Salem Office
180 Ramsgate Sq. SE
Salem, OR 97302
503-485-0672
(Fax) 503-485-0673

Portland Office
1800 Blankenship Rd. Suite 140
West Linn, OR 97068
503-908-7513
(Fax) 503-974-9651

Common Sleep Disorders

Sleep Apnea

Sleep Apnea is a disorder of breathing during sleep. Typically it is accompanied by loud snoring. Apneas during sleep are brief periods throughout the night in which breathing stops. People with sleep apnea do not get enough oxygen during sleep. There are 2 major types.

Obstructive Sleep Apnea (OSA) is the most common type and is due to an obstruction in the upper airway during sleep. Bed partners notice breathing pauses approximately 10 to 60 seconds between loud snores. The narrowing of the upper airway can be a result of several factors including inherent physical characteristics, excess weight, and alcohol consumption before sleep.

Central Sleep Apnea (CSA) is caused by a delay in the signal form the brain to breathe . With both obstructive and central apnea you must wake up briefly to breathe, sometimes hundreds of times during the night. Usually there is no memory of these brief awakenings. The result is poor quality of sleep with subsequent daytime sleepiness.

Most Common Symptoms of OSA are:

  • Loud Snoring
  • Waking up unrefreshed and having trouble staying awake during the day
  • Waking up with headaches
  • Waking up during the night with the sensation of choking or gasping for air
  • Frequent trips to the bathroom during the night

 

Insomnia

There are three major types of Insomnia.

  • Difficulty falling asleep
  • Difficulty staying asleep (many awakenings)
  • Waking up too early

How much sleep does a person need?

Enough to feel alert during the day. Typically 7 to 8 hours (varies from person to person) of good quality sleep.

What can cause Insomnia?

Many things can cause insomnia. Insomnia is not a disorder it is a complaint. The goal is to find the underlying problem causing the complaint. Almost any sleep disorder can present themselves as insomnia including circadian disorders, sleep apnea, restless legs, and the list goes on. So ruling out a sleep disorder is important. Medications, herbs and caffeine can cause insomnia. Life events can cause insomnia but it is usually temporary. Anxiety about falling asleep can also be responsible, however, if the anxiety is due to a long history of insomnia, the anxiety is probably not the problem and you need to find out what is the underlying cause. Once sleep is restored to normal the anxiety will usually go away. Physical problems such as pain can be the underlying cause. There is also the possibility of mental problems, and a good sleep doctor that works with insomnia can rule this in or out sometimes without an all night sleep study. This problem can be treated using many different techniques. (More information coming)

Insomnia is classified into:
Transient insomnia – lasting for a few nights
Short-term insomnia – two or four weeks of poor sleep
Chronic insomnia – poor sleep that happens most nights and last a month or longer

Transient and short-term insomnia generally occur in people who are temporarily experiencing one or more of the following:

  • stress
  • environmental noise
  • extreme temperatures change in the surrounding environment
  • sleep/wake schedule problems such as those due to jet lag
  • medication side effects

Chronic insomnia is more complex and often results from a combination of factors, including underlying physical or mental disorders. One of the most common causes of chronic insomnia is depression. Other underlying causes include arthritis, kidney disease, heart failure, asthma, sleep apnea, restless legs syndrome, Parkinson’s disease, and hyperthyroidism. However, chronic insomnia may also be due to behavioral factors, including the misuse of caffeine, alcohol, or other substances; disrupted sleep/wake cycles as may occur with shift work or other nighttime activity schedules; and chronic stress.

Daytime symptoms of insomnia include:

  • Sleepiness
  • Anxiety
  • Impaired concentration
  • Impaired memory
  • Irritability

 

Narcolepsy

Leptics, no matter how much they sleep, continue to experience a irresistible need to sleep. People with narcolepsy can fall asleep while at work, talking, and driving a car for example. They may also experience periods of cataplexy (loss of muscle tone) ranging from a slight buckling at the knees to a complete, “rag doll” limpness throughout the body. These are typically triggered by emotions such as laughter, anger, excitement or startle.

Narcolepsy is a chronic disorder affecting the brain where regulation of sleep and wakefulness take place. Narcolepsy can be thought of as an intrusion of dreaming sleep (REM) into the waking state.

The prevalence of narcolepsy has been calculated at about 0.03% of the general population. Its onset can occur at any time throughout life, but its peek onset is during the teen years. Narcolepsy has been found to be due to a deficiency or lack of a neurotransmitter in the brain called “Hypouetin” which is responsible for maintaining alertness.

  • Excessive sleepiness.
  • Temporary decrease or loss of muscle control, triggered by emotions (Cataplexy)
  • Vivid dream-like images when drifting off to sleep or waking up. (Visual Hallucinations)
  • Waking up unable to move or talk for a brief time. (Sleep Paralysis)

 

Restless Legs Syndrome

Restless legs syndrome (RLS) is a discomfort in the legs which is relieved by moving or stimulating the legs. This feeling is difficult to describe and commonly referred to as a crawling, tingling or prickling sensation. It is commonly associated with sleep onset insomnia, but it can also cause frequent awakenings from sleep. It is believed to result from Dopamine receptor dysfunction in the brain. Based on this hypothesis, several medications (dopaminergic agents) have been found very helpful in alleviation RLS symptoms.

 

Periodic Limb Movement Disorder

Another common sleep disorder is Periodic Limb Movements in Sleep (PLMS). PLMS are characterized by leg movements or jerks which usually occur every 20 to 40 seconds during sleep. PLMS causes sleep to be disrupted leaving the person with excessive daytime sleepiness. These movements are typically reported by the bed partner. Most patients with PLMS also have Restless Legs symptoms while awake, and often times both conditions are treated using the same medications.

 


Rapid Eye Movement (REM) Behavior Disorder

Normal sleep has 2 distinct states: non–rapid eye movement (NREM) and rapid eye movement (REM) sleep (see Sleep: Understanding the Basics for details of various stages of sleep). NREM sleep is divided into 4 stages. During REM sleep, rapid eye movements occur, breathing becomes irregular, blood pressure rises, and there is loss of muscle tone (paralysis). However, the brain is highly active, and the electrical activity recorded in the brain by EEG during REM sleep is similar to that recorded during wakefulness. REM sleep is usually associated with dreaming. REM sleep accounts for 20-25% of the sleep period.

In a person with REM sleep behavior disorder (RBD), the paralysis that normally occurs during REM sleep is incomplete or absent, allowing the person to “act out” his or her dreams. RBD is characterized by the acting out of dreams that are vivid, intense, and violent. Dream-enacting behaviors include talking, yelling, punching, kicking, sitting, jumping from bed, arm flailing, and grabbing. An acute form may occur during withdrawal from alcohol or sedative-hypnotic drugs.

RBD is usually seen in middle-aged to elderly people (more often in men). Despite its dramatic and often dangerous nature of its symptoms, RBD is easily treated by medication taken at bedtime. The diagnosis however must be established first since it can be confused with other disorders such as seizures and sleep walking which are treated in completely different ways.

 

Circadian Rhythm Disorders

Circadian rhythm disorders are disruptions in a persons circadian rhythm — a name given to the “internal body clock” that regulates the (approximately) 24-hour cycle of biological processes. There are patterns of brain wave activity, hormone production, cell regeneration, and other biological activities linked to this 24-hour cycle.

The circadian “clock” in humans is located in the suprachiasmatic nucleus (SCN), which is a group of cells located in the hypothalamus (a portion of the brain). Circadian rhythms are important in determining human sleeping patterns.

Common Circadian Rhythm Disorders

  • Jet Lag or Rapid Time Zone Change Syndrome: This syndrome consists of symptoms including excessive sleepiness and a lack of daytime alertness in people who travel across time zones.
  • Shift Work Sleep Disorder: This sleep disorder affects people who frequently rotate shifts or work at night
  • Delayed Sleep Phase Syndrome (DSPS): This is a disorder of sleep timing. People with DSPS tend to fall asleep at very late times and have difficulty waking up in time for work, school, or social engagements.
  • Advanced Sleep Phase Syndrome: Advanced sleep phase syndrome is a disorder in which the major sleep episode is advanced in relation to the desired clock time. This syndrome results in symptoms of evening sleepiness, an early sleep onset, and waking up earlier than desired.

Why 'Willamette Sleep Center' ?

  • Medical Director Dr. Gabr is Board Certified in Sleep Medicine, Neurology, and Clinical Neurophysiology.
  • Sleep Physician has more than 25 years in evaluating Patients and interpreting Sleep Studies.
  • Registered & Licensed Sleep Technologists with years of experience in Conducting and Scoring Sleep Studies.
  • Salem Center is Fully Accredited for both In-Lab as well as Home Sleep Testing.
  • State-of-the-Art Facilities that provide a Private, Comfortable, and Secure Environment.
  • Comprehensive, Individualized Care that assures effective Patient Treatment and Satisfaction.
  • Clinical Evaluation, Sleep Studies, DME/CPAP Supplies, and Close Follow-up all done in One Place.