Did you know that sleep plays an important role in human disorders and medical conditions? In turn, sleep related problems impact almost every field of medicine.
It's important to understand how and why sleep problems affect health and lifestyle. In certain disease states, sleep plays a critical role. In these situations, insufficient sleep can trigger disease episodes or cause existing symptoms to worsen.
Thus, proper sleep management is necessary, whether in health or in disease.
What are some examples of sleep affecting disease states?
Episodes of diseases such as asthma attacks or strokes have a tendency to happen at night or early in the morning. This has been attributed to changes in heart rate, hormones, and other biochemical and physiological reactions associated with sleep. Sleep is also known to be involved in affecting epilepsy, where certain sleep rhythms of the brain appear to offer some protection to the onset of seizure activity. By the same token, sleep deprivation can trigger seizures in certain types of epilepsy.
Most mental diseases such as depression and schizophrenia are associated with sleep disorders. For example, individuals with mental disorders may experience lessened sleep, disturbed sleep, or sleeping at the wrong times of day. If someone with a mental disease has insufficient sleep, this often causes the disease symptoms themselves to worsen (e.g. paranoia, mania, etc.) This can actually create a cycle which is difficult to break, where disturbed sleep affects the person's ability to function, resulting in even worse sleep problems, which in turn exacerbates the mental problems.
The immune system is also involved in interacting with neurons involved in sleep patterns. Indeed, one of the most common early symptoms in those with auto-immune disorders is a feeling of excessive sleepiness or tiredness.
Sleep disorders are common in many neurological problems. Some examples of these are stroke, Alzheimer's disease, and head injury. Some of these sleep disorders are due to changes in the brain chemistry and neurotransmitters involved in sleep, caused directly by the neurological problem itself. Other sleep disorders are due to side effects of the medications used to control these neurological diseases, and are therefore an indirect effect of the disease.
Patients who are hospitalized for a particular disease or condition may also find themselves developing sleep problems because of hospital routines or treatment schedules.
Those who suffer pain caused by a disease or condition may be unable to sleep well because of the pain, creating a new sleep problem.
Therefore, people with any disease or condition would benefit from addressing sleep problems in order to increase quality of life and overall health.
What are some examples of sleep problems affecting otherwise healthy individuals?
Otherwise healthy individuals can also develop sleep problems. Indeed, if a healthy person is extremely deprived of sleep, he or she can develop hallucinations or paranoia. Those symptoms are more usually associated with severe mental illnesses. Yet sufficient sleep deprivation will induce these symptoms (although not the mental disease itself) in healthy individuals.
As a normal response to an infection (such as a bad cold, the flu, or a throat infection), the immune system tries to kill off these viruses or bacteria. In doing so, the cytokines produced by the immune system tends to cause a feeling of sleepiness. You will have experienced that yourself when you feel sleepy during an infectious disease. This sort of sleepiness is in a sense 'normal' because the body is responding normally and correctly to disease (although the disease itself is a problem). Indeed, sleep may be the body's way of ensuring that resources are conserved to allow the immune system to mount its attack.
Stress can also trigger sleep problems in healthy individuals. Even though a person may not be clinically considered mentally ill in any way, stress can manifest itself in causing sleep difficulties. Some examples of this are job stress, difficult interpersonal relationships, moving to a different city, having an additional family member join the household and so on. Usually sleep problems brought on by stress tend to be temporary and return to normal over time, but not always.
Sleep disorders affect the individual and the community
People all over the world suffer from sleep disorders every year. Some of these disorders are long-term chronic conditions, while others are only short-term. Such sleep problems can affect anyone, regardless of gender, socioeconomic status, religion, educational level, and so on.
Sleep disorders affect not only the individual but the community too. The direct costs of these sleep problems include doctor's visits, therapy visits, and/or medication. The indirect costs are thought to be much greater, and these refer to things such as lost productivity at work. In addition to loss of function at work, lack of sleep also affects interpersonal relationships with others, poor judgment when driving, and other problems which impact the community as a whole. Thus improved sleep in every individual can result in improved harmony in the entire community.
Did you know that the vast majority of sleep disorders can be managed effectively under the care of a health professional? There are actually more than 70 distinct sleep disorders, and four of the more common ones are insomnia, restless legs syndrome, sleep apnoea, and narcolepsy.
Insomnia is very common, and most individuals will suffer from short-term insomnia at some point during their lifetime. The cause of insomnia will differ from one person to another. For example, it can result from jet lag, diet, stress, an effect of another disease, a side effect of medication, and so on. Difficulties sleeping at night almost always affect the well-being and job performance of the person the following day. Fortunately, short term insomnia may resolve by itself or it may be easily treated by a doctor through a brief regimen of sleeping pills.
However, long term insomnia is much more serious and somewhat more difficult to treat. Sleeping pills can cause problems in the long term and often do not work well after a few weeks. Instead, light therapy and other ways of adjusting the circadian rhythms can be of help to those with ongoing insomnia.
Restless legs syndrome
Restless legs syndrome (RLS) involves an uncomfortable sensation in the legs requiring movement for relief. The sensation has been described as tingling, pricking, or crawling. Severe RLS tends to be a lot more common in older people, although younger people can also get it. Other conditions may cause or trigger RLS, such as pregnancy, diabetes or anaemia.
The reason that RLS causes sleep problems is that the legs continue to move at night, and this can lead to disrupted sleep. Although it is not always as widely known as other sleep conditions, RLS is surprisingly common and affects a great number of people.
There is a related disorder called periodic limb movement disorder (PLMD) and this causes jerky movements of the legs and other limbs. Because these movements come at about 20 to 40 second intervals, these cause a lot of awakening during the night. PLMD patients suffer from extremely fragmented sleep.
Fortunately, RLS and PLMD can be treated by drugs which affect dopamine, a neurotransmitter. Interestingly, this suggests that abnormalities in dopamine communication within the brain cause the symptoms of these disorders. This also suggests that improved therapies may become available in the future as more becomes known about the exact mechanism of these diseases.
Sleep apnoea is a problem where the breathing is interrupted during sleep. It is usually associated with loss of muscle tone or fat build-up, which can weaken the windpipe. The windpipe then collapses occasionally while breathing during sleep, and this is called obstructive sleep apnoea. Usually this occurs in conjunction with loud snoring. It's important to remember that not all individuals who snore will have sleep apnoea. Also, there is another form of sleep apnoea involving malfunctioning of the neurons which control breathing.
In obstructive sleep apnoea, air flow can be blocked for anywhere from 10 seconds to a minute when the person tries to inhale air, causing suction and resulting in collapse of the windpipe. Normal individuals do not have this issue because their windpipe is strong enough to withstand the normal suction of air during breathing. In a sleep apnoea episode, when the oxygen levels decrease in a person's blood due to a collapsed windpipe, the brain then alerts the individual to wake up enough to tighten respiratory muscles and open the windpipe. At this point the person may gasp or snort, and then go back to sleep.
Sleep apnoea episodes often get repeated literally hundreds of times each night. This causes interrupted sleep with frequent awakenings, leading to daytime sleepiness and irritability. The daytime symptoms and decreased function of a sleep apnoea patient are similar to those of someone with chronic insomnia. However, unlike most insomnia patients, sleep apnoea patients are not allowed to take any sleeping pills or sedatives as these can prevent the sleep apnoea patient from awakening sufficiently to breathe again.
It is thought that many cases of sleep apnoea go undiagnosed each year. Those who are at risk of sleep apnoea (snoring, or obesity, or daytime sleepiness) should see a physician. Sleep apnoea can be diagnosed during sleep at a specialized sleep centre by analysing the patient's breathing, heartbeat and brain waves. Fortunately, mild sleep apnoea can be relieved by lifestyle changes such as weight loss or avoiding sleeping on the back. For more severe cases, surgery or special sleep devices are necessary.
Narcolepsy is a disorder resulting in "sleep attacks" during the daytime, even if there was a normal amount of sleep at night time. Attacks of narcolepsy range from several seconds to over half an hour. Narcolepsy usually first emerges in adolescence, and is often hereditary. However, onset of narcolepsy can also be caused by neurological disease or a head injury.
In addition to the daytime sleep episodes, people with narcolepsy can also experience hallucinations, temporary paralysis upon waking, cataplexy (loss of muscle control when emotional) and interrupted sleep at night. Because these symptoms tend to be more typical of REM sleep than of wakefulness, it is thought that narcolepsy results from a malfunctioning sleep regulation system in the brain.
Fortunately, narcolepsy can usually be treated with drugs such as stimulants which can help control the symptoms and prevent the person from falling asleep at the wrong times.
Sleep is involved in some way in all aspects of health and disease, and sleep disorders are highly prevalent worldwide.
Sleep disorders decrease the quality of life of the individual, yet the effects do not end there. Loss of productivity at work, decreased judgment and poor interpersonal relationships caused by insufficient sleep in individuals can also cause problems within the wider community.
Proper management of sleep disorders and an increased awareness of good sleep habits will not only help the individual, but make for more harmonious living within the community as a whole. If you suffer from a sleep problem, you should have it investigated and addressed by a healthcare professional. Make your sleep a priority. This is not solely for your own benefit, but also for the good of those around you.