In Principles and Practice of Sleep Medicine, 3rd edition (2000), the authors make a distinction between sleep-related eating disorder and nocturnal eating syndrome, “which was originally described as a combination of insomnia and nocturnal binge eating with morning anorexia. Patients with nocturnal eating syndrome also have recurrent awakenings from sleep associated with inability to get back to sleep without eating. Patients are fully awake during these episodes and able to remember them the next day….” Sleep-related eating disorder usually begins in adulthood and is characterized by eating episodes which occur after sleep onset.
The condition is far more prevalent than previously thought, according to Mark Mahowald, MD, Director of the Minnesota Regional Sleep Disorders Center, and Carlos H. Schenck, MD, of the Department of Psychiatry at the University of Minnesota Medical School in Minneapolis.
In an article published in NSF’s Sleep Medicine Review (January 1994), they identified the effects of the disorder, including:
– weight gain (or failure to lose weight when dieting);
– fear of choking while eating during sleep;
– fear of injury from starting fires or while preparing foods during sleep;
– sleep disruption; and
– a feeling of loss of control.
However, the primary symptom is almost nightly eating after falling asleep. Patients may try to avoid sleep-eating by locking the refrigerator or the bedroom door, paying someone to sleep in the kitchen, or placing derogatory signs on the refrigerator—all to no avail.
Who has sleep-related eating disorder?
Two-thirds of the patients are women, and the average age is 27 (although it is a behavior that usually begins in the late teens and early 20s). Almost three-fourths eat nightly—some up to eight times a night. Most prefer high-calorie food, and 43% are overweight. A study shows that 84% are either completely unaware or only partially aware of their nighttime eating.
“I try not to focus on whether the person is fully awake, because it’s not that relevant,” says David N. Neubauer, MD, Associate Director of the Johns Hopkins Sleep Disorder Center at the Johns Hopkins University School of Medicine. “And whether they remember eating or not isn’t really an important distinction. What is important is that they are highly driven, that the behavior happens almost every night, and it usually begins about an hour after going to sleep.”
What causes sleep-related eating disorder?
Sometimes it is induced by a medication such as amitriptyline (a sedating anti-depressant) or zolpidem (a sedative medication), but other primary sleep disorders such as obstructive sleep apnea or periodic limb movement disorders may trigger the sleepwalking and sleep-eating. The most current research indicates it isn’t connected with daytime eating disorders such as anorexia nervosa or bulimia. In most cases, it doesn’t seem to be caused by hunger, since eating prior to bedtime often doesn’t prevent sleep-eating. “This is not primarily an eating disorder,” says Dr. Neubauer. “This is mostly a sleep disorder.”
“In some cases there were apparent triggering events such as encephalitis, auto-immune hepatitis, narcolepsy, cessation of drug/alcohol abuse or smoking or stress,” wrote Mahowald and Schenck, “Slightly more than one half of one large series of patients reported a past history of repeated emotional, physical or sexual abuse beginning during childhood.” However, they noted that while many patients have either a mood or anxiety disorder, there was no direct association between the psychiatric condition and the sleep-eating. Dr. Neubauer adds that the disorder seems to be a relative of non-REM parasomnias—arousal disorders such as sleep terrors or sleep walking.
What is the treatment for sleep-related eating disorder?
A number of medicines have been tried to treat these disorders, including dopaminergic agents, anti-convulsants, anti-depressants, and opiates. However, Dr. Neubauer is optimistic about finding an effective treatment. “There are several reports in the literature of a wide variety of medications and also several behavioral and psychotherapeutic strategies,” he says. “Success has been limited with all of these in certain patients; however, there is not yet a consensus of a particular treatment approach being effective for a majority of people.
“I believe there is a lot of potential in behavioral/psychotherapeutic interventions, perhaps in combination with medication. This is a fascinating sleep disorder, and I’m hopeful there will be further research.”
If you answer yes to any of the questions listed below, you may have chronic fatigue syndrome (CFS), which is also called chronic fatigue immune dysfunction syndrome (CFIDS).
Have you been tired (fatigued) for a long time–more than 6 months–even though you are getting enough rest and are not working too hard?
Has your doctor been unable to find illnesses that could explain your symptoms?
Are you able to do less than half of what you used to do because you feel tired?
Have you had problems that keep coming back or don’t go away for 6 months or more with four or more of the following signs and symptoms?
Tender or painful lymph nodes in neck or armpits
Unexplained muscle soreness
Pain that moves from joint to joint but doesn’t include redness or swelling
Headaches that are different from the kind you usually get or headaches that make your whole head hurt
Trouble with short-term memory or concentration
Feeling tired for more than 24 hours after exercise that didn’t bother you before
People with CFS may have other symptoms as well.
What causes chronic fatigue syndrome?
No one is certain about what causes CFS. The symptoms may be caused by an immune system that isn’t working well. Or they may be caused by some kind of virus. Researchers are looking for the cause of CFS.
How is chronic fatigue syndrome treated?
The first step is to see if there is a medical cause for your fatigue. Your doctor will probably want to review your symptoms and medical history, and give you a physical exam. Your doctor may also want to do some blood tests, but lab testing is not often helpful.
Some of the symptoms, such as muscle aches, sleep problems, anxiety and depression, can be treated with medicine. The medicine can only reduce your symptoms and allow you to be more active, not cure the fatigue. So far, there is no medicine that cures the entire syndrome. Most symptoms improve with time.
How can I help myself?
Keep a daily diary to identify times when you have the most energy. Plan your activities for these times.
Keep up some level of activity and exercise, within your abilities. Your doctor can help you plan an exercise program to maintain your strength at whatever level is possible. Exercise can help your body and mind.
Give yourself permission to recognize and express your feelings, such as sadness, anger and frustration. You need to grieve for the energy you have lost.
Ask for support from family and friends. Look for support groups or counseling in your community. Your doctor is another important source of help. Emotional support is important in coping with a chronic health problem.
If your memory and concentration are affected by chronic fatigue, keep lists and make notes to remind yourself of important things. Also, give yourself more time for activities that take concentration. Medicine may also help you sleep better, which might improve your memory and concentration.
How can my doctor help?
Your doctor can work with you to provide symptom relief and to help you find ways of coping with the way CFS changes your life. Chronic fatigue affects you physically, emotionally and socially. When you address all of these factors, you have the best chance of adjusting to your illness and feeling more satisfied with your life.
If you have CFS, a good long-term relationship with your doctor helps. This relationship can be the key to helping you feel less frustrated.
Bruxism is the technical term for grinding and clenching that abrades teeth and may cause facial pain. People who grind and clench, called bruxers, unintentionally bite down too hard at inappropriate times, such as in their sleep. In addition to grinding teeth, bruxers also may bite their fingernails, pencils and chew the inside of their cheek. People usually aren’t diagnosed with bruxism until it is too late because so many people don’t realize they have the habit. Others mistakenly believe that their teeth must touch at all times. About one in three people suffer from bruxism, which can easily be treated by a dentist.
Can bruxism cause harm?
People who have otherwise healthy teeth and gums can clench so often and so hard that over time their teeth become sensitive. They experience jaw pain, tense muscles and headaches along with excessive wear on their teeth. Forceful biting when not eating may cause the jaw to move out of proper balance.
What are the signs?
When a person has bruxism, the tips of the teeth look flat. Teeth are worn down so much that the enamel is rubbed off, exposing the inside of the tooth, which is called dentin. When exposed, dentin may become sensitive. Bruxers may experience pain in their temporomandibular joint (TMJ)-the jaw-which may manifest itself as popping and clicking. Women have a higher prevalence of bruxism possibly because they are more likely to experience tissue alterations in the jaw resulting from clenching and grinding. Tongue indentations are another sign of clenching.
Stress and certain personality types are at the root of bruxism. For as long as humankind has existed, bruxism has affected people with nervous tension. Anger, pain and frustration can trigger bruxing. People who are aggressive, competitive and hurried also may be at a greater risk for bruxism.
What can be done about it?
During regular dental visits, the dentist automatically checks for physical signs of bruxism. If the dentist or patient notices signs of bruxism, the condition may be observed over several visits to be sure of the problem before recommending and starting therapy.
The objective of therapy is to get the bruxer to change behavior by learning how to rest the tongue, teeth and lips properly. When some people become aware of their problem, simply advising them to rest their tongue upward with teeth apart and lips shut may be enough to change their behavior and relieve discomfort. However, the dentist can make a plastic mouth appliance, such as a night guard that’s worn to absorb the force of biting. This appliance can prevent future damage to the teeth and helps change the patient’s destructive behavior.
Biofeedback is used to treat daytime clenchers by using electronic instruments to measure muscle activity and to teach patients how to reduce muscle activity when the biting force becomes too great. Researchers are looking for other ways of treating bruxism, especially for those who tend to clench in their sleep. One researcher developed an experimental lip simulator that electrically stimulates the lip when a person bites down too hard while sleeping. However, that method is being refined because the stimulation can wake sleepers several times in a night.
Nightmares are scary dreams. Most children have them from time to time. One out of every 4 children has nightmares more than once a week. Most nightmares happen very late in the sleep period (usually between 4 a.m. and 6 a.m.). Your child may wake up and come to you for comfort. Usually, he or she will be able to tell you what happened in the dream and why it was scary. Your child may have trouble going back to sleep. Your child might have the same dream again on other nights.
What are night terrors?
Some children have a different kind of scary dream called a “night terror.” Night terrors happen during deep sleep (usually between 1 a.m. and 3 a.m.). A child having a night terror will often wake up screaming. He or she may be sweating and breathing fast. Your child’s pupils (the black center of the eye) may look larger than normal. At this point, your child may still be asleep, with open eyes. He or she will be confused and might not answer when you ask what’s wrong. Your child may be difficult to wake. When your child wakes, he or she usually won’t remember what happened.
Will my child keep having nightmares or night terrors?
Nightmares and night terrors don’t happen as much as children get older. Often, nightmares and night terrors stop completely when your child is a teenager. Some people, especially people who are imaginative and creative, may keep having nightmares when they are adults.
When should I worry about nightmares or night terrors?
Nightmares and night terrors in children are usually not caused by mental or physical illness. Often nightmares happen after a stressful physical or emotional event. In the first 6 months after the event, a child might have nightmares while he or she gets used to what happened in the event. If nightmares keep happening and disturb your child’s sleep, they can affect your child’s ability to function during the day. Talk with your doctor about whether treatment will help your child.
What should I do?
Night terrors and sleepwalking require that you protect your child during sleep. Be sure your home is safe (use toddler gates on staircases and don’t use bunk beds for children who have nightmares or night terrors often). Talk with your doctor if your child ever gets hurt while sleeping. Your doctor may want to study your child during sleep.
Parasomnia, which means “around sleep,” includes sleepwalking, night terrors, bedwetting, and narcolepsy. All can create family difficulties, and some may be harmful to the child.
They are a group of acute, undesirable, episodic physical phenomena that usually occur during sleep, or are exaggerated by sleep. Even though parasomnias occur during different stages of sleep and at different times during the night they are characterized by partial arousals before, during, or after the event. Most parasomnias are precipitated or perpetuated by stress, and an interaction between biological and psychological factors is presumed in many cases.
Disoriented arousals, though sometimes occur in adults, are more commonly seen in infants and children. These arousals may begin with yelling or crying and violently moving around in bed. The sleeper seems to be alert and upset, but may resist any attempt to be comforted. In most cases, awakening a person who is experiencing a parasomnia can be very difficult. Disoriented arousals can last any where from a few minutes to half-an-hour. After the agitation ceases, the sleeper may awaken for a short time and then return to sleep.
During sleep walking vision seems to remain intact; coordination of the central nervous system is maintained to some extent, although accidental injuries have been reported (see photograph). An episode can last from minutes to an hour. More than one episode a night is rare, as is the likelihood of complex manoeuvres.
Night terrors usually start with a terrifying scream, increased heart and breathing rates, sweating and a frightened expression. They last from one to several minutes, and should be distinguished from nightmares. Nightmares are parasomnias associated with REM sleep and occur during the middle and last third of sleep, when REM periods are more abundant and intense; patients arouse easily and quickly. In contrast to nightmares, which are frightening dreams with vivid recall, patients rarely remember specific details of a night terror.
Hypnagogic Hallucinations and Sleep Paralysis
Hypnagogic hallucinations are brief periods of dreaming while between the stages of sleep and consciousness. These dreams can be frightening and can often cause a sudden jerk and arousal just before sleep onset. For example, you may see yourself falling and awaken with a sudden jerk, just before impact.
Sleep paralysis is the sensation of feeling paralyzed upon awakening, usually immediately following a dream. This is commonly associated with the loss of muscle tone during dreams, called atony. This loss of muscle tone during the dreaming stage, prevents one from acting out his or her dreams. Hypnagogic hallucinations and sleep paralysis can occur together. Although commonly seen in people with narcolepsy, they can also affect others, especially those individuals who are sleep-deprived. While they can be frightening, these events are not physically dangerous and usually last only a few minutes.
Many childhood sleep disorders are actually types of parasomnia. Somnambulism, night terrors, bedwetting, talking while asleep, and body rocking are much more common in children than they are in adults. Most children outgrow these problems before adolescence. Parents may note an increase in frequency or intensity when their child is ill, under stress, or taking certain medications.
Nocturnal seizures occur during sleep and are commonly diagnosed by undergoing a overnight sleep study (PSG). They can cause the sleeper to cry, scream, walk, move about and or curse. These seizures can be treated with medications.
REM Behavior Disorder
REM Behavior Disorder is the ability to act out your dreams. The obvious problem with acting out your dreams, is the potential to cause injury. All body muscles, with the exception of those used in breathing are usually paralyzed during REM (dreaming) sleep. In some cases this paralysis is incomplete or absent, thus allowing dreams to be acted out. Behavior such as this can be violent and result in serious injuries to the victim and bed-partner. After awakening the sleeper will usually be able to recall vivid dreaming. Medication is used to treat this disorder.
Grinding Your Teeth
Grinding of the teeth during sleep or bruxism, is a very common occurrence and little evidence suggests that it is associated with other medical or psychological problems. In some cases oral appliances are used to reduce dental injury. For an example see the bottom portion of OSA.
Rhythmic-movement disorder is seen most often in younger children, yet can also occur in adults. The movements usually consist of recurrent headbanging, headrolling and body rocking. The individual may also moan or hum during these movements. Other rhythmic disorders include shuttling (rocking back and forth on hands and knees) and folding (raising the torso and knees simultaneously). Typically these movements will occur just before sleep begins or during sleep. Medical or psychological problems are unlikely to be associated with this disorder. Behavioral treatments may be effective in some cases, the majority of children will eventually grow out of it.
Sleepwalking is a disorder in which a child partly, but not completely, awakens during the night. The child may walk or do other things without any memory of doing so.
What are the symptoms of sleepwalking?
The child may sit up in bed and repeat certain movements, such as rubbing his or her eyes or fumbling with clothes. The child may get out of bed and walk around the room. The child may look dazed, and his or her movements may be clumsy. When you talk to your child, he or she usually will not answer you.
What should I do if my child sleepwalks?
The most important thing you can do is prevent injury by removing dangerous objects from areas that your child might reach. You should keep doors and windows closed and locked. This is especially important if you live in an apartment. If necessary, your child may have to sleep on the ground floor of your home.
When you find your child sleepwalking, you should gently guide your child back to bed. You shouldn’t yell or make a loud noise to wake your child up. You shouldn’t shake your child. Finally, you should never make your child feel ashamed about sleepwalking.
Should I worry if my child sleepwalks?
No. Most children who sleepwalk don’t have emotional problems.
What happens to children who sleepwalk?
Most children outgrow sleepwalking. If your child sleepwalks for a long time, talk to your doctor. Your doctor may want to look at the problem more closely. Some medicines can be used to treat sleepwalking.
For most people, dreams are purely a “mental” activity: they occur in the mind while the body is at rest. But people who suffer from REM behavior disorder (RBD) act out their dreams. They physically move limbs or even get up and engage in activities associated with waking. Some talk, shout, scream, hit, punch, or fly out of bed while sleeping! RBD is usually noticed when it causes danger to the sleeping person, their bed partner, or others they encounter. Sometimes ill effects such as injury to self or bed partner sustained while asleep trigger a diagnosis of RBD. The good news is that RBD can usually be treated successfully.
Why Does RBD Occur?
What we call “sleep” involves transitions between three different states: wakefulness, rapid eye movement (REM) sleep, which is associated with dreaming, and non rapid eye movement (N-REM) sleep. There are a variety of characteristics that define each state, but to understand REM Behavior Disorder it is important to know that it occurs during REM sleep. During this state, the electrical activity of the brain, as recorded by an electroencephalogram, looks similar to the electrical activity that occurs during waking. Although neurons in the brain during REM sleep are functioning much as they do during waking, REM sleep is also characterized by temporary muscle paralysis.
In some sleep disorders such as narcolepsy and parasomnias, like REM behavior disorder, the distinctions between these different states breaks down; characteristics of one state carry over or “invade” the others. Sleep researchers believe that neurological “barriers” that separate the states don’t function properly, though the cause of such occurrences is not entirely understood.
Thus, for most people, even when they are having vivid dreams in which they imagine they are active, their bodies are still. But, persons with RBD lack this muscle paralysis, which permits them to act out dramatic and/or violent dreams during the REM stage of sleep. Sometimes they begin by talking, twitching and jerking during dreaming for years before they fully act out their REM dreams.
In the course of “acting out their dreams,” people with RBD move their arms and legs in bed or talk in their sleep, or they might get out of bed and move around without waking or realizing they’re dreaming. The only sensations the sleeper experiences are what is occurring in their dream. And many of these dreams can be violent or frightening, causing injury to the sleeper and his bed partner.
Who has RBD?
Drs. Mahowald and Schenck and others have found that more than 90% of RBD patients are male, and that the disorder usually strikes after the age of 50, although some patients are as young as nine years old. Most RBD patients are placid and good-natured when awake; however, many of them display rhythmic movements in their legs during non-REM and slow-wave sleep.
A telephone survey of more than 4,900 individuals between the ages of 15 and 100 indicated that about two percent of those surveyed experience violent behaviors during sleep; Mahowald and Schenck estimate that one-quarter of them were probably due to RBD, which means it may be experienced by 0.5% of the population.
What causes RBD?
Studies of animals may explain REM behavior disorder. Animals who have suffered lesions in the brain stem have exhibited symptoms similar to RBD. Cats with lesions affecting the part of the brain stem that involves the inhibition of locomotor activity will have motor activity during REM sleep: they will arch their backs, hiss and bare their teeth for no reason, while their brain waves register normal REM sleep.
“REM behavior disorder underscores the importance of basic science research in animals,” says Mahowald, “because without the information obtained in basic science animal research, the disorder could never have been identified. Sleep is such a young field that we have the opportunity to take advantage of the fact that there is a close collaboration between basic science and clinicians.”
How is RBD diagnosed?
Because a number of parasomnias may be confused with RBD, it is necessary to conduct formal sleep studies performed at sleep centers that are experienced in evaluating parasomnias in order to establish a diagnosis. In RBD, a single night of extensive monitoring of sleep, brain, and muscle activity will almost always reveal the lack of muscle paralysis during REM sleep, and it will also eliminate other causes of parasomnias.
How is RBD treated?
Clonazepam, a benzodiazapine, curtails or eliminates the disorder about 90% of the time. The advantage of the medication is that people don’t usually develop a tolerance for the drug, even over a period of years. When clonazepam doesn’t work, some antidepressants or melatonin may reduce the violent behavior. However, it’s a good idea to make the bedroom a safe environment, removing all sharp and breakable objects.
What other disorders are associated with RBD?
Drs. Schneck and Mahowald have conducted research indicating that 38% of 29 otherwise healthy patients with REM behavior disorder went on to develop a parkinsonian disorder, presumably Parkinson’s disease (PD), a degenerative neurological disease characterized by tremors, rigidity, lack of movement or loss of spontaneous movement, and problems with walking or posture. Other studies have found associations between RBD and other neurodegenerative diseases related to Parkinson’s. “We don’t know why RBD and PD are linked,” says Dr. Mahowald, “but there is an obvious relationship, as about 40% of individuals who present with RBD without any signs or symptoms of PD will eventually go on to develop PD.”
Should patients with RBD be concerned about developing Parkinson’s?
“People with RBD will understandably be concerned about the possibility of the later development of PD, given the statistics,” says Mahowald. “We are not aware of anything that can be done to prevent or delay the development of PD in those destined to do so. We recommend an annual evaluation by a neurologist, so if PD is going to develop, it can be detected and treated at the earliest possible time.
“Given the fact that the majority of patients with RBD who went on to develop PD were already taking clonazepam, it is unlikely that clonazepam will reduce the likelihood of developing PD in those so predisposed.”
Insomnia is the body’s way of saying that something isn’t right. Many things can cause insomnia — things like stress, too much caffeine, depression, changes in work shifts, and pain from medical problems, such as arthritis.
Many people have insomnia. People who have insomnia may not be able to fall asleep. They may wake up during the night and not be able to fall back asleep, or they may wake up too early in the morning.
Is insomnia a serious problem?
It’s not really a serious problem for your health, but it can make you feel tired, depressed and irritable. It can also make it hard to concentrate during the day.
How much sleep do I need?
Most adults need about 7 to 8 hours of sleep each night. You know you’re getting enough sleep if you don’t feel sleepy during the day. The amount of sleep you need stays about the same throughout adulthood. However, sleep patterns may change with age. For example, older people may sleep less at night and take naps during the day.
What can my doctor do to find out why I’m not sleeping?
Your family doctor may ask you and your bed partner some questions about your sleep habits (such as when you go to bed and when you get up), any medicine you take, and the amount of caffeine and alcohol you drink. Your doctor may also ask if you smoke. Other questions may include how long you’ve been having insomnia, if you have any pain (such as from arthritis), and if you snore while you sleep. Your doctor may also ask about events or problems in your life that may be upsetting you and making it hard for you to sleep.
What is a sleep diary?
If the cause of your insomnia is not clear, your doctor may suggest that you fill out a sleep diary. The diary will help you keep track of when you go to bed, how long you lie in bed before falling asleep, how often you wake during the night, when you get up in the morning and how well you sleep.
How is insomnia treated?
The treatment of insomnia can be simple. Often, once the problem that’s causing the insomnia is taken care of, the insomnia goes away. The key is to find out what’s causing the insomnia so that it can be dealt with directly. Simply making a few changes in their sleep habits helps many people.
What can I do to improve my sleep habits?
Tips to help you sleep – Here are some things you can do to help you sleep better:
1. Go to bed and wake up at the same time every day, including weekends, even if you didn’t get enough sleep. This will help train your body to sleep at night.
2. Develop a bedtime routine. Do the same thing every night before going to sleep. For example, take a warm bath and then read for 10 minutes every night before going to bed. Soon you’ll connect these activities with sleeping, and doing them will help make you sleepy.
3. Use the bedroom only for sleeping or having sex. Don’t eat, talk on the phone or watch TV while you’re in bed.
4. Make sure your bedroom is quiet and dark. If noise is a problem, use a fan to mask the noise or use ear plugs. If you must sleep during the day, hang dark blinds over the windows or wear an eye mask.
5. If you’re still awake after trying to fall asleep for 30 minutes, get up and go to another room. Sit quietly for about 20 minutes before going back to bed. Do this as many times as you need to until you can fall asleep.
6. Avoid or limit your use of caffeine (coffee, tea, sodas, chocolate), decongestants, alcohol and tobacco.
7. Exercise more often, but don’t exercise within a few hours before going to bed.
8. Learn to reduce or manage the stress in your life.
9. Don’t lie in bed worrying about things. Set aside another time just for worrying. For example, spend 30 minutes after dinner writing down what’s worrying you and what you can do about it.
10. Try eating a light snack before going to bed, but don’t eat too much right before bedtime. A glass of warm milk or some cheese and crackers may be all you need.
11. Don’t nap during the day if naps seem to make your insomnia worse.
Will sleeping pills help?
Sleeping pills can help in some cases, but they are not a cure for insomnia. They’re only a temporary form of relief. They’re best used for only a few days. Regular use can lead to rebound insomnia. This occurs when a person quits taking sleeping pills and his or her insomnia comes back.
Sleeping pills can be unsafe to use if you have certain health problems. Ask your doctor if sleeping pills would be helpful for you.
If you have restless legs syndrome (RLS), you may recognize these symptoms:
An urge to move the legs, often accompanied by uncomfortable sensations in the legs, usually described as a creeping or crawling feeling, but sometimes as a tingling, cramping, burning or just plain pain. Some patients have no definite sensation, except for the need to move. (The arms may also be affected, but that’s much less common.)
The need to move the legs to relieve the discomfort, by stretching or bending, rubbing the legs, tossing or turning in bed, or getting up and pacing the floor. Moving usually offers some temporary relief of symptoms.
A definite worsening of the discomfort when lying down, especially when you’re trying to fall asleep at night, or during other forms of inactivity, including just sitting.
A tendency to experience the most discomfort late in the day and at night.
Sleep disturbances are common with RLS and are a major effect. The sleep disturbances can range from mild to severe, but sleep problems are often the reason that people suffering from RLS seek a doctor’s help. If leg twitching or jerking is also present, a related disorder called periodic limb movements during sleep (PLMS) may be the cause. With PLMS, the leg movements may be severe enough to awaken you. In RLS, PLMS-like symptoms can sometimes occur during wakefulness, as well as in sleep.
How common is RLS?
According to the National Center on Sleep Disorders Research, “restless legs syndrome is a common, under diagnosed, and treatable condition.” Recent research suggests it affects about 10% of adults in North America and Europe with rates increasing with age. Lower prevalence has been found in India, Japan and Singapore, indicating that racial or ethnic factors are associated with RLS.
What causes RLS?
The cause of RLS is still unknown, but the symptoms tend to worsen over the years and become more severe in middle-to-old age. The fact that it occurs three to five times more frequently in first-degree relatives of people with RLS than in people without RLS suggests that heredity may be involved. Pregnancy or hormonal changes may temporarily worsen RLS symptoms. Some cases of RLS are associated with iron deficiency anemia or nerve damage in the legs due to diabetes, kidney problems, alcoholism and Parkinson’s disease. Stress, diet or other environmental factors may play a role for some people. All of these cases are said to be secondary RLS. If there is no family history of RLS and no associated condition causing the disorder, RLS is said to be idiopathic, meaning without a known cause.
Because RLS patients were found to respond positively to treatment with levodopa, scientists have been investigating whether RLS is caused by dopamine deficiency. Dopamine is a chemical found naturally in the central nervous system where it largely functions as a neurotransmitter.
RLS can begin at any age and many individuals with RLS can trace their symptoms back to childhood, when their symptoms may have been called “growing pains” or attributed to hyperactivity because they had difficulty sitting quietly.
Is RLS serious?
The symptoms of RLS can range anywhere from bothersome to incapacitating. Fluctuations in severity are common, and occasionally the symptoms may disappear for periods of time. Anxiety as bedtime approaches, frustration with nighttime awakenings, moodiness and depression, difficulty concentrating and excessive daytime sleepiness have all been reported in association with RLS. It also can affect marital, family and social relations as well as having an adverse effect on school, work or other activities. Another effect can be increased drowsiness while driving or great difficulty performing overnight shift work.
How is RLS diagnosed? Associated features commonly found in RLS include:
A compelling urge to move the limbs.
Motor restlessness; for example, floor pacing, tossing and turning, and rubbing the legs.
The symptoms may be worse or exclusively present at rest, with variable and temporary relief by activity.
Symptoms are worse in the evening and at night.
Sleep disturbances and daytime fatigue.
Normal neurological exam in primary RLS.
Involuntary, repetitive, periodic, jerking limb movements, either in sleep or while awake and at rest.
Can RLS be treated?
Most cases of RLS respond well to medical treatment. According to NCSDR, there are a number of pharmacological treatments for RLS, including:
Dopaminergic agents, which include dopamine precursor combinations such as carbidopa-levodopa. These may be used on a one-time basis and are useful for persons with intermittent RLS because dopamine agonists may take longer to have an effect.
Dopamine agonists such as ropinirole, pergolide, and pramipexole. These are useful in moderate to severe RLS, and recent reports indicate dopamine agonists are highly successful, but the role of long-term use is unknown.
Opioids such as codeine, hydrocodone, oxycodone, propoxyphene, and ramadol, which can be used intermittently, but they also have been used successfully for daily therapy.
Benzodiazepines such as clonazapam and temazepam, which are helpful in some patients when other medications aren’t tolerated, and they may be prescribed to help improve sleep.
Anticonvulsants such as carbamazepine and gabapentin, which can be considered when dopamine agonists have failed. They may be useful in those with coexisting peripheral neuropathy and/or when RLS discomfort is described as pain.
Iron (ferrous sulfate), which is used in patients with serum ferritin levels of <50 mcg. Clonidine may be useful in hypertensive patients.
Narcolepsy is a disabling neurological disorder of sleep regulation that affects the control of sleep and wakefulness. It may be described as an intrusion of the dreaming state of sleep (called REM or rapid eye movement sleep) into the waking state. Symptoms generally begin between the ages of 15 and 30. The four classic symptoms of the disorder are excessive daytime sleepiness; cataplexy (sudden, brief episodes of muscle weakness or paralysis brought on by strong emotions such as laughter, anger, surprise or anticipation); sleep paralysis (paralysis upon falling asleep or waking up); and hypnagogic hallucinations (vivid dream-like images that occur at sleep onset). Disturbed nighttime sleep, including tossing and turning in bed, leg jerks, nightmares, and frequent awakenings, may also occur. The development, number and severity of symptoms vary widely among individuals with the disorder. It is probable that there is an important genetic component to the disorder as well. Unrelenting excessive sleepiness is usually the first and most prominent symptom of narcolepsy. Patients with the disorder experience irresistible sleep attacks, throughout the day, which can last for 30 seconds to more than 30 minutes, regardless of the amount or quality of prior nighttime sleep. These attacks result in episodes of sleep at work and social events, while eating, talking and driving, and in other similarly inappropriate occasions. Although narcolepsy is not a rare disorder, it is often misdiagnosed or diagnosed only years after symptoms first appear. Early diagnosis and treatment, however, are important to the physical and mental well-being of the affected individual.
Is there any treatment?
There is presently no cure for narcolepsy; however, the symptoms can be controlled with behavioral and medical therapy. The excessive daytime sleepiness may be treated with stimulant drugs or with the drug modafinil (Provigil), which was approved by the FDA for this use in 1999. Cataplexy and other REM-sleep symptoms may be treated with antidepressant medications. At best, medications will reduce the symptoms, but will not alleviate them entirely. Also, many currently available medications have side effects. Basic lifestyle adjustments such as regulating sleep schedules, scheduled daytime naps and avoiding “over-stimulating” situations may also help to reduce the intrusion of symptoms into daytime activities.
What is the prognosis?
Although narcolepsy is a life-long condition, most individuals with the disorder enjoy a near-normal lifestyle with adequate medication and support from teachers, employers, and families. If not properly diagnosed and treated, narcolepsy may have a devastating impact on the life of the affected individual, causing social, educational, psychological, and financial difficulties.
What research is being done?
The NINDS supports a broad range of clinical and basic research on sleep disorders including narcolepsy. NINDS has notified investigators that it is seeking grant applications in both clinical and basic sleep and wakefulness research, including basic and clinical research in narcolepsy. In 1999, a research team working with canine models identified a gene that causes narcolepsy — a breakthrough that brings a cure for this disabling condition within reach. The researchers are currently searching for defective versions of this gene in people with narcolepsy.
Narcolepsy Network, Inc.
10921 Reed Hartman Hwy.
Cincinnati, OH 45242
National Sleep Foundation
1522 K Street NW
Washington, DC 20005
Doctors estimate that about 12 million Americans have sleep apnea. Men and people who are over 40 years old are more likely to have sleep apnea, but it can affect anyone at any age. If you are interested in meeting other people with sleep apnea, you can contact the American Sleep Apnea Association to find the location of a support group near you.
Will this problem change my life?
Actually, sleep apnea may already have affected you more than you know. Chances are things will improve for you once the diagnosis is made. If your sleep problem can be solved by not using alcohol or sleep medicine, losing weight if you’re overweight and sleeping on your side, you will quickly begin to feel much more rested and energetic. If you must wear the mask while sleeping, you should soon feel the benefits. If you need surgery, you’ll be able to sleep better afterwards. Whatever your treatment, remember that you are not alone and help is available.
At first, sleep apnea isn’t harmful. However, it can cause serious problems if it isn’t treated. Your risk of heart disease and stroke is higher if serious sleep apnea goes untreated. You are also more likely to have traffic accidents if you drive while you’re sleepy. If you have sleep apnea, it is very important for you to get treatment.
Is there anything I can do to help my sleep apnea?
Yes. The following steps help many people with sleep apnea sleep better:
Stop all use of alcohol or sleep medicines. These relax the muscles in the back of your throat, making it harder for you to breathe.
If you are overweight, lose weight.
Sleep on your side instead of on your back.
If you still have problems, you can wear a special mask over your nose and mouth while you are sleeping. This treatment is called “continuous positive airway pressure,” or CPAP. The mask will keep your airway open by adding pressure to the air you breathe. The mask helps most people with sleep apnea. In a very few cases, surgery is necessary to remove tonsils or extra tissue from the throat.
Your doctor can diagnose sleep apnea. The person you sleep with may notice it first. You, or that person, may notice heavy snoring or long pauses in your breathing during sleep. Even if you don’t remember waking up during the night, you may notice daytime sleepiness (such as falling asleep at work, while driving or when talking), and irritability or fatigue. You may also notice that you have morning headaches, forgetfulness, mood changes and a decreased interest in sex.
If you have symptoms of sleep apnea, your doctor may ask you to go to a sleep center for a sleep study. Tests done at the sleep center may reveal which kind of sleep apnea you have. You may need to take some equipment home with you to do a sleep study there.
People with sleep apnea stop breathing for 10 to 30 seconds at a time while they are sleeping. These short stops in breathing can happen up to 400 times every night! If you have sleep apnea, the periods of not breathing may make you wake up from deep sleep. If you are waking up all night long, you aren’t getting enough rest from your sleep.
There are two kinds of sleep apnea: obstructive apnea and central apnea. Obstructive sleep apnea is the most common type. Nine out of 10 people with sleep apnea have this type of apnea. If you have obstructive apnea, something is blocking the passage or windpipe (called the trachea) that brings air into your body. You keep trying to breathe, but you can’t get enough air because of the blockage. Your windpipe might be blocked by your tongue, tonsils or uvula (the little piece of flesh that hangs down in the back of your throat). It might also be blocked by a large amount of fatty tissue in the throat or even by relaxed throat muscles.
Central sleep apnea is rare. This type is called central apnea because it is related to the function of the central nervous system. If you have this type of apnea, the muscles you use to breathe don’t get the “go-ahead” signal from your brain. Either the brain doesn’t send the signal, or the signal gets interrupted.
A sleep study is a recording of data about your sleep and breathing patterns that’s helpful in the diagnosis of sleep disorders. Many people who have sleep disorders are unaware of their problem, and in some cases a family member will notice the signs before the patient does.
Your physician may choose to evaluate you for a sleep disorder through polysomnography (PSG) if you show any of the following symptoms: snoring, restless sleep, daytime sleepiness, difficulty concentrating, anxiety or depression, and morning headaches. PSG is a low-risk assessment of sleep cycles and sleep stages through use of continuous recordings of brain waves, muscle activity, eye movement and respiratory rate.