There are a variety of sleep disorders that can adversely affect your overall health. Most of us take a good night’s sleep for granted but many people may have symptoms and illnesses that are directly or indirectly related to sleep disturbances.
Epworth Sleepiness Scale
For patients who report symptoms that may be related to sleep disturbances, the first diagnostic tool the doctor uses is the Epworth Sleepiness Scale. The Epworth Sleepiness Scale is a screening tool for rating whether a patient has any daytime sleepiness associated with sleep disturbance.
Fill out the Epworth Sleepiness Scale form. If you total is higher than a 10, consult with your doctor about a sleep study.
Although most of us think of insomnia as being a simple difficulty with falling asleep, the problem is much more complex and multi-faceted.
Most people who experience insomnia will have an acute episode but it does not become a long-term condition. The problem comes when insomnia persists beyond three months’ time and becomes a chronic condition.
There are several different contributing factors that have to be considered with insomnia and we screen patients historically for any symptoms suggestive of obstructive sleep apnea, restless leg syndrome, or other problems.
There are additional factors to be considered, such as circadian rhythm disorders, where the internal clock is shifted. It could be shifted to an earlier time, which is much more common in seniors, where they develop an advanced sleep phase disorder. In young patients, particularly high school students, we sometimes see delayed sleep phase, where they are brought in with complaints of not being able to sleep but having significant sleepiness during the early part of the day.
A comprehensive sleep history enables us to obtain information as to duration of the symptoms, what time they go to bed, and whether they have difficulties with sleep onset versus sleep maintenance. That can make a difference as far as diagnostic evaluation and treatment.
Obstructive sleep apnea is an increasingly common diagnosis among American adults and is caused by obstruction of the upper airway. In addition to being a contributing factor to insomnia, sleep apnea can be related to a host of serious health problems.
Sleep apnea has been shown in multiple studies to increase your risk not only of cardiovascular but also cerebrovascular morbidity. There have been studies on the effect of the vibrations created during snoring on the carotid system and increasing development of atherosclerosis in the vessels, so that puts these patients at a higher risk for stroke.
Severe obstructive sleep apnea patients have frequent premature ventricular contractions, or extra heartbeats. If those happen in a run, you can go into ventricular fibrillation, and that’s death if you’re sleeping. Primary risk factors for sleep apnea patients include cardiac arrhythmias, congestive heart failure, myocardial infarction, and stroke, to make no mention of the daytime problem of non-restorative sleep.
There are a number of movement disorders that can affect sleep. The most well-known of these is restless leg syndrome, or RLS.
When it comes to restless leg syndrome, we are learning more about this condition as time goes on. It’s not quite as common as sleep apnea, but it’s also not something most doctors ask about. RLS is a very treatable condition, but it can disrupt sleep and lead to the same problems in terms of a patient’s ability to function at full capacity, especially at work.
Restless leg syndrome is essentially defined by three criteria: discomfort in the legs, which is made worse at rest and is alleviated by movement. We screen patients for other potential causes, such as iron deficiency, anemia, and hepatic (liver) or renal (kidney) dysfunction. We also look at their medications to see whether there’s anything in their medication list that may be causing it, such as a dopamine blocker.
The other disorder that goes along with this condition is called periodic limb movement disorder, or PLMD. It’s a variant of restless leg syndrome, and/or obstructive sleep apnea that actually requires a sleep study to make the diagnosis because patients do not present with specific complaints. They just say that they’re not sleeping well, and if they sleep with a spouse, their spouse may notice that they kick a lot while sleeping. The patient, however, will not be aware of these movements.
Testing and Treatment
There are several tests which can assist in the evaluation of sleep disorders. The Epworth Sleepiness Scale works as an initial diagnostic tool, but before putting patients through a sleep test in the lab, leading-edge technologies can provide some needed answers.
The patient may be screened for evidence of hypoxemia, or low blood oxygen, with something called a pulse oximeter. The patient wears a portable device on their finger and if they do sleep, their oxygen level may dip during REM (rapid eye movement) sleep, and that can be an indicator that they have sleep apnea. The pulse oximeter records their oxygen level throughout the night by measuring the transference of infrared light passing through the capillary bed in the finger.
Actigraphy is a very useful technology. It is used primarily to look for circadian rhythm disorders. It’s a watch that basically senses light perception and movement, so it’s good at keeping track of when the patient is awake and when they’re sleeping. The patient wears it for about a week and then we check to see what their cycle is on a day-to-day basis.
In certain instances, a formal sleep study is recommended. Of course, most patients do not require this type of testing initially, so we recommend that they see a sleep physician before undergoing a sleep study. We can diagnose the problem and determine the proper treatment that gets patients back to a good night’s sleep and, ultimately, optimum health.