Idiopathic hypersomnia refers to a disorder wherein the patient feels excessively sleepy despite getting large amounts of sleep (usually 10 or more hours a night, as well as naps during the day), and all usual causes have been ruled out. The patient does not have narcolepsy, obstructive sleep apnea, sleep-based movement disorders, or take meditations for which fatigue is a side effect.
Idiopathic hypersomnia often has its onset during the teenage years. Kids are frequently misdiagnosed as depressed, lazy, or with ADHD. They may respond partially to the standard ADHD treatment of stimulants; an older class of treatments for the sleep disorder also focused on stimulant medications. Newer treatments are also available, and effective support groups aid treatment.
When kids are dismissed as lazy or misdiagnosed with depression, however, treatments will not be effective, and may be harmful. As a primary sleep disorder, the brain chemical alternations that happen with idiopathic hypersomnia are quite different from the ones that go along with depression or other psychological illnesses. Most tragic is when kids are dismissed as lazy, and no treatment at all is offered.
If your child has difficulty getting up in the morning despite adequate sleep, has dizzy spells and feels tried and sleepy throughout the day, a formal sleep evaluation may be helpful. Our medical staff has significant interest and experience in both hypersomnia and narcolepsy; by choosing our clinic, you gain the benefit of his years of experience in treating this, and many other, sleep disorder. Call us today to make an appointment.
CIRCADIAN RHYTHM DISORDERS
While delayed sleep phase syndrome is the most common circadian rhythm disorder, there are several other variants that are often seen by sleep specialists. They include:
- Advanced sleep phase disorder: Often seen in the elderly, where someone goes to bed very early (often between 6 and 9 p.m.) and then wakes early in the morning (between 2 and 5 a.m.). They often complain of insomnia as well as sleepiness in the afternoon.
- Jet lag: More troublesome when travelers move eastward, this complaint results from a disconnect between the body's biological clock and the pattern established in the new time zone. When moving west, most people delay sleep and then settle into the new pattern, but moving east is difficult, as going to sleep earlier than normal is more difficult. Jet lag is usually a short term complaint.
- Shift work disorder: For workers who frequently rotate shifts, or work exclusively at night, they sometimes find that they struggle with either insomnia or excessive sleepiness, sometimes both.
Depending on the disorder, as well as how much it affects the patient's quality of life, a sleep specialist will often recommend a combination of behavior therapy or sleep hygiene, bright light therapy, and medication.
Diagnosing a circadian rhythm disorder is difficult. If you feel that this may be affecting your quality of life, look for a sleep specialist near you.
Most small children wet the bed from time to time; it is only when bedwetting persists beyond the age of 6 or 7 that pediatricians start to look for other causes. A full physical exam is generally conducted to rule out chronic constipation, urinary tract infections, and stress that may cause secondary bedwetting (defined as when someone begins to wet the bed after six months of dryness).
If other causes for bedwetting cannot be found, the next step is to look for signs of obstructive sleep apnea. The first sign you should look for is whether or not your child snores regularly at night. Children with these sleep disorders have altered levels of the hormones ADH (antidiuretic hormone) and ANP (antinatriuretic peptide). In most children, ADH decreases the amount of urine produced during sleep, and also suppresses ANP, which dumps water and sodium into the kidneys, creating urine and the need to empty the bladder.
In children with OSA, or who regularly snore, the ratio between ADH and ANP is thrown off. These kids create more urine during sleep, which causes them to wet the bed. Studies have shown that 40% of kids with OSA wet the bed, and as many as two thirds respond quickly to treatment of their apnea.
Other signs of OSA would include pauses in breathing during sleep, regularly being difficult to wake, complaints of daytime tiredness, or declining behavior and performance in school.
If you are concerned about your child's sleep, contact us to schedule a complete sleep evaluation with a pediatric sleep specialist.
No definitive cause of teeth grinding or nocturnal bruxism has yet been determined, but at least one study has linked the behavior to the onset of sleep apnea. Dr. Mark Burhenne of AskTheDentist has talked about how teeth grinding, especially in adults, is a sign that someone is struggling to keep their airway open.
If your dentist suggests that your teeth grinding is a problem, your next step should be to talk to your doctor about obstructive sleep apnea and call us for a sleep evaluation.
SLEEP AND EPILEPSY
Epilepsy is tightly related to sleep. Sleep activates the electrical charges in the brain that trigger seizures. In fact, many seizure patients have seizures during sleep for years of which they are unaware. They suffer from daytime sleepiness, which then can make their epilepsy harder to control. Many of the medications that control seizures can also disrupt sleep.
There is also significant comorbidity between obstructive sleep apnea and epilepsy; OSA is a risk factor for epilepsy that is more difficult to control. Studies have also found that those who need to use two or more medications to control their seizures are more likely to develop OSA.
If you have epilepsy, it's particularly important to watch for symptoms of OSA. These might include snoring, mouth breathing, noisy breathing, struggling to breathe at night, night sweats, or excessive daytime sleepiness.
Do not stop any antiepileptic medicines without your doctor's say so, but if you believe you may have OSA together with your epilepsy, contact us today to schedule a sleep study.