Primary snoring is characterized by loud upper airway sounds during sleep. As much as 60% of the population snores at one
time or another and the prevalence increases with age. Although primary snoring is not life threatening, it can be
considered a social nuisance. In recent polls conducted by the National Sleep Foundation, 31% of Americans take measures
to deal with their partner's snoring on a regular basis. These include sleeping in another room or using earplugs to block
the noise. Many treatments are available for snoring, including nasal strips, throat sprays, prescription nose medications,
mouth guards and various surgical procedures aimed at reducing the amount of tissue at the back of the throat.
Obstructive Sleep Apnea (OSA) is characterized by the recurrent collapse of the upper airway at the level of the soft
palate and tongue during sleep. Obesity, facial deformities and enlarged upper airway structures can contribute to the
airway's collapse. Apneas are associated with oxygen deprivation and can cause cardiac arrhythmias, or irregular heart
beats, during sleep. Although generally unnoticed by the sleeper, apneas cause repetitive and brief arousals, leading
to poor sleep quality and daytime sleepiness. Patients suffering from OSA may experience difficulty with concentration
or memory, poor mood control, impotence or feelings of depression. They may also suffer from hypertension (high blood
pressure), heart failure or abnormal heartbeats. If left untreated, OSA can increase the risk for sudden heart attack
or stroke by as much as 60%. The good news is OSA is a very treatable condition. Treatment options can range from
Continuous Positive Airway Pressure (CPAP) to surgery to dental implants.
A careful sleep history and an overnight sleep study are used to distinguish primary snoring from OSA.
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Insomnia can mean difficulty falling asleep, difficulty staying asleep, waking up too early, or sleep that is chronically
non-restorative or of poor quality. According to the National Sleep Foundation, about one-half of America’s adults say
they frequently experience at least one symptom of insomnia. Insomnia is characterized as being acute, chronic, or primary.
Acute insomnia lasts less than one month. Chronic insomnia occurs consistently for one month or longer and is likely to be
associated with an underlying medical or psychological condition. Primary insomnia is often lifelong and occurs without an
underlying cause. When acute insomnia is not addressed, poor sleep can become a habit. The insomniac continually expects
that he or she will have difficulty sleeping, a vicious cycle occurs, and insomnia can become long term.
There are pharmacological and behavioral treatments for insomnia and these two approaches are often combined. For acute
or chronic insomnia, a sleep specialist will determine if there is an underlying problem and treat this condition first.
Behavioral treatments include stimulus control, sleep restriction, cognitive behavioral therapy and relaxation training.
Pharmacological treatments for insomnia include over-the-counter (OTC) medications and prescription hypnotics. OTCs are
usually antihistamines and have ingredients that may leave a person feeling groggy and less alert in the morning. They
stay in the body longer and side effects may include headaches, nausea, reduced reaction times and dizziness. The Food
and Drug Administration (FDA) has approved many sleep promoting medications, called hypnotics. These sleep medications
are effective with fewer side effects than other sleeping medications, and are usually prescribed for short periods of time.
A careful sleep history, including a review of current medications, and sometimes an overnight sleep study are used to
determine the cause of insomnia.
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Restless Legs Syndrome (RLS) is a neurological movement disorder, and is often referred to as the most common medical
problem ever heard of. It affects an estimated 12 million adults, usually those in middle age, but it may first appear
in children as growing pains. It is more prevalent in women than men, often first appearing during pregnancy. The National
Sleep Foundation found 17% of adults, ages 55-84, reported symptoms of RLS, which include unpleasant feelings in the legs
and an urge to move them. These unpleasant feelings are often described as tingling, pulling,, creeping or nervousness in
the limbs and are more prevalent in the evening and at night, resulting in disrupted sleep. Family history accounts for
approximately one-half of those diagnosed. Anemia, or low iron levels, has also been found to be contributors.
Many RLS sufferers also experience Periodic Limb Movement Disorder (PLMD) during the night. PLMD is characterized by
periodic jerking or kicking of the legs making it difficult to fall and stay asleep. This results in sleep deprivation
and daytime sleepiness for the individual, and also disturbs the sleep of a bed partner.
A detailed sleep history, certain blood tests, and sometimes an overnight sleep study, are required to diagnose RLS and PLMD.
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Narcolepsy affects approximately one in 2000 people, and its cause is unknown at this time. Onset occurs mostly between
the ages of 15 and 25 years. The primary symptom is excessive daytime sleepiness with uncontrollable urges to sleep. Other
symptoms vary among individuals, but can include cataplexy (episodes of muscle weakness during intense emotions), sleep
paralysis (brief paralysis at sleep onset or awakening), and/or hypnogogic hallucinations (dreams that continue into
wakefulness). Untreated, narcolepsy can severely impair many areas of an individual's functioning, including the ability
to safely operate a car or maintain employment.
A careful sleep history including a review of current medications, an overnight sleep study and a daytime nap study are
required to diagnose narcolepsy.
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Circadian rhythm sleep disorders are those that are related to the timing of sleep within the 24-hour day. They can
include Delayed Sleep Phase Syndrome, Advanced Sleep Phase Syndrome and Shift Work Sleep Disorder.
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is marked by sleep onset and wake times that are later than desired in order to fulfill social and work obligations.
Typically DSPS patients are frustrated by their attempts to fall asleep and arise earlier. They are considered night
people, preferring to stay up later, and sleep in, in the morning. Very often, medication has little to no effect in
aiding sleep onset, and may aggravate the daytime symptoms of sleepiness and difficulty awakening.
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is a disorder characterized by the inability to delay sleep onset and final morning awakening. Although a mild degree of
ASPS may be a normal part of aging, frustration may occur at the difficulty remaining awake in the evening and the early
morning insomnia that accompany this disorder.
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can be very challenging as shift work requires sleep in the daytime, when our natural instinct is to remain awake. The
day sleeper may experience sleep onset insomnia, difficulty remaining asleep, complaints of un-refreshing sleep and
difficulty remaining awake during their work shift.
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Nightmares are frightening dreams that usually awaken the sleeper during REM sleep. Night terrors are characterized by
sudden arousal from slow wave sleep with a piercing scream or cry, followed by manifestations of intense fear and a
temporary inability to regain full consciousness. The person is usually inconsolable, and will not remember the event
in the morning.
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Sleepwalking consists of a series of complex behaviors that are initiated during slow wave sleep and result in walking
during sleep. There may be difficulty in arousing the patient during a sleepwalking episode and amnesia afterward is common.
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During REM sleep a person is paralyzed except for the eyes and breathing muscles. This is called atonia. In REM Behavior
Disorder (RBD) muscle atonia does not occur and the sleeper is free to exhibit elaborate motor activity associated with
dreaming. These behaviors may be violent or injurious to the sleeper and may disrupt sleep continuity.
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Bruxism is a movement disorder characterized by grinding or clenching of the teeth during sleep. Bruxism may cause abnormal
wear of the teeth or jaw muscle discomfort. Bruxism may increase in severity during times of stress or when another sleep
disorder such as Obstructive Sleep Apnea (OSA) is present.
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Bedwetting or sleep enuresis is the recurrent and involuntary voiding of urine during sleep. Bedwetting can be associated
with other medical conditions such as diabetes, urinary tract infection or epilepsy. These conditions need to be properly
treated before other treatments for bedwetting can be explored.
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Diabetes can cause frequent awakenings and disrupted sleep. Many diabetics have the urge to urinate several times
throughout the night. They may also suffer from Restless Legs Syndrome (RLS) or Periodic Limb Movement Disorder (PLMD).
Diabetes can contribute to obesity, which is one of the contributing factors in Obstructive Sleep Apnea (OSA).
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Sleep-related gastroesophageal reflux is characterized by regurgitation of stomach contents into the esophagus during
sleep. The sleeper may experience episodes of chest discomfort or burning and may complain of frequent awakenings.
Other symptoms may include a sour or bitter taste in the mouth, coughing, choking or heartburn.
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Depression is a mood disorder that can contribute to insomnia, and less frequently, excessive sleepiness. Generally,
the insomnia or excessive sleepiness will improve once the depression if treated. Depression can also be a symptom of
sleep deprivation caused by Obstructive Sleep Apnea (OSA).
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Sleep disturbance associated with anxiety is characterized by a sleep onset or maintenance insomnia due to excessive
anxiety about one or more life circumstance. The insomnia can become chronic if proper behavioral modification is not
introduced.
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Parkinsonism refers to a group of neurological disorders with symptoms of diminished muscular activity (hypokinesia),
tremor and muscular rigidity. Insomnia is the most common complaint from patients with the disorder.
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