sleep disorders
brain, spinal cord, and nerve disorders
Insomnia and Excessive Daytime Sleepiness (EDS)
Usually, the cause of insomnia can be identified based on the person's description of the current problem and results of a physical examination. Many people have obvious problems, such as poor sleep habits, stress, or coping with shift work. Certain symptoms are cause for concern: Falling asleep while driving or during other potentially dangerous situations Frequently falling asleep without warning Stopping breathing during sleep or waking up with gasping or choking (reported by a bed partner) Moving violently or injuring self or others during sleep Sleepwalking A heart or lung disorder that is constantly changing (is unstable) Attacks of muscle weakness ( Cataplexy attacks) A recent stroke People should see a doctor soon if they have warning signs or if their sleep-related symptoms interfere with their daily activities. If healthy people have sleep-related symptoms for a short time (less than 1 or 2 weeks) but do not have warning signs, they can try Sleep hygiene that can help improve sleep. If these changes do not help after a week or so, people should see a doctor. The doctor asks people about the following: Their sleep patterns Habits around bedtime Use of drugs (including recreational drugs) Use of other substances (such as alcohol,caffeine, and tobacco) Degree of stress Medical history (including disorders that can interfere with sleep) Level of physical activity Disorders that interfere with sleep include Chronic Obstructive Pulmonary Disease (COPD) , People may be asked to keep a sleep log. In it, they record a detailed description of their sleep habits, with sleep and wake times (including awakening during the night), use of naps, and any problems with sleeping. When considering the diagnosis of insomnia, the doctor considers that some people need less sleep than others. If people have excessive daytime sleepiness, the doctor may ask them to fill out a questionnaire indicating how likely they are to fall asleep in various situations. The doctor may ask their sleep partner to describe any abnormalities that occur during sleep, such as snoring and pauses in breathing. A physical examination is done to check for disorders that can cause insomnia or excessive daytime sleepiness, particularly obstructive sleep apnea. Tests are not needed if symptoms suggest a cause such as poor sleep habits, stress, shift work disorder, or restless leg syndrome (an irresistible urge to move the legs or arms just before or during sleep). Doctors sometimes refer people to a sleep disorders specialist for evaluation in a sleep laboratory. Reasons for such a referral include An uncertain diagnosis Suspicion of certain disorders (such as Sleep Apnea , a Insomnia or excessive daytime sleepiness persisting despite basic measures to correct it (changing behavior to improve sleep and taking sleep aids for a short time) Presence of warning signs or other symptoms such as nightmares and twitching of the legs or arms during sleep Dependence on sleep aids The evaluation consists of polysomnography and observation (and sometimes video recording) of unusual movements during an entire night's sleep. Other tests are sometimes also done. is usually done overnight in a sleep laboratory, which may be located in a hospital, clinic, hotel room, or other facility that is equipped with a bed, bathroom, and monitoring equipment. Electrodes are pasted to the scalp and face to record the brain's electrical activity ( Electroencephalography , or EEG) as well as eye movements. Applying these electrodes is painless. The recordings help provide doctors with information about sleep stages. Electrodes are also attached to other areas of the body to record heart rate ( Amultiple sleep latency testis done to distinguish between physical fatigue and excessive daytime sleepiness and to check for narcolepsy. People spend the day in a sleep laboratory. They are given the opportunity to take five naps at 2-hour intervals. They lie in a darkened room and are asked to take a nap. Polysomnography is used as part of this test to assess how quickly people fall asleep. It detects when people fall asleep and is used to monitor the stages of sleep during the naps. Themaintenance of wakefulness testis used to determine how well people can remain awake while sitting in a quiet room. This test helps determine how severe daytime sleepiness is and whether people can safely do their usual daily activities (such as driving a car). Tests to evaluate the heart, lungs, and livermay be done in people with excessive daytime sleepiness if symptoms or results from the physical examination suggest that another disorder is the cause. 