriate treatment plan for the individual.

Some sleep disorders can be treated with behavioral changes such as losing weight; developing better sleep habits; and avoiding alcohol, caffeine, and sleep medications. If you are unsure that you suffer from a sleep disorder, a sleep quiz may help you decide if you need to seek treatment.

For mild sleep disorders, oral appliances can be used to keep the airway open by holding the tongue or jaw forward, increasing the airway space behind the tongue.

Moderate to severe sleep apnea is usually treated with a CPAP (Continuous Positive Airway Pressure). During this treatment, a patient wears a mask over the nose during sleep, and positive air pressure is forced through the airway and/or nasal passages.

Severe sleep apnea may require surgery. Usually a surgeon will suggest the patient be on CPAP for at least a month before pursuing surgery. The most common surgical procedures to treat sleep apnea include removal of adenoids and tonsils, nasal polyps or other growths, or other tissue in the airway and correction of structural deformities.

Good Sleep Habits* *Information from the American Academy of Sleep Medicine

• Maintain a regular wake time, even on days off work and on weekends
• Try to go to bed only when you are drowsy
• If you are not drowsy and are unable to fall asleep for about 20 minutes, leave your bedroom and engage in a quite activity elsewhere. Do not permit yourself to fall asleep outside the bedroom. Return to bed when, and only when, you are sleepy. Repeat this process as often as necessary throughout the night.
• Use your bedroom only for sleep, sex, and time of illness.
• Avoid napping during the daytime. If you nap, try not to do so at the same time every day and for no more than one hour. Mid-afternoon (no later than 3 p.m.) is best for most people.
• Establish relaxing pre-sleep rituals such as a warm bath, light bedtime snack, or ten minutes of reading.
• Exercise regularly. Confine vigorous exercise to early hours, at least six hours before bedtime, and do mild exercise at least four hours prior to bedtime.
• Keep a regular schedule. Regular times for meals, medications, chores, and other activities help keep the inner clock running smoothly.
• While a light snack before bedtime can help promote sound sleep, avoid large meals.
• Avoid ingestion of caffeine within six hours of bedtime.
• Don't drink alcohol when sleepy. Even a small dose of alcohol can have a potent effect when combined with tiredness.
• Avoid the use of nicotine close to bedtime or during the night.
• Sleeping pills should be used only conservatively. Most doctors avoid prescribing sleeping pills for periods longer than three weeks.
• Do not drink alcohol while taking sleeping pills or other medications.

The Sleep Quiz* *Information from the American Academy of Sleep Medicine

Read the statements below. Choose TRUE or FALSE.

1. I feel sleepy during the day, even when I get a good night's sleep.
   TRUE FALSE
2. I get very irritable when I can't sleep.
   TRUE FALSE
3. I often wake up at night and have trouble falling back asleep.
   TRUE FALSE
4. It usually takes me a long time to fall asleep.
   TRUE FALSE
5. I often wake up very early and can't fall back to sleep.
   TRUE FALSE
6. I usually fell achy and stiff when I wake up in the morning.
   TRUE FALSE
7. I often seem to wake up because of dreams.
   TRUE FALSE
8. I sometimes wake up gasping for breath.
   TRUE FALSE
9. My bed partner says my snoring keeps her/him from sleeping.
   TRUE FALSE
10. I've fallen asleep driving.
    TRUE FALSE