WHAT I TREAT
I see the full range of sleep disorders from Insomnia to the rarer Kleine-Levin syndrome. In all of them, a careful diagnosis needs to be made, as sleep problems often co-exist with other medical, and/or mental health conditions. Sleep disorders can be chronic, severely disabling, and potentially shorten a person's lifespan. Most sleep disorders can be treated effectively. Here are some of the most common ones.
INSOMNIA
This is the most common sleep disorder: when one struggles to fall or stay asleep. It typically comes with anxiety around sleep and makes bedtime and the night a dreaded event. Often, it impairs daytime functioning. It can be associated with a number of physical and/or mental health problems. Short-term sleeping problems are very common and usually resolve spontaneously. If insomnia persists for more than 3 months, medical advice is recommended.
OBSTRUCTIVE SLEEP APNOEA, OTHER
SLEEP-RELATED BREATHING DISORDERS
While snoring is a nuisance for the bed-partner, if there are also pauses in breathing during sleep and tiredness during the day, it may point to Obstructive Sleep Apnoea (OSA). Additional warning signs for OSA are morning headaches, heartburn/indigestion, weight gain, high blood pressure, heart rhythm abnormalities, or diabetes. OSA is more common in people who are overweight. It can cause severe health problems and increase the risk of heart attacks and stroke. If you experience some of the above, a sleep test for OSA could be helpful.
CIRCADIAN RHYTHM SLEEP-WAKE DISORDERS
Having a morning, or evening preference as lark, or night owl, is normal. But when the timing of sleep is far out of synch with more usual sleep times, it can cause severe disruptions of sleep and difficulties adhering to personal or professional commitments. In some people, their internal body clock runs much slower than 24 hours and they find themselves periodically in and out of synch with the usual night-day sleep-wake rhythm. A strict sleep-wake schedule supported by bright light and melatonin can help get back into a more normal sleep-wake pattern. Melatonin is a hormone and must not be mistaken for a sleeping pill.
NARCOLEPSY AND EXCESSIVE SLEEPINESS
Excessive Sleepiness can also be its own disorder, such as narcolepsy, or idiopathic hypersomnia. Narcolepsy can also cause recurrent sleep paralysis, cataplexy (sudden loss of muscle tone, often triggered by emotions, e.g., laughing from a joke), and dream intrusions into wakefulness. These conditions persist life-long and require treatment with stimulant medications. Again, a careful diagnosis is needed to make sure appropriate treatment is given.
RESTLEG LEGS SYNDROME AND SLEEP-RELATED MOVEMENT DISORDERS
Restless Legs can be distressing. During sleep, periodic limb movements can persist and result in poor sleep quality, causing daytime tiredness despite what may appear as sufficient sleep. In sleepers without bed partners, crumpled up sheets can be the only indication of this condition, hence it is also known as the "silent sleep thief". These conditions are more common with iron deficiency but can also be associated with neuropathy, diabetes or pinched nerves in the back. Various forms of sleep myoclonus can also cause "jumps and jerks" in sleep. Some forms of epilepsy may only cause brief movements in sleep and can be mistaken for a parasomnia, or a sleep-related movement disorder, however, the distinction is important as treatment differs and nocturnal seizures can be dangerous.
PARASOMNIAS
Sleep talking, sleep walking, night terrors, nightmares, sleep eating, sexsomnia and confusional arousals are common sleep disorders in Non-REM, deep sleep. Medically, these conditions are harmless, but they can cause severe disruption of sleep and can be associated with behaviours that are potentially dangerous to the sleepers and their bed partners. REM-Sleep Behaviour Disorder is a parasomnia that arises from REM sleep and manifests as enacting dreams, sometimes with violent movements, again, potentially injuring sleepers or their bed partners. This condition is associated with a significantly increased risk of developing Parkinson's Disease, or forms of dementia later in life.