Hypersomnia can interfere with your ability to function at home, work, or school. A nap or sleep attack while driving or operating dangerous machinery can be life-threatening. In fact, hypersomnia may be responsible for one out of five motor vehicle accidents.

Hypersomnia has been recognized as a medical problem for a long time. In the 17^th Century, it was described as patients with a sleepy disposition who suddenly fall fast asleep. About 30 percent of people complain of excessive daytime sleepiness today. About five percent of the population may be diagnosed with hypersomnia. Hypersomnia is usually diagnosed between the ages of 17 and 24, and is more common in women.

Symptoms of Hypersomnia

According to the Diagnostic and Statistical Manual of Mental Disorders, to diagnose hypersomnia you need to experience excessive sleepiness despite getting at least seven hours of sleep and lapse into naps several times each day, or sleep more than 9 hours at night and still feel sleepy, or experience sleep drunkenness. These symptoms must occur at least three times per week for at least three months. The symptoms must be severe enough to interfere with your function at home, work, or school. Other symptoms may include:

• Naps or sleep attacks that don’t improve sleepiness
• Feeling anxious, restless, depressed, or irritable
• Having very little energy
• Slowed thinking or speech
• Poor memory
• Frequent headaches
• Loss of appetite

Causes of Hypersomnia

Causes of hypersomnia are divided into secondary and primary causes. Secondary causes are excessive daytime sleepiness caused by another disease. In these cases, hypersomnia is one of the symptoms of another condition. These conditions include:

• Sleep apnea
• Drug or alcohol abuse
• Side effects from prescription drugs
• Depression or bipolar disorder
• Obesity
• Parkinson’s disease
• Multiple Sclerosis
• Brain tumor or head trauma
• Hypothyroidism
• Epilepsy
• Long-term sleep deprivation

Primary hypersomnia is hypersomnia caused by a specific condition in which excessive sleepiness is the main symptom. There are three causes of primary hypersomnia:

• Idiopathic hypersomnia is hypersomnia of an unknown cause. This condition may be due to a genetic defect passed down through families, since 39 percent of people have a family history.
• Narcolepsy is a disease caused by low levels of the brain messenger (neurotransmitter) hypocretin. This neurotransmitter helps control waking up from sleep. Narcolepsy causes symptoms of hypersomnia and may also cause sudden loss of muscle tone triggered by strong emotions, called cataplexy. It may also cause hallucinations and sleep paralysis when falling asleep or waking up.
• Kleine-Levin syndrome is a rare condition that causes recurring episodes of sleeping for up to 20 hours along with increased appetite and other abnormal behaviors. Episodes can last for days or weeks. Between episodes sleep and other behaviors return to normal. Episodes may be triggered by alcohol use or an infection. The cause is unknown and episodes tend to decrease with older age.

Diagnosis and Treatment

Diagnosis of hypersomnia is based on the symptoms, sleep studies, and brain wave studies. Treatment depends on the cause. Hypersomnia caused by another disease may improve when that condition is treated, such as thyroid replacement for hypothyroidism or continuous positive airway pressure (CPAP) for sleep apnea.

A new medication was recently approved to treat idiopathic hypersomnia called Xywav, it contains the minerals calcium, magnesium, and potassium along with a narcolepsy medication called sodium oxybate. Other medications may include stimulant drugs, Parkinson’s disease drugs, wakefulness drugs, and antidepressants. Along with medications, good sleep habits and the avoidance of the stimulants caffeine, nicotine, and alcohol are helpful. Some patients improve with planned naps during the day.

Although not a fatal disease, untreated hypersomnia can be difficult to live with, affect your quality of life, and can even be dangerous. Most cases of hypersomnia tend to be long-term conditions. Let your doctor know if you have any of the symptoms of hypersomnia. Medications can help.

The post What Is Hypersomnia? appeared first on University Health News.

If you’re not sleeping well, there are plenty of possible reasons: There are about 80 different sleep disorders, in addition to the most common sleep disorder, obstructive sleep apnea. Here’s a look at some sleep disorders other than sleep apnea.

Restless Legs Syndrome

Restless legs syndrome (RLS) is characterized by uncomfortable sensations in the legs and feet while lying in bed. Sensations of RLS have been described as tingling, itching, creeping, crawling, or tightness.

Experts suspect that RLS is related to low levels of dopamine, the chemical that carries signals between brain cells that control body movement. RLS often coexists with Parkinson’s disease, a condition caused by insufficient dopamine production.

In some people, RLS symptoms can be eased or prevented with medications such as gabapentin (Neurontin), gabapentin enacarbil (Horizant), and pregabalin (Lyrica). Drugs that stimulate dopamine receptors in the brain are sometimes prescribed, but side effects associated with these medications can be problematic.

Research has linked RLS with risk factors including obesity, physical inactivity, alcohol consumption, and smoking. Some evidence suggests that deficiencies of certain nutrients, including vitamins D and B12, folate, iron, and magnesium, may contribute to RLS.

Periodic Limb Movement Disorder

In periodic limb movement disorder (PLMD), the legs (or, less commonly, the arms) move during sleep. These movements can last from a fraction of a second to five seconds, and they can range from brief muscle twitches to more violent, jerking movements.

Some antidepressants can aggravate PLMD, and withdrawal from sedative drugs can bring on the condition or make it worse. PLMD has been associated with kidney disease, diabetes, anemia, and sleep apnea.

PLMD often causes frequent nighttime awakenings, but most people who have PLMD are not aware of the movements or disruptions in their sleep. People with PLMD also may experience the tingling or creepy-crawly sensations of RLS.

Medications used to treat PLMD are similar to the ones used for RLS. Deficiencies of vitamins D and B12, iron, and/or folate may trigger PLMD.

Narcolepsy

Narcolepsy is a chronic neurological disorder that stems from a genetic trait that may be triggered by autoimmune conditions or other factors.

In narcolepsy, the brain is unable to regulate sleep-wake cycles normally. The major symptom of narcolepsy is excessive daytime sleepiness. In most cases, the urge to sleep during the day interferes with daytime activities.

About 70 percent of people with narcolepsy experience cataplexy, an abrupt loss of muscle tone that may be provoked by strong emotions. Other symptoms include sleep paralysis (being unable to move during the transition from REM sleep to wakefulness) and vivid hallucinations before falling asleep or upon awakening.

Modafinil (Provigil), armodafinil (Nuvigil), and solriamfetol (Sunosi) are FDA-approved medications for treating the excessive daytime sleepiness resulting from narcolepsy. Sodium oxybate (Xyrem) is a nighttime medication approved for narcolepsy with cataplexy.

People with narcolepsy are urged to keep a regular sleep schedule and avoid sleep deprivation. They may also take regularly scheduled brief naps at times when they feel sleepiest.

Hypersomnia

Hypersomnia is characterized by episodes of excessive daytime sleepiness, even with adequate nighttime sleep. The condition is different from the daytime sleep episodes of narcolepsy. People with hypersomnia feel driven to nap, often for long periods; however, the naps are not refreshing. Other symptoms may include anxiety, irritability, restlessness, slowed thinking, and memory problems.

Hypersomnia may be caused or worsened by another sleep disorder such as sleep apnea, drug or alcohol abuse, medication withdrawal (or by some medications themselves), head trauma, depression, epilepsy, or multiple sclerosis.

Hypersomnia is treated by addressing the underlying cause. If no cause is found, the disorder is called idiopathic hypersomnia and may be treated with similar approaches used for narcolepsy, including medications and behavioral changes.

Sleep Paralysis

If you have ever awakened from a dream and been unable to move, you’ve experienced sleep paralysis. The episodes may last from a few seconds to several minutes. Some people become frightened or panicky during sleep paralysis, mistakenly thinking they are in danger.

Sleep paralysis sometimes occurs if you haven’t had enough sleep. If it occurs frequently, it may be a sign of another sleep disorder, such as obstructive sleep apnea or narcolepsy.

Most people do not require treatment for sleep paralysis. Keeping a regular sleep schedule and avoiding sleep deprivation or sleep loss are strategies that may help.

REM Sleep Behavior Disorder

REM sleep behavior disorder (RBD) is the opposite of sleep paralysis: People lose the normal paralysis that occurs during REM sleep and essentially act out their dreams. These behaviors may be violent; people with RBD may strike out at their bedmate or suffer injuries from falling or jumping out of bed.

RBD may be brought on by the abrupt withdrawal of drugs or alcohol. It’s more likely to occur in people with Parkinson’s disease, dementia, anxiety, cerebrovascular disease, or post-traumatic stress disorder.

These are just a few of the many sleep disorders that have been identified. It’s also possible to have trouble sleeping even if you don’t have a sleep disorder. Factors that commonly interfere with sleep include medical conditions, medications, and poor sleep hygiene.

If you have problems sleeping for several weeks or you’re often sleepy during the day, don’t ignore it. Good sleep isn’t a luxury; your body and brain require it to function optimally.

The post Frequent Daytime Fatigue May Be Caused by a Sleep Disorder appeared first on University Health News.

As a clinician, I usually start with simple sleep hygiene for my sleep deprived patients: doing something restful and quiet during the hour before bedtime, with no electronic device use during that time. Some soothing herbal tea or a relaxing bath can help, too. It’s important to sleep in a cool room, and keep the TV turned off while in bed. Of course, eliminating or reducing caffeine and alcohol consumption are key as well. If these steps all fail to restore good sleep, we proceed to evaluate for sleep disorders.

Many people have silent sleep apnea—it’s “silent” because it’s never diagnosed or treated. How do you know if you have sleep apnea?

The classic image of a person with obstructive sleep apnea (OSA) is the Pickwickian character who is obese, with a ruddy complexion and mild shortness of breath. This patient also may suffer from narcolepsy and fall asleep sitting up. But we now know that most people with sleep apnea do not fit this profile; rather, they are usually mildly to moderately overweight, and they present with fatigue as well as cardiac or pulmonary problems.

The tip-off signs of OSA are snoring, gasping for air, and periods in which the person actually stops breathing briefly. If your partner or a member of your household mentions any of these to you, immediate sleep testing is warranted. The testing is also warranted if you have chronic fatigue, obesity, or certain types of heart failure that manifest with swelling of the legs and feet and shortness of breath with exertion.

Sleep testing may require an overnight stay at a sleep lab, but many patients are tested with at-home sleep study kits that they self-apply at night and mail back to be analyzed.

If OSA is diagnosed, there are many potential solutions. People who are overweight or obese often have significant improvements with weight loss. Some patients require oxygen delivery to the nose and/or mouth via a continuous positive airway pressure (CPAP) machine.

Sleep problems are commonly associated with menopause or anxiety; however, if you have persistent daytime fatigue, don’t assume it’s due to these factors. Chronic sleepiness and tiredness, especially in obese individuals, should be carefully evaluated. While one never wants to find out they have a medical disorder, diagnosis is a must in order to get treatment that will alleviate OSA. Effective treatment of OSA can have remarkable effects on patients’ health, mood, memory, and energy levels; in fact, many patients say they “feel like a new person” once their OSA is treated.

The post Better Sleep Means Better Health appeared first on University Health News.

If you’re not sleeping well, there are plenty of possible reasons: There are about 80 different sleep disorders. Here’s a look at some sleep disorders and treatment options that are most effective for each condition.

Restless Legs Syndrome

If you experience uncomfortable sensations in your legs and feet as you lie in bed, and you feel like you must move your legs to stop the sensations, you may have restless legs syndrome (RLS). Sensations of RLS may be described as tingling, itching, creeping, crawling, or tightness.

Experts suspect that RLS is related to low levels of dopamine, the chemical that carries signals between brain cells that control body movement. RLS often coexists with Parkinson’s disease, a condition caused by insufficient dopamine production.

In some patients, RLS symptoms can be eased or prevented with medications that include gabapentin (Neurontin), gabapentin enacarbil (Horizant), clonazepam (Klonopin), and pregabalin (Lyrica). Drugs that stimulate dopamine receptors in the brain are sometimes prescribed. However, side effects associated with these medications can be problematic, so they are less commonly used.

Research has linked RLS with risk factors including obesity, physical inactivity, alcohol consumption, and smoking, so making healthy lifestyle changes may help. Some evidence suggests that deficiencies of certain nutrients, including vitamins D and B12, folate, iron, and magnesium, may contribute to RLS, so getting more of these nutrients may alleviate symptoms.

Periodic Limb Movement Disorder

In periodic limb movement disorder (PLMD), your legs (or, less commonly, your arms) move while you are asleep. These movements can last from a fraction of a second to five seconds, and they can range from brief muscle twitches to more violent, jerking movements.

Often, the cause of PLMD cannot be identified. Some antidepressants can aggravate PLMD, and withdrawal from sedative drugs can bring on the condition or make it worse. PLMD has been associated with kidney disease, diabetes, anemia, and sleep apnea.

PLMD often causes frequent nighttime awakenings, but most people who have PLMD are not aware of the movements or disruptions in their sleep. People with PLMD also may experience the tingling or creepy-crawly sensations of RLS.

Treatment for PLMD is indicated only if the disorder causes problems, such as multiple awakenings or excessive daytime fatigue. Medications used to treat PLMD are similar to the ones used for RLS, including dopaminergic agents, gabapentin, and sedatives. Deficiencies of vitamins D and B12, iron, and/or folate may trigger PLMD, so supplementing these nutrients may improve the condition.

Narcolepsy

Narcolepsy is a chronic neurological disorder that stems from a genetic trait that may be triggered by autoimmune conditions or other factors. Narcolepsy has been linked to anxiety, depression, and diseases of the nervous and digestive systems.

In narcolepsy, the brain is unable to regulate sleep-wake cycles normally. The major symptom of narcolepsy is excessive daytime sleepiness. In most cases, the urge to sleep during the day is strong and interferes with daytime activities.

About 70 percent of people with narcolepsy experience cataplexy, an abrupt loss of muscle tone that may be provoked by strong emotions. Other symptoms of narcolepsy include sleep paralysis (being unable to move during the transition from REM sleep to wakefulness) and vivid hallucinations before falling asleep or upon awakening.

Modafinil (Provigil), armodafinil (Nuvigil), and solriamfetol (Sunosi) are FDA-approved daytime medications for treating the excessive daytime sleepiness resulting from narcolepsy. Sodium oxybate (Xyrem) is a nighttime medication approved for narcolepsy with cataplexy.

Traditional stimulants such as amphetamines, as well as newer ones such as methylphenidate (Ritalin), can be used to improve alertness, but these drugs can cause potentially dangerous side effects such as elevated blood pressure, extreme nervousness, and physical dependence.

People with narcolepsy are urged to keep a regular sleep schedule and avoid sleep deprivation. They may also take regularly scheduled brief naps at times when they feel sleepiest.

Hypersomnia

Hypersomnia is characterized by episodes of excessive daytime sleepiness, even with adequate nighttime sleep. The condition is different from the daytime sleep episodes of narcolepsy. People with hypersomnia feel driven to nap, often for long periods; however, the naps are not refreshing. Other symptoms may include anxiety, irritability, restlessness, slowed thinking, and memory problems.

Hypersomnia may be caused or worsened by another sleep disorder such as sleep apnea, drug or alcohol abuse, medication withdrawal (or by some medications themselves), head trauma, depression, epilepsy, or multiple sclerosis.

Hypersomnia is treated by addressing the underlying cause. If no cause is found, the disorder is called idiopathic hypersomnia and may be treated with similar approaches used for narcolepsy, including medications and behavioral changes.

Sleep Paralysis

If you have ever awakened from a dream and been unable to move, you’ve experienced sleep paralysis. The episodes may last from a few seconds to several minutes. Some people become frightened or panicky during sleep paralysis, mistakenly thinking they are in danger.

Sleep paralysis sometimes occurs if you haven’t had enough sleep. If it occurs frequently, it may be a sign of another sleep disorder, such as obstructive sleep apnea or narcolepsy.

Most people do not require treatment for sleep paralysis. Keeping a regular sleep schedule and avoiding sleep deprivation or sleep loss are strategies that may help. Medications that suppress REM sleep can be given to people who experience repeated episodes of sleep paralysis.

REM Sleep Behavior Disorder

REM sleep behavior disorder (RBD) is the opposite of sleep paralysis: People lose the normal paralysis that occurs during REM sleep and essentially act out their dreams. These behaviors may be violent and aggressive; people with RBD may strike out at their bedmate or suffer injuries from falling or jumping out of bed.

RBD may be brought on by the abrupt withdrawal of drugs or alcohol. It may occur in people with Parkinson’s disease, dementia, anxiety, cerebrovascular disease, or posttraumatic stress disorder. Taking SSRI antidepressants and other psychiatric medications has been linked with a higher incidence of RBD.

Medications can help reduce the number and severity of episodes and decrease the chance for injuries. The medications used to treat RBD include Parkinson’s drugs and benzodiazepines such as clonazepam.

These are just a few of the many sleep disorders that have been identified. It’s also possible to have trouble sleeping even if you don’t have a sleep disorder. Many factors that commonly interfere with sleep include medical conditions, medications, poor sleep hygiene, and high stress levels.

If you have problems sleeping for several weeks, don’t ignore it, and don’t take over-the-counter sleep aids for more than two weeks. Good sleep isn’t a luxury; your body and brain require it to function optimally, and not getting it can be harmful to your health.

The post Don’t Underestimate the Impact Poor Sleep Has on Your Health appeared first on University Health News.

If your doctor has referred you to a lab for a sleep study, odds are you’re a chronic snorer or have symptoms of sleep apnea, such as temporarily stopping breathing during the night and/or being exhausted and sleepy during the day even if you had a full night of sleep. Here are some things you should know before you schedule a sleep study:

Q: What Is a Sleep Study? A sleep study is a test that measures how well you sleep and determines whether you have any sleep problems, and how severe they are. During the test, electrodes on flexible wires are attached via (easily removed) glue to your head and body. These electrodes monitor your brain waves, rapid eye movements, oxygen levels, breathing patterns, respiratory efforts, snoring, muscle tone, leg movements, and heart rate, among other things.

Q: What Are the Three Types of In‑lab Sleep Studies?

1. Polysomnogram (PSG). A PSG is an overnight sleep study that records brain activity, eye movements, heart rate, blood pressure, oxygen levels, body movement, and more. PSGs are used to help diagnose some of the following:

• Sleep-related breathing disorders, such as obstructive sleep apnea (OSA).
• Sleep-related seizure disorders.
• Sleep-related movement disorders, such as limb movement disorder.
• Sleep-related disorders caused by excessive daytime sleepiness.

2. Multiple Sleep Latency Test (MSLT). A MSLT is a sleep study that is performed during the day to measure how sleepy you get or to discern whether breathing treatments for your disorder are working properly. MSLTs generally follow a polysomnogram and record whether you fall asleep during the test, and if so, which stages of sleep you enter. In an MSLT, you are generally given five 20-minute nap opportunities spaced 2 hours apart, while a sleep technician monitors your brain activity and eye movements. An MSLT is often used to test for narcolepsy.
3. Maintenance of Wakefulness Test (MWT). An MWT is a daytime sleep study that measures how alert you are during the day and your ability to stay awake. It is usually performed after a PSG, and can help determine if your sleepiness is a safety concern.

Q: What Issues Can a Sleep Study Detect? A sleep test can help determine whether you snore, and if so, how frequently and severely. It can also help a doctor diagnose sleep apnea. A sleep study can monitor your movements to detect any sleep-related seizure disorders or sleep-related movement disorders, such as periodic limb movement disorder. On a more basic level, it can analyze your sleep patterns and help you learn—in more detail—about the quantity and quality of the sleep that you’re getting.

Related post: “The Apnea-Alzheimer’s Connection“

The post FAQ: Sleep Study appeared first on University Health News.

American Sleep Apnea Association
www.sleepapnea.org
asaa@sleepapnea.org
888-293-3650
641 S St. NW, 3rd Floor
Washington, DC 20001-5196

Better Sleep Council
(A trade association of the mattress industry)
www.bettersleep.org

Hypersomnia Foundation
www.hypersomniafoundation.org
info@hypersomniafoundation.org
678-842-3512
4514 Chamblee Dunwoody Rd., #229
Atlanta, GA 30338

Narcolepsy Network

Home NEW

NarNet@narcolepsynetwork.org
888-292-6522
P.O. Box 2178
Lynnwood, WA 98036

National Center on Sleep Disorders Research
www.nhlbi.nih.gov/about/divisions/national-center-sleep-disorders-research
Building 31
31 Center Dr.
Bethesda, MD 20892

National Heart, Lung, and Blood Institute (NIH)
www.nhlbi.nih.gov/health-topics/sleep-deprivation-and-deficiency
Building 31
31 Center Dr.
Bethesda, MD 20892

National Institute on Aging
www.nia.nih.gov
niaic@nia.nih.gov
800-222-2225
800-222-4225 (TTY)
Building 31, Room 5C27
31 Center Dr. MSC 2292
Bethesda, MD 20892

National Sleep Foundation
www.sleepfoundation.org

Restless Legs Syndrome Foundation
www.rls.org
info@rls.org
512-366-9109
3006 Bee Caves Rd., Suite D206
Austin, TX 78746

Sleep Education
(A resource provided by the American Academy of Sleep Medicine)
www.sleepeducation.org
630-737-9700
2510 N. Frontage Rd.
Darien, IL  60561

The post Resources appeared first on University Health News.

acute pain: Pain resulting from a single incident, such as surgery, a sprain, or an accident. Acute pain may interfere with sleep while the pain is felt.

adaptive servo ventilation: Positive airway pressure support delivered through a machine resembling a CPAP device that automatically adjusts air pressure based on the detection of changes in breathing. May be recommended for patients with central or more complex sleep apnea.

advanced sleep phase syndrome: A condition that causes people to fall asleep far too early and awaken far too soon.

automatic behavior: Performing routine activities without being aware. People with narcolepsy may exhibit automatic behavior between wakefulness and sleep.

bilevel titration: Positive airway pressure support delivered through a machine resembling a CPAP device, which provides dual pressure settings that may automatically adjust air pressure. Used for patients who have low oxygen levels, severe obesity, chest wall deformities, neuromuscular disease, and other conditions.

brain waves: The electrical activity of the brain as seen on encephalography (EEG).

cataplexy: A sudden loss of muscle tone in narcolepsy that may cause a person to fall to the ground.

central sleep apnea: A condition that occurs when the brain fails to send appropriate signals to the muscles that control breathing during sleep.

chronic pain: Pain that fails to get better over time. Chronic pain can have lasting effects on the ability to sleep normally.

chronotherapy: A system of adjusting the sleep cycle by moving bedtime backward over a period of nights.

circadian system: Our 24-hour biological clock that governs fluctuating physiological processes, including alertness, metabolic rate, body temperature, and hormones.

cognitive behavioral therapy: A treatment that combines behavioral modification with strategies to encourage positive thoughts, such as those about sleep.

continuous positive airway pressure (CPAP): A treatment that forces air through the nose at a continuous pressure to prevent throat tissue from collapsing during sleep.

delayed sleep phase disorder (DSPD): A condition in which falling asleep is regularly delayed by more than two hours.

delayed sleep phase syndrome: A condition in which a person regularly falls asleep late and finds it difficult to get out of bed at a normal time.

environmental sleep disorder: Sleep difficulties caused by external factors, such as noise, light, or a too-warm bedroom.

Epworth Sleepiness Scale: A tool used by sleep experts to determine whether someone has a sleep problem or a sleep disorder.

generalized anxiety disorder: A common form of excessive worrying that keeps a person awake at night.

homeostatic drive: A system that builds the desire to sleep the longer you remain awake.

hypersomnia: A sleep disorder characterized by prolonged nighttime sleep or excessive daytime sleepiness. People with hypersomnia are driven to nap but awaken without feeling refreshed.

hypnagogic hallucinations: Vivid, often disturbing hallucinations that occur right before falling asleep.

hypnopompic hallucinations: Vivid, often disturbing hallucinations that occur upon awakening.

hypnotics: Medications designed to make you fall asleep more quickly, sleep longer and better, and awaken less often during the night.

hypoxia: Low blood oxygen levels, a condition that can be caused by obstructive sleep apnea.

insomnia: A common sleep disorder characterized by the inability to fall asleep quickly, frequent awakenings followed by difficulty falling back asleep, and awakening too early. This causes daytime sleepiness and feelings of fatigue and moodiness.

intensive sleep retraining: A form of cognitive behavioral therapy that provides immediate feedback as to when sleep occurs.

jet lag: A sleep phase disorder in which a person’s sleep-wake cycle is out of sync with the time zone they are in.

melatonin: A chemical released by the brain to prepare the body for sleep.

multiple sleep latency test: A test that measures how fast you fall asleep and whether REM sleep is incorrectly occurring during the day.

myelin: Insulation on nerve cells in the brain and spinal cord. Sleep increases the production of myelin.

narcolepsy: A neurological disorder that causes excessive daytime sleepiness, often with the inability to stay awake.

nocturia: The urge to urinate frequently at night.

non-rapid eye movement (NREM) sleep: The three stages of sleep with gradual deepening of sleep that we pass through before reaching REM sleep.

obstructive sleep apnea: A common sleep disorder that occurs when tissue in the back of the throat collapses, forcing the sleeper to awaken gasping for air.

periodic limb movement disorder: A condition that causes you to move your arms and legs every few seconds throughout the night.

phototherapy: Exposure to specific wavelengths of light for a prescribed amount of time.

phrenic nerve: A nerve in the neck and chest that plays a role in breathing.

polysomnography: A sleep study conducted in a sleep lab in which brain waves, blood oxygen level, heart rate, breathing rate, and eye and leg movement are monitored. Polysomnography is used to diagnose sleep disorders.

rapid eye movement (REM) sleep: The stage of sleep in which dreaming occurs. It is so named because the eyes dart about as if watching the dreams.

REM sleep behavior disorder: A condition in which people lose the normal paralysis that occurs during REM behavior and act out their dreams.

restless legs syndrome (RLS): A syndrome that causes creepy-crawly sensations in the legs or forces a person to move their legs without stopping right before falling asleep. RLS can prevent a person from falling asleep normally.

seasonal affective disorder: A form of depression triggered by lack of sunlight that causes a person to sleep longer, but still feel sleepy during the day.

serotonin: A brain chemical that promotes sleep.

sleep debt: The accumulated amount of time without getting adequate sleep.

sleep drunkenness: A disorder characterized by confusion or inappropriate behavior following arousal from sleep.

sleep efficiency: The ratio of the total time spent asleep to the total time spent in bed.

sleep hygiene: Good habits that promote good sleep.

sleep paralysis: The inability to move during the transition from REM sleep to wakefulness.

sleep propensity: The desire to sleep that grows during the day and kicks in at night.

sleepwalking: A sleep disorder that occurs when a person becomes suspended between wakefulness and sleep and causes people to get out of bed and walk around without being aware of their actions.

suprachiasmatic nucleus (SCN): A location in the brain near where the optic nerves cross that receives information about light and darkness from the brain cells. The SCN sends signals to other parts of the brain that control hormones, body temperature, and other functions that influence whether we feel sleepy or wide awake.

uvulopalatopharyngoplasty: Surgery for obstructive sleep apnea that involves cutting away part of the uvula, soft palate, tonsils, and excess tissue in the throat.

The post Glossary appeared first on University Health News.

Sleep disorders can be caused by medical problems or stressful situations. Some sleep disorders affect your ability to get to sleep and stay asleep, while others disrupt the structure of your sleep. Despite the availability of effective treatments, most adults with sleep problems don’t seek help, even if their physicians ask if they have trouble sleeping. In this chapter, we’ll discuss some of the common sleep disorders and what can be done to treat them.

Snoring

Snoring is a very common problem: More than half of the respondents in a National Sleep Foundation poll said other people have told them they snore. Among snorers, 64 percent say their snoring can be as loud as talking, and one in six say they snore so loudly it can be heard in the next room.

Snoring usually is a sign that your upper airway is compromised in some way. During sleep, the muscles in the mouth, throat, and upper airway relax. When this happens, these muscles and the tissues they support sag and partially block air intake. As you inhale more deeply, you pull more of this tissue into your airway. The snoring noise comes from the vibrations of the sagging tissue as air passes through the narrowed opening. (Incidentally, how loudly you snore does not always indicate the severity of your breathing problem.)

Research has linked loud snoring with a higher risk of several health problems. One study showed that loud snorers were 40 percent more likely to have high blood pressure, 34 percent more likely to have a heart attack, and 67 percent more likely to have a stroke than people who do not snore. Quiet snoring was associated only with an increased risk of high blood pressure in women.

In the most severe cases, the sagging tissue repeatedly blocks airflow to the lungs during the night—a condition called OSA (see Chapter 5). This condition interrupts your breathing and decreases the amount of oxygen in your blood; see Chapter 5 for detailed information on the health problems associated with OSA, as well as treatment options for the condition.

Risk Factors

The tendency to snore increases with age. In women, snoring increases after menopause begins. Risk factors also include being overweight or obese, smoking, alcohol consumption, and  the use of sedating medications, tranquilizers, or muscle relaxants.

The environment also may play a role in snoring. In one study, researchers found that short-term rises in temperature and particulate matter (air pollution) were associated with breathing abnormalities during sleep.

Treatment

In some cases, losing weight can help resolve snoring by reducing the amount of excess tissue in the throat. Most snorers snore more frequently and loudly when they sleep on their backs. Some people sew half a tennis ball into their pajama backs or buy “anti-snore” belts, shirts, or other devices that prevent back sleeping.

Over-the-counter adhesive strips that stretch across the nostrils or small plastic cones inserted inside the nostrils can widen the nostrils to admit more air. Nasal and decongestant sprays can reduce airway swelling, but the effects are often temporary. Some people use a mouth guard that repositions the lower jaw and the tongue to reduce snoring; this is an appliance that can be obtained from and fitted by a dentist.

In some cases, surgery that reduces the amount of excess tissue and removes the tonsils or nasal obstructions can relieve or lessen snoring. If sleep apnea is present, other treatment options need to be considered.

Restless Legs Syndrome

If you experience uncomfortable, creepy-crawly sensations in your legs and feet as you lie in bed before falling asleep, and you get relief only by shifting positions repeatedly, rubbing your legs, or getting up and moving around, you may have restless legs syndrome (RLS). RLS causes uncontrollable urges to move your legs when you lie down. If these movements also occur during sleep, they are called periodic limb movements, or PLMs (see the next section in the chapter for more on PLM). The sensations of RLS may be described as tingling, itching, pulling, crawling, or tightness that typically occur when you’re sitting or lying down later in the afternoon or evening. Some people with RLS have difficulties falling asleep due to these sensations.

Experts suspect that RLS may be related to dopamine, the neurochemical that carries signals between brain cells that control body movement. If the system that produces dopamine doesn’t work properly, communication between nerve cells is interrupted. Not surprisingly, RLS often co-exists with Parkinson’s disease, a condition caused by insufficient dopamine production. RLS also is common in patients undergoing hemodialysis and in people with neuropathy.

Recent studies have linked RLS with modifiable risk factors such as obesity, physical inactivity, alcohol consumption, and smoking.

RLS and Health Conditions

Research increasingly links RLS to various health conditions. One study found that RLS may raise a middle-aged woman’s risk of developing high blood pressure, regardless of her age, weight, smoking status, or cardiovascular status. Specifically, the study found high blood pressure in:

26 percent of those who had five to 14 incidents of RLS each month

33 percent of those who had more than 15 incidents of RLS a month

21.4 percent of those who had no RLS symptoms

Severe RLS also may be associated with increased risk for stroke.

As many as half of all people with RLS have a family history of the disorder. The problem also can be caused by medications (especially antidepressants), nerve damage, and medical conditions such as diabetes and kidney disease. And some research suggests RLS may be caused by an iron deficiency that affects dopamine-producing cells in the brain.

There are no specific diagnostic tests for RLS; usually, RLS is diagnosed based on your report of symptoms to your doctor.

How RLS Is Treated

Medications. RLS symptoms can be eased with medication. Dopaminergic drugs, which stimulate dopamine receptors in the brain and are used to treat Parkinson’s disease, have been considered the drugs of choice. Two of the most effective medications are pramipexole (Mirapex) and ropinirole (Requip). However, side effects associated with these agents, including potential worsening in symptoms requiring escalating doses of medication (“augmentation”), has led most doctors to consider treatment using alternative medications. Other side effects of dopaminergic agents include nausea, drowsiness, vomiting, dizziness, and fatigue, and an increase in compulsive symptoms. Due to concerns about long-term heart problems, pramipexole has also fallen out of favor.

Many people with RLS find relief with anticonvulsants, such as gabapentin (Neurontin), or narcotic opioids such as hydrocodone or oxycodone. A modified formulation of gabapentin, gabapentin enacarbil (Horizant), received FDA approval for treatment of RLS and has been considered an effective and safe option in moderate and severe cases. Clonazepam (Klonopin), a benzodiazepine sedative, may be effective in reducing RLS symptoms. Pregabalin (Lyrica), a drug used to treat seizures and pain associated with damage to the long nerves and fibromyalgia, also appears to be an effective RLS treatment, with the concern of potential residual sleepiness.

Non-drug approaches are available to help improve sleep quality for some individuals with RLS. Foot wraps, vibratory pads, and compression stockings have varying degrees of efficacy.

Iron Supplementation. Since low levels of ferritin (a protein that stores iron) have been implicated in RLS, you may want to ask your doctor if you should have your ferritin levels tested. Some people with chronic disease or cancer may become anemic due to a drop in the number of oxygen-carrying red blood cells they have, which leads to the development of RLS. If you have iron-deficiency anemia, oral iron supplements may help improve RLS. Due to the low absorption rate of iron, some patients need intravenous infusions to normalize their iron levels.

Periodic Limb Movement Disorder

In periodic limb movement disorder (PLMD), your legs or arms may move while you are asleep. These movement episodes can be as brief as a fraction of a second or last as long as five seconds; frequently, they recur every 20 to 40 seconds in one or both legs. Movements can range from brief muscle twitches or an upward flexing of the feet to more violent, jerking movements. Movements may cluster into episodes lasting anywhere from a few minutes to several hours.

You may have PLMD if you experience:

• Repetitive movements of the limbs during sleep
• An increase in symptoms with alcohol use
• Daytime sleepiness, fatigue, and insomnia
• RLS associated with inadequate sleep quality.

PLMD affects men and women equally. Tricyclic and selective serotonin reuptake inhibitor (SSRI) antidepressants can aggravate PLMD, and withdrawal from drugs such as barbiturates, benzodiazepines, and sedatives can bring on the condition or make it worse. The disorder can be exacerbated by illnesses such as kidney disease. In some cases, PLMD may be a sign of kidney disease, diabetes, anemia, sleep apnea, or another disorder. However, the exact cause is often unknown.

PLMD is associated with frequent nighttime awakenings, so it’s no surprise that daytime fatigue or sleepiness is a common symptom of the disorder. However, most people are not even aware of the movements that disrupt their sleep, and, as with snoring, a bedmate is often the one who notices. People with PLMD also may experience the tingling or creepy-crawly sensations of RLS. PLMD is diagnosed with a sleep study conducted in a sleep center.

How PLMD Is Treated

Treatment for PLMD is indicated only if the disorder causes problems, such as multiple awakenings or excessive daytime fatigue.

Medications used to treat PLMD are similar to the ones used for RLS; they include dopaminergic agents, gabapentin, benzodiazepines, and opiates for severe cases. An evaluation of iron storage and vitamins D, B₁₂, and folic acid levels is also advised, as deficiencies of these nutrients may trigger PLMD.

Narcolepsy

Narcolepsy is a chronic neurological disorder that affects about one in every 2,000 Americans. The disorder stems from a genetic trait that may be triggered by autoimmune or other factors. Narcolepsy has been linked to other serious coexisting conditions, particularly anxiety, depression, digestive diseases, diseases of the nervous system, and diseases of the sensory organs.

Symptoms of narcolepsy may include:

• Excessive daytime sleepiness, often causing a person to fall asleep multiple times during the day
• Cataplexy (abrupt loss of muscle tone) triggered by strong emotions
• Sleep paralysis
• Hallucinations
• Automatic behaviors
• Fragmented nighttime sleep

In narcolepsy, the brain is unable to regulate sleep-wake cycles normally. The major symptom of narcolepsy is excessive daytime sleepiness. Individuals with the disorder experience difficulty in maintaining alertness during the day. In most cases, the urge to sleep during the day is intense and compelling, and interferes with daytime activities.

About 70 percent of people with narcolepsy experience an abrupt loss of muscle tone (cataplexy), which may be provoked by strong emotions such as anger or delight. An episode of cataplexy can be mild, involving specific muscle groups (the head may droop or the knees may buckle), but in severe cataplexy, the person may collapse and fall to the ground. During a cataplectic episode, people remain fully conscious but are unable to speak. These attacks may last a few seconds to several minutes and can occur infrequently over years or multiple times in a single day.

People with narcolepsy may experience sleep paralysis—a brief period of being unable to move during the transition from REM sleep to wakefulness. Up to 10 percent of people with narcolepsy also have vivid hallucinations before falling asleep or upon awakening, which may include hearing things, seeing things, and experiencing tactile sensations. Images in the environment, such as objects that move, may be incorporated into these dream-like experiences. These hallucinations can be disturbing, raising fears of mental illness, and they may result in an initial misdiagnosis when reported to a doctor.

People with narcolepsy may exhibit automatic behaviors while transitioning between wakefulness and sleep. They may perform routine activities with a reduced awareness of what they are doing, or they may insert irrelevant words or phrases into a conversation or stop speaking without being aware of it. The sleep of people with narcolepsy is often fragmented, with frequent awakenings and increased body movements.

Diagnosing Narcolepsy

You don’t need all these symptoms for a diagnosis of narcolepsy. The disorder, which often begins in young adulthood, frequently goes undiagnosed for many years, because doctors may not consider narcolepsy when people complain of daytime sleepiness, fatigue, or problems with concentration and memory. Hallucinations and episodes of muscle weakness or paralysis also may be misdiagnosed.

Sleep specialists use several tools to help diagnose narcolepsy, including the Epworth Sleepiness Scale (see Chapter 1), to assess daytime sleepiness. Tests conducted in the sleep lab include polysomnography and the Multiple Sleep Latency Test (MSLT). The MSLT measures how fast you fall asleep, which is an objective measure of sleepiness, and whether REM sleep occurs during the day, which is abnormal.

Treatment for Narcolepsy

Drug Treatments. There is no cure for narcolepsy, but medications can help increase daytime alertness. Modafinil (Provigil), armodafinil (Nuvigil), and solriamfetol (Sunosi) are FDA-approved daytime medications for treating the excessive daytime sleepiness that results from narcolepsy. Sodium oxybate (Xyrem) is a nighttime medication approved for narcolepsy with cataplexy and is effective at reducing the disrupted sleep associated with narcolepsy, leading to an improvement in daytime alertness and a reduction in cataplexy events.

Traditional stimulants, such as amphetamines, as well as newer ones, such as methylphenidate (Ritalin), can be used to improve alertness and ward off sleepiness. However, these stimulants may have negative side effects, including elevated blood pressure, increased nervousness, and dependence. Low doses of antidepressants have been used in the past to reduce cataplexy, sleep paralysis, and the hallucinations that occur during transitions to and from sleep. Since sodium oxybate was approved for treating cataplexy, these drugs have been used less frequently.

While sleepiness, daytime sleep episodes, and cataplexy can be controlled with drug treatment in most cases, none of the available medications produces a fully normal state of alertness during the day. Medications may be modified as time goes on and symptoms change.

Behavioral Strategies. Drug therapy for narcolepsy should always be accompanied by the adoption of behavioral strategies. Many people with narcolepsy are urged to take regularly scheduled brief naps (15 to 30 minutes) at times of the day when they tend to feel sleepiest. Improving the quality of nighttime sleep can combat excessive daytime sleepiness and help relieve persistent fatigue, so it’s important to maintain a regular sleep schedule and to avoid alcohol and caffeinated beverages before bedtime.

Hypersomnia

Hypersomnia is characterized by episodes of excessive daytime sleepiness, even with adequate nighttime sleep, or prolonged nighttime sleep. This condition is different from the daytime sleepiness and sleep episodes of narcolepsy or feeling tired due to occasional insomnia. People with hypersomnia feel driven to nap, often for long periods of time, but the naps usually are not refreshing. Hypersomnia sufferers also often have difficulty awakening from a long sleep and may feel disoriented when they do. Other symptoms may include anxiety, irritability, lack of energy, restlessness, slowed thinking and speech, appetite loss, and memory problems. These symptoms can be severe and interfere with daytime functioning. Although hypersomnia usually affects adolescents and young adults, it also can occur later in life and mistakenly may be attributed to aging.

Hypersomnia may be caused by another sleep disorder such as sleep apnea, drug or alcohol abuse, medication withdrawal (or by some medications themselves), head trauma, or a tumor. Medical conditions such as depression, epilepsy, multiple sclerosis, and obesity may contribute to hypersomnia. Some people may have a genetic predisposition to hypersomnia. Not surprisingly, hypersomnia can lead to drowsy driving and auto accidents.

Treatment

Hypersomnia is treated by addressing the underlying cause. If no cause is found, the disorder is called idiopathic hypersomnia and may be treated with similar approaches used for narcolepsy, including medications and behavioral changes.

Daytime stimulants such as methylphenidate or modafinil may be tried. Those who do not respond may find relief with the gamma-aminobutyric acid-A receptor antagonist flumazenil (Romazicon), which is given sublingually (under the tongue) or transdermally (through the skin). In one study, this drug helped relieve symptoms in 63 percent of the patients in the study. Overall, it provided a lasting benefit to 39 percent of patients who had failed to achieve satisfactory symptom control with more conventional medications.

At this time, there are no FDA-approved medications for the treatment of hypersomnia, since this condition has been poorly studied. The Hypersomnia Foundation has established patient-
centered databases that will help advance research and foster collaborative approaches for evaluating and treating this condition.

In cases of sleep fragmentation, behavioral changes such as avoiding caffeine, alcohol, and activities that delay bedtime may help.

Sleep Paralysis

If you’ve ever had the sensation of awakening from a dream unable to move, you’ve experienced sleep paralysis. Roughly 8 percent of the population has experienced this condition. Unlike the sleep paralysis associated with narcolepsy, sleep paralysis can occur by itself during the transition between REM sleep and wakefulness in individuals who do not have narcolepsy. Episodes range in duration from seconds to several minutes.

Sleep paralysis is due to the loss of muscle tone that occurs during REM sleep and is considered to be a partial manifestation of REM sleep. While dream-like activity can accompany sleep paralysis, you’re conscious but unable to move. The resulting panic may make you feel like you can’t breathe. However, your respiration is not impaired. Some individuals become frightened during sleep paralysis, mistakenly thinking they are being attacked.

Sleep paralysis sometimes occurs if you haven’t had enough sleep or you’re trying to catch up on lost sleep. If it occurs frequently, it may be a sign of another sleep disorder, such as obstructive sleep apnea or narcolepsy.

Treating Sleep Paralysis

Most of the time, no treatment is required. However, tricyclic or SSRI antidepressants, both of which suppress REM sleep, can be helpful for people who experience repeated episodes. In most cases, after experiencing a few episodes of sleep paralysis, people realize it is harmless, which can help relieve the panic and fear that often accompanies this condition. Sometimes, the problem goes away by itself.

Sleepwalking

Sleepwalking is classified as a parasomnia, which consists of behavioral manifestations (similar to talking in your sleep) that may occur during sleep, usually during the first third of the night. Although individuals who sleepwalk are not aware of what they’re doing and may be difficult to rouse, part of their brain is awake enough to enable them to carry out an action. Most of the time, sleepwalkers are not awake enough to carry out complex movements or behaviors. However, some sleepwalkers make their way around a room or their house; in extreme cases, they have been known to leave their house and even drive long distances. Accidents and injuries are worrisome potential consequences of sleepwalking.

Sleepwalking episodes can last from minutes to hours. When the episode is over, the person is often able to get back into bed and quickly go back to sleep. When the person awakens in the morning, he or she usually has no memory of what occurred.

Up to 15 percent of the population may experience varying degrees of sleepwalking. Although sleepwalking most commonly first occurs in childhood, it can persist into later life and may run in families. In some cases, sleepwalking may present for the first time during adulthood. It may indicate the presence of an underlying sleep disorder or be triggered by the use of medications (like sleep medications) or alcohol. Sleepwalking is more likely to occur if you’re sleep-deprived. Other triggers include stress, the use of sedatives, and obstructive sleep apnea.

Sleep Drunkenness

As many as one in seven people are affected by sleep drunkenness, a disorder that involves confusion or inappropriate behavior during or following arousal from sleep, usually due to a forced awakening. For example, a person who is sleep-drunk may answer the phone instead of turning off the alarm clock.

Having sleep apnea or a mental health disorder, or taking mood-altering drugs such as antidepressants, raises the risk of having a sleep drunkenness episode. It also occurs more often in people who get less than six or more than nine hours of sleep a night.

REM Sleep Behavior Disorder

In REM sleep behavior disorder (RBD), people lose the normal paralysis that occurs during REM sleep and essentially act out their dreams. These behaviors tend to be violent and aggressive; people with RBD may strike out at their bedmate, kick, and yell. In more severe cases, people with RBD also may get out of bed during an episode and crash into furniture, break windows, or fall down stairs and injure themselves. The episodes usually occur late at night or early in the morning, and most occur during REM sleep. Immediately following the episode, the person may report a dream that is consistent with the actions performed during the episode. RBD typically occurs in men over age 60.

RBD may be brought on by the abrupt withdrawal of drugs, such as hypnotics that suppress REM sleep, or alcohol. It may occur in people with Parkinson’s disease, dementia, anxiety, cerebrovascular disease, post-traumatic stress disorder, and underlying sleep disorders. The use of SSRI antidepressants and other psychiatric medications also can predispose people to developing RBD.

Higher Risk of Neurological Disorders

RBD also may be a harbinger of future Parkinson’s disease or dementia. One study suggested that people with symptoms of RBD have twice the risk for developing mild cognitive impairment or Parkinson’s disease within four years of diagnosis of the sleep problem. In another study of individuals with RBD, the risk for developing a neurodegenerative disease within five years of diagnosis was 18 percent—but the risk rose to 41 percent at 10 years and 52 percent at 12 years. Another study found that close to half of patients diagnosed with idiopathic RBD developed a neurological disorder, most commonly Parkinson’s disease or Lewy body dementia.

Early recognition of RBD could mean earlier treatment for these other disorders, resulting in better daily functioning. The disorder is diagnosed with studies done in the sleep lab to differentiate it from sleepwalking, nightmares, or sleep-related epilepsy.

How RBD Is Treated

RBD can be helped by a number of treatments, including Parkinson’s drugs. Clonazepam (Klonopin) taken before bedtime may suppress violent behaviors during sleep.

Preliminary intervention trials have been conducted to see if treating RBD might head off Parkinson’s disease. Recent studies of the antioxidant supplement coenzyme Q10 (CoQ10) suggest that high doses (1,200 mg a day) might slow the progression of Parkinson’s or relieve symptoms. There are no apparent side effects with CoQ10, and some experts say it may have benefits for people with RBD. In some cases, discontinuing the drug(s) that may have triggered the problem, stopping alcohol use, or treating the underlying condition (for example, sleep apnea) may resolve RBD.

Nocturnal Eating Disorder

Nocturnal eating disorder is similar to sleepwalking, except that people eat while they are asleep. Some people can consume half or more of their entire daily calorie intake in the middle of the night and not be aware of it. The only evidence of this disorder is weight gain and dirty dishes or empty food packages. It may not matter if the food is raw, cooked, or frozen. Some people eat spoiled food—a danger with this disorder, as is leaving the stove on when returning to bed. Even if those who are affected awaken in the middle of the episode, they continue eating. These individuals do not go to bed hungry or thirsty and have no sense of fullness after binge eating.

The disorder occurs more often in women than in men and may be related to stress. It may be caused by sleep medications or coexist with other sleep disorders, as well as eating disorders such as bulimia (bingeing and purging) or anorexia nervosa. In some cases, treating the coexisting disorder helps resolve nocturnal eating disorder. Behavioral therapies, as well as medications such as carbidopa (Sinemet, which also contains levodopa) or topiramate (Topamax), may be beneficial. Stopping potential triggers such as sleep medications also may resolve or improve symptoms.

Night Eating Syndrome

Night eating syndrome (NES) is related to nocturnal eating disorder, except that in NES, people are awake when they eat at night. These people eat little or nothing during the day, binge late at night, have trouble falling asleep, and then awaken—sometimes more than once—to eat again. Individuals with this disorder are fully aware of their eating behavior.

Experts say as many as 10 percent of obese people seeking treatment for their weight may have NES, and it is thought that disruptions in circadian rhythms and hormones related to sleep, hunger, and stress may play a role. One study found that people with NES did not have the normal increase in melatonin or leptin (a hormone that tells the brain when you’ve had enough to eat) to control appetite. At the same time, they showed high levels of the stress hormone cortisol. The disorder tends to run in families.

People with NES seem to prefer to eat carbohydrates, which boost levels of the neurotransmitter serotonin, alleviating stress and elevating mood. There’s little research on the syndrome, but since stress is a factor, learning stress-reduction techniques may help, as may SSRI antidepressants, which increase serotonin levels. Behavioral approaches and cognitive therapy may also help reduce or eliminate night eating.

The post 6. Other Common Sleep Disorders appeared first on University Health News.

• Obstructive sleep apnea (OSA) is by far the most common, affecting as many as 18 million men and women in the United States. In OSA, breathing is interrupted when the upper airway is blocked by the collapse of excess soft tissue in the back of the mouth behind the tongue during sleep.
• Central sleep apnea occurs when there is a change in the brain’s signal regulating the muscles that control breathing.

If you have OSA, you may awaken suddenly, gasping for air. Having your airway blocked is like trying to drink through a wet paper straw—you keep sucking on it, but nothing gets through. Although snoring and excessive daytime sleepiness are the most common symptoms of OSA, the condition also can produce choking, snorting, dry mouth, and headaches in the morning. Even if you are snoring, choking, or gasping, you’re probably unaware of it, since these behaviors occur during sleep. Usually, they don’t bring you to a fully awakened state. In most cases, the symptoms are noticed by a person’s bed partner or another member of the household.

In a single night, a person with OSA may have from five to more than 100 episodes of abnormal breathing per hour of sleep. The cutoff of air may lead to low levels of oxygen and high levels of carbon dioxide in the blood, alerting the brain to signal the upper airway muscles to open. When this happens, sleep becomes lighter and is interrupted. These frequent arousals keep you from getting the deep, continuous, restorative sleep you need and cause daytime sleepiness. The frequent blockages in breathing also may elevate nighttime blood pressure and cause heart rhythm disturbances.

For people with OSA who suffer from daytime sleepiness, heart disease is a particular concern (see “Excessive Sleepiness Connected to Heart Disease Risk”). Treatment of OSA is the first-line approach to overcome sleepiness in these patients. However, in some cases, residual excessive sleepiness continues. Fortunately, the U.S. Food & Drug Administration has approved medications to relieve daytime sleepiness from OSA. While the medications may reduce the likelihood of a driving accident or other potential incident caused by falling asleep during the daytime, whether it lowers heart disease risk is yet unknown. These medications include modafinil (Provigil), armodafinil (Nuvigil), and solriamfetol (Sunosi).

Vitamin D deficiency also has been linked to OSA and other sleep disorders, including restless legs syndrome (see Chapter 5). Vitamin D deficiency is common: One study found that 74 percent of participants were deficient in this “sunshine vitamin.” However, more research is needed to determine if there’s a correlation between vitamin D levels and OSA severity, and whether vitamin D supplementation may help alleviate OSA. However, vitamin D plays such an important role in our health that anyone who is vitamin D-deficient should talk to their doctor about taking vitamin D supplements or increasing daily sun exposure in a safe manner.

Sleep Apnea and Your Health

OSA predisposes people to multiple health problems. The most common associations are:

High blood pressure. Up to half of people with OSA have high blood pressure. Mild and moderate OSA have been linked with a more than three times higher risk of developing hypertension. Severe OSA may affect the ability to control blood pressure, even if a patient is taking three or more blood pressure medications (see “Blood Pressure Control Affected by OSA”).

Diabetes. OSA is associated with a higher incidence of insulin resistance and glucose intolerance, two conditions that contribute to an increased risk of type 2 diabetes. OSA also has been linked with diabetes onset at a younger age and diabetes that is more difficult to control.

Poor quality of life. OSA can lead to irritability, sexual dysfunction, depressed mood, and accidents caused by dozing off while driving or working. If OSA symptoms, such as loud, frequent snoring, interrupt your bed partner’s sleep, it may have a negative effect on your relationship.

Liver damage. OSA may be a risk factor for liver damage caused by reduced oxygen supply to the liver during sleep.

Obesity. Severe OSA may predispose individuals to weight gain. Anyone with a higher number of apneas and hypopneas (a milder sleep-associated respiratory event characterized by shallow breathing) per hour of sleep is at particularly high risk and may gain weight steadily over time.

Parkinson’s disease. OSA appears to increase the risk of Parkinson’s disease, but only in women.

Low bone density. OSA nearly triples the risk of osteoporosis in women, and severe OSA has been connected with low bone density in men.

Cancer. Multiple research studies have linked OSA with cancer incidence, resistance to cancer treatments, and cancer mortality. The connection is particularly strong in women (see “OSA May Increase Cancer Risk in Women”).

Stroke. Research suggests that OSA doubles or triples the risk of stroke in middle-aged and older men. The risk appears in men with mild sleep apnea and rises with the severity of OSA. Studies have linked a higher stroke risk in women  only with severe OSA. Conversely, up to two-thirds of patients who suffer a stroke develop OSA later, even if they do not fit the typical OSA patient type (see “OSA Common After Stroke”).

Heart attack. OSA increases the risk of having a heart attack or dying from one by 30 percent over a period of four to five years. OSA may disturb the balance between “bad” LDL cholesterol and “good” HDL cholesterol and increase the likelihood of developing aggressive atherosclerotic plaques that narrow or block coronary arteries. If these plaques rupture or completely block blood flow to the heart, they can cause a heart attack. Studies also have shown that patients with OSA have multiple blood vessels narrowed by atherosclerosis, as well as extensive vessel involvement.

Arrhythmias/sudden cardiac death. OSA doubles the risk of sudden cardiac death. In studies, the most common predictors for arrhythmias (irregular heartbeat) were an age of 60 or older, 20 or more apnea-hypopnea episodes per hour of sleep, and an oxygen saturation level below 78 percent during sleep. Fortunately, treating OSA with continuous positive airway pressure after ablation (a procedure that restores normal heartbeat) has been shown to lower the likelihood the arrhythmia will recur.

Memory loss. In a study linking OSA to brain damage and memory loss, MRI scans revealed that structures in a region of the brain that deals with memory were almost 20 percent smaller in people with OSA than in those without the sleep disorder. It is thought that the repeated drops in oxygen that occur throughout the night may be causing these brain cells to lose function and die.

Alzheimer’s disease. A good night’s sleep seems to be important for the brain to clear the beta-amyloids that form the plaques associated with Alz­heimer’s disease (AD).

OSA that develops after age 65 doubles the risk of developing AD, the most common form of dementia; the more severe the OSA, the higher the risk. In one study, AD symptoms appeared an average of 60.8 months after OSA was diagnosed—13 to 18 months sooner than in study participants without OSA. OSA severity also made a difference. Mild OSA (five to 15 apneas per hour of sleep) increased AD risk 1.67 times, moderate OSA (15 to 30 apneas per hour) increased risk 1.81 times, and with severe OSA (30 or more events per hour), the risk was 2.63 times above normal. Women with OSA were at higher risk of developing AD than men with OSA. Education level was also an important risk factor: Adults with a high school education or less had twice the risk of adults who attended graduate school.

Scientists have linked poor sleep quality along with poor diet to the early accumulation of the plaques associated with AD. Part of the mechanism may involve cortisol, a hormone manufactured by the body that plays a role in regulating many core functions, including sleep. Cortisol levels naturally rise and fall with day and night. However, diets characterized by high intake of refined sugars, salt, animal fats, and animal proteins, and by low intake of fruits and vegetables, can boost the cortisol level at night so that it interferes with the natural circadian system, resulting in poor sleep quality. Scientists suggest that dietary changes that influence the body’s cortisol levels—and in turn promote good sleep—might be a safe and novel way to help protect the brain.

Post-surgery delirium. OSA has been linked with a more than two-fold risk of delirium, a sudden state of severe confusion and diminished brain function, after surgery.

Poor blood flow. Researchers have pinpointed a possible reason for the toll OSA takes on the brain: MRI images have revealed weaker blood flow in the brains ofindividuals with the sleep disorder.

Sleep Apnea and Women

Like severe snoring, sleep apnea once was thought to occur mostly in men, but it affects women, too, particularly after menopause. OSA may be underdiagnosed in women, and there may be some clinical differences in the presentation between the sexes as well. A Canadian study found that women with OSA were more likely than men to suffer from depression, an underactive thyroid (hypothyroidism), or insomnia.

Other research suggests that OSA may pose hidden dangers for women. Autonomic responses—the controls that impact such functions as blood pressure, heart rate, and sweating—are weaker in people with OSA, but even more so in women than in men. While women with OSA may appear to be healthy, their OSA symptoms tend to be subtler, which often means their sleep problems are missed, and an OSA diagnosis is delayed.

Diagnosing OSA

Often, the first person to spot OSA is your bedmate, who complains that you snore loudly or that you repeatedly gasp for breath during the night. If you have symptoms of OSA, report them to your physician.

Unfortunately, OSA often goes undiagnosed in older adults. Researchers found that 56 percent of American adults ages 65 and older are considered at high risk for OSA, yet only 8 percent have been treated for the sleep disorder. In the small percentage of adults who were given a sleep study, OSA was confirmed in 94 percent, and 82 percent were subsequently treated with CPAP. According to sleep experts, some older patients do not realize that snoring, daytime sleepiness, and fatigue are not normal symptoms of aging, but rather are symptoms of OSA that can contribute to a number of serious ­medical conditions.

The American Academy of Sleep Medicine recommends that physicians ask their patients if they have any symptoms of OSA during routine examinations. The American College of Physicians recommends that physicians consider offering a sleep study to patients who experience unexplained daytime sleepiness.

Lab-Based Sleep Study

Sleep specialists diagnose OSA with a sleep study. For an in-depth, comprehensive study, you will likely spend the night in a sleep lab. A test called polysomnography will record a variety of bodily functions, including brain waves, to detect the various stages of sleep, muscle activity, eye movements, heart rate, breathing, airflow, and blood ­oxygen levels.

Electrical sensors will be attached to your scalp, eye area, face, and legs to measure movement. Bands will be placed around your chest and abdomen to help gauge your breathing patterns, and a clip to measure blood oxygen through the skin will be attached to one finger. Airflow through your nose and mouth will be monitored with several devices to assess the frequency and severity of breathing problems. The study is not painful, and most people sleep well enough in the lab to yield useful findings.

The test shows if and how frequently breathing events related to apnea or hypopnea occur, and if there are periods of low blood oxygen and reduced airflow. All of this data is analyzed to determine if a diagnosis of OSA is warranted, and, if so, the level of severity. Sleep studies also can help identify other sleep disorders, such as narcolepsy, periodic limb movements, and abnormalities in sleep stage distribution.

Home Sleep Study

The most recent guidelines from the American Academy of Sleep Medicine suggest that people who don’t have other complicating medical problems, such as severe cardiopulmonary disease, take a home sleep test for OSA. Adults between the ages of 18 and 65 who have a high probability of moderate-to-severe OSA and no other medical conditions are most likely to benefit from a home test.

Home testing involves the use of a portable system that is worn while you sleep in your own bed. The system monitors and records respiration, heart rate, air flow, blood oxygen level, and time spent snoring during the night.

Future Diagnostic Tests

In the future, it may be easier to diagnose OSA using technology currently in development and testing. These approaches will require a review by the FDA to determine validity and safety for home use.

Emerging research also shows that analyzing a person’s breathing sounds while awake may accurately detect OSA. Larger studies are needed to confirm these findings.

Treating OSA

There are no FDA-approved medications to treat OSA itself, only daytime sleepiness caused by OSA. Although medical marijuana is being increasingly used to treat many medical conditions, the American Academy of Sleep Medicine does not recommend it for OSA. In pilot clinical trials of dronabinol, a synthetic form of tetrahydroconnabinol, many patients experienced intense daytime sleepiness as a side effect. In addition, its effects and safety over time have not been studied.

If you have OSA, an important part of the treatment involves making lifestyle changes, such as losing weight, if applicable. You also may be urged to quit smoking and avoid the use of alcohol, sleeping pills, and muscle relaxants, all of which make the airway more likely to collapse during sleep.

In many cases, sleeping position influences the severity of OSA. Up to 75 percent of people with OSA experience more frequent and longer pauses in breathing when they sleep on their backs. Special pillows that help keep you on your side rather than on your back while sleeping, and a device that vibrates when you roll onto your back, have been shown to reduce back sleeping by 84 percent, which reduced the severity of OSA. Elevating the head of your bed about six inches also may help. However, often, it is insufficient to overcome OSA.

If your OSA has caused high blood pressure or other problems, these conditions will need separate treatments. Some people with OSA also may suffer from hypothyroidism (an underactive thyroid), and thyroid hormone replacement may need to be considered.

Losing Weight

Losing weight is an effective way to reduce OSA symptoms and associated disorders. A large body of evidence has shown that people who lose weight can cut their number of apneas by half or more. Often, the most severe cases of OSA are associated with obesity.

The most effective and healthiest diets are those that go beyond calorie and portion control and supply your body with optimal nutrition. Adopting healthy eating behaviors that become part of your daily routine will help you maintain a healthy weight and better overall health on a long-term basis. Fad diets, on the other hand, may result in rapid weight loss, but generally, they are very difficult to stick with, and they may not meet all of your nutrition needs.

Calorie control can be an effective method of weight loss and weight management. Knowing how many calories foods contain can help you to incorporate “checks and balances” into day-to-day eating (for example, making up for any high-calorie treats with lower-calorie options at other times of the day). However, some people find calorie counting difficult, or they simply don’t want to keep track of numbers all day every day. For these people, a more structured eating plan may be easier to follow.

Weight-Loss Programs. Many people who are trying to lose weight get good results from following commercial weight-loss diets, such as WW (the new name for Weight Watchers), Jenny Craig, and Nutrisystem. In its annual report on the best diets in America, U.S. News & World Report has ranked WW the No. 1 dietary plan for weight loss for the past several years.

WW allocates foods a certain number of points based on their fat, calorie, and fiber content. You are given a specific number of daily points, depending on your present weight and activity level; if you stick to the number of points, you lose weight. (Many healthy foods have zero points.) WW has different programs, including ones that offer workshops and personal coaching, so you can choose the level that’s best for you. And if you have a smartphone, you can use the WW app to keep track of all of your information.

Another option is the national nonprofit Take Off Pounds Sensibly (TOPS), which provides tools, information, and support. TOPS members choose one of three eating plans to follow. Support is a key element of TOPS; you can attend weekly meetings in person or online and exchange tips and strategies with other members.

Healthy Eating Patterns. A Mediterranean-style diet has been linked with many health benefits, and researchers have found that following this diet and exercising regularly may help reduce sleep apnea symptoms. Researchers examined 40 obese patients with OSA. Half were given a low-fat diet, while the other half followed a Mediterranean diet, which emphasizes fruits, vegetables, legumes, whole grains, and healthy fats and is low in sweets, red meat, and processed foods. Both groups were encouraged to increase their physical activity, and both groups received continuous positive airway pressure (CPAP) therapy. Six months later, an overnight sleep study revealed that those who followed the Mediterranean diet had fewer apnea episodes during REM sleep, as well as a greater decrease in abdominal fat, than those who followed a low-fat diet.

Other strategies that may help with weight loss include intermittent fasting, eating more plant-sourced foods and fewer animal-sourced foods, and following a vegetarian or vegan diet. If you don’t want to follow a regimented diet plan, you can try old-fashioned sensible eating, making small changes every day—perhaps eating less sugar and fewer processed foods, eating more fiber-rich foods, using portion control, and making overall healthier food choices.

The bottom line: Different people will find success with different diets, and you may have to try several before you find the one that works for you. You also can get professional help: Ask your doctor for a referral to a registered dietitian nutritionist, who can evaluate your nutrition needs and consider your lifestyle and food preferences to devise an eating plan that will help you lose weight safely.

Using an Oral Appliance

The American Academy of Sleep Medicine recommends oral appliances for the treatment of chronic snoring and mild cases of OSA in individuals who don’t improve with lifestyle changes. These devices help keep the throat open by repositioning the tongue and lower jaw. A dentist specializing in sleep medicine fits the oral appliance, monitoring closely for comfort to avoid dental movement or joint discomfort. A repeat sleep study while wearing the device is recommended to determine whether it improves the patient’s breathing. About half of patients are helped to some extent by the device.

Using a Sleep Mask

For moderate and severe OSA, a continuous positive airway pressure (CPAP) device, which forces air through the nasal passages at a pressure that prevents the tissues of the throat from collapsing during sleep, is generally prescribed. The device delivers air through a small mask that fits over the nose, and, if needed, also over the mouth. Some newer masks deliver air through nasal pillows, which are placed at the opening of the nostrils. The correct air pressure is calibrated after a night in the sleep lab. Some devices can vary the flow of air to match an individual’s specific breathing pattern, while others start out the night with a lower air pressure and slowly increase it, so the wearer can fall asleep before the full pressure kicks in.

CPAP is not a cure but a treatment for OSA. Apneas will recur if you use the device improperly or stop using it. However, treating OSA with CPAP has been shown to provide many health benefits. It improves blood pressure control and cardiovascular function. It also reduces daytime fatigue and sleepiness and restores memory consolidation, improving quality of life. In a 2015 study of middle-aged overweight and obese adults, wearing a CPAP device for eight hours a night for two weeks improved blood sugar control and the ability of insulin to regulate blood sugar.

CPAP also has been shown to lower hospital readmission rates and emergency room visits among people with heart disease and to reduce the risk of death in people with OSA who also have chronic obstructive pulmonary disease (COPD) or obesity (see “CPAP Is a “Must” for Obese Patients with OSA”).

CPAP machines also may provide automatic self-adjusting pressure based on need, called APAP (A is for auto). This technology may be a better option for patients who have OSA predominantly during specific stages of sleep (e.g., REM sleep) or while sleeping on their backs. Some of the newer machines are able to function in either CPAP or APAP mode, and are preset and adjusted based on each person’s need as prescribed by their doctor.

Alternatives to CPAP

A different treatment for mild OSA and snoring uses a self-adhesive, one-way resistor valve that is applied to the opening of each nostril nightly. The disposable device produces positive airway pressure that may effectively treat snoring and mild OSA. Unfortunately, it’s not possible to predict who will respond best to this therapy.

Hypoglossal Nerve Stimulation. The most recent OSA therapy approved by the U.S. Food & Drug Administration (FDA) utilizes a pacemaker-like nerve-stimulating device. The device is surgically implanted in the chest, with an electrode that monitors breathing patterns and a second probe placed under the skin and connected to the hypoglossal nerve under the jaw on one side. During inhalation, the device stimulates the nerve, which controls muscles in the upper airway and tongue and opens the airway. (Another name for this treatment is “upper airway stimulation,” or UAS.) This treatment has been found to produce a significant drop in the number of apneas per night, resulting in meaningful improvements in snoring, daytime alertness, and sleep-related quality of life. (How does UAS compare with CPAP? See “Which OSA Treatment Is Best?”)

The device is approved as a second-line therapy, meaning that only patients who failed, or are not candidates for, CPAP are eligible for this treatment.

Surgery

For severe snoring associated with OSA, surgery may be used to reduce excess tissue in the upper airway to make breathing easier. Surgery is not without risks, however. It may not be completely successful, and it may even lead to the development of scar tissue; therefore, careful evaluation by an ear, nose, and throat physician or oral surgeon is recommended. The success rate for surgical treatment of OSA is about 40 percent, depending on the type of surgery and the criteria for success.

UPPP.  For many years, uvulopalatopharyngoplasty (UPPP) was the primary surgical treatment for OSA. In UPPP, part of the uvula, soft palate, tonsils, and excess tissue in the throat are removed. UPPP requires general anesthesia and an overnight hospital stay. In laser-assisted uvulopalatoplasty (LAUP), an outpatient procedure, a laser is used instead of a scalpel. UPPP and LAUP may reduce or eliminate OSA. However, their effectiveness is difficult to predict, and the benefits may not be lasting. Today, a growing number of patients who would have been treated with UPPP or LAUP are treated with hypoglossal nerve stimulation.

Ablation. High-frequency radio-wave ablation uses radiofrequency energy from a probe to generate heat that shrinks the structures in the upper airway, including the uvula and the base of the tongue. The heat is delivered to the tissues beneath the mucous membrane, so patients experience less post-operative discomfort than with UPPP or LAUP. However, this procedure is not yet approved as a treatment for sleep apnea; it’s used primarily for snoring.

Turbinectomy. In cases of enlarged tissue in the nose, a surgical reduction of the inferior turbinates (tissue located inside the nose) may reduce snoring. This approach should be personalized based on an individual’s anatomy and underlying health issues, as well as the severity of OSA.

Central Sleep Apnea (CSA)

In OSA, breathing stops because the airway becomes blocked by tissue. In CSA, patients stop breathing because their brains stop sending the signal to breathe. CSA is associated with other health conditions and an increased risk of mortality. CSA is most often associated with heart failure, but it is also common in patients who take medications that suppress breathing, such as opioids for pain management. CSA may even occur upon starting treatment with a CPAP for OSA.

A treatment similar to CPAP called adaptive servo-ventilation (ASV) is often effective in treating CSA. ASV has been very successful in treating central changes in breathing during sleep. An ASV machine looks very similar to CPAP or APAP machines; however, it has a more advanced system for adjusting the pressure settings during inhalation and exhalation. However, ASV is not recommended in cases in which patients have some other health conditions. For example, sleep experts often advise against using ASV in patients with severe, symptomatic heart failure. Typically, ASV is also not recommended in cases of extreme obesity that lead to shallow breathing at night.

An entirely different approach that is similar to the nerve stimulator for OSA is now available for treating CSA. This approach uses an implanted pacemaker-type device to stimulate the phrenic nerve, which runs from the neck to the diaphragm, to control the breathing muscles. The first such device, the “Remede- System,” was approved by the FDA in 2017. In the clinical trial leading to its approval, CSA patients who received the implant experienced a 50 percent drop in the severity and frequency of their apnea episodes (compared to 11 percent of the placebo group), hypoxia (low oxygen in the blood), and arousals, and they also reported improved sleep quality and quality of life. The system was found to be safe as well as effective. This treatment is now available in many hospitals in the United States.

The post 5. Sleep Apnea appeared first on University Health News.

Screening Questionnaires

When being evaluated for a diagnosis of depression, you can expect to be asked to describe your symptoms in detail. Some health-care professionals use screening questionnaires to be sure no symptoms are missed and to quantify them more precisely.

Guidelines from the American Psychiatric Association recommend that people with major depressive disorder complete a rating scale—either administered by their doctor or completed on their own—to assess the type, frequency, and severity of their symptoms. Using a rating scale to evaluate symptoms can help doctors and mental health professionals tailor the treatment plan specifically to you. They also can be used later to determine whether treatment is working.

Diagnosing depression as well as determining which treatments individuals with depression are most likely to respond to remain important challenges for physicians and researchers. Although the development of reliable tests is still at an early stage, one hope is that blood, saliva, or other tests may eventually help point us in the right direction (see “Blood Marker for Depression Uncovered”).

Exams and Tests

In addition to having a detailed interview, you may need a physical examination and diagnostic tests to rule out illnesses that cause symptoms of depression, such as a thyroid problem, stroke, central nervous system tumor, head injury, or multiple sclerosis. People with typical signs and symptoms of depression usually do not need to have a detailed physical work-up, but those with complex medical problems, or those whose symptoms do not neatly fit the diagnosis of depression (for example, they have fatigue and weight loss without sadness or loss of interest) should have a physical exam. Diagnostic tests may include the following blood tests that can detect medical conditions that can cause depression symptoms:

• blood sugar (glucose) levels
• complete blood count (CBC)
• levels of hormones, such as thyroid hormone
• levels of inflammation markers, such as erythrocyte sedimentation rate (ESR) and c-reactive protein (CRP)
• levels of minerals, such as calcium and iron
• levels of vitamins such as B₁₂, folate, and vitamin D
• liver and kidney function tests
• markers of infection, such as Lyme disease.

Imaging tests such as magnetic resonance imaging (MRI) or computed tomography (CT) scans of the brain may be ordered to rule out tumors, bleeding, or neurological disorders such as multiple sclerosis. Similarly, electrophysiological tests that assess electrical waves in the brain or heart are sometimes used to evaluate depression. These include an electrocardiogram (ECG) which diagnoses heart problems, and an electroencephalogram (EEG) which is used to rule out a seizure disorder (epilepsy).

Neuropsychological testing may help to diagnose cognitive and memory complaints. They also may be used if attention deficit/hyperactivity disorder (ADHD) or certain other mental health conditions that have a neurological basis are believed to play a role in symptoms. These tests are usually administered by a specially trained neurologist or neuropsychologist.

Commonly used short tests of cognitive functioning include the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA). These tests generally take only a few minutes to administer and include some very basic questions, such as those related to what time it is and where you are. You may also be asked to identify certain everyday items, like a wristwatch. More complex questions require you to remember a series of words, copy a design, or follow written instructions.

The MMSE and MoCA are only rough screening tools for cognitive impairment, however. To obtain a diagnosis for a specific condition, such as dementia or ADHD, you will typically have to undergo a more complete evaluation. This usually involves one or more interviews with a neurologist or neuropsychologist as well as any number of questionnaires or tests, depending on what your concerns and symptoms are. These tests may be delivered orally, via computer, or with pen and paper. Poor sleep can impact mental health. Thus, a sleep study may help uncover reasons for interrupted sleep or unusual daytime drowsiness, such as obstructive sleep apnea, restless legs syndrome, or narcolepsy. These conditions may contribute to or mimic the symptoms of depression.

For a sleep study, you must be hooked up to several monitoring devices that record your breathing, movement, heart rate, and brain waves while you sleep. You are usually also asked to complete questionnaires about how you sleep and how tired you feel both before and after the sleep study.

Traditionally, these tests are conducted in a sleep clinic or hospital, but increasingly, at-home monitoring kits are becoming available. These are mostly prescribed to assess for sleep apnea.

Finally, physicians may order medication or drug testing to check blood levels of certain medications, or to look for drugs and other substances that may cause or worsen depression symptoms.

Once you’re diagnosed with depression, the next step is to get treatment. Even mild depression is unlikely to go away if you ignore it, and it may well worsen over time. Untreated depression often leads to greater problems in your life and can take a major toll on your physical health.

The post 4. Diagnosing Depression appeared first on University Health News.