9 Common sleep problems and abnormalities

Three Medical Classifications of Sleep Disorder

1. Dyssomnia

Dyssomnia refers to difficulty in initiating or maintaining sleep or excessive sleepiness during the day. It is attributed to one of three types:

A. Intrinsic Dyssomnia

  • Definition: Originates from within the body.

  • Examples:

    • Narcolepsy

    • Sleep apnea

    • Stress-related sleep issues

B. Extrinsic Dyssomnia

  • Definition: Originates from outside the body.

  • Examples:

    • Environmental factors (noise, light, temperature)

    • Altitude effects

    • Drug and substance use

C. Circadian Dyssomnia

  • Definition: Disruptions based on biological rhythms, particularly the sleep-wake cycles.

  • Examples:

    • Jet lag

    • Shift work disorder

2. Parasomnia

Parasomnia involves undesired disturbances during sleep, encompassing various phenomena:

A. Arousal Disorders

  • Examples:

    • Sleep walking (somnambulism)

B. Sleep Stage Transition Disorders

  • Examples:

    • Sleep talking (somniloquy)

C. REM Disorders

  • Examples:

    • Nightmares

    • REM behavior disorder (acting out dreams)

D. Other Forms

  • Examples:

    • Bed wetting (enuresis)

    • Teeth grinding (bruxism)

3. Medical/Psychiatric Disorders Not Specifically Related to Sleep

  • Examples:

    • Chronic pain syndromes

    • Schizophrenia

    • Depression

Jet Lag (Dyssomnia)

  • Definition: A condition caused by the circadian clock being temporarily desynchronized from local time after traveling across time zones.

A. Effects of Traveling East vs. West

  • Going East: New local time is later than old local time.

    • Symptoms: Difficulty in falling asleep, tendency to awaken later.

  • Going West: New local time is earlier than old local time.

    • Symptoms: Easier to fall asleep but awaken too early.

B. Recovery Time

  • Traveling West: Approximately 1 day per time zone traveled.

  • Traveling East: Approximately 1.5 days per time zone traveled.

  • Individual Differences: Recovery times can vary based on personal physiology.

C. Coping Strategies for Minimizing Jet Lag

  1. Homeostatic Drive:

    • Stay awake at least 16 hours on travel day before bedtime at the new location.

    • Set an alarm to wake up at the usual hour in the new local time.

  2. Circadian Adjustment:

    • Utilize good sleep hygiene and Zeitgebers (time cues).

    • Evening Recommendations:

      • Go to bed at the new local bedtime in a quiet and cool room.

      • Engage in relaxing activities before bedtime; consider melatonin for the first several nights.

    • Morning Recommendations:

      • Do not sleep late; establish a morning routine (e.g., eat breakfast early, engage in exercise, expose to bright light, and some background noise like talk or TV).

Shift Work and Its Implications

  • Definition: Work obligations that require nighttime shifts or rotating schedules can cause significant issues with circadian synchronization (dyssomnia).

A. Consequences of Shift Work

  • Emotional problems

  • Social problems

  • Physical health issues

  • Higher rates of divorce

  • Increased accidents and job mistakes

B. Tolerance Levels

  • Approximately 20% of workers find it intolerable.

C. Coping Mechanisms for Shift Workers

  1. Minimize frequent rotations between shifts.

  2. Use bright white work lighting.

  3. Consider pharmacological aids such as Modafinil.

D. Night Shift Paralysis

  • Definition: A state where individuals are conscious but unable to move.

  • Prevalence: Reported by 12% of nurses (classical form of parasomnia).

Example of Night Shift Paralysis

  • Scenario: An air traffic controller experiences night shift paralysis while trying to manage two aircraft that converged dangerously. The individual was completely aware but unable to move, creating a near-miss incident at work.

  • Symptoms: Numbness and inability to move arms and legs; awareness of surroundings without physical control. The paralysis lasted approximately 3 minutes until resolved.

Sleep Paralysis (Parasomnia)

  • Definition: A phenomenon characterized by the experience of awakening but being unable to move.

A. Common Experiences

  • Individuals often report feeling a presence or weight on their chest, often described as an animal, alien, or monster.

B. Potential Causes

  • Anomalous activation of REM-on cells during awakening leading to continued muscle atonia (loss of muscle tone) associated with REM sleep.

  • Some researchers posit it may also be a dream experience, where the sensation of paralysis is part of a dream.

Case Report of Sleep Paralysis

  • Individual: David J. Hufford, a college student in 1964, experienced a particularly frightening episode where he perceived a malignant being during an episode of night paralysis.

  • Symptoms: Acute fear, inability to move, the feeling of suffocation, and a compulsion to escape once paralysis ceased, highlighting the interplay of psychological distress and sleep phenomena.

Night Terrors (Parasomnia)

  • Definition: Sudden awakenings from slow-wave sleep (SWS) characterized by intense fear and panicked behaviors.

A. Prevalence

  • Most common in children, often resolving without treatment as they age.

B. Symptoms

  • Awakening with screams, flailing limbs, and an inability to recall any dream content.

Sleepwalking (Parasomnia)

  • Definition: A disorder beginning during slow-wave sleep where individuals may engage in activities while being mostly unaware.

A. Characteristics

  • Individuals may sit up and display a blank stare or engage in routine behaviors such as:

    • Urinating

    • Cleaning

    • Going to the fridge

  • Awareness: Minimal, leading to safety concerns.

B. Predictors

  • Factors include age, stress, sleep deprivation, and genetic predispositions.

  • Peak Occurrence: Age 12, with a decline in frequency as individuals mature.

C. Managing Sleepwalkers

  1. Avoid waking them abruptly; instead:

    • Prevent injury

    • Guide them back to bed safely.

    • Use simple suggestions or questions to help them transition back to sleep.

Sleepwalking Used in Legal Defense

  • Case Study: Kenneth Parks, a 23-year-old man, drove 15 miles while sleepwalking and committed a violent crime against his in-laws.

  • Legal Outcome: Found not guilty due to non-insane automatism; highlights the legal implications of sleep disorders in criminal behavior. No further sentences, emphasizing that sleepwalking is not classified as a mental disorder under legal standards.

Sleep Talking (Parasomnia)

  • Definition: Verbal expressions during sleep, primarily occurring in stage 2 NREM sleep or followed by NREM stage transitions.

A. Correlation with Sleepwalking

  • Sleep talking is often associated with sleep walking incidents.

B. Prevalence

  • Common in 50% of young children, typically involves nonsensical mumbling but can exhibit up to 100 recognizable words.

  • Individuals are generally unaware upon waking of their sleep talking activities.