Sleep Disorders and Therapeutics

Chronic Fatigue Syndrome (CFS), also known as myalgic encephalomyelitis (ME), is a complex disorder characterized by extreme fatigue that persists for at least six months and is not significantly improved by rest. Common symptoms include severe fatigue impeding daily activities, malaise, body pain, cognitive impairment, sore throat, and disturbed sleep. Diagnosis involves excluding other conditions with similar symptoms and meeting specific criteria like persistent fatigue for at least six months, worsened by exertion. Treatment aims at symptom management and enhancing quality of life, as there is no cure. Pain relief medications like ibuprofen or prescription drugs such as pregabalin and duloxetine help manage discomfort. Orthostatic intolerance may require medications to regulate blood pressure or heart rhythms. Addressing depression is crucial, aiding in coping with the challenges of chronic illness. Effective management strategies can alleviate symptoms and improve overall well-being for individuals with CFS.

Circadian rhythm disorders originate from disruptions in the body's natural clock, often involving the hypothalamus and suprachiasmatic nucleus (SCN). Causes include brain damage, vision impairments, travel, shift work, and unknown factors. Risk factors encompass age, genetics, air travel direction, shift timing changes, and neurodevelopmental differences like ADHD or autism spectrum disorder. Complications range from difficulties in school or work schedules to the development of other sleep disorders like chronic insomnia. Substance misuse, accidents, and injuries are potential consequences due to daytime sleepiness. Management involves addressing underlying causes through lifestyle adjustments, medical interventions, and behavioral therapies. Diagnosis entails a comprehensive assessment, including questionnaires, exams, lab testing, imaging scans, and sleep logs. Treatments vary, including adjusting lighting, taking melatonin supplements, and behavioral adjustments. Prevention is challenging, but maintaining good sleep habits and limiting exposure to disruptive factors like bright lights may help mitigate risk. However, jet lag from air travel across time zones remains a normal consequence.

Bruxism often goes unnoticed until symptoms, like teeth destruction, are identified during a dental exam. Symptoms vary depending on the type; nocturnal bruxism worsens upon waking, while awake bruxism may escalate throughout the day. Signs include tooth sensitivity, facial and neck pain, jaw muscle soreness, earaches, and headaches. Stress, anxiety, and certain medications are linked to its development. Risk factors include age, personality type, medication use, and family history. Complications, such as TMJ disorder, loose teeth, and facial changes, may arise in severe cases. Diagnosis involves dental exams and symptom evaluation. Treatment ranges from lifestyle changes and stress management to dental interventions like mouth guards and corrective procedures. Sleep studies and therapy may be necessary for associated sleep disturbances or psychological issues. Strategies to minimize grinding include avoiding stimulants, stress reduction techniques, and using warm compresses or night guards. Professional help is crucial for severe cases.

Narcolepsy, often misunderstood, brings persistent drowsiness, impairing life and raising accident risks. It disrupts sleep-wake cycles, leading to excessive sleepiness and challenges staying awake. Narcolepsy manifests as Narcolepsy Type 1 (NT1), linked with cataplexy and low hypocretin-1, and Narcolepsy Type 2 (NT2), lacking cataplexy or low hypocretin-1. Despite rarity, NT1 affects 20-67 individuals per 100,000, with underdiagnosis issues. Symptoms include daytime sleepiness, automatic behaviors, disturbed sleep, paralysis, hallucinations, and cataplexy (NT1 only). These symptoms vary in severity and timing. In children, symptoms differ, with daytime sleepiness showing as restlessness or irritability, possibly mistaken for behavior problems. Children may sleep longer at night and have more sleep-related movements. Cataplexy in children is subtler, often affecting the face. Early recognition and tailored management are vital, particularly in children, to address academic, social, and psychological impacts and mitigate accident risks. Treatment, including behavioral and medicinal interventions, must adapt to children's needs, ensuring safety and long-term effectiveness.

Night terrors, often called sleep terrors, are nocturnal episodes characterized by intense fear, primarily affecting children but also occurring in adults. Unlike nightmares, individuals typically remain asleep during night terrors, which can last from 30 seconds to several minutes. These episodes involve behaviors like screaming, sleepwalking, limb thrashing, and heavy breathing, often leaving the person confused upon waking. Although terrifying, night terrors are usually harmless and tend to resolve spontaneously. Factors contributing to night terrors include fever, stress, sleep deprivation, genetics, and underlying medical conditions like sleep apnea or mental health disorders. Diagnostic evaluation may involve a sleep study to assess sleep patterns and rule out other sleep disorders. Treatment focuses on managing underlying conditions, improving sleep hygiene, and addressing stress. Medications like benzodiazepines or SSRIs may be prescribed in severe cases. Simple interventions like creating a safe sleep environment, reducing stress, and maintaining a consistent sleep schedule can also help alleviate night terrors. While more common in children, night terrors can affect adults, often associated with mental health issues like bipolar disorder or depression.

Non-24-hour sleep-wake disorder (N24SWD) disrupts the body's internal clock, causing sleep and wake times to shift progressively later or earlier than the typical 24-hour cycle. Individuals with N24SWD often experience fluctuations in mood, appetite, and alertness due to their desynchronized circadian rhythm. Despite efforts to maintain a regular sleep-wake cycle, common solutions like caffeine are often ineffective. The disorder can significantly impact daily life, making it challenging to fulfill work, school, or social obligations. In severe cases, individuals may develop depression as a result of the stress and disruptions caused by the disorder. N24SWD is most prevalent in individuals with total blindness, affecting approximately 50% of this population due to the absence of light input to regulate the internal clock. However, it can also occur in sighted individuals, albeit less commonly, and is often misdiagnosed as other sleep disorders. Treatment options include melatonin supplements, tasimelteon, and bright light therapy to help regulate the sleep-wake cycle and alleviate associated symptoms.

Parasomnias encompass various sleep disorders characterized by unusual behaviors or experiences during sleep. They are classified into three main groups: NREM-related, REM-related, and "other." NREM-related parasomnias, occurring during non-REM sleep stages, include confusional arousals, sleepwalking, night terrors, and sleep-related eating disorders. REM-related parasomnias manifest during REM sleep and include REM sleep behavior disorder (RBD), sleep paralysis, and nightmare disorder. The "other" category encompasses parasomnias occurring during transitions between sleep and wakefulness or across sleep stages, such as exploding head syndrome, sleep-related hallucinations, and bedwetting. These disorders can significantly disrupt sleep quality and daily functioning. Seeking medical advice is crucial for proper diagnosis and management, as treatments may vary depending on the specific parasomnia and its underlying causes.

Periodic Limb Movements Disorder is a sleep disorder characterized by repetitive and involuntary movements of the legs or, less commonly, the arms during sleep. These movements typically occur every 20 to 40 seconds and can disrupt sleep patterns, leading to daytime fatigue and sleepiness. The exact cause of PLMD is not fully understood but is believed to involve abnormalities in the nervous system. Symptoms may include restless sleep, frequent awakenings, daytime fatigue, and irritability. Diagnosis often involves a comprehensive evaluation of medical history, physical examination, and a sleep study to monitor limb movements during sleep. Treatment options for PLMD may include medications such as dopaminergic agents, benzodiazepines, or anticonvulsants, as well as lifestyle modifications like maintaining a regular sleep schedule and avoiding stimulants before bedtime

Rhythmic Movement Disorder is a sleep disorder characterized by repetitive and stereotyped movements of large muscle groups just before or during sleep. These movements typically involve rocking, head banging, or body rolling and often occur in infants and young children. The exact cause of RMD is not fully understood, but it is believed to be related to the immaturity of the nervous system or a way of self-soothing. Symptoms may include rhythmic movements during sleep, which can be loud enough to disrupt others' sleep in shared spaces. Diagnosis often involves a thorough evaluation of medical history and sleep patterns, sometimes supported by video recording during sleep. Treatment options for RMD are usually focused on providing a safe sleep environment and addressing any underlying issues contributing to the disorder. Techniques such as gentle sleep training and creating a calming bedtime routine may help manage symptoms. In most cases, RMD resolves on its own as a child grows older, but seeking medical advice can provide guidance on appropriate management strategies.

Restless Leg Syndrome is a neurological disorder characterized by an uncontrollable urge to move the legs, usually due to uncomfortable sensations such as tingling, itching, or aching. These sensations typically occur when at rest, especially in the evening or at night, and can significantly disrupt sleep. The exact cause of RLS is not fully understood, but it is believed to involve abnormalities in dopamine levels in the brain and may have a genetic component. Symptoms of RLS can vary in severity and may be aggravated by factors such as stress, caffeine, or certain medications. Diagnosis is typically based on a thorough medical history and evaluation of symptoms, sometimes aided by specific diagnostic criteria. Treatment for RLS aims to alleviate symptoms and may include lifestyle changes, such as regular exercise and avoiding triggers, as well as medications to regulate dopamine levels or address underlying conditions. Additionally, practicing good sleep hygiene and relaxation techniques can help manage symptoms and improve sleep quality for individuals with RLS.

Sleepwalking, also known as somnambulism, is a sleep disorder characterized by performing various activities while asleep and not fully conscious. These activities can include walking, talking, and engaging in complex behaviors. Sleepwalking episodes typically occur during deep non-rapid eye movement (NREM) sleep, particularly during the first few hours of sleep. The exact cause of sleepwalking is not fully understood, but it is believed to involve disruptions in the transition between sleep stages, genetic factors, and triggers such as sleep deprivation, stress, or medications. Symptoms of sleepwalking include walking around the room or house, talking incoherently, and performing routine activities. Diagnosis is usually based on a thorough medical history and evaluation of symptoms, sometimes aided by polysomnography. Treatment for sleepwalking often involves addressing underlying causes such as sleep disorders or stress, as well as implementing safety measures to prevent injury during episodes. Medications may also be prescribed in some cases to help control symptoms.

Sleep paralysis, recognized as a parasomnia, represents an aberrant sleep phenomenon often associated with an underlying diagnosis of narcolepsy, a neurological disorder characterized by impaired regulation of wakefulness. It manifests in two primary forms: isolated sleep paralysis and recurrent sleep paralysis. Isolated sleep paralysis denotes singular occurrences, typically not indicative of narcolepsy, while recurrent sleep paralysis involves multiple episodes over time and may coincide with narcolepsy. Recurrent isolated sleep paralysis (RISP) integrates these features, presenting ongoing instances of sleep paralysis absent narcoleptic symptoms. The hallmark symptom of sleep paralysis is atonia, manifesting as the inability to move or speak during episodes, often accompanied by sensations of chest pressure, breathing difficulty, and emotional distress such as panic. Approximately 75% of cases involve hallucinations, categorized into three types: intruder hallucinations, chest pressure hallucinations (incubus), and vestibular-motor (V-M) hallucinations. These episodes typically emerge in childhood or early adulthood, with increased frequency observed in one's 20s and 30s. Duration varies from seconds to minutes, with an average length of approximately six minutes. Predominantly distressing, sleep paralysis episodes evoke feelings of fear in about 90% of cases, though a minority may experience more pleasant hallucinations. Effective management strategies involve understanding the underlying mechanisms and addressing associated sleep disturbances and psychological distress.