||| Sleep Medicine
At Mecklenburg Neurological Associates
we have Board Certified Sleep Specialists, Kenneth
T. Ashkin, MD, Carolyn E. Hart, MD and Michael M.
Amiri, MD. Here are their answers to some common sleep-related
|Sleep Medicine 1:
Sleep Disorders Centers
|What Is A Sleep Disorders Center?
It is a medical facility for diagnosing
and treating patients with sleep-related disorders.
These conditions include difficulties in falling asleep,
staying asleep or remaining awake. The most serious
symptoms of sleep disorders are daytime sleepiness,
excessive use of sleeping pills, nighttime chest pains,
morning headaches, heavy snoring and breathing irregularities
A center’s services are provided by professionals
experienced in sleep-related disorders and sleep-exacerbated
disease. Specialty consultants with certification
in neurology, pulmonary medicine, psychiatry and psychology
are always available.
Basic Sleep Patterns
Most adults need seven to eight hours of sleep at
night although some people need less than four and
other more than ten. When an individual’s sleep
is adequate, that person should feel alert throughout
the day. We can determine our sleep needs by measuring
daytime alertness. Some people fall asleep at times
when they should normally be able to stay awake. This
symptom is very dangerous. Such abnormal sleep is
a sign of several different sleep disorders and can
be successfully treated.
Sleep patterns change with the aging process. Infants
may sleep up to 16 hours per day, while the elderly
may experience more disturbed sleep and a greater
need for naps. Daytime naps may disturb sleep for
some people, but for others they are a normal part
of a healthy sleep-wake pattern.
Everyone dreams every night – and in color.
Some people do not recall their dreams, leading them
to think that they never dream. Dreams can enrich
our lives by their imaginative content and psychological
meaning, but they can also become nightmares and cause
General Information On Sleep Disorders
Insomnia is a symptom that may be caused by many conditions.
Some of them are psychological (chronic depression
or temporary stress), environmental (noise) or psychological
(chronic breathing disorder or temporary pain). Another
common cause of insomnia is misuse and overuse of
Cannot Sleep At Proper Time
When the regular pattern of sleeping and waking is
disrupted, some individuals find that it is difficult
to resume a sleep-wake schedule that fits their needs.
This may be caused by shift work or other changes
in schedule. Some complaints of insomnia or daytime
sleepiness may be due to undiscovered changes in the
People who are too sleepy during the day and feel
muscular weakness when they are angry, surprised,
or amused may have narcolepsy. Sometimes narcoleptics
experience terrifying dreams or hallucinations just
as they fall asleep. Narcolepsy often emerges in young
adulthood and is a life-long medical disorder.
Sleep Apnea and Snoring
Snoring is not always just a normal annoying occurrence.
If light, it may be indeed by trivial. However, heavy
snoring may be a symptom of a serious sleep disorder
called sleep apnea.
People with sleep apnea stop breathing again and again
during sleep. These apneas last 10 to 90 seconds and
may occur several hundred times a night. The symptoms
of sleep apnea are excessive daytime sleepiness, high
blood pressure and heavy snoring.
When people have chronic breathing problems or lung
disease, their symptoms often worsen during sleep.
Complete evaluation of such respiratory diseases sometimes
require measurement of blood oxygenation during sleep.
People who have periodic leg movements (nocturnal
myoclonus) during sleep may not get proper rest and
feel they have either insomnia or excessive sleepiness.
Nightmares and Night Terrors
Nightmares are frightening dream experiences which
can later be recalled. These may occur at any age.
Night terrors are often accompanied by an anguished
scream – yet the victim seldom recalls the experience.
Night terrors generally disappear after adolescence.
The causes of nightmares and night terrors are unknown.
Bedwetting, Sleepwalking and
These disorders are common in childhood. Bedwetting
is particularly common.
Sleepwalking is also common in childhood and can be
dangerous. Sleepwalkers should be protected by reducing
the risk of falling and removing other dangers from
their bedroom. Sleeptalking is also common. Sleeptalking
is usually incomprehensible and rarely of psychological
significance. Most important is to determine whether
the troublesome behavior is benign or a sleep-related
What Can Be Done About A Sleep Disorder?
Most of the disorders mentioned can be effectively
treated once they have been accurately diagnosed.
Some conditions require medication. Others may require
a change in daily habits and working schedule. When
sleep apnea is present, weight loss or an upper airway
operation may be necessary to diminish the serious
It is important to emphasize that correct treatment
can be undertaken only after the real medical condition
has been accurately diagnosed.
|Sleep Medicine 2:
|What is Sleep Apnea?
Sleep apnea refers to non-breathing episodes during
sleep, occurring as frequently as several hundred times
per night. Loud, irregular snoring occurs as the person
attempts to breathe at the end of each apneic episode.
Although the individual may have had a full night’s
sleep, he still feels tired during the day.
This surprisingly common sleep disorder is an illness
which can progress in severity and become life-threatening
if not detected and properly treated. Over twenty million
(20,000,000) Americans suffer from sleep apnea.
Although it seems to be more common in middle-age men
and affects 40% of all people over sixty years of age,
anyone at any age may develop sleep apnea.
Three Types Of Sleep Apnea
Obstructive sleep apnea (most common) is caused by an
obstruction from the tonsils, uvula or fatty tissue,
or by involuntary muscle relaxation which blocks airflow
Central sleep apnea is caused by the brain failing to
send proper signals to regulate breathing.
Mixed sleep apnea refers to a combination of central
and obstructive types.
A routine medical examination cannot reveal the main
symptoms of this illness because the patient’s
respiration remains normal while awake. Proper diagnosis
of the severity and type of sleep apnea can only be
determined by special monitoring of the individual’s
sleep. These tests are available at accredited sleep
centers which use highly sensitive, technical equipment.
Sleep apnea can develop into life-threatening health
problems. During apneic episodes, the oxygen content
of the blood decreases causing blood pressure to rise
sharply and the heart to slow down or stop. Sleep apnea
can cause personality changes, morning headaches, hypertension,
irregular heart rhythm, impotence and even death.
Symptoms That No Amount Of Sleep Will Cure
Very often a person suffering from sleep apnea may not
be aware of his loud snoring and breathing irregularities
during sleep. The spouse is usually the first to recognize
the symptoms and is disturbed during the night by loud
snoring or restless movements of the bed partner. The
person may only recognize that he is excessively tired
during the day, even though he slept through the night.
Symptoms while asleep:
· Loud irregular snoring,
snorting or gasping for breath
body movements before the person starts to breath again
· Excessive sweating during sleep
Irregular pounding or beating of the heart when gasping
Symptoms while awake:
· Excessive daytime
· Complaints of insomnia
or lack of restful sleep
· Rapid weight
gain sometimes to the point of obesity
Confusion or brief memory loss upon awakening
Unexplained morning headache
· High blood
Sleep Apnea can generally be treated very effectively
once properly diagnosed and categorized as to type and
severity. Treatments for each type of sleep apnea may
Obstructive sleep apnea:
· Weight loss
· Surgery to remove
· The nasal CPAP (Continuos
Positive Airway Pressure), a device worn over the nose
that is attached to an air compressor which keeps airways
Central sleep apnea:
Mixed sleep apnea:
· The same as for obstructive apnea
|Sleep Medicine 3:
Narcolepsy, The Sleeping Illness
|What is Narcolepsy?
Narcolepsy is a life-long neurological illness, primarily
characterized by sudden uncontrollable sleep attacks
and persistent daytime sleepiness.
Narcolepsy affects more than 500,000 Americans and symptoms
arise as early as the onset of puberty and continue
throughout life. Recent scientists have confirmed a
genetic marker for this disease confirming that narcolepsy
may be hereditary. A child with a parent having narcolepsy
has one chance in twenty of being affected.
Symptoms may vary from mild to totally disabling and
may appear suddenly or gradually over a period of years.
With narcolepsy, a person’s entire lifestyle is
dominated by sleep attacks resulting in a constant battle
to stay awake. Sudden uncontrollable sleep attacks may
occur at any time or during any activity (such as driving,
eating or talking). Concentration and memory recall
may be greatly restricted by excessive daytime sleepiness
and limited daytime alertness. Secondary psychological
problems may become serious causing severe depression
for the narcoleptic who feels misunderstood and alone
in his sleepy world.
No Amount Of Sleep Will Cure
Excessive daytime sleepiness, despite a full night’s
sleep, may include constant fatigue and dullness of
Uncontrollable sleep attacks, lasting from minutes to
hours, may occur suddenly at inappropriate times when
others normally would be alert.
Cataplexy, (affecting 70% of all narcoleptics) is a
sudden loss of muscle tone or muscle weakness usually
triggered by extreme emotions such as laughter, anger,
fear, elation or surprise. An attack may range from
a brief experience of muscle weakness (sagging of the
jaws or bucking of the knees) to profound loss of muscle
tone resulting in total body collapse. During the attack,
the person remains conscious but is unable to speak
or regain physical control for a brief time.
Automatic behavior refers to doing tasks, (usually routine
in nature) without conscious thinking. Later the person
is unable to recall details of having done a task.
Sleep Paralysis refers to the inability to move upon
falling asleep or waking up. The person has conscious
awareness of not being able to move the body.
Hypnagogic hallucinations are intense, vivid dream-like
experiences which occur between wakefulness and sleep.
Hallucinations can involve some or all of the human
senses, making it difficult to distinguish from reality.
Experiences may be frightening or interesting. Accompanied
with sleep paralysis, the individual may experience
a terrifying nightmare, but be unable to "escape"
from the frightening object (such as dreaming an intruder
is breaking into the house, but being unable to move
or call for help).
Treatment is available. Narcolepsy can be properly diagnosed
by monitoring an individual’s sleep at an accredited
sleep center. Even though narcolepsy is a life-long
illness, the symptoms for most narcoleptics can be managed
with a careful balance of medications, educational support
and personal care. By understanding and accepting the
sleepy nature of this disorder, narcoleptics can adjust
their lifestyles to maximize their daily their daily
alertness and lead as full a life as possible.
|Sleep Medicine 4:
Falling Asleep Can Be As Easy As Counting Sheep
|Everyone knows that a good night’s
sleep makes the difference between feeling good or grumpy
the next day; between functioning at peak performance
or stumbling sluggishly through the day.
Research tells us that sleep is as vital to our health
and well-being as a balanced diet or exercising regularly.
We spend 1/3 of our lives sleeping, more time than working
or playing. This important part of active living restores
and prepares our body for daytime alertness and better
Today’s busy lifestyle, late meals, too much coffee,
irregular schedules, and unnecessary stress can cause
sleep problems. Experts tell us that we need to develop
good routine sleep habits. Each person in evaluating
their own sleep habits should:
Try These Tips:
1. Develop regular sleep habits. Each individual must
determine how much sleep he requires at night to be
fully alert and energetic during the day.
2. Slow down and unwind before bedtime. Try reading
for pleasure, a warm glass of milk, or a relaxing soak
in the tub.
3. Get up the same time seven days a week, no matter
how well you have slept. This maintains your biological
clock and will result in establishing a fairly regular
4. Your bedroom should be a comfortable resort for sleeping.
5. Breathe deeply to induce drowsiness. Take a series
of three very slow, deep breaths, exhaling fully each
time. This helps break tension.
6. Exercise daily to promote good sleep. This releases
energy and mental tension. Late evening exercise disturbs
7. Accept occasional nights with less sleep. They’re
part of life. Although uncomfortable, all of us experience
a few nights when sleep is more difficult.
8. If your sleep is still disturbed, ask for help. Contacting
a sleep specialist in a fully accredited sleep center
will help determine possible physical factors involved.
They also can give you other tips on specific sleep
habits you can apply.
Avoid the following:
1. Don’t try to force yourself to sleep. If you
can’t fall asleep within 15-30 minutes, go into
another room and do something relaxing until you feel
2. Napping during the day. Although naps might be refreshing,
they tend to decrease the amount of sleep at night.
Exceptions: Narcoleptics sometimes need a refreshing
nap before driving a car or to ward off later sleep
3. Strenuous mental and physical activities in the evening.
The mind and body should relax before sleeping.
4. Caffeine in the evening which disturbs sleep. All
coffee (even decaffeinated), most teas, colas, and chocolate
contain caffeine. (Did you know it takes three hours
for one cup of coffee to leave your system?)
5. Smoking before bedtime. Nicotine is a stimulant.
Smoker’s coughing may disrupt sleep.
6. Alcohol in the late evening. the sedation tends to
wear off in 2 – 3 hours and causes disturbed sleep
in the latter half of the night.
7. Long-term use of sleeping pills. This may produce
a dependency and can reduce the quality of sleep.
8. Going to bed on an empty stomach, especially if you
are dieting. Mild, fruit juice (unsweetened), a banana,
or yogurt keep your stomach satisfied without adding
too many calories.
9. Taking problems to bed. Try relaxing yourself into
sleep with soothing music or pleasant imagery (like
walking on the beach in a cool breeze). Counting sheep
is the oldest trick in the book for a simple reason
– it works! According to research, this technique
distracts both sides of the brain with soothing, repetitive
activity – you literally bore yourself to sleep.