The NHS is facing increasing demands for sleep disorder tests—the number performed has doubled from 69,919 in 2007/8, to 147,610 in 2017. Clearly, our sleeping problems are getting worse.
The main method for checking sleep disorders is polysomnography, which involves observing sleep patterns and recording signals from electrodes which are placed onto various parts of the body. These tests can incorporate other techniques such as electroencephalography (EEG) to monitor brain waves, electromyography (EMG) to examine muscle tone and electrocardiography (ECG) to check the heart, alongside recordings of breathing movements.
Particularly worrying is NHS data published in 2018 showing a rising number of children diagnosed with sleep disorders, up from 6,520 in 2012/13 to 9,420 cases in 2018. Sleep consultant at The Sleep Sanctuary, Rachel Taylor labels sleep issues ‘the hidden public health crisis.’
Insomnia refers to sleeplessness generally, yet there are there are three different types of insomnia: transient, acute and chronic. Both transient and acute insomnia are short term, though while transient insomnia will only last for no longer than a week, acute insomnia can span several weeks and can be caused by extended periods of stress. Chronic insomnia has far more complex and varying reasons ranging from chronic stress to physical disorders such as sleep apnoea.
The majority of sleep disorder tests are used to diagnose sleep apnoea. The term derives from the Greek word ‘apnea’ meaning ‘without breath’. There are three categories of apnoea: obstructive, mixed and central. The most diagnosed type of apnoea is obstructive, otherwise referred to as OSA.
In all types of sleep apnoea, breathing is disrupted during sleeping by relaxation of the throat muscles, causing the throat to narrow and block the airways.
The interrupted breathing caused by OSA deprives the brain of oxygen, leading to the brain being compelled into wakefulness to allow normal breathing.
See Also: The Significance of Sleep
Several studies have tied the occurrence of sleep apnoea to a higher risk of developing Type 2 diabetes, due to the effect of interrupted sleep on metabolism, so it causes more of a risk to health than simply being tired.
Discussing the dangers of a sleep apnoea episode, Dr Phyllis Zee, a sleep apnoea expert at Northwestern University explains, “There’s little air exchange for 10 seconds or more at a time… oxygen goes down and the body’s fight or flight response is activated. Blood pressure spikes, your heart rate fluctuates, and the brain wakes you up partially to start your breathing again. This creates stress.” Each episode therefore increases your risk of experiencing a stroke, which is why apnoea must never be left untreated.
In some cases, occurrence of OSA can be reduced by lifestyle changes, such as quitting smoking, limiting alcohol intake and stopping the use of sedatives.
More severe cases of OSA necessitate extra attention and can be treated using surgical treatments such as tonsillectomy, where enlarged tonsils are removed to prevent the blockage of airways during sleep; adenoidectomy, which involves removing adenoids, if they are found to be enlarged and restricting the airways; tracheostomy, where an artificial insertion is created in the trachea or windpipe that is held open by a tracheostomy tube; or finally bariatric surgery or weight loss surgery, which treats OSA by combatting one of its biggest causes, obesity.
See Also: 20 Ways to Beat Insomnia
There are technologies which can be used to treat OSA short of surgery. A pressurised device designed for the airways known as a Continuous Positive Airway Pressure device (CPAP) works by providing a continuous supply of compressed air via a pump and typically comes with a mask to cover both the nose and mouth. The mild air pressure prevents the airways from collapsing when inhaling during sleep and reduces snoring, promising a better bedtime for you and anyone else in the house.
Uses of a CPAP device to treat severe OSA can have potential, mild side effects from pressurised air entering the stomach, such as abdominal pain, headaches and bloating. An alternative which should avoid these side-effects is the Mandibular Advancement Device (MAD), similar in appearance to the gumshields used in competitive sports. The MAD prevents the collapse of airways by changing the jaw and tongue position, pushing outwards to increase airflow. It is advised you have a MAD created for you by a dentist, to match the alignment and shape of your teeth, rather than purchasing a device online.
See Also: What Causes Obstructive Sleep Apnoea?
Can’t Stop Moving
Restless Leg Syndrome (RLS) is a neurological disorder which creates an uncontrollable feeling of discomfort in the legs and arms. In most cases, there is no obvious cause, and the NHS refers to this as idiopathic or primary restless leg syndrome. The condition has similarities to Periodic Limb Movement Disorder, but this appears to have different causes.
Some neurologists believe the neurotransmitter dopamine could play a role in primary restless leg syndrome, as it is involved in governing muscle movements. But RLS can also be brought about by iron deficiency or kidney failure, when it is known as secondary RLS.
Pregnancy has been shown to increase the likelihood of experiencing RLS—up to one in five pregnant women will experience RLS in the last trimester.
Lifestyle changes can help ease the symptoms. These include frequent exercise, stopping smoking and avoiding stimulants in the evening such as caffeine and alcohol. Applying hot or cold compresses to leg muscles and practicing gentle yoga is equally effective in relaxing the muscles and reducing symptoms of RLS.
Risks and results
In cases of primary restless leg syndrome where low levels of dopamine are responsible, dopamine agonists may be suggested. The NHS recommends ropinirole, pramipexol and the rotigotine skin patch to balance dopamine (though these do have potential side effects such as nausea, dizziness and, in extreme cases, impulse control disorder (ICD), though these subside once the medication has been stopped.
Codeine-based painkillers can be used to treat symptoms of RLS, and severe and extremely painful cases of RLS can be treated with migraine drug gabapentin, or epilepsy treatment pregabalin.
All sleep disorders are associated with a higher risk of cardiovascular disease, but this risk is greater in individuals with RLS, as rapid leg movement can increase both blood pressure and heart rate. You can cut your risk by maintaining a healthy diet, getting regular exercise and quitting smoking.
Cognitive Behavioural Therapy (CBT) for treating insomnia looks at relaxation training, sleep restriction and stimulus control. Relaxation training encourages muscles in different parts of the body to relax and calm the body; breathing exercises, specific meditation techniques and guided imagery can all help the body to transition into a state of relaxation.
Similarly, stimulus control works by conditioning the brain to associate the bedroom with sleep. Stimulus control will restrict all non-sleep related activities from the bed, and ensure you’re only getting into bed when you’re actually sleepy to eradicate unhealthy sleeping habits. In conjunction with stimulus control, sleep restriction can be used to remove poor sleeping habits by introducing subtle behavioural changes. These can include keeping a regular bedtime, stopping excessive napping or getting out of bed a specific time after waking up.
The Holistic Way
A poll conducted by sleepcouncil.org. found that temperatures above 18.3 degrees Celcius cause sleeplessness for 52 percent of Brits.
CBD (cannabidiol) oil or capsules have been suggested as an effective form of self-treatment for summer sleeplessness. The theory is that CBD, a natural ingredient derived from the hemp plant, interacts with the body’s endocannabinoid system, governing physiological and cognitive processes, and helps your circadian rhythm (the body’s natural cycle of adjustment to light and temperature between day and night) correct for the change in temperature in summer.
A relatively low-tech way to reduce stress and encourage relaxation is the pillow speaker – this plays ambient music from a smartphone app, which you hear through bone conduction rather than air conduction, so it shouldn’t disturb your sleeping partner.
Researched as a way to relax autistic children, this sort of design was found to be helpful in inducing sleep in adults during studies in American universities. It’s a passive system – it doesn’t in any way monitor or react to your sleep state – but it’s thought to regulate stress by activating the vagus nerve, which conveys sensory information from the organs to the central nervous system.
So if you’re suffering from lack of sleep, you don’t have to take it lying down—there are plenty of bedtime therapies to help you get your Z’s.
This feature was orignally published in the Winter edition of Live to 100 with Dr Hilary Jones, which you can read here