Category Archives for Sleep Disorders

Narcolepsy: The Most Common Cause of Hypersomnia

What is narcolepsy?

Do you feel excessive sleepiness during the daytime? Do you get sleepy easily in a calm environment at any time of the day? If the answer to these questions is yes then you may be suffering from hypersomnia and the most common cause of this condition is narcolepsy.

Narcolepsy is the most common neurological disorder that disrupts sleep/wake pattern leading to hypersomnia.

We will examine what causes narcolepsy and how to cure it.

   Narcolepsy: the commonest cause of hypersomnia

What is narcolepsy?

Narcolepsy is defined by ICSD as irresistible urges to sleep occurring on a daily basis for at least three months with the following laboratory findings present…

  • On the multiple sleep latency test (MSLT), mean sleep latency is ≤8 minutes and two or more sleep-onset rapid eye movement (REM) periods are found in patients who have had at least 6 hours of sleep the night before the test
  • CSF hypocretin-1 levels ≤110 pg/mL (or one-third of mean control values) are also considered to be diagnostic

The DSM criteria for narcolepsy includes:

  • Irresistible attacks of refreshing sleep that occur daily over at least three months
  • The presence of cataplexy and/or recurrent rapid eye movement intrusions in the transition between sleep and wakefulness as manifested by sleep paralysis and hypnopompic or hypangogic hallucinations

Narcolepsy may be associated with cataplexy. This is defined as a transient loss of muscle tone that occurs suddenly in response to strong emotion. That is, during sleep, a paralysis-like condition may occur.

What are the types of narcolepsy?

Your narcolepsy may be one of three types.

These are:

1.Narcolepsy with cataplexy

This is the most frequent neurological cause of hypersomnia. The classic tetrad of symptoms (described later) is seen in this type of patient

2. Narcolepsy without cataplexy

The occurrence of EDS (excessive daytime sleepiness) and irresistible episodes of sleep without associated cataplexy. Other features may also be present, eg automatic behavior, hypnic hallucinations or sleep paralysis. Nocturnal sleep is usually less disturbed than in narcolepsy with cataplexy

3. Narcolepsy due to a medical condition

A consistent chronological link with the presumed underlying causative medical condition is found

What causes narcolepsy?

To understand narcolepsy, you need to have some idea about normal sleep cycles. Human sleep pattern cycles through two stages: REM (rapid eye movement) sleep and non-REM sleep. When you fall asleep, sleep is light and gradually become deeper. Both light and deep stages are part of non-REM sleep. The first stage of REM sleep comes after 90 minutes of sleeping. This is the dreaming portion. With narcolepsy, the REM pattern of sleep starts immediately after sleeping and even occurs randomly in the  daytime. This means that the normal sleep/wake pattern is disrupted.

The exact mechanism is not clear but there are some known causes. Narcolepsy with cataplexy is linked to a loss of hypothalamic neurons that contain hypocretin. An underlying autoimmune process may lead to the elimination of the hypocretin cells. Several studies show that narcolepsy with cataplexy is associated with human leukocyte antigen (HLA) subtypes DR2/DRB1*1501 and DQB1*0602. First-degree relatives of patients with these subtypes have a 10- to 40-fold increased risk for narcolepsy with cataplexy

What are the symptoms of narcolepsy?

The classical ‘tetrad’ of symptoms are helpful for diagnosis but suffered by only a minority of patients with narcolepsy.

These are: 1) excessive sleepiness; 2) cataplexy; 3) sleep paralysis; 4) hypnagogic hallucinations.

  • Excessive daytime sleepiness and associated cataplexy (sudden bilateral loss of muscle tone with preserved consciousness triggered by a strong emotional reaction such as laughter or anger) are by far the most common complaints. More often a cataplectic attack will be partial, eg involving jaw muscles (difficulty with articulation), facial muscles (grimacing), or thigh muscles (brief unlocking of the knees). Attacks vary from seconds to minutes, with a frequency of a few a year to several a day, and (very rarely) repeated ‘status cataplecticus’.
  • Other REM sleep phenomena also occur but are not necessary for the diagnosis to be made. These include sleep paralysis (sometimes up to 10 minutes long) and vivid hallucinations on falling asleep (hypnagogic) or, less commonly, waking up (hypnopompic).
  • Sleep may also be disturbed due to frequent awakenings, disturbing dreams, sleep-talking and REM-related sleep behaviors (from phasic muscle twitching to more dramatic dream enactment).
How does it affect people?

Narcolepsy may  impact seriously on your education, work, relationships, ability to drive or recreational activities and can have negative effects on self-esteem and mood.

How to cure narcolepsy?

There are, fortunately, effective treatments available for narcolepsy.

  • Daytime somnolence can be treated with stimulants (modafinil, methylphenidate, dexamfetamine). It’s possible, also, to use sodium oxybate.
  • Cataplexy is treated with TCAs (clomipramine 10–75mg/day is licensed) or SSRIs (and possibly other antidepressants: venlafaxine, nefazodone, mirtazapine, atomoxetine). These drugs may also improve your REM-related symptoms, hypnagogic/hypnopompic hallucinations and sleep paralysis. Note: abrupt withdrawal of antidepressants may potentially cause cataplectic episodes or even status cataplecticus. So, never discontinue your drugs, without consulting your physician. Sodium oxybate is newly licensed for cataplexy, is not associated with a rebound cataplexy on withdrawal but can cause significant side-effects (nausea, nocturnal enuresis, confusional arousals, headache) and there is also a danger of abuse.
  • Other treatments for poor sleep and REM-related symptoms are benzodiazepines (e.g. clonazepam) and possibly sodium oxybate are helpful.

Be aware that these drugs are not for over the counter use. Consult your doctor and he will choose the best suitable drug for you.

Besides drug treatment, some behavioral treatments are also worthwhile. The following advice may be helpful for you:

Establish good sleep habits for narcolepsy:

  1. Maintain a regular sleep schedule. Estimate how long you need to sleep and try to follow that. Most adults require 6-8 hours and teens 9-10 hours per day
  2. Develop a consistent sleep schedule
  3. Take regular daytime naps. It will help you to improve mood and alertness. A short sleep of 15-20 minutes will refresh you but don’t make it much longer. Find out the best time for a nap and stick to it
  4. Make your bedroom comfortable for sleeping. Keep TVs, computers and cell phones out of your bedroom
  5. If you wake up at night, don’t engage with your smartphone or TV. Restrict yourself from social media like Facebook
  6. Avoid caffeine in the evening
  7. Don’t take any medication without consulting your doctor. Many drugs are associated with sleep cycle interruptions

Stay active:

A boring, inactive period will make anyone sleepy. It is more harmful when you have narcolepsy. Try to keep yourself busy. Do some interesting work in your leisure time

Control your diet:

A heavy meal stimulates sleep. When you have narcolepsy, this may also provoke cataplexy. Try to keep you meal size smaller. You may increase your frequency of eating to compensate.

Get help from your family:

If your cataplexy is related to specific stimulations like laughing, joking or crying, try to avoid these situations. Discuss with your friends and family.

Remember that for any neurological disorder the success of treatment depends mostly on the patient. The doctor can only prescribe you but cure depends on your compliance to treatment.

So, try to follow any prescriptions and advice. Most importantly, establish good sleeping habits.

Have a nice sleep!

Insomnia : An Overview

What is insomnia?

Have you ever suffered from a difficulty in falling asleep or frequent night time awakenings? For most people, the answer is yes.

Insomnia (or sleep disturbance) is a common symptom with a prevalence rate of 30-40% in the general population. But a single episode of sleep disturbance is not a serious problem. The rate of significant insomnia disorder is only 5-10%.

So, what is insomnia and when should it be called clinically significant?

Here we will examine the causes and best treatment options.

How to cure insomnia -

What is insomnia?

Persistent problems falling asleep, maintaining sleep or poor quality of sleep for at least 3 days a week for one month is considered clinically significant insomnia. It is most commonly a symptom rather than a disease itself. It may be due to any specific underlying diseases or without any identifiable causes.

What are the types of insomnia?

If insomnia is temporary, it is termed as acute insomnia.

When it’s persistent and mostly due a specific cause it is known as chronic insomnia.

It may also be classified as primary or secondary depending on the causes.

  1. Primary insomnia: no identifiable cause
  2. Secondary insomnia: due to an underlying disease.
What are the causes of insomnia?

Your insomnia may be a result of wide range of factors. Here are some probable causes:

Causes of Primary insomnia:

  • Psychophysiological insomnia: difficulty initiating and maintaining sleep with associated somatized tension anxiety; over-concern with the inability to sleep, and learned sleep prevention
  • Paradoxical insomnia: also called ‘sleep state misperception’: patient complains of little or no sleep without objective evidence of sleep disturbance
  • Adjustment sleep disorder: sleep disturbance temporally related to stress, conflict or environmental change causing emotional arousal. The disorder usually resolves once the stress is no longer present
  • Inadequate sleep hygiene: clinically significant disruption of the normal sleep/wake schedule due to a wide range of daily living activities (eg level of coffee consumption or frequent late nights)
  • Idiopathic insomnia: Rare, lifelong inability to sleep adequately

Secondary or comorbid causes of insomnia

  • Sleep disorders classified elsewhere: sleep-related breathing disorders; circadian rhythm disorders; sleep-related movement disorders
  • Insomnia due to medical condition: pain (arthritis, peptic ulcer, headache), respiratory disorders (COPD, cystic fibrosis, asthma), diabetes, Parkinson’s disease, endocrine disorders (Addison’s disease, Cushing’s syndrome)
  • Insomnia due to mental disorder
  • Drugs and alcohol

Several drugs may cause insomnia. As an example, antidepressants (MAOIs, SSRIs, venlafaxine or reboxetine); anti-Parkinsonian medication; bronchodilators (aminophylline, theophylline or pseudoephedrine); cardiovascular medication (β-blockers, clonidine, high-dose digoxin, verapamil); chemotherapy agents; corticosteroids/anabolic steroids; NSAIDs (high-dose); stimulants (dexamfetamine methylphenidate, amphetamines, cocaine, caffeine, nicotine); levothyroxine withdrawal/dependency (hypnotics, opiates, alcohol, or cannabis)

What are the symptoms of insomnia?

You will suffer from various problems if your sleep is affected…

  1. Difficulty in falling asleep
  2. Trouble with maintenance of sleep
  3. Excessive daytime sleepiness
  4. Irritability
  5. Inability to concentrate
  6. Inadequate sleep quality or duration
  7. The problem persists in spite of having the opportunity to sleep
How does it affect people?

Insomnia is a risk factor for developing depressive, anxiety and substance abuse disorders. Insomnia is associated with motor vehicle accidents, work absenteeism, and reduced quality of life.

How to cure insomnia?

There are effective treatments available for insomnia. In the case of secondary insomnia you need to receive treatment for the underlying disease first. For primary insomnia, both pharmacological and non-pharmacological treatments are available.  The best treatment for insomnia is non-pharmacological. If still the problem persists, your doctor will advise you some drugs.

How can I get rid of insomnia without drug therapy?

There are several pointers you can follow to improve your quality of sleep. Try to follow the advice below.

  1. Cognitive behavioral therapy (CBT)

The aim of CBT is to break the cycle of insomnia. Poor sleep quality leads to stress and makes you anxious about not being able to sleep. This, in turn, causes further tension and anxiety which makes your sleeping habits poorer and can lead to the development of dependency on sleeping pills… Then a worsening of insomnia and so the vicious cycle goes on. Contact a psychiatrist for proper advice regarding CBT.

  1. Maintain sleep hygiene

        Establish good sleep habits:

  • Control environmental factors (noise, light, temperature)
  • Avoidance of caffeine-containing drinks after about 4pm
  • Not smoking for at least an hour before bed
  • Regular exercise (not late at night)
  • Avoid drugs causing insomnia

      Stimulus control:

  • Go to bed only when sleepy; avoid other activities (with the exception of sex) whilst in bed. If sleep does not occur, do not remain in bed for more than 10–20 minutes, get up and go to another room (without turning on all the lights), returning to bed only when sleepy
  • Establish a regular time to get up with no more than 1 hour variation (even at weekends and during holidays)
  • Sleep restriction if your sleep is fragmented… A sleep restriction strategy may help you to reduce total time spent in bed and improve the quality of sleep by consolidation. Try to maintain a sleep-wake diary
What are some medications available for insomnia?

There are different groups of drugs available for insomnia.

This, though, is the last option only if non-drug treatment does not work for you. Contact your doctor and he will assess your conditions to exclude any secondary causes. If any underlying disease is present, it must be treated first.

The drugs available are benzodiazepines like clonazepam, diazepam, bromazepam as well as non-benzodiazepines like zolpidem, zopiclone or zopeplon. The drug most suitable for you will be selected by your doctor.

To conclude, insomnia may be a tiresome experience but it’s not incurable. If not properly treated, it may affect your daily life severely. Don’t panic as it will just worsen the problem.

Contact your doctor as soon as possible to choose the best treatment for your insomnia and lead a happy life.


Have you every woken up because your roommate or your partner was snoring too loud?

Well, once in a while everyone snores during their sleep – some more than others! – and it can be a real inconvenience to the person sleeping next to you. Saying that it is just an inconvenience is an understatement because it has been linked to various health problems that range from daytime fatigue and irritability to more pressing concerns such as developing obstructive sleep apnea and creating relationship problems between your partner.

How to stop snoring 2016

1. What is snoring?

In simple terms, it is noisy breathing when you are sleeping. The mechanics of snoring are not that complex. Essentially, what happens is that when you are awake the muscles of the pharynx (throat) and the tongue have a certain amount of tension in them but when you are in a supine position (meaning laying on your back) while you sleep, the muscles of your tongue and pharynx relax. This leads to the constriction of the air passage. When you breathe in with force, the pharynx vibrates. This produces the sound that you call snoring.

But the good news is that it is curable!

2. Causes of snoring

Snoring can occur for various reasons but identifying why is the first step to treating the issue. Engage your partner to monitor your sleep pattern. This will help build trust and show your level of seriousness for dealing with this problem and along with that show how much you value your relationship.

What are these reasons?

  • Age: As you get older, the tone of your muscles decrease including the muscle tone of your tongue and pharynx. This will cause narrowing of the air passage leading to snoring
  • Obesity: If your BMI is above 30 then you are medically obese. The thing with obesity is that the deposits of fat around your neck will cause the narrowing of the air passage leading to snoring
  • Your Anatomy: The way you are built will affect the way you sleep. If we compare men and women, men are more prone to snore as they have narrower air passages. If you have enlarged tonsils or adenoids, cleft palate or long uvula this can also be the cause of your snoring problem
  • Sinus Problems : If your nasal passages are obstructed or blocked due to a stuffy nose this will create a vacuum leading to forced inspiration and then snoring
  • Smoking, Alcohol, Medication: Smoking has been linked to causing inflammation of the upper air passageways leading to narrowing. Alcohol acts as a relaxant decreasing the muscle tone while medications like benzodiazepine and barbiturates act as tranquillizers and decrease the muscle tone. All these pose as risk factors for snoring
  • Sleep posture : If you sleep on your back you are more prone to snore during the night
3. Symptoms of snoring

Snoring itself can lead to sleep apnea which is a potentially harmful condition so if you’re snoring then it’s probably best to get this checked by your doctor.

Snoring can cause a wide array of symptoms:

  • Number one on this list is excessive day time fatigue. You may experience lethargy while carrying on with your everyday routine which is due to lack of proper sleep during the night
  • Headaches are another symptom, especially during the morning after you wake up
  • Irritability and fatigue which can affect your interaction with other people and create social as well as psychological problems
  • Decreases sex drive (libido)
  • It can also affect your cognition which includes your attention span and your memory along with your overall level of awareness
  • Obstructive Sleep Apnea is a serious condition in which a person stops breathing for a few seconds during the night due to obstruction of the air passages and then a sudden gasp of air which signals the resumption of breathing. OSA itself is a risk factor for the development of hypertension, heart attack and stroke
4. How to stop snoring?

There are various treatment options for snoring but this will depend on your visit to a sleep specialist who, after performing a sleep test, will determine which option is best for you.

Life Style Modification

  • Losing weight: Losing a few pounds will result in a decrease in the amount of fat around your neck lessening the incidence of snoring
  • Exercise: Exercising various muscles in your body will lead to improved tone of those muscles and an indirect effect on the muscles of your throat (pharynx) leading to improved air way passage functioning
  • Avoid smoking and alcohol intake: They both lead to inflammation and relaxation of the muscles so avoiding these substances will improve your condition
  • Changing your sleeping position: Instead of sleeping on your back, try sleeping on your side. This will prevent your tongue from falling back into the throat and keep the airway open.

Medical Treatment

  • Orthopedic pillow: This is a specially designed pillow that will keep the jaw open and keep reduce snoring
  • Using appliances that are made by dentists to maintain a patent airway such as nasal strips and dilators
  • Continuous positive airway pressure (CPAP): A machine pumps air under pressure into your throat while you wear a mask over your mouth and nose which will keep the airway open when you sleep
  • Surgery: Tonsillectomy, adenoidectomy or uvulopalatopharyngoplasty will remove tissues growth which are the cause of the narrowing and ultimately lead to an increased size of the airway
  • Palatal implant: This is also known as the pillar procedure. It involves inserting plastic implants into the soft palate to prevent it from collapsing
  • Treating your nasal disorders will lead to a decreased incidence of snoring

The best way to stop snoring is to stick to the lifestyle adjustment scheme and follow the treatment plan laid out by your physician. For sleep apnea patients, having a good CPAP machine will really help during sleep. Along with having a good quality CPAP pillow, this will benefit anyone with a neck problem and aid in the relief from snoring ensuring a sound sleep.

Snoring is a condition which is often overlooked but if it remains untreated it leads to various problems including social, psychological and mental issues along with the chance of developing sleep apnea.

If you snore, take measures before it goes too far and causes complications.