Insomnia is difficulty in either getting to sleep or staying asleep, is very common. There are many reasons for difficulty getting to sleep or staying asleep, and it is important to have a careful evaluation with your doctor to ensure there are not associated medical conditions that are contributing to the sleep difficulties. To effectively treat insomnia, underlying causes need to be found and addressed. Other investigations that can be used in insomnia are actigraphy.
Insomnia treatment combines changing behaviours and thoughts around sleep with drug treatment if needed. Using drugs alone is rarely successful and does not cure insomnia. Recent research has shown that long term improvements in insomnia are best when medications are used initially in combination with addressing behaviour and thoughts about sleep, but then gradually withdrawn rather than continued indefinitely. Despite this, some people will need ongoing treatment with drugs. The choice of drugs available is changing with newer drugs becoming available and being tested in research studies that should provide safe long-term treatments for insomnia. Cognitive-Behavioural Therapy (CBT), mindfulness and hypnosis can be used in conjunction with a thorough assessment, and supportive counselling, to improve sleep quality and regain a sense of control over sleep patterns. If you have a sleep problem that is interfering with your social, emotional, occupational or physical functioning it is advisable that you make an appointment with one of our sleep psychologists.
Narcolepsy is an uncommon condition affecting around 3 people in every 10,000. Even though it is uncommon, many people have heard of narcolepsy and know that one of the features of narcolepsy is difficulty staying awake. People with narcolepsy have difficulty staying awake and have a tendency to fall asleep quickly and often unexpectedly. In addition to this, patients with narcolepsy can experience sudden onset of muscle weakness triggered by strong emotions such as laughing or anger, a feeling of paralysis on waking, and vivid dreams whilst going to sleep.
Recent research on narcolepsy has shown that narcolepsy is due to damage to a small group of cells in the brain that produce the neurotransmitter orexin or hypocretin. It is not clear what causes these orexin producing cells to become damaged, but this process can be triggered by infection or illness. Symptoms most commonly develop in late teenage years, and once established, symptoms persist. It is not unusual for people with narcolepsy to be diagnosed with other conditions such as depression or psychosis, because of the tiredness and hallucinations, but if cataplexy (sudden muscle weakness) is present the diagnosis is quite clear. To confirm a diagnosis and rule out other conditions contributing to sleepiness, a sleep study followed by a daytime napping test – a multiple sleep latency test – is usually performed. Once the diagnosis of narcolepsy is confirmed, treatment consists of using napping and sleep scheduling strategies as well as medications to manage sleepiness, cataplexy and other symptoms of narcolepsy. Current medications used to treat sleepiness include modafinil and dexamphetamine, and cataplexy is usually treated with anti-depressant medications. In the future we hope to be able to treat narcolepsy with orexin replacement and there is active research underway to make this a reality.
Restless Legs Syndrome:
Restless legs syndrome is a common condition characterised by 4 main symptoms:
A need to move the legs, usually accompanied or caused by uncomfortable, unpleasant sensations in the legs. Sometimes the need to move is present without the uncomfortable sensations and sometimes the arms or other body parts are involved in addition to the legs.
The need to move and unpleasant sensations are exclusively present or worsen during periods of rest or inactivity such as lying or sitting.
The need to move and unpleasant sensations are partially or totally relieved by movement such as walking or stretching at least as long as the activity continues. The need to move and unpleasant sensations are generally worse or exclusively occur in the evening or night.
Assessment of patients with restless legs symptoms requires a careful clinical evaluation, completing an RLS Rating Scale, ensuring iron levels are adequate with a blood test, and usually a sleep study to characterise the leg movements and look for co-existing conditions that can worsen restless legs such as sleep apnea.
Restless legs symptoms can be improved by iron replacement if iron levels are low, and simple measures such walking or pacing can provide short-term relief. Frequent or severe symptoms can be treated with daily medication, usually taken at night 1-2 hours before symptoms usually develop. A number of medications are effective, and in more severe cases a combination of medications may be required. The medications that can be used include dopamine agonists, anti-epileptics such as gabapentin, opiates and benzodiazepines.
Sleep related movement disorders :
Abnormal behaviours during sleep can take many forms. The most common forms are sleep walking and sleep talking, but other examples include acting out dreams, eating during sleep, or yelling out during sleep. Collectively, all of these behaviours are called parasomnias.
Parasomnias occur for a range of reasons, and treatment involves determining whether the events arise from non-REM or REM sleep and whether events occur spontaneously or are triggered by other sleep disruptions such as due to sleep apnea or leg movements during sleep. For this reason, a sleep study is an important part of evaluating parasomnias, and even if there is no abnormal behaviour on the night of the sleep study, there are subtle features on a sleep study that can give insights into the cause of parasomnias.
Parasomnias that arise out of non-REM sleep usually arise in childhood and continue in adulthood, but reduce in frequency with age. Often these parasomnias can be sufficiently reduced by avoiding alcohol and sleep deprivation, but if needed, they usually respond to medication. REM related parasomnias - such as the Rem-Sleep Behaviour Disorder (RBD) more commonly come on in middle-age, and if frequent or disturbing to bed partners require treatment with medication. Sleep apnea or leg movements during sleep can worsen both non-REM and REM parasomnias, so if these conditions are present treating them can help to reduce the frequency of parasomnias.