Sleep Disorders

What is Insomnia?

Insomnia is characterized by a difficulty to fall asleep, o by waking up during the night and having trouble falling back to sleep. Often there is the feeling of non-remedial sleep, of poor quality, with daytime fatigue. Other long term consequences of insomnia are irritability, difficulty to concentrate, memory problems, depression and more.

Why do some people suffer from insomnia?

Insomnia has many causes, some of them being psychiatric such as anxiety, depression, long term use of some drugs or alcohol; in case of the latter, especially after consumption is halted.  It may be associated with other sleep disorders which facilitate its interruption, favoring being awake. Primary insomnia, the most common form, is found mainly in women, but can also occur in men. This type of insomnia is characterized by an abnormal response to stress, such as losses, financial problems, sickness or even living with a partner, changes, work promotions and more. The victim will also present trouble sleeping at night or during the day (which is not advised), and this is often associated to intense mental activity, with a greater influx of thoughts.  

Many times insomnia can worsen or be caused by inadequate habits we pick up during life. It is usually a group of factors that cause trouble sleeping, associated with a propensity for insomnia. Those who suffer from insomnia often have family members with the same problem.

How do physical diseases cause insomnia?

Currently breathing problems during sleep are frequent causes of poor quality sleep. This situation can cause small breathing pauses, known as apneas, which culminate in quick awakenings. Since these patients may suffer from many apneas and, as a result, many awakenings, they may think they are sleeping for many hours, but still Wake up tired and feel sleepy during the day. Diseases that cause pain, particularly during the night, may also cause insomnia. There is a clinical condition called fibromyalgia, mostly found in women, and that cause pain in certain parts of the body. Other physical diseases such as hormonal disorders, hyper and hypothyroidism, psychiatric and neurological diseases such as anxiety and depression, Parkinson’s, ischemic brain diseases and Alzheimer’s may also cause insomnia.

How is insomnia treated?

Insomnia treatment begins after the correct diagnosis, identification and approach of its cause when detected. In general, medical prescriptions that help sleep and do not cause chemical dependence; along with behavioral and cognitive measures, is the best form of treatment. Doctors and healthcare professionals such as psychologists and social workers may help people with insomnia and recognize its symptoms, their often inappropriate habits and, through special techniques, provide a better quality of life and sleep.

What is Apnea?

Apnea/hypopnea is the interruption/lowering of air flow (breathing), which may lead to low blood oxygen levels and awakenings.

Obstructive Sleep Apnea (OSA) is the most common, and is usually marked by pauses in breathing that last over 10 seconds and are considered abnormal once they become more frequent than 5 times per hour of sleep. OSA is a disorder that can be caused by anatomical alterations and by the lowered activity of the dilator muscles of the pharynx (upper airway, behind the tongue).

In children OSA is different than in adults. In general, there are anatomical alterations such as the growth of the adenoids and tonsil, and those can be corrected. In adults, the anatomical alterations may not be so easy to locate and neuromuscular factors can have an important role, as well as aging. Obesity greatly aggravates the clinical picture of OSA. These alterations lead to the narrowing of the upper airway and cause apnea, or pauses in breathing.

The most common symptoms of OSA are: loud snoring, with intermittent pauses in breathing during sleep (seen by those who live with the afflicted person) and daytime hypersomnia. Restless sleep, higher urge to urinate during the night, memory and thought alterations and sexual impotence may also occur.

How is apnea treated?

There are various methods that can be applied in the treatment of apnea, varying by case:  

  1. Sleep hygiene and loss of weight
  2. CPAP equipment
  3. Treatment with intra-oral equipment
  4. Surgery

What is narcolepsy?

Narcolepsy is a disorder marked by daytime sleepiness, with bouts of sleep, cataplexy and alterations in REM sleep. It occurs in about 0,02 to 0,18% of the population of the USA, Europe and Japan; in Brazil there is still no study for this. This means roughly 1 in every 2000 people are afflicted, which is not a very low rate. Narcolepsy is still not often diagnosed. Cataplexy is the only specific symptom of narcolepsy, mas it may not be present in all cases.

Genetic factors affect the occurrence of narcolepsy.

Although most cases are sporadic and don’t occur in the Family, the risk of a direct family member of a patient with narcolepsy to have the same disorder is 40 times higher than in general.

Human narcolepsy is caused primarily by a deficiency of the protein hypocretin in the brain.

How is narcolepsy treated?

Narcolepsy is a disease that is benign in a way, however treatment is long term. The drugs used to treat narcolepsy can be central nervous system stimulants and tricyclic antidepressants if needed in case of cataplexy. The treatment will control the symptoms, especially the sleep attacks and the cataplexy (loss of muscle tone), by administering drugs which allow the patients to maintain their normal professional and social activities.

Parallel to treatment, it is recommended that a few voluntary naps be taken during the day to reduce daytime sleepiness.

During treatment, the patient must not engage in risk activities. Such as driving or handling equipment that demands constant attention.

What is bruxism?

Bruxism is a disorder characterized by grinding or pressing the teeth (as in chewing) during sleep. Its cause is still not entirely known, however, during bruxism, the force applied to the teeth and musculature of the mouth is excessive and causes muscular and dental symptoms such as: facial pain, muscular discomfort while chewing, headaches, abrasion of the teeth and damage to the gums. A typical sign is the wearing down of the teeth enamel. For this reason, bruxism is generally detected by a dentist.

How is bruxism treated?

Many treatments are being studied, but for now, it is usually recommended to use an oral appliance, made of acrylic resin, called occlusal splint. This type of treatment provides a stable joint position, protecting the teeth and their support structures (gums, jaw, etc.).

What is somnambulism?

Just as with sleep terrors, somnambulism normally occurs in childhood. It can be identified by talking, sitting up or even walking through the bedroom or even the whole house. Safety measures to ensure no serious accidents happen to the child or adult are necessary.

How is somnambulism treated?

Normally treatment is not necessary, since usually somnambulism disappears with age. In case the episodes become frequent and serious, medication must be used.

What is restless leg syndrome (RLS)?

It is an irresistible urge to move the legs, which alleviates an unpleasant sensation in the lower limbs. Such symptoms occur during the night, before sleep, and many times end up interrupting or preventing sleep, leading to insomnia. Treatment is drug based. If the patient suspects there is a problem, they must see a Sleep Medicine doctor.

What is Periodic Leg Movements (PLM)?

They are usually movements of small amplitude, such as flexing the feet or legs. The least from 0,5 to 5 seconds, and happen once every 20 or 40 seconds. They may be followed by brief awakenings in the elderly. When they cause symptoms to occur during the day they must be treated. Treatment is also mainly drug based. The diagnosis requires a polysomnography. Both RLS and PLM can occur more often in the family.

Problems arising from PLM

11% of patients suffer insomnia
17% have hypersomnia
11% report fatigue, stress, etc.

Our Centers

Marselhesa - Private and Insured Polysomnography

Rua Marselhesa, 500 - São Paulo - + 55 11 5908-7222

Napoleão - Clinic and Research

Rua Napoleão de Barros, 925 - São Paulo - + 55 11 2149-0188

Clínica do Sono - Private Appointments

Rua Marselhesa, 500 - São Paulo - + 55 11 2108-7666

Desenvolvido por Spinola comunicação Integrada