What is Sleep Medicine?
Literally, sleep medicine deals with the clinical problems of disturbed sleep. Since the first truly clinical sleep disorders centers and laboratories were developed in the late ‘60’s’ and early 70’s, over three hundred sleep disorder diagnoses have been identified and codified. This incredible explosion of information and direct application to the diagnosis and treatment of patients has lead to the establishment of this specialty of medicine. At the same time a parallel development in technology has allowed us to more easily and accurately study the processes of sleep and apply it to the problems that patients present.
Restless Leg Syndrome
The restless legs syndrome is a very common problem in which the affected person has a variety of uncomfortable sensations such as tingling, aching or other hard to describe sensations. The result of these sensations is an intense desire, or compulsion, to move the legs. The restlessness typically worsens during the day, reaching a peak in the hours before or at bedtime. In restless legs syndrome (RLS) of severe degree, the discomfort begins earlier and earlier in the day, and some patients have symptoms all through the day. These feelings are difficult for people to describe exactly, some describe them as an “antsy” feeling and some have used the term “heebie-jeebies”. RLS can become first an irritation and eventually, a very disruptive, even unbearable problem.
Sleep Apnea
Sleep apnea ia a very common disorder (up to 10% of men and up to 5% of women) of sleep in which breathing stops while a person is asleep. There are two types of sleep apnea, obstructive and central.
Narcolepsy
Narcolepsy/Cataplexy is a disorder of sleep in which the mechanisms which control sleep and arousal are abnormal. The cause is unknown. The components of narcolepsy include excessive daytime drowsiness, cataplexy, hypnogogic hallucinations and sleep paralysis. New medications have introduced recently which have significantly improved the treatment of narcolepsy.
SLEEP APNEA AND DIABETES: Which is the chicken and which is the egg?
Even in the early experience with sleep in a purely clinical sleep disorders center, an interesting clustering of sleep apnea, obesity, cardiovascular disease, cerebrovascular disease, congestive heart failure and diabetes was often seen. At the time, in the mid-80’s, these relationships were already being studied, but there were, then, no firm data. Myths about sleep were common: 1. sleep apnea was thought to be a male-only problem, 2. sleep apnea was caused exclusively by obesity, 3. sleep apnea was interesting, but not really a “medical” problem, and 4. sleep apnea could easily be solved if the obese patient just had the discipline to lose 50-100 pounds of body weight. Things have changed. The inter-relationship between sleep apnea, diabetes, obesity, and vascular disease is now being studied seriously.
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Frequently mistaken for narcolepsy, this condition has recently been recognized as a distinct clinical entity. Here's how to spot the subtle differences.
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