![]() ![]() The following is a description of some of the major sleep disorders. Effective control of sleep apnea can produce more consolidated nighttime sleep and a dramatic improvement in daytime alertness and functioning.Sleep-related difficulties affect many people. Surgical intervention often eliminates snoring but may not eliminate the apnea. However, the mainstay of therapy is continuous positive airway pressure during sleep, which is accomplished by having the patient wear a tight-fitting nasal mask. ![]() Weight loss is frequently beneficial in overweight patients with sleep apnea. Observations by the patient's bed partner or another family member can provide the physician with crucial information. The major clinical clue to sleep apnea is a history of loud, excessive snoring, punctuated by pauses that are followed by stuttered gasps for breath. Sleep apnea may be associated with hypothyroidism, neurodegenerative disorders and cardiovascular disorders. Risk factors for sleep apnea include male sex and obesity (especially a heavy neck). The apneic events usually result from complete or partial occlusion of the airway (obstructive sleep apnea) or, less commonly, from a decrease in the respiratory drive (central sleep apnea). The degree of distress reported by the patient should influence the treatment decision. Up to one third of elderly persons have measurable periodic leg movements during sleep however, only relatively high rates of events and high percentages of associated arousal should be regarded as clinically significant. 9 Risk factors for these two disorders include increasing age, renal failure and iron deficiency (serum ferritin level less than 50 ng per mL). If necessary, the diagnosis can be confirmed by electromyography of limb muscle activity during nighttime monitoring in a sleep laboratory. Periodic limb movement disorder may be suspected based on information obtained from a bed partner. Restless legs syndrome is primarily a clinical diagnosis. The delayed sleep onset related to restless legs syndrome and the sleep disruption from periodic limb movements cause daytime sleepiness. ![]() They may, however, produce many brief arousals that disrupt sleep organization and decrease the amount of time in the deeper stages of sleep. Hundreds of limb movements may occur during a single night, but most of the time they do not awaken the affected person. The patient's bed partner typically perceives these episodes as kicks that occur in cycles of 20 to 40 seconds. This idiopathic condition is characterized by episodes of stereotypic rhythmic movement, usually of the legs, although other muscle groups, including the arms, may be involved in severe cases. Periodic limb movement disorder, another primary sleep disorder, may accompany restless legs syndrome or occur independently. Therapy with a benzodiazepine receptor agonist may be indicated after careful evaluation. Formal sleep studies may be needed when a primary sleep disorder is suspected or marked daytime dysfunction is noted. Evaluation of sleep problems in the elderly includes careful screening for poor sleep habits and other factors that may be contributing to the sleep problem. Sleep apnea can lead to excessive daytime sleepiness. Restless legs syndrome and periodic limb movement disorder can disrupt sleep and may respond to low doses of antiparkinsonian agents as well as other drugs. ![]() Primary sleep disorders are more common in the elderly than in younger persons. Caffeine, alcohol and some medications can also interfere with sleep. Poor sleep habits such as irregular sleep-wake times and daytime napping may contribute to insomnia. Problems with sleep organization in elderly patients typically include difficulty falling asleep, less time spent in the deeper stages of sleep, early-morning awakening and less total sleep time. Refreshing sleep requires both sufficient total sleep time as well as sleep that is in synchrony with the individual's circadian rhythm. ![]()
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