Sleep disorders go beyond insomnia

Accord­ing to sleep experts, one in four adults are walk­ing around like zom­bies feel­ing like death warmed up as a result of dis­rupt­ed sleep.

Sleep dis­or­ders range in sever­i­ty from snor­ing and insom­nia to rest­less leg syn­drome and obstruc­tive sleep apnoea, and are far more com­mon than peo­ple think.

Some 40 per cent of the UK adult pop­u­la­tion snore and around 30 per cent suf­fer from insom­nia, either find­ing it hard to fall asleep and stay asleep or wak­ing up too ear­ly still feel­ing tired. There are no spe­cif­ic trig­gers for insom­nia, but trau­mat­ic events, injury, loss of a loved one or dif­fi­cul­ties at work can all con­tribute.

As we get old­er, the risk of insom­nia increas­es and 50 per cent of peo­ple over 65 will suf­fer from it at some time, accord­ing to pri­vate health­care providers Bupa. More women suf­fer from insom­nia than men.

A crammed lifestyle can make it a strug­gle to strike an effec­tive work-life bal­ance and this caus­es many of us to go short of pre­cious sleep­ing time. Yet this trend could be a health time bomb.

Sci­en­tists believe that, if we sleep less than six hours a night and have dis­turbed sleep, we stand a 48 per cent greater chance of dying from heart dis­ease and a 15 per cent greater chance of devel­op­ing or dying from a stroke. So our work-hard, play-hard soci­ety encour­ages us to sac­ri­fice sleep to the detri­ment of our health.

The num­bers are wor­ry­ing. More than 3.5 mil­lion of us suf­fer from exces­sive sleepi­ness, usu­al­ly caused by poor sleep, which most peo­ple blame on the pres­sures of a 24/7 soci­ety. Occa­sion­al nights of dis­rupt­ed sleep won’t harm our health, but the cor­ro­sive men­tal impact increas­es as it becomes a trend.

Dif­fi­cul­ty con­cen­trat­ing and poor deci­sion-mak­ing, described as brain fog by some, fol­low and some peo­ple can nod off dur­ing the day risk­ing injury at work, on the road or in the home.

Con­verse­ly, too much sleep – hyper­som­nia – can also derail health. Over­sleep­ing can result in extreme sleepi­ness through the day, which caus­es anx­i­ety, reduced ener­gy and mem­o­ry issues. Stud­ies in the Unit­ed States indi­cate that peo­ple sleep­ing more than nine hours a night are 50 per cent more like­ly to get dia­betes than those sleep­ing sev­en hours a night, giv­ing it a sim­i­lar risk pro­file as under­sleep­ing.

Some peo­ple just love sleep­ing, but for oth­ers it could be a sign of under­ly­ing health prob­lems caused by poor diet and lifestyle. The Men­tal Health Foun­da­tion says over­sleep­ing occurs in up to 40 per cent of those with depres­sion.

Occa­sion­al nights of dis­rupt­ed sleep won’t harm our health, but the cor­ro­sive men­tal impact increas­es as it becomes a trend

Sleep dis­or­ders are a major con­tribut­ing fac­tor to fatal road acci­dents, heart dis­ease, strokes, absen­teeism, lost pro­duc­tiv­i­ty and the break­down of mar­riages, so their impact should not be under­es­ti­mat­ed.

Most peo­ple elect to sol­dier on, but there is help. GPs can chart a “sleep his­to­ry” to detect behav­iour pat­terns that can be changed to encour­age bet­ter regimes. Sleep­ing tablets are some­times pre­scribed in the short term, but GPs most­ly believe this does not treat the cause. Chron­ic insom­nia suf­fer­ers – prob­lems last­ing more than a month – may be treat­ed with cog­ni­tive behav­iour­al ther­a­py to break the sleep­less cycle.

Alter­na­tive ther­a­pies, such as acupunc­ture, have been shown in clin­i­cal tri­als to improve sleep qual­i­ty and sev­er­al stud­ies have shown that reg­u­lar med­i­ta­tion, either alone or as part of a yoga ses­sion, for exam­ple, results in high­er blood lev­els of mela­tonin, which is an impor­tant reg­u­la­tor of sleep.

Self-help steps, such as abstain­ing from caf­feine and alco­hol six hours before bed­time, men­tal­ly switch­ing off from work and cre­at­ing a calm­ing envi­ron­ment can help recal­i­brate sleep pat­terns.

But there are more seri­ous sleep dis­or­ders includ­ing rest­less leg ayn­drome (RLS) and sleep­walk­ing. RLS, which can be trig­gered by anaemia or iron defi­cien­cy, can cause mis­ery with severe­ly dis­rupt­ed sleep, while sleep­walk­ing car­ries the risk of injuries. Sleep­walk­ing nor­mal­ly involves episodes that last some ten min­utes, but extreme cas­es have involved peo­ple leav­ing their hous­es and dri­ving cars.

By far the most seri­ous con­di­tion is obstruc­tive sleep apnoea (OSA) which, if left untreat­ed, can be life threat­en­ing. OSA occurs when some loca­tions in the upper air­way, from nose to wind­pipe, become blocked. This may be due to large ton­sils, the mus­cles of the soft palate at the base of the tongue and the uvu­la (the small fleshy piece of tis­sue hang­ing at the back of the throat) relax­ing or the tongue flop­ping back­wards. Poten­tial obstruc­tions become more fre­quent with age.

OSA is usu­al­ly seen in loud snor­ers who, while asleep, may stop breath­ing for between ten and twen­ty five sec­onds at a time, depriv­ing the blood­stream and brain of vital oxy­gen. The brain responds by send­ing a sig­nal to the snor­er to wake up and peo­ple with OSA often come round strug­gling to breathe and gasp­ing for air. Severe suf­fer­ers may expe­ri­ence 30 or more such events every hour.

“Hav­ing OSA is like being reg­u­lar­ly stran­gled dur­ing sleep,” says Pro­fes­sor Ram Dhillon, of North­wick Park Hos­pi­tal, Lon­don, an ear, nose and throat expert with a spe­cial inter­est in snor­ing and sleep apnoea. “The sufferer’s body goes into fight or flight mode pump­ing out adren­a­line into the blood stream, rais­ing the heart rate and increas­ing the risk of heart attack, irreg­u­lar heart­beat and hyper­ten­sion.

“Many patients with hyper­ten­sion are treat­ed with beta block­ers when the root of the prob­lem may be their sleep pat­tern and they prob­a­bly don’t need to be on expen­sive drugs.”

A recent Dutch study in the Euro­pean Jour­nal of Pre­ven­ta­tive Car­di­ol­o­gy showed that good qual­i­ty sleep could reduce 57 per cent of heart-relat­ed deaths each year. It looked at the risk of chron­ic dis­ease in 14,000 peo­ple over a 12-year peri­od and showed that poor sleep is as impor­tant a risk fac­tor for car­dio­vas­cu­lar dis­ease as oth­er lifestyle fac­tors, such as being over­weight or smok­ing.

Around 90 per cent of patients seen at London’s Roy­al Bromp­ton Cen­tre for Sleep suf­fer from OSA, which is on the increase as the pop­u­la­tion gets heav­ier and less active. Untreat­ed cas­es of OSA are cost­ing the NHS £432 mil­lion a year, accord­ing to the Sleep Alliance.

The pres­ence of long-term OSA is detri­men­tal to the brain as well as the heart, research at Impe­r­i­al Col­lege Lon­don is begin­ning to show. “Frag­ment­ed sleep plus low oxy­gen lev­els at night caused by OSA can poten­tial­ly accel­er­ate mem­o­ry loss,” says Pro­fes­sor Mary Mor­rell, a sleep and res­pi­ra­to­ry phys­i­ol­o­gy expert at Impe­r­i­al Col­lege Lon­don, who is work­ing on a study into sleep depri­va­tion and cog­ni­tive decline in old­er patients.

But Dr Math­ew Hind at the Roy­al Bromp­ton empha­sis­es that sleep dis­or­ders can be treat­ed. “They can have a seri­ous effect on people’s lives as they become accus­tomed to feel­ing unre­freshed when they wake up and gen­er­al­ly sleepy dur­ing the day,” he says. “Yet once treat­ed, peo­ple improve dra­mat­i­cal­ly.”

SNORING

SNORT, RATTLE ‘N’ ROLL

Around 3.5 mil­lion peo­ple in the UK suf­fer fre­quent nights of dis­turbed sleep due to snor­ing.

Far from a joke, snor­ing can affect many aspects of life if left untreat­ed. It can cause exces­sive tired­ness and poor con­cen­tra­tion as well as rela­tion­ship prob­lems.

Snor­ing occurs because of the vibra­tion gen­er­at­ed as air rush­es past the tis­sues of the mouth, nose and throat.

Most peo­ple pic­ture snor­ers as over­weight, beer-drink­ing males. Yet snor­ing is not con­fined to men. Old­er women and chil­dren also snore. In fact, after the menopause women catch up with their male coun­ter­parts in the snor­ing stakes.

Snor­ing can be caused by a num­ber of fac­tors. Being over­weight often means you have extra fat around the throat, which can stop air flow­ing smooth­ly dur­ing breath­ing. Sleep­ing on the back also caus­es the tongue to fall back into the throat nar­row­ing the air­way.

Colds and aller­gies can trig­ger snor­ing as suf­fers end up breath­ing through the mouth. Drink­ing too much alco­hol or tak­ing sleep­ing tablets can cause the throat mus­cles to relax and cre­ate block­ages.

Peo­ple with res­pi­ra­to­ry dis­or­ders, such as asth­ma and chron­ic obstruc­tive pul­monary dis­or­der are also more prone.

Lifestyle changes, such as los­ing weight, can some­times improve the prob­lem. There are also a range of anti-snor­ing devices, such as mouth guards and nasal strips.