Dr Deshmukh on Sleep Disorder in Pune Times of India - May 28,2012.

Sleepless in Pune

Study shows ours is the 6th most sleep-deprived city in the country

Neha Ghatpande

     

Posted On Monday, May 28, 2012 at 09:01:40 AM

A health study recently published by The Associated Chambers of Commerce and Industry of India(ASSOCHAM) has found that Pune ranks sixth when it comes to those affected with sleep disorders.  Doctors in the city have also confirmed that they are seeing a large number of youngsters, seeking treatment for various sleep disorders.  The most common sleep disorders amongst Puneites were insomnia, sleep apnea and snoring, that has serious health ramifications. Number of patients has tripled in two years and they are mostly youngsters. “The most prominent reason in Pune is the work pattern.   The number of jobs in the BPO and IT industry that demand night shifts has increased. Stress is also a major reason for sleep disorders,” said Dr. He added that obesity and breathing-related problems are on the rise in the city, that also contribute to sleep disorders.    Doctors believe people are unaware or unable to understand that sleep disorders have to be treated. Many, who cannot sleep or suffer from sleep-related problems indulge in self medication and take sleeping pills.  Dr Swapnil Deshmukh, who runs a sleep speciality clinic in Pune and is a psychiatrist, said that the first issue with patients who have sleeping disorders is that they have to deal with their addiction to sleeping pills. “I see many patients who take 5 to 6 sleeping pills daily.  First, we reduce their intake of pills and then treat them. Self medication can lead to heart and blood pressure problems. People should consult doctors before taking sleeping pills,” he said.  Health and social problems  The first sign of a sleep disoprder is a severe headache, abdominal pain, acidity, poor digestion, general weakness, heart and blood pressure problems. “Sleeping pills or their overuse can cause such physical ramifications if the disorder is not treated at an early stage,” said Dr Deshmukh.   In case of insomnia, anxiety and depression is caused due to the lack of sleep. Upto 20 per cent of sleep disorders can be psychological,” added Deshmukh. These persons perform poorly in their professions and have punctuality problems. Their self confidence is affected.   Pune’s most common sleep disorders Insomnia: Sleeplesness Sleep Apnea: Breathing problems Snoring      The signs  •    First one should rule out temporary situations such as examinations, profession pressure of meeting a deadline or any emotional problem. If sleeplessness or disturbed sleep patterns persist, then one should see a specialist.     Causes •    Number of jobs in BPO and IT industry that demand night shifts has increased •    Stress related problems •    Obesity and breathing-related problems    Dietary and lifestyle changes •    Doctors advise very few dietary changes but they are vital •    Avoiding soft drinks, chocolate and foods containing tannin or caffeine in addition to coffee and tea •    Dinner should be very light and should not include high-calorie food  •    Should be eaten two hours before bedtime   Exercises •    Meditation and Yoga in the evening •    No gym after office hours •    Walking and simple exercises  •    Hot water bath at night  •    Washing feet with cold water before going to bed      Case Studies   32 -year-old IT professional Sleep disorder: Snoring  This IT professional, with mild obesity could not go on trips with his friends because of his sleeping disorder which started affecting his psychological health. Dr studied his sleep pattern. He had a high-degree snoring problem.  An endoscopy was performed and a blockage was discovered in his nose. He was asked to lose weight and a radiographic treatment was performed which removed the blockage. This has solved his snoring problem and increased restful sleep. His social and psychological health has improved. 50-year-old financial sector employee Sleep disorder: Restless leg syndrome A woman suffered restless leg syndrome — a rare disorder in which a person keeps moving his/her legs unknowingly. The problem is caused due to the secretion of a certain chemical in the brain.  She was addicted to three sleeping pills. She had sought many treatments, but the disorder was not diagnosed. Her sleep pattern was studied and she was treated with simple medication.  Dr Deshmukh had to first deaddict her from sleeping pills and asked her to follow a simple diet and exercises. Her professional life was suffering as a result of poor concentration and her family life too was stressed. Dr Deshmukh, 09923291312.

How can I get a good night's sleep ?

How can I get a good night's sleep ?

 

Most people would agree that there's nothing better than a good night's sleep. Stressful day at the office? Long hours doing outdoor-work and housework? All this can be repaired with a nice, long sleep. You awake the next day feeling calm, refreshed and ready for anything -- the stresses, aches and pains of the previous day are long gone.

 

Are you getting enough sleep?

Ask yourself the following questions:

Do you often feel drowsy during the day?

Do you usually fall asleep within the first five minutes after lying down in bed?

If you answered “yes” to either of these, you're likely to be sleep deprived or have a sleep disorder.

 

No matter how much sleep you need, if you don't get enough, you will suffer the effects of sleep deprivation. Research has shown that in tests of driving ability and hand-eye coordination, people deprived of sleep perform as badly as, or even worse than, people who are intoxicated. It's no wonder that drowsiness is a major cause of traffic accidents and deaths. Sleep deprived may experience slowed speech, apathy, impaired memory, deflated emotional response and an inability to multitask. Aside from these bothersome side effects chronic sleep deprivation has been linked to high blood pressure, depression and other psychiatric problems, heart disease, obesity, diabetes, and cancer. If deprived of sleep, Children and young adults are more likely to perform less in exams and get more prone for addiction to alcohol and other drugs. 

WHAT WE CAN DO TO AVOID ABOVE COMPLICATIONS?

HOW WE CAN IMPROVE OUR SLEEP QUALITY NATURALLY?

 

Practicing good sleep hygiene, including maintenance of a regular bedtime and awakening schedule, is the best way to ensure restful and restorative sleep. Avoidance of caffeine, alcohol, nicotine, TV or computer work, and strenuous exercise in the 2 hours prior to bedtime can also help improve the quality of your sleep. Having medium dinner, morning yoga / walk, optimum temperature of bed room and quite environment will help you. Many people report that they lie awake at night worrying about problems or situations they will face during the coming day. In this case, it can be helpful to write a to-do list or a list of items to act upon the following day prior to bedtime, giving yourself permission to "let go" of these items during the night. If you have trouble falling asleep try – washing your feet in cold water, empty your bladder before going to bed, don’t keep watch just next to bed as it will make you nervous if you don’t get sleep on time.

If you are concerned about the quality of your sleep or if you have the symptoms of a sleep disorder, it is important to consult your health care practitioner. He or she can help you determine the cause of your sleep problem and recommend appropriate therapy. Never take sleeping pills or over counter medications without consulting a sleep specialist as they can be addictive and make your problem worse on long run in addition to their other side effect.  Good sleep pattern is key to healthy life. On this world sleep day- let’s care for it as we spend one third of our life span sleeping….

 Dr Swapnil Deshmukh

MD (Psychiatrist)

Sleep disorder specialist

9923291312.

ARCHITECTURE OF SLEEP

What is sleep?

There are over 20 definitions of "sleep" in several dictionaries. The first, a verb, seems most appropriate:

to take the rest afforded by a suspension of voluntary bodily functions and the natural suspension, complete or partial, of consciousness; cease being awake.

Physiologically, sleep is a complex process of restoration and renewal for the body. Scientists still do not have a definitive explanation for why humans have a need for sleep. We do know that sleep is not a passive process or "switching off" of body functions; sleep is believed to be important in many physiologic processes including the processing of experiences and the consolidation of memories. It is also clear that sleep is essential, not only for humans but for almost all animals.

The importance of sleep is underscored by the symptoms experienced by those suffering from sleep problems. People suffering from sleep disorders do not get adequate or restorative sleep, and sleep deprivation is associated with a number of both physical and emotional disturbances. In addition, sleep is influenced by the circadian rhythms (regular body changes in mental and physical characteristics that occur in the course of about 24 hours). These are controlled by brain neurons that respond to light, temperature and hormones and other signals and comprise the body's biological clock. This clock helps regulate the "normal" awake and sleep cycles. Disruption of these cycles can make people sleepy at times people want to be awake. For example, travelers experience "jetlag" when they cross time zones. When a New Yorker arrives in Paris at midnight Paris time, his or her body continues to operate (their biological clock) on New York time. It may take some time (about 1-3 days) to reset a person's biologic clock, depending on how much it has been altered by the time change.

There is evidence that some aspects of sleep are under genetic influence; a gene termed DEC2 is being investigated as causing people that possess it to require only about 6 hours of sleep. Researchers have only begun to examine the genetics involved in sleep.

What are the stages of sleep?

There are two general states of sleep: 1) rapid eye movement (REM) sleep, and 2) non-rapid eye movement (NREM) sleep. NREM sleep is further subdivided into stages (see below).

1. REM sleep (rapid-eye movement):REM sleep is unlike any of the other stages of sleep. It was first described in 1953 when sleep researchers noticed a unique pattern of brain waves (signals recorded on an EEG), a type of test that measures the electrical impulses within the brain). These brain waves had a fast frequency and low voltage, similar to the brain waves seen in the normal awake state. Other characteristics of REM sleep include complete inactivity of the voluntary muscles in the body, with the exception of the muscles that control eye movements. Rapid eye movements are also observed during REM sleep. People who are awakened during REM sleep often report that they were dreaming at the time. About 20% to 25% of sleep time is REM sleep; in infants it can comprise about 40%.

2. NREM (non-rapid eye movement):NREM sleep has traditionally been considered to be divided into 4 stages. However, new guidelines from the American Academy of Sleep Medicine (AASM) published in 2007 have recharacterized NREM sleep as occurring in 3 stages, according to the pattern of brain electrical activity:

·      Stage N1 sleep, or the transition from wakefulness to deeper sleep. This is the lightest stage of sleep, and people may not always perceive they are asleep when in this stage.

·       Stage N2 sleep is a true sleep state, and accounts for 40% to 50% of sleep time.

·   Stage N3 sleep has been called deep sleep, delta sleep, or slow wave sleep. This stage accounts for about 20% of sleep in young adults.

Sleep typically occurs in cycles that range from 90 to 120 minutes in length, with 4-5 cycles occurring during each night's sleep. In the first half of the night, there is a transition from wakefulness into stage N1 sleep, then to stages N2, and N3. Stages N2 and N3 then reappear, followed by the first instance of REM sleep. Cycles of stage N2 and REM sleep alternate with each other for the second half of the night.

Disruptions in the entire sleep cycle or in the individual phases are believed to account for the various types of sleep disorders.

How much sleep does a person need?

Individuals vary greatly in their need for sleep; there are no established criteria to determine exactly how much sleep a person needs. Eight hours or more may be necessary for some people, while others may consider this to be too much sleep.

The National Institutes of Health (NIH) suggests that most average adults need about 7 to 9 hours of sleep each night. Newborn by contrast, sleep from 16 to 18 hours a day. preschool typically sleep between 10 and 12 hours a day. Older, school going and teen need at least 9 hours of sleep a night. Women in the pregnancy have been observed to need a few more hours' sleep than is usual for them.

Does the amount of sleep we need change as we age?

Changes in the sleep cycle do occur with aging. Deep or slow wave sleep (Stage N3) sleep declines as we age, while light sleep (Stage N1) increases with age, so that older adults may spend less time in the more restorative stages of sleep and more time in lighter sleep. Older people are also more easily aroused from sleep. While some people believe that older adults need less sleep as they get older, there is no scientific evidence that older people need less sleep than younger adults.

What are signs and symptoms of sleep deprivation?

Feeling tired or drowsy at any time during the day is a symptom of not having enough sleep. Being able to fall asleep within 5 minutes of lying down in the evening also may be a sign a person may be suffering from sleep deprivation. People who suffer from sleep deprivation often experience so-called "microsleeps," which are short bursts of sleep in an otherwise awake person.

Sleep-deprived people perform poorly on tests such as driving simulators and tests of hand-eye coordination. Sleep deprivation can also magnify the effects of alcohol, meaning that a sleep-deprived person will be more susceptible to becoming impaired after alcohol consumption than a well-rested person. Caffeine and other stimulants cannot successfully overcome the drowsiness associated with sleep deprivation.

What are and what causes sleep disorders?

Sleep disorders are disruptions of the sleep cycle or the quality of sleep. About 40 million Americans are believed to suffer from chronic sleep disorders, with millions more affected on an occasional basis. Doctors have defined over 70 different types of sleep disorders, but the most common sleep disorders are insomnia, sleep apnea, restless legs syndrome, and narcolepsy.

·   INSOMNIA   is the perception of poor-quality sleep, including the inability to fall asleep or stay asleep. Because people differ in their need for sleep, there are no fixed criteria that define insomnia. Insomnia is very common and occurs in 30% to 50% of the general population. Approximately 10% of the population may suffer from chronic (long-standing) insomnia.
· SLEEP APNEA is another common sleep disorder characterized by a reduction or pause of breathing (airflow) during sleep. Central sleep apnea (CSA) occurs when the brain does not send the signal to the muscles to take a breath, and there is no muscular effort to take a breath. Obstructive sleep apnea (OSA) occurs when the brain sends the signal to the muscles and the muscles make an effort to take a breath, but they are unsuccessful because the airway becomes obstructed and prevents an adequate flow of air. Mixed sleep apnea occurs when there is both central sleep apnea and obstructive sleep apnea.

· RESTLESS LEG SYNDROME, also known as nocturnal myoclonus, is a type of sleep disorder characterized by uncomfortable sensations in the legs and an uncontrollable desire to move the legs. These abnormal sensations usually occur in the lower legs shortly after going to bed. During the early stages of sleep, these episodes of leg movement often last up to an hour. The abnormal sensations of RLS are quite variable. They have been described as a crawling, creeping, pulling, drawing, tingling, pins and needles, or prickly discomfort. They are not cramping in character.

·NARCOLEPSY is a disease of the central nervous system that results uniformly in excessive daytime sleepiness (EDS). Other primary symptoms of narcolepsy include the loss of muscle tone (cataplexy), distorted perceptions (hypnagogic hallucinations), and the inability to move or talk (SLEEP PARALYSIS). Additional symptoms can include disturbed nocturnal sleep and automatic behaviors (affected persons carry out certain actions without conscious awareness). All of the symptoms of narcolepsy may be present in various combinations and degrees of severity.

Other sleep disorders include: Periodic limb movement disorder, Hypersomnia, sleep walking, snoring,  nightmares and shift work sleep disorder.

How are sleep problems diagnosed?

Doctors use a number of different tests to evaluate sleep and determine whether a sleep disorder is present. A careful medical history and physical examination are performed to help identify any medical conditions that may be interfering with the person's sleep. The health care practitioner will also ask about the use of prescription and non-prescription medications as well as alcohol, tobacco, and caffeine use. Laboratory tests may also be used to help diagnose any medical conditions that may cause sleep problems.

In some cases, specialized testing is recommended to help determine whether or not a person may be suffering from a sleep disorder. Some of the most common sleep tests include the following:

·         Polysomnography is often simply referred to as a "sleep study." In this test, doctors use electrodes attached to the face and scalp to measure brain waves (EEG) and muscle tone during a night's sleep. Other body functions such as airflow, breathing effort, blood oxygen levels, leg movements, (ECG), and body position may also be measured if needed. Sleep studies are most commonly performed in specially designed labs in hospitals or clinics.

·         The multiple sleep latency test (MSLT) is designed to measure daytime sleepiness. The test is based upon the fact that the sleepier an individual is, the faster he or she will fall asleep. In this test, the patient is given four to five opportunities to nap in a quiet, dark room, usually at two hour intervals during the day. Body functions such as EEG and muscle tone are measured as in polysomnography. The time period needed from wakefulness to sleep onset is measured to determine the "sleep latency." This is repeated during each of the naps, and an average time for sleep latency across all the naps is calculated. Usually a sleep latency of 5 minutes or less is signifies severe daytime sleepiness.

·         Related to the MSLT is the maintenance of wakefulness test (MWT), which measures the individual's ability to stay awake when reclining in a quiet, darkened room.

·         The Epworth sleepiness scale is a questionnaire that is given to patients, often as part of an office visit to a health care practitioner. The test asks individuals to rate how likely they would be to fall asleep in a number of situations (such as a passenger in a car, sitting quietly after lunch, etc.).

How are sleep problems treated?

The treatment of sleep disorders depends upon the exact disorder and the degree of severity of the symptoms. Both medical and non-medical approaches are generally used in the treatment of sleep disorders. In some cases, such as sleep apnea, surgical treatments may be considered.

Sleep hygiene

Non-medical treatment options are often referred to as sleep hygiene. Sleep hygiene is the practice of behavioral habits that offer the maximum potential for restorative and sound sleep. Good sleep hygiene practices include:

·         Avoid caffeine, nicotine, and alcohol use before bedtime. Some studies have shown that caffeine consumed early in the day can have an effect on the ability to fall asleep at night.

·         Have and adhere to a regular bedtime and waking schedule

·         Maintain a comfortable sleep environment, including a comfortable temperature

·         Do not lye in bed awake, worrying about not sleeping (or anything else negative). This produces anxiety that can actually make the problem worse.

·         Get regular daily exercise (it is recommended that individuals avoid exercise two hours prior to bedtime)

Other therapies

Of course, many people with sleep disorders will require treatment beyond sleep hygiene measures. Behavioral therapies are successful for many people who suffer from insomnia. These therapies may consist of stimulus control measures, such as using the bed for sleeping and sex only and not for other activities such as reading or TV watching. Sleep restriction therapies are often used to help individuals avoid staying in bed too long and actually over-sleeping after a night of insomnia.

Sleep aids (prescription and OTC)

Medications can be of value in treating some types of sleep disorders. However, since sedating medications typically have the potential for addiction and abuse, their use must be carefully supervised by a health care practitioner.

·         In sleep apnea and other sleep disorders in which airway obstruction is a problem, topical nasal decongestants may provide some relief. However, many clinicians warn people with sleep apnea never to use sleeping pills or medications that are sedative as the person could be prevented from waking enough to stimulate breathing, which could lead to brain damage or sudden death.

OTC sleep medications are sometimes used for the short-term treatment of insomnia. These include the sedating antihistamines . However, this is not a recommended use of these or other similar drugs due to their many side effects and the possibility of long-term drowsiness the following day.

 Melatonin a chemical released from the brain which induces sleep, has been tried in supplement form and promoted as a natural sleep remedy for treatment of insomnia. But studies have shown that it has been generally ineffective in treating common types of insomnia, except in specific situations in patients with known low levels of melatonin.

Dental appliances and CPAP devices (continuous positive airway pressure; a device worn over the face that holds the airway open by maintaining constant air pressure) have been effective in the management of sleep-related breathing disorders, including sleep apnea.

Are sleep problems and disease related?

Sleep problems occur in a number of different medical and psychiatric conditions. For example, asthama or stroke are conditions that tend to occur frequently during the night or early morning hours. The relationship between sleep stages and certain types of seizures is complex and not completely understood, but certain sleep stages tend to either exacerbate or prevent the spread of seizure activity in the brain.

Sleep problems occur with chronic pain and conditions in which pain is worse at night, because the pain may interfere with sleep. Pain medications and other types of medications taken on a regular basis for chronic conditions can also have an effect on an individual's sleep pattern. Those suffering from cancer and brain injury are also commonly affected by sleep disturbances.

Psychiatric diseases such as depression are also associated with sleep problems. This condition can be associated with both too much sleep and too little sleep. In fact, sleep problems are associated with a majority of mental disorders, and poor quality or insufficient sleep can worsen the symptoms of mental illness.

How can I get a good night's sleep?

Practicing good sleep hygiene (see above), including maintenance of a regular bedtime and awakening schedule, is the best way to ensure restful and restorative sleep. Avoidance of caffeine, alcohol, nicotine, and strenuous exercise in the hours prior to bedtime can also help improve the quality of your sleep. Many people report that they lie awake at night worrying about problems or situations they will face during the coming day. In this case, it can be helpful to write a to-do list or a list of items to act upon the following day prior to bedtime, giving yourself permission to "let go" of these items during the night.

If you are concerned about the quality of your sleep or if you have the symptoms of a sleep disorder, it is important to consult your health care practitioner. He or she can help you determine the cause of your sleep problem and recommend appropriate therapy.

DR S DESHMUKH

ARE YOU SUFFERING FROM SLEEP DISORDER?

Whether you have a sleep disorder and you're looking for sleep disorder information, or you're looking to find ways to counteract your sleep disorder, this sleep disorders primer will give you relevant sleep disorders information to help you get the good night's sleep you desperately need.

Lying in bed, waiting for sleep to come can be a bit like spending the night in a slow-motion hell. The clock seems not to move, each environmental sound, from a dripping faucet to the dog snoring at the foot of the bed, seems amplified, and insignificant daytime events can take on a menacing life of their own. Welcome to sleeplessness.

Sleep disorders, from insomnia to sleep apnea to sleep deprivation due to work schedules or caring for sick family members, take an enormous toll on sufferers and society at large. The National Commission on Sleep Disorders Research estimates that 40 million Americans suffer from chronic sleep disorders and another 20 to 30 million experience sleep problems intermittently. And since sleep disorders increase with aging, those suffering from chronic sleep disorders are expected to rise to 79 million and those suffering from intermittent problems to increase to 40 million by 2010, as the U.S. population ages.

The costs of sleep-related problems are staggering. The commission estimated direct costs of sleeplessness at $15.9 billion annually and another $100 billion or more in indirect costs, such as litigation, property destruction, hospitalization and death resulting from sleep disorders and sleep deprivation.

Sleep problems can be induced by overconsumption of caffeine or alcohol, may be a side effect of medications, or can develop as secondary effects of another illness, such as arthritis, or a bladder condition, or a psychological disorder such as depression. But in a large number of cases, primary sleep disorders are the cause of sleeplessness or disrupted sleep.

Although more than 200 sleep disorders centers exist in the United States, experts estimate that 95 percent of those suffering from sleep disorders go undiagnosed, suffering needlessly from conditions that could be treated.

On the following pages, you will find descriptions of the 9 most common sleep disorders.

1: Delayed Sleep Phase Disorder

What is it? When a person's biological clock gets out of sync with accepted norms, sleep disorders arise. In delayed sleep phase insomnia, the person falls asleep and awakens later than required for normal activities such as work and school. Once the person falls asleep, however, his or her sleep is restful and uninterrupted. Awakening at an acceptable time, even with an alarm clock, is extremely difficult. Resulting symptoms include daytime sleepiness, particularly in the morning; fatigue; impaired memory and concentration; low productivity, particularly in the morning.

How common is it? Relatively rare (fewer than 2 percent of those seeking help at sleep disorder clinics are diagnosed with it). It frequently begins during childhood and is most common during adolescence. These symptoms are also seen in people suffering from depression.

What's the treatment? Two therapies are used:

·         Chronotherapy—This technique re-sets the person's biological clock by having the person stay up and awaken three hours later each day over a several-day period until their sleep and awake times are in sync with others. During that time they cannot nap, and once they've changed their schedule they must maintain it even on weekends (varying it by no more than an hour) to prevent the return of the problem.

·         Light therapy—This technique uses bright lights (as bright as sunlight) for two hours in the morning and avoids bright light for several hours before bedtime to shift the sleep-wake cycle. Special light boxes for this purpose are available through medical supply sources and are similar to those used to treat people with seasonal affective disorder.

2: Advanced Sleep Phase Disorder

What is it? This condition, in which the person's biological clock shifts to earlier hours—typically falling asleep before 9 p.m. and awakening between 3 and 5 a.m. and failing to return to sleep.

How common is it? This condition occurs most often in older people. In fact, some doctors believe it is more a normal consequence of aging than a disorder.

What's the treatment? Light therapy is effective in helping people to delay their sleep phase. The person is administered bright light (through special light boxes purchased through medical supply sources. They are similar to those used to treat seasonal affective disorder) for two hours before bedtime, which helps to delay sleep, and avoided at other times.

3: Non-24-Hour Sleep-Wake Syndrome

What is it? In this condition, the person's biological clock is 25 hours or longer, meaning that sleep and wake times are continually getting later.

How common is it? While this condition is rare, it seems to be more common in the blind than in the general population. One study showed that 75% of blind people complain of sleep problems. This may, in part, be due to the lack of light cues for waking and sleeping.

What's the treatment? Light therapy, in which the person is exposed to bright lights (as bright as sunlight) for two hours in the morning and avoids bright light for several hours before bedtime to shift the sleep-wake cycle, can be effective in patients with sight.

4: Jet Lag

What is it? Also known as time-zone change, jet lag is a disruption in sleep patterns following travel across time zones. It occurs because the traveler's internal "clock" is out of sync with the new time zone. Symptoms include difficulty falling asleep, difficulty arising, and disrupted sleep, all leading to daytime sleepiness, headache and general malaise.

How common is it? Jet lag is a common problem for travelers, and more common in those over 50 than in those under 30. Incidence varies depending on how many time zones and the direction of travel. When traveling westward, the traveler's internal clock is ahead of local time and the traveler typically tires early and awakens early. When traveling eastward, the traveler's internal clock is behind local time and the traveler typically falls asleep and awakens later than local time, and often is very sleepy during the day and particularly in the morning. These effects may be felt a day or two after travel. Frequent travelers can develop chronic jet lag symptoms.

What's the treatment? In general, traveling westward is easier than traveling eastward. A westward traveler can make up for about a 1.5-hour difference per day; an eastward traveler makes up about one hour per day. Adjusting to travel from Los Angeles to New York, for example, (a three-hour time difference) would take three days, but only two days on the return trip.

Some steps that can minimize the effects of jet lag are to adjust your sleep schedule to the new location during the days preceding your trip. Avoid alcohol and caffeine during your trip. Both can effect the quality of your sleep. Taking 5 mg. of melatonin at bedtime during the first few days following arrival may help in adjustment. Some prescription short-acting hypnotics can help relieve jet lag. Exercise and keeping well hydrated (with nonalcoholic or caffeine-free drinks) can also help in the adjustment to a new time zone. Light therapy, as used in advanced and delayed sleep disorders, may help in adjustment.

5: Shift Work

What is it? The constant changing of sleep patterns among day, evening and night shifts has been linked to gastrointestinal and cardiovascular disease, increases in alcohol and tranquilizer use, and chronic sleep disorders.

How common is it? About 20 million U.S. workers, or about 22% of the workforce, are shift workers.

What's the treatment? Studies have found several methods can be effective in dealing with the impact of shift work on sleep. Using extremely bright lights during night-shift work and having a darkened bedroom at home can help adjustment. Exercise programs can help, and melatonin taken at bedtime can also be useful.

6: Obstructive Sleep Apnea

What is it? Obstructive sleep apnea is the temporary cessation of breathing due to the blockage of the upper airways during sleep. These brief obstructions result in many sleep interruptions each hour, which dramatically affects the quality of sleep. Since these awakenings are rarely remembered, sleep apnea sufferers are unaware of the source of their symptoms: daytime drowsiness, increased irritability or depression, decreased concentration and work productivity and even an increased number of traffic accidents. In fact, the excessive daytime drowsiness often is mistaken for narcolepsy. Loud, consistent snoring is a hallmark of obstructive sleep apnea.

How common is it? Sleep apnea is suffered by about 4% of men and about 2% of women.

What's the treatment? Overweight sufferers of obstructive sleep apnea benefit from weight loss. Avoidance of alcohol, narcotics and sedatives, which increase OSA incidence. Some patients respond to bedtime doses of protriptyline, a tricyclic antidepressant, and several other prescription medications. For most, however, other measures are needed. These include:

·         Position alarms, which sound if the person remains on his back (the position in which most apnea incidents occur) for more than 15 seconds. These and sewing tennis balls into the back of sleep shirts to prevent sleeping on the back are used.

·         Dental appliances that shift the jaw forward, expanding the airway.

·         Surgery to repair upper airway (tonsillectomy, adenoidectomy, or a resectioning of the uvula and soft palate).

·         Nasal Continuous Positive Airway Pressure (CPAP), a device that delivers a stream of air through a mask worn over the nose during sleep.

7: Narcolepsy

What is it? Narcolepsy is characterized by extreme, overwhelming sleepiness during the day. It is caused by a dysfunction of the brain mechanisms controlling sleep and waking. The person may suddenly fall asleep in midsentence, while at work, or behind the wheel of a car. Other symptoms of narcolepsy include the sudden loss of muscle tone while awake when surprised or upset (which can be severe enough to cause a collapse), and vivid hallucinations as the person is falling asleep, and sleep paralysis, a condition in which the body's normal paralysis of large muscles during REM sleep fails to end upon waking. Narcolepsy appears to run in families.

How common is it? Narcolepsy is rare, occurring in about 100,000 Americans. It may start in childhood but typically peaks in young adulthood.

What's the treatment? The symptoms of narcolepsy can be found in several other conditions, including obstructive sleep apnea, so accurate diagnosis is critical. Researchers now believe that narcolepsy is caused by the lack of receptors for the neurotransmitter hypocretin, which regulates the sleeping and waking states. Modafinil, which promotes alertness, has been shown to be effective in the treatment of narcolepsy. Behavioral changes that can help include avoiding caffeine nicotine and alcohol in the late afternoon or evening, regular exercise at least three hours before bedtime, and scheduling several short naps or one longer nap (20 to 40 minutes) each day.

8: Restless Leg Syndrome (RLS)

What is it? Restless Leg Syndrome is characterized by aching, itching, tingling and burning in the lower legs as the sufferer is falling asleep and typically requires him or her to get up and walk around for relief. The aching may also be accompanied by periodic limb movements that may continue for minutes or hours. It typically develops in middle age and appears to run in families. (Goetz: Textbook of Clinical Neurology, 1114)

How common is it? RLS occurs in about 2 to 5 percent of adults.

What's the treatment? Restless leg syndrome responds to levodopa, a drug also used to treat Parkinson's disease, and several other medications. Symptoms may be reduced by avoiding or reducing caffeine and alcohol and establishing a regular exercise program.

9: Sleepwalking

What is it? Sleepwalking, which is most common in children, occurs during stage 3 and stage 4 sleep, the deepest levels, and is thought to be caused by a partial arousal from deep sleep. While the child's brainwaves are those of deep sleep, the sleepwalker moves as though awake. The episodes are typically brief—less than ten minutes—and usually occur during the first three hours of sleep. The sleepwalker usually has no recollection of the event in the morning.

How common is it? Sleepwalking occurs in more than 10% of children. Most children outgrow it. It appears to run in families. Sleepwalking episodes may be triggered by fever or some medications. Unpredictable sleep schedules, sleep deprivation and stress may also contribute to sleepwalking episodes.

What's the treatment? The child's safety during these episodes is of primary concern. Parents should ensure that doors and windows are locked and that no objects are left out that could cause falls or other injuries. When a child is sleepwalking, gently guide the child back into bed. Don't try to awaken him.

Hypnosis can be an effective treatment. Medications such as benzodiazepine or tricyclic antidepressants at bedtime can also be effective, but rebound episodes often occur when the medication is stopped.

DR S DESHMUKH

MD SLEEP SPECIALIST

PUNE