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What Goes Wrong in Sleep? An Overview of Sleep Disorders

What Goes Wrong in Sleep? An Overview of Sleep Disorders

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Written by Dr. Ruwanthi Jayasekara

Consultant Respiratory Physician (MBBS, MD Medicine, MRCP UK, ESRS/ Expert Somnologist)

Good sleep is essential for a good life, and we spend about one-third of our lives sleeping. Therefore, it is essential to be aware of disorders that can occur during sleep, how to identify them, and treatments are available for them.

What types of sleep disorders are there?

There are many types of sleep disorders but here are some of the most common ones: 

  • Insomnia (difficulty in falling asleep and/or staying asleep)
  • Sleep related breathing disorders (eg. Sleep apnoea)
  • Central disorders of hypersomnolence (conditions with excessive sleep)
  • Parasomnias (involves unusual and undesirable physical events or experiences that disrupt your sleep)
  • Sleep-related movement disorders 

Let’s take a deeper look into each of the above-mentioned sleep disorders including how each affects the patient and what they can do to prevent them.

types of sleep disorders

Insomnia

People with insomnia find it very difficult to fall asleep and/or sleep well at night despite having a suitable environment and time to sleep. This will result in an impairment in their daytime functioning. In some people, this can be short-term, such as in anticipation of a stressful event like facing an exam or starting a new job. In others, this goes on for many months and years, causing distress to the patient.

Patients with insomnia will be evaluated using 

  • Sleep diaries – These let you measure and record when the patient went to bed, when they woke up during the night and woke up in the morning
  • Actigraphy – It is a wearable sleep test that tracks the patient’s movements while they are sleeping to analyse when they’re asleep and awake
  • Polysomnography (sleep study) – It is a comprehensive test that records brain waves, oxygen level in blood, heart rate, breathing, leg movements, etc during the sleep study.

This condition’s management includes sleep hygiene measures, medication revision and cognitive behavioural therapy.

Sleep-related Breathing Disorders

These conditions are involved with abnormal and difficult respiration during sleep. While some of these sleep-related breathing disorders have low health impacts, others may have serious consequences due to their effects on the patient’s sleep and balance of oxygen and carbon dioxide in their blood.

There are a few types of sleep-related breathing disorders. They are 

  • Obstructive sleep apnoea 
  • Central sleep apnoea
  • Sleep-related hypoventilation disorders
  • Sleep-related hypoxemia

Some risk factors of obstructive sleep apnoea are 

  • Male sex
  • Ageing
  • Obesity
  • Smoking
  • Alcohol use 
  • Certain craniofacial features such as receding jaw or small chin
  • Patients or their bed partners complain of loud snoring
  • Fragmented sleep
  • Getting up frequently to go to the toilet
  • Feeling excessively sleepy in the daytime
  • Feeling irritable and moody in the daytime

Apnoeic Spells and its Treatments

Sometimes a spouse may notice that the patient stops breathing at night for prolonged periods. This phenomenon is known as an apnoeic spell. Patients are evaluated with sleep studies called ‘polysomnography’, tests that evaluate sleep in detail and diagnose the underlying sleep disorder. The first line treatment is CPAP therapy (a device that provides continuous positive airway pressure). Additionally, weight loss with exercise and a healthy diet are also substantial.

Central Disorders of Hypersomnolence

These are a rare group of sleep disorders where patients complain that they are always sleepy during the day and the night. Patients tend to fall asleep in the daytime even after adequate sleep. E.g. Narcolepsy. Some patients with excessive sleepiness may have an underlying undetected medical or psychiatric condition. 

Excessive sleep has a significant detrimental impact on the patient’s life. These patients must be evaluated with sleep studies and blood investigations before starting their treatment.

Circadian Rhythm Sleep-Wake Disorders

Circadian rhythm sleep-wake disorders are a group of disorders where the patient’s body’s clock, which helps to maintain a regular day and night pattern, is affected. 

There are several types of circadian rhythm sleep-wake disorders.

  • Delayed sleep-wake phase disorder

This is where the patient does not fall asleep until the morning and tends to wake up in the afternoon – the patient’s circadian clock is delayed compared to the average population. These patients may struggle to wake up on time for school and work. 

  • Advance sleep-wake phase disorder

On the other hand, this disorder tends to have an early sleep pattern and early rise pattern. There are various types of disorders. Shift workers also suffer from the detrimental effects of not sleeping on time and staying awake when they should be sleeping. 

  • Jet lag disorder 

This is another condition in which people suffer due to crossing time zones. Understanding these conditions is vital as many treatment modalities help reduce these problems.

Parasomnias

Parasomnias are another set of sleep disorders involving a lot of sleep movement. In certain sleep stages, some people have confusional arousals, sleepwalking, sleep terrors, sleep-related eating, violent movements in sleep, acting out dreams, nightmares etc. Patients are evaluated with a sleep diary and polysomnography. These conditions must be identified and treated as many patients suffer from poor sleep and daytime dysfunction due to these issues.

Sleep-related Movement Disorders

Sleep-related movement disorders include restless leg syndrome and periodic limb movement disorder, where the patient has a lot of leg movement at night, leading to disturbed sleep.

How do you prevent sleep disorders from occurring in the first instance?

The baseline management of any sleep disorder is the maintenance of good sleep hygiene practices.

  • Maintain a regular sleeping and waking up time
  • Have regular meals
  • Avoid caffeinated drinks close to bedtime
  • Avoid smoking and alcohol
  • Keep your devices away at least one hour before bedtime

Despite these measures, if a patient feels that they have an issue with their sleep, it is best not to delay diagnosis, as sleep is essential for a healthy life. They can consult experienced sleep specialists via the oDoc app to have a comfortable and convenient consultation in just three taps within the comfort of their own home.

Dr Ruwanthi Jayasekara

SLMC 25147

Chest Physician

Sources

  1. How Is Actigraphy Used to Evaluate Sleep, Sleep Foundation (2022)
  2. Sleep-Related Breathing Disorders, Sleep Foundation (2022)
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5 Home Remedies for Mosquito Bites

5 Home Remedies for Mosquito Bites

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Mosquito bites
“..what hurts more is probably the blisters and bumps they leave behind..” 🦟

The whining of a mosquito is a familiar sound that hovers past our ears these days. Ever noticed how active these creatures are during power cuts at night, buzzing non-stop around us, aiming to make a smooth landing on our skin? 

And what hurts more is probably the blisters and bumps they leave behind. Here are five easy home remedies for those painful mosquito bites that take an eternity to go away.

What happens under your skin after a mosquito bites you?

When a mosquito bites, it uses its long mouthpart; proboscis (which looks like a tiny needle), to prick your skin and suck your blood. When this occurs, its saliva is released into your bloodstream. Your body acknowledges this as an allergen, signalling your immune system to transmit the chemical ‘histamine’ to the area bitten by the mosquito. This is done to remove the allergen from your body. 

The histamine triggers an inflammatory response causing the area around the mosquito bite to swell and itch.  In some people, the bites may develop into an allergy as well.

Mosquito bites a person hand

Do all mosquitoes drink blood?

No, it’s only the female mosquito that drinks blood. This is because proteins present in the human blood are essential for the development of mosquito eggs.

How does a mosquito spread diseases?

When an infected mosquito bites, it transfers the infection via its saliva into your bloodstream, passing the infection onto you. Since mosquitos practise ‘sip feeding’, the process of sucking blood from multiple sources, the infection tends to spread among many people.

Home remedies for mosquito bites​

Here are some natural remedies for mosquito bites that can help reduce the itch and inflammation:

       1. Ice

Apply a bag of crushed ice or an ice pack over your bumps for about 10 mins to reduce the itch and swelling.

       2. Honey

Honey has vital anti-inflammatory properties. Apply a drop of honey onto the affected area. This would help reduce the itch and pain.

      3. Aloe Vera

Aloe vera helps increase the speed of wound healing. To use this on your mosquito bites, cut a small section of an aloe vera plant and apply its gel onto the affected area. Let this dry on your skin and reapply again as necessary.

      4. Onion

This common kitchen vegetable has natural antifungal and antibacterial properties, which helps lower irritations associated with the skin. Cut an onion slice and apply it to the area of mosquito bites for a few minutes. Then, remove the slice and rinse the area thoroughly.

     5. Apple Cider Vinegar

The antimicrobial and antioxidant properties of apple cider vinegar helps treat many skin conditions such as eczema. Add a drop of apple cider vinegar on your bump . If you have several bites, soaking a cloth in cold water and vinegar and applying it to the affected area may give you some relief and reduce itching.

home remedies for mosquito bites

When should you visit a doctor?

You can consult a doctor via oDoc if you experience an allergic reaction to mosquito bites or see the following symptoms of dengue passed on by mosquitos:

  • Fever
  • Nausea
  • Vomiting
  • Aches and pains (behind the eyes, muscles or joints)
  • A rash

With the number of dengue patients increasing in the country, it is vital that you maintain a clean surrounding around your homes and prevent the population of mosquitos. Applying a mosquito repellent such as citronella oil will also help you avoid mosquito bites. If you think you are undergoing a severe allergic reaction caused by mosquito bites you can consult a dermatologist, or if you are experiencing the above dengue fever symptoms, you can consult a GP via the oDoc app.

Sources

  1. 16 Home Remedies for Mosquito Bites, Healthline (2022)
  2. Mosquito Bites: What They Look Like, Why They Itch & Treatment, Cleveland Clinic (2021)
  3. Dengue – Symptoms and Treatment, CDC (2021)
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