What is Insomnia?

Do you have difficulty falling asleep? Do you wake up in the middle of the night and have difficulty falling back to sleep? Do you wake up earlier than your alarm and have difficulty falling back to sleep? If you answered “yes” to any of these questions, then you might have Insomnia.

Insomnia is defined as difficulty falling asleep. There are two main categories of insomnia: sleep onset and sleep maintenance insomnia.

Sleep onset insomnia is a difficulty falling asleep at the beginning of the night. It is usually triggered by a stressful event, like a death in the family or before a hard test at school. Normally it should resolve when the trigger is no longer present (after you have taken the test), but in some people the insomnia becomes a chronic problem. With sleep onset insomnia, it is always important make sure that other sleeping disorders, like restless legs syndrome and sleep apnea are adequately treated, as they can exacerbate it.

Sleep maintenance insomnia occurs when a person has difficulty falling asleep after waking up in the middle of the night. The most important point about sleep maintenance insomnia is that there is often an underlying physiologic problem of sleep (like Sleep Apnea) that is leading to the awakenings in the first place. If this problem is not adequately addressed, then it can be very difficult to treat sleep maintenance insomnia.

Who Gets Insomnia?

Anyone can get insomnia. Most people experience at least once in their lives. It is estimated that approximately 10% of the general population have chronic insomnia. Insomnia is considered a problem when it has not resolved in a reasonable period of time.

I Think I Might Have Insomnia, How Do I Find Out If I Have It?

Make an appointment with your primary care physician, or if your insurance allows it, go straight to a sleep specialist. If your physician thinks you might have insomnia, then he/she will either treat you with a medication or refer you to a sleep specialist for further evaluation.

How Is Insomnia Treated?

The treatment of insomnia with medications has become a multibillion-dollar industry, but the best treatment methods are actually behavioral methods. Behavioral treatments range from developing good sleep habits to group cognitive behavioral therapy. For the short-term, most of the newer sleeping pills, including Ambien™, Sonata™, Lunesta™, and Rozerem™ can provide immediate relief. Ask your doctor about what option is right for you.

Visit The Sleep Specialist at www.SleepSpecialist.com for more information about sleep problems. If you are in the Portland, Oregon area and you need a sleep doctor, visit Westside Sleep Center, or call (503) 245-4556 to make an appointment to see Dr. Fromherz.

What is Restless Legs Syndrome?

Do you have difficulty sitting still on an airplane because your legs are uncomfortable? Do your restless legs prevent you from falling asleep at night? If you answered “yes” to any of these questions, then you might have Restless Legs Syndrome (RLS).

RLS is an uncomfortable sensation in the legs that appears at rest or at bedtime. It creates an irresistible urge to move the legs. When the legs are moved, this sensation is temporarily relieved. RLS is a problem because it prevents people from falling asleep and the uncomfortable sensation can cause a great deal of distress.

Who Gets Restless Legs Syndrome?

Anyone can have it at any age. It is estimated to occur in up to 1 in 10 adults in the United States. In some people it is inherited and in some it occurs spontaneously. Nobody knows why it occurs but it is believed to be due to a problem with the neurotransmitter dopamine in the nervous system. Since iron is involved in the production of dopamine, some people with low iron have RLS. Up to 80% of people with RLS also have a separate but related disorder call Periodic Limb Movement Disorder (leg kicking that usually occurs after the person has fallen asleep).

I Think I Might Have RLS, How Do I Find Out If I Have It?

Make an appointment with your primary care physician, or if your insurance allows it, go straight to a sleep specialist. If your physician thinks you might have RLS, then he/she can treat you with various medications and/or correct an iron deficiency, if present.

How Is RLS Treated?

In a small number of patients, correcting iron levels can help with RLS. Behavioral methods like hot baths and relaxation methods may also be effective. Many patients require a medication. The FDA recently approved a medication called Requip™ which has been clinically proven to help relieve the symptoms of RLS. Many other classes of medications can also be helpful including benzodiazepines, other Parkinsons Disease medications, seizure medications, and narcotics. Ask your doctor about what option is right for you.

Visit The Sleep Specialist at www.SleepSpecialist.com for more information about sleep problems. If you are in the Portland, Oregon area and you need a sleep doctor, visit Westside Sleep Center, or call (503) 245-4556 to make an appointment to see Dr. Fromherz.

What Is Narcolepsy?

Do you have unexplained daytime sleepiness? Do you have episodes of weakness triggered by humor or anger? Do you ever have episodes of paralysis or hallucinations as you are falling asleep or waking-up? If you answered “yes” to any of these questions, then you might have Narcolepsy.

People with narcolepsy typically have daytime sleepiness, cataplexy, sleep paralysis, hallucinations upon falling asleep or waking-up, and poor quality sleep. Except for cataplexy, all of these problems can occur in other sleep disorders like Sleep Apnea.

Cataplexy is unique to narcolepsy. It is a sudden, unexplained weakness or paralysis triggered by emotions. There is no loss of consciousness and these events usually only last for several seconds to a few minutes.

Who Gets Narcolepsy?

Narcolepsy occurs in approximately 1 in 2000 people in the general population. It usually occurs spontaneously, but it can also be inherited. Nobody knows why it occurs, but in 2000 it was discovered that people with narcolepsy with cataplexy are missing (or have very little of) a neurotransmitter called hypocretin.

I Think I Might Have Narcolepsy, How Do I Find Out If I Have It?

Make an appointment with your primary care physician, or if your insurance allows it, go straight to a sleep specialist. If your physician thinks you might have narcolepsy, then he/she should refer you to a sleep specialist for further evaluation.

How Is Narcolepsy Treated?

Narcolepsy is usually treated with a combination of lifestyle modification and medications. It is important to realize that even with optimal treatment, most people with narcolepsy continue to have a degree of daytime sleepiness.

Behavioral modification involves short naps and proper choice of employment. People with narcolepsy generally do better with jobs that are mentally and physically stimulating rather than sedentary in nature. Employers should be notified that people with narcolepsy may need to take short naps during the course of a workday.

There are two types of medication for narcolepsy: those for daytime sleepiness and those for cataplexy. Medications that help with daytime sleepiness include amphetamines and the newer wake promoting agents like Provigil™. Medications that help with cataplexy are the antidepressants, like Prozac™ and Effexor™. A medication called Xyrem™ helps with both daytime sleepiness and cataplexy. Ask your doctor about what option is right for you.

Visit The Sleep Specialist for more information about sleep problems. Dr. Scott Fromherz is located in Tigard, Oregon at Westside Sleep Center , the premier sleep center in the northwest.

What is Sleep Apnea?

Are you feeling sleepy all the time? Do you snore? Is your doctor having a difficult time treating your high blood pressure? If you answered “yes” to any of these questions, then you might have Sleep Apnea (also called Obstructive Sleep Apnea or OSA).

Sleep Apnea is a condition involving pauses or decreases in breathing during sleep. It is usually due to airway collapse. This collapse occurs in the nose and/or the throat – anywhere from where air enters the nostrils to the back of the tongue. Imagine a straw collapsing when trying to suck on a thick milkshake. Frequently, this airway collapsibility problem is inherited and starts in childhood. In the daytime, it is not a problem because there is good muscle-tone in the airway and the brain monitors breathing. But at night, the throat muscles become relaxed and the brain is not as attentive to the airway. So on inhalation, the airway walls can either completely collapse or significantly narrow. This is a problem because 1) the body must struggle to breathe and 2) the brain has to “wake up” to reopen the airway.

These frequent awakenings lead to fragmentation of nighttime sleep. You may not remember them because they are so short. In fact, patients with sleep apnea can wake-up more than 30 times an hour and think that they slept uninterrupted through the night. Since sleep must be continuous and consolidated in order to be restorative, a number of cognitive problems can occur with sleep fragmentation: daytime sleepiness, memory problems, concentration difficulties, emotional instability, irritability, slowed reaction time, and most importantly, an increased risk of motor vehicle accidents.

There are also cardiovascular consequences of this constant “struggling to breathe.” This puts a strain on the heart and blood vessels, leading to increased risk of high blood pressure, heart disease and stroke.

Finally, there are social implications to Sleep Apnea. The snoring associated with sleep apnea can disrupt the sleep of others. In fact, one study showed that when a person treats his/her sleep apnea, the sleep partner gets the equivalent of one hour more sleep per night.

Sleep apnea is a progressive disease and often gets worse with age. Weight gain, alcohol, and other sedating/relaxing substances exacerbate it.

Who Gets Sleep Apnea?

A common misconception is that only overweight men that snore loudly have sleep apnea, but the facts are:

1) Sleep apnea can occur without snoring
2) Thin people can have sleep apnea
3) Women can have sleep apnea
4) Children can have sleep apnea

In other words, anyone can have it. Even skinny women. Even children.

I Think I Might Have Sleep Apnea, How Do I Find Out If I Have It?

Make an appointment with your primary care physician, or if your insurance allows it, go straight to a sleep specialist. If your physician thinks you might have sleep apnea, then he/she can refer you for a sleep study or comprehensive sleep evaluation.

How Is Sleep Apnea Treated?

There are four main categories of treatment for sleep apnea: Continuous Positive Airway Pressure (CPAP), Surgery, Oral Appliances, and Behavioral Modification.

The most effective way to treat sleep apnea is with CPAP. CPAP is a mask worn over the nose attached by a hose to an air compressor. The air compressor gently and quietly blows room-air into the nose, which “stents” the airway open, preventing airway collapse. This is the most effective way to treat sleep apnea, and all patients diagnosed with sleep apnea should at least try it before considering other options.

Surgery can be an effective way to treat sleep apnea. A number of different procedures can be performed. These range from nasal septum repair to jaw reconstruction. Talk to your doctor about whether surgery is the right option for you.

An oral appliance is a device made by a dentist or an orthodontist designed to pull your lower jaw forward. By pulling your lower jaw forward, the tongue is pulled away from the back of the throat. If your airway obstruction is occurring behind the tongue, then this can be an effective way to treat your sleep apnea. The treatment of sleep apnea with oral appliance should be a coordinated effort between the sleep physician, the dentist/orthodontist, and the patient.

Behavioral modifications can help in the treatment of sleep apnea, but are usually the least effective. These include such techniques as weight loss, sleeping on your side, and avoiding alcohol before bedtime.

None of these treatment options is ideal, but they all can be useful in treating sleep apnea and resulting in more restful sleep. With risks like heart attack and stroke, you should do everything you can to get your sleep apnea under control. If you think you have sleep apnea, contact your doctor or go to a sleep center. It could be the best decision you ever made.

Visit The Sleep Specialist. An informational site devoted to all matters sleep.