What Are The Most Common Sleeping Problems?
The 2 largest groups of patients seen are those with insomnia and excessive daytime sleepiness.
The most common causes of insomnia are related to high arousal states at night, so one is unable to fall asleep even when feeling tired at night. This can happen because of poorly managed stress, mentally stimulating activities late into the night (eg. working, arguments, exercise), stimulants such as caffeine or smoking, or disease states like depression and anxiety.
Excessive daytime sleepiness is most often due to not getting enough sleep at night, which if not voluntary, is commonly due to obstructive sleep apnoea, which causes sleep fragmentation due to recurrent awakenings and prevents the patient from entering deep sleep which is most restorative. [top]
When Should You Do With Patients With A Sleep Problem?
Many sleep problems can be diagnosed with a comprehensive sleep history. Lifestyle factors contributing to poor sleep such as excessive caffeine use, late-night exercise or eating and poorly managed stress should be identified. All patients with insomnia should be screened for depression and treated accordingly, with questionnaires such as the Beck Depression Inventory as useful time-saving tools. The best long term outcomes for conditioned insomnia result from good sleep hygiene instruction and behavioural modification techniques eg. relaxation therapy. Sleeping pills are only recommended for short term relief (should not exceed 2-4 weeks) while patients are learning to implement good sleep practices.
In patients who have excessive daytime sleepiness or recurrent awakenings of unclear cause, a sleep study should be considered to rule out sleep apnoea and other causes of arousal. Difficult cases of chronic insomnia or daytime sleepiness, patients needing a sleep study, or patients with dependence on sleeping pills should be referred to specialist Sleep Disorders clinics. [top]
What Is A Sleep Study And When Is A Sleep Study Indicated?
A sleep study involves staying overnight in the sleep laboratory and being hooked up to a machine which is monitored by sleep technologists. Sleep patterns can be studied in the laboratory using machines which record brainwave activity, breathing, heart rate and limb movements during sleep. At least 6 hours of sleep are recorded using electrodes attached to the scalp and limbs, special belts across the chest and abdomen, airflow monitors and ECG leads.
A sleep study is usually indicated in patients in whom sleep related breathing disorders and abnormal movements in sleep are suspected, to rule out sleep apnoea and nocturnal seizures. Patients with recurrent awakenings of unclear cause should also undergo a sleep study to determine the cause of the repeated arousals.
[top][back][more] |
