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Sleep Disturbance

November 18th, 2010

Patients often present to ENT clinics with sleep disturbance. Their symptoms can include insomnia, interrupted sleep, interrupted sleep of the sleeping partner, poor energy levels and daytime sleepiness.

The stages of sleep
Sleep is divided into five stages. The first four are associated with deepening sleep, decreased muscle activity and slowed breathing and pulse rate. The fifth stage is reached when rapid eye movement occurs. It is in this stage that dreaming occurs. The fourth stage is the deepest form of sleep during which the patient is the least arousable. It is associated with delta waves on the electroencephalogram.

How many people are affected?
Sleep disorder, in its various forms, is very common. A third of adults report sleep disorder at some point in their lives. 20-40% of adults report sleep disorder at some time in the year. 17% rate their sleep disorder as serious. 20% of adults complain of chronic insomnia.

Sleep disorder is more common in women with a female:male ratio of 3:2. Men are more likely to have obstructive sleep apnoea (OSA). 4% of men have OSA compared with 2.5% in women.

Sleep disturbance gets worse with age. In the 30 to 50 year old age group, 5% suffer. Over 50 years this rises to 30%. The elderly experience decrease sleeping periods, awake more often in the night and are more likely to take medications which disrupt sleep.

The causes of sleep disturbance can be split into medical, psychological and environmental problems.

Medical problems
These are myriad and include heart failure, neurological conditions, thyroid problems and other disorders of the hormone system, acid reflux from the stomach, stimulants (caffeine and alcohol), certain medications and upper airway obstruction.

Psychological problems
These include depression, post-traumatic stress, anxiety, thought disorder and psychiatric medication.

Environmental problems
Life-threatening events, shift-working, jet lag, changes in altitude, hot sleeping environment, environmental noise (e.g. snoring form the sleeping partner) or frequent external disturbance.

Given the number of serious medical conditions that can cause sleep disturbance, patients should always consult their primary care doctor.

Simple life-style changes may also help. Dietary modifications are not generally required but avoiding big meals and spicy foods 3 hours before bedtime helps.

Stimulants and substances that disturb sleep architecture should be avoided. These include caffeine, alcohol and nicotine. Nicotine and caffeine should be avoided from late afternoon onwards.

Strenuous exercise is good during the day but should be avoided in the 3 hours before sleep. Psychologically stimulating activities should also be avoided including tense films, engrossing novels, thrilling TV and arguments.

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