What is Narcolepsy? image via ThisYearsLove on Flickr

Most people know that narcolepsy is a sleep disorder that causes people to fall asleep at unusual times.  Although this condition is generally used for the comedic value with someone suddenly falling asleep while eating and winding up with their face in a bowl of soup, for those people with the condition, it is no laughing matter.  According to the American Sleep Association, as many as 200,000 Americans may have narcolepsy, although only about a quarter have been diagnosed.  Diagnosis rates are so low because the symptoms do not always present in such a way that people seek medical treatment.

What is Narcolepsy?

Narcolepsy is a neurological disorder that affects regulation of the sleep-wake cycle causing excessive sleepiness, frequent sleep attacks, cataplexy, hypnagogic hallucinations, and sleep paralysis.  Also categorized as a sleep disorder, narcolepsy can make it difficult to function because the sudden onset of sleep attacks can make everyday activities like working or driving dangerous.

Narcolepsy affects the brain’s ability to control the timing of sleep.  Those with the condition do not experience the same predictable sleep patterns as others.  People with narcolepsy jump directly to REM sleep when they fall asleep and they can experience short periods of involuntary REM sleep during waking hours.  These episodes are referred to as sleep attacks and are responsible for the perception that people with narcolepsy fall asleep while eating their soup.

What Causes Narcolepsy?

To date, no definitive cause of narcolepsy has been identified.  Research is being conducted by various groups including the National Institute of Neurological Disorders and Stroke into several possible contributing factors.   As some people with narcolepsy have lower than normal amounts of a protein called hypocretin, researchers are looking into what causes the deficiency and how it relates to the disorder.  Researchers are also looking at the possibility that narcolepsy is an autoimmune disease.  Narcolepsy also tends to run in families and genetic research may provide additional information into cause and options for treatment.

What are the Symptoms of Narcolepsy?

Although symptoms generally appear in adolescence, many people with the disorder won’t be diagnosed or treated for 10-15 years after the onset of symptoms.  There are four primary symptoms:

1. Excessive Daytime Sleepiness (EDS) – For many people with the disorder, EDS is the first symptom they experience.   EDS is responsible for the sleep attacks associated with this condition and causes people to involuntarily fall asleep at inappropriate times.  The excessive sleepiness is pervasive and has no relationship to the amount of sleep the person got the night before.
2. Cataplexy – This is the sudden and unexplained loss of muscle tone that some people with narcolepsy experience.  Although they are conscious throughout the attack, they generally cannot speak and may lose the use of their arms and/or legs.
3. Hypnogogic Hallucinations – People with narcolepsy may experience unusual and often frightening dreams during the sleep-wake or wake-sleep transition that take place in their current environment.
4. Sleep Paralysis – This symptom presents as a temporary inability to move or speak during the sleep-wake or wake-sleep transition.  It can last for seconds or minutes and may also accompany hypnogogic hallucinations.

How is it Diagnosed?

Narcolepsy is diagnosed through a series of tests including a physical exam, blood work, an ECG, an EKG, a polysomnogram, and a multiple sleep latency test.

How is it Treated?

There is no cure for narcolepsy but most people with the disorder can live near-normal lives with the use of medication and behavioral therapy.  Often treatment for narcolepsy includes scheduled naps throughout the day and maintaining a regular sleep, exercise, and meal schedule.

Related Articles:

• Strange Sleep Disorders (valleysleepcenter.com)
• Are You Suffering From A Sleep Disorder or Depression? (valleysleepcenter.com)
• 7 Tips to a Good Night’s Sleep (valleysleepcenter.com)

How much sleep do you need? image via by IllogicalJake on Flickr

Sleep is one of the pillars of good health.  It is as important to your wellbeing as the air you breathe and the food you eat.  Like water, sleep is something we cannot survive without for an extended period of time.  Studies have established the link between sleep and a variety of diseases including diabetes, cardiovascular disease, congestive heart failure and obesity.  It has never been more apparent that sleep is essential to living a healthy lifestyle.

And yet, many of us continue to act as if sleep is a luxury that we can’t afford.  We skip sleep to catch up on work without realizing we are decreasing our productivity the next day just by being overtired.  When we do sleep, we don’t sleep enough leading to a cumulative sleep deficit that results in significant deficits in cognition, memory, attention, and complex decision making according to research compiled by the National Institutes of Health.   We are compromising our long term health and short term productivity to make a few short term gains.

The NIH report also concluded that one of the biggest challenges we face in the area of sleep medicine is not funding for research or new avenues to pursue but rather the education of the general public as to the seriousness of the problem.   Until the prevailing attitude that adequate sleep isn’t a requirement changes, people will continue to sacrifice sleep to get more done and idolize those who seem to thrive and succeed on a few hours sleep a night.

The best way to change minds and adjust attitudes is with education, so let’s test your sleep IQ and see if you know as much as you think you do about sleep.  Answer True or False to the following statements:

1. On average, adults need 5-8 hours of sleep a night depending on how active they are during the day.
2. The environment most conducive to sleep is a comfortable bed in a room that is dark, quiet, and cool.
3. If you need to stay up 4 extra hours and finish a project tonight, you can make up that time on the weekend by sleeping in for the same number of hours.
4. Having a glass of wine at bedtime can help you fall asleep faster and get a good night’s sleep.
5. Taking a nap can improve productivity and alertness without negatively impacting sleep later that night.

1. False.  The NSF recommends that on average adults need between 7 and 9 hours of sleep each night.
2. True.  Creating the right sleep environment can be the key to a good night sleep according to the NSF.
3. False.  Sleep debt accumulates over time and can be very difficult to “pay back”. The NSF says that keeping a regular sleep schedule during the week and on weekends can help maintain good sleep hygiene.
4. False.  The NSF recommends avoiding alcohol in the hours before bedtime in order to get a good night sleep.  Although alcohol can make you drowsy, it can impact the quality of your sleep all night long.
5. True.  The NSF states that napping can help with alertness and productivity.

Want to know more?  Take these other fun sleep quizzes.

• National Geographic’s Need More Sleep? Quiz
• National Institute of Health’s Interactive Sleep Quiz
• Dr. Oz’s Sleep Quiz
• Discovery’s Body Works Sleep Challenge
• AAA Drowsy Driving Prevention Sleep Quiz

Related Articles:

• Health Effects of Over-Sleeping (valleysleepcenter.com)
• Depression Drug May Hold the Key to Helping Cure Insomnia (valleysleepcenter.com)
• Break Those Bad Bedtime Habits (valleysleepcenter.com)

How can a CPAP Machine help you? Image via Flickr.

While most people associate the Continuous Positive Airway Pressure or CPAP machine with Sleep Apnea, it is also used to treat other conditions.  Because the machine helps keep airways open with a constant flow of air, it is also used to help people with respiratory difficulties and for those in the hospital who need assistance with oxygen and carbon dioxide exchange.

How it Works

The CPAP machine delivers a constant stream of air into a mask or nasal pillow that provides enough air pressure to keep airways open during sleep.  Although it appears that the constant flow of air keeps the airway open, it is actually the air pressure created by the air input in combination with the sealed mask that produces this result.  CPAP machines can be used with a variety of delivery mechanisms including a nasal pillow, nose mask, or full face mask.  Regardless of which kind of mask is used, the most important consideration is that the mask can be sealed to the face in order to create and maintain the required air pressure.

The amount of pressure needed to achieve the desired result is determined on an individual basis.  If the CPAP is being used to treat sleep apnea, the required pressure is determined during a sleep study and usually ranges from 4 to 14 cmH2O (centimeters of water, used to measure air pressure). Higher pressures are commonly used, though the device mode will often be switched to BiLevel PAP in order make it more comfortable to breathe.

Conditions it is Used to Treat

Although most commonly connected to the treatment of sleep apnea, CPAP is also used to treat the following conditions:

• Congestive heart failure
• Respiratory failure
• Ventilation needed for neuromuscular conditions
• Hypoxia
• COPD
• Assisting with breathing in the neo-natal intensive care unit

Common Problems Using the Machine

The primary issue people have when using a CPAP machine at home is discomfort experienced when wearing the mask.  Some people find it too constricting and others find the sensation of exhaling against the air pressure difficult or unpleasant.

People who are prone to anxiety or claustrophobia may have more trouble acclimating to the use of a CPAP machine than others.  However, this can often be alleviated with desensitization.  The best first option is to come in during the day and try CPAP, apart from a sleep study. Using CPAP without the wires required during a sleep study and on a lower pressure than prescribed for sleep, while also getting to see the different types of masks and try out different pressure settings, will greatly assist in easing anxieties.

Other complications that increase the likelihood of noncompliance include nasal congestion, runny nose, sinus infections, bronchitis, and dry eyes or nasal passages.   It is important to note, however, that according to the National Sleep Foundation, these complications are generally temporary and will disappear as the person acclimates to the use of the machine.   Serious side effects of CPAP usage are rarely noted and therefore not a contributing factor to people choosing not to use the machine.

Keys to Compliance

The fit of the mask is one of the most important factors in achieving compliance.  There are many different masks available that come in a variety of shapes and sizes and some are specifically designed to maximize comfort.  Finding the right mask improves the likelihood that the machine will be used consistently.  Cognitive behavioral therapy at the start of CPAP treatment may also aid in compliance especially for those suffering from anxiety over using the machine.

Do you know which foods will help you fall and stay asleep all night? Image via Flckr.

If you are one of the millions of Americans having trouble sleeping tonight, the remedy might be just down the hall, hidden behind the pantry door.  In the battle against insomnia, there are do’s and don’ts.  Most of the time when food shows up on a list of tips to help improve your sleep, it is on the don’t list.  Don’t eat anything spicy.  Don’t drink alcohol.  Don’t drink caffeine.  Don’t eat a heavy meal right before bed.   But there are also ways that food can show up on your list of things to do.  Here are 7 things you can do tonight to improve your chance of falling asleep and staying asleep all night long.

1.     Tryptophan isn’t just in turkey.

Don’t feel up to making Thanksgiving dinner once a week so you can snack on turkey to help you sleep?  Don’t worry!  While turkey does contain tryptophan, there are several other foods that do too.  This list includes chicken, dairy products, oatmeal, and even eggs.  Eating any of these as a snack can help you find the sleep you seek.

2.     Think small.

While it isn’t a good idea to eat a big heavy meal right before bedtime, it is generally a good idea to have a small, healthy snack about 45 minutes before you hit the sack.  The National Sleep Foundation recommends choosing a snack that contains both carbs and protein for the best result.

3.     Snack for better sleep.

People who are trying to lose weight are frequently told not to eat after a certain time.  But this can actually make it harder to lose weight because going to bed hungry can keep you from getting the sleep you need which makes weight loss much harder.  Plan a healthy snack before bed to keep your tummy from rumbling until morning.

4.     Drink tea.

Tea, especially blends formulated to promote relaxation, can help you get to sleep by signaling the brain that it is time to wind down.  Try chamomile or lemon balm which are both known to promote sleep.

5.     Eat fruit.

But not just any fruit.  Tart cherries are a natural source of melatonin, the hormone that tells your body it is time for bed.   You can eat them whole or have a small glass of juice.

6.     Better nights with B6.

Research indicates that vitamin B6 deficiencies can inhibit the natural production of melatonin which may contribute to sleepless nights.  Boost your B6 by eating fish, bananas, and hummus, which are all great sources this vitamin.

7.     Calm yourself with calcium.

According to EatingWell.com, initial research indicates that calcium deficiency may contribute to problems with sleep.  Give yourself twice the chance of getting a good night’s sleep by snacking on a dairy product that increases your calcium and provides tryptophan.

There is no question that decisions we make throughout each day impact the quality and quantity of sleep we get each night.  Understanding the link between food and sleep can help ensure you get the sleep you need while also keeping you from unknowingly sabotaging yourself.  If you find yourself tossing and turning tonight, reaching for the right snack can help get you drifting back to dreamland.

In a recent segment on ABC News, Diane Sawyer spoke about the insomnia epidemic affecting American women.   Today’s women are struggling to juggle the multiple demands on their time from jobs to families to finances and it is keeping them up at night.  Lack of sleep contributes to several health problems and makes this juggling act even harder to manage.

Polling performed by the National Sleep Foundation found that 63% of women experience insomnia a few nights a week.  According to the segment, almost 30% of women use sleeping pills to get the sleep they need a couple nights a week.  But those in the sleep field are finding there may be more effective ways to treat and even cure long term insomnia.

The problem with sleep aids, according to the ABC segment, is that they don’t result in lasting change.  Women may get the sleep they need when they take a sleeping pill, but that won’t make it easier to sleep on the nights that they don’t.  This can lead to dependency issues over the long term and doesn’t offer a way out of insomnia.  However, using cognitive behavior therapy to rewire the brain can effectively reset our internal sleep instinct.

In the segment, Diane Sawyer offered three tips for women who are struggling with insomnia and are looking for alternatives to sleep aids.

1.   Tame Anxiety

If worries are keeping you up at night and aiding in your insomnia, take a minute before bed to write down things you need to remember or journal about what is making you anxious.  Sometimes just getting troubling thoughts out of your head can help you fall asleep.  The National Sleep Foundation also recommends relaxation techniques like yoga, meditation, or guided relaxation to help quiet a tumultuous mind.

2.   Restrict Sleep

While it might seem counterintuitive to restrict sleep in order to fix problems with insomnia, sleep restriction can be an effective way to modify sleep limiting behavior patterns.  As outlined by the Stanford Center for Sleep Sciences and Medicine, sleep restriction involves limiting the amount of time spent in bed to help improve overall sleep quality.  The process starts by limiting the time spent in bed to the average number of hours the person is sleeping per night.  If you go to bed at 10 and wake up at 6 but only sleep for about 6 hours, sleep restriction would change your time in bed to 12 to 6 AM.  Over time, as the quality of sleep improves, time spent in bed in increases in 15 or 30 minute intervals until you are getting the sleep you need.

3.   Use Your Bedroom Appropriately

If you are struggling with insomnia and getting to sleep at night, it is a good idea to take a step back and look at what is going on in your bedroom.  If you are doing anything other than sleeping or having sex, you need to eliminate those other activities.  Doing things like working, watching TV, or exercising in the bedroom can send mixed signals to your brain about what is supposed to be happening when you go to bed.  By limiting bedroom activities to sleep and sex, you are creating space for sleep both in your home and in your head.

No matter what is keeping you up at night, if you are experiencing long term problems with insomnia or if lack of sleep is impacting your life, you should talk to your doctor and make sure you are not suffering from a sleep disorder.

About Valley Sleep Center:

Since 2002, Valley Sleep Center, accredited by the American Academy of Sleep Medicine, has provided Arizona with diagnostic sleep disorder testing in a home-like atmosphere, ensuring a comfortable, relaxing experience for patients.  Their Board Certified Sleep Medicine Specialists consist of experienced and knowledgeable physicians who provide expert advice across a multitude of sleep related disorders including insomnia, sleep apnea, snoring, excessive daytime sleepiness, hypertension, sleepwalking, and pediatric sleep problems.  They accept most insurance plans as well as Medicare.  For more information contact Lauri Leadley at 480-830-3900; http://www.valleysleepcenter.com.

Do you know what happens during a sleep study? Read more to find out!

If your doctor has requested that you participate in a sleep study, you may be wondering what exactly you are signing up for.  This test, which most commonly refers to a polysomnogram, is a painless way for your doctor to see what it happening while you sleep.  It is an important tool for diagnosing sleep disorders and can also used to gauge the effectiveness of sleep disorder treatments.  Sleep studies can be performed in the hospital or a sleep lab and are non-invasive.  Most studies involve spending a night or two sleeping at the testing facility with sensors attached to various points on your body that measure and record things like your heart rate, eye movement, and brain activity while you are sleeping.

Types of Sleep Studies

Generally, if someone refers to a sleep study, they are talking about a polysomnogram, but there are other types of sleep studies used to diagnose and treat sleep disorders.  According to the National Blood and Lung Institute within the National Institutes of Health, these are the four of the most commonly used sleep studies and what you can expect during each test.

1.     Polysomnogram

This test is performed during an overnight stay at a sleep center and records brain activity, eye movement, heart rate, and blood pressure.  In addition, this test captures information specific to how you are breathing including how much oxygen is in your blood, the amount of air moving through your nose, the movements of your chest, and whether or not you snore.   The polysomnogram is often the first sleep study performed and is used to diagnose a variety of sleep disorders including sleep apnea.

The test starts with the attachment of electrodes on your scalp, face, chest, limbs, and one finger.  These electrodes contain small sensors that record the various pieces of information that are tracked during the study.  Elastic belts will also be placed around both your chest and abdomen to monitor and measure your breathing and the movements of your chest.  All these sensors have wires attached to them that send the information about you to the sleep center’s computer over the course of the study.  It may seem like all this equipment will make it difficult to sleep comfortably, but few people actually experience difficulties sleeping.

2.     Multiple Sleep Latency Test (MSLT)

This test is performed during the day and is generally done as a follow-up to a polysomnogram.  It measures daytime sleepiness and is performed four or five times over the course of a single day.  The actual testing takes about 30 minutes each time.  Your brain activity is monitored during the test and if you fall asleep, the type of sleep you experience is recorded.  This test is useful for diagnosing narcolepsy and some of the hypersomnias.

While this test also requires the use of electrodes, there are fewer than with a polysomnogram.   Within a few hours of waking up from your polysomnogram, you will be asked to relax in a quiet room while measurements are taken.  Each test will take about 30 minutes and will be followed by a 2 hour break during which you will have to remain awake.

3.     Maintenance of Wakefulness Testing

This test is also performed during the day and gauges your ability to remain awake and alert.  Like the MSLT, it is often performed the day after a polysomnogram and can take almost the whole day.  While the MSLT measures whether or not you fall asleep, this test asks you to try and stay awake throughout the testing period.  During the test, you will be required to sit still and stare straight ahead.  Each period lasts about 40 minutes and requires that you be connected to tracking sensors.  The test is repeated four times over the course of the day and each test period is separated by a 2 hour break.

4.     Home-Based Portable Monitor Test

This test measures many of the same things that a polysomnogram measures but instead of spending the night at a sleep center, you perform the test at home.  Testing equipment and instructions for using the equipment and performing the testing are provided by your doctor or at a sleep center.

Once you have completed your sleep study, it may take several weeks to get the results.  Your doctor or sleep specialist will walk through the results with you, explain any next steps, and answer any questions you have about the testing.

About Valley Sleep Center:

Since 2002, Valley Sleep Center, accredited by the American Academy of Sleep Medicine, has provided Arizona with diagnostic sleep disorder testing in a home-like atmosphere, ensuring a comfortable, relaxing experience for patients.  Their Board Certified Sleep Medicine Specialists consist of experienced and knowledgeable physicians who provide expert advice across a multitude of sleep related disorders including insomnia, sleep apnea, snoring, excessive daytime sleepiness, hypertension, sleepwalking, and pediatric sleep problems.  They accept most insurance plans as well as Medicare.  For more information contact Lauri Leadley at 480-830-3900; http://www.valleysleepcenter.com.