Other Sleep Disorders

 

 

Insomnia:

 

may present as difficulty in falling asleep, maintaining sleep or early morning awakening or as a non-refreshing feeling even after adequate duration of sleep. Can be of various types like primary, secondary (to drugs/alcohol, medical disorders, other sleep disorders etc). Prevalence of insomnia is around 30% general population globally, leads to poor quality of life and gives rise to various illnesses.Treatment involves thorough diagnostic work up, medications, psychotherapy (CBTi and Behavior therapy) and treatment of coexistent disorders if any.

 

Hypersomnia:

 

presents as difficulty in getting up in the morning and/or staying awake. Symptoms may include sudden falls/ loss of muscle tone during daytime, sleep attacks (irresistible urge for sleep), spending excessive time sleeping in bed. It can also be secondary to various medical/ sleep disorders, drug intake etc.Treatment involves medications after confirmation of diagnosis. Underlying causes may need to be treated first.

 

Circadian rhythm sleep disorders:

 

includes difficulty in adjusting sleep/ wake time in shift works or those involving east-west travel across states. Also some present with sleep time and wake time delayed (e.g. 2-4am and 12-2 pm respectively) or advanced (e.g. 7-8 pm and 2-4 am respectively) compared to socio-cultural standards. Usually more common in adolescents, young adults and elderly. It leads to a multitude of problems, particularly in social, personal or professional adjustment, not to mention increases risks for cardiac, gastrointestinal, metabolic illnesses, even carcinoma.Treatment involves confirmation of diagnosis, pharmacotherapy, phototherapy and behavior therapy.

 

Sleep related movement disorders (includes Restless Leg Syndrome):

 

includes grinding teeth during sleep, movement of legs and toes intermittently during sleep, an urge to move legs or pain or discomfort on lying down or at rest. Associated with numerous micro-arousals, difficulty falling asleep/ maintaining sleep and feeling unrefreshed after waking up. it leads to poor quality of life, fatigue in daytime, loss in energy and libido, and gives rise to various illnesses including cardiometabolic illness. Treatment involves primarily pharmacotherapy (along with oro-dental prosthetic devices for bruxism)

 

Parasomnias:

 

includes sleep walking, sleep talking, dream enactment (acting out dreams in sleep), confusional arousals, night terrors, excessive nightmares etc.Treatment primarily involves pharmacotherapy after confirmation of diagnosis.

 

Overall, very successful treatment of all the above is possible and involves a thorough assessment, sleep study test, few laboratory investigations and pharmacotherapy, psychotherapy (behavior and cognitive behavior therapies) and phototherapy as and when required.