Is your sleep a problem? (Sleep Disorders) Let's find out exactly what this is!

Sleep is an essential part of our lives. Just like eating and drinking. But sometimes this sleep becomes a problem for us. Some people cannot fall asleep at all, while others cannot fall asleep even when they do. So today we are going to talk about these sleep-related problems, or in medical terms , sleep disorders .

What are these sleep disorders?

Simply put, sleep disorders are conditions that prevent your body from getting the rest it needs and staying refreshed during the day. There are more than 80 types of sleep disorders. These mainly affect:

• How well you sleep (sleep quality) matters. Sometimes, even after sleeping for hours, your body doesn't feel any relief. That's how it is.
• When you fall asleep and whether you can stay asleep (sleep duration and consistency). Some people can't fall asleep for hours after going to bed. Others wake up in the middle of the night and can't get back to sleep.
• How much sleep and wakefulness you get (amount or duration of sleep).

It's normal for all of us to have trouble sleeping from time to time. But you may have a sleep disorder if you experience any of the following:

• If you often have trouble sleeping.
• If you feel tired during the day even though you sleep at least seven hours at night.
• If sleep has become a problem to the point where it is difficult to perform normal daily activities.

How are sleep disorders mainly classified?

The way sleep disorders are classified has changed over time. Recently, the International Classification of Sleep Disorders (ICSD) has classified sleep disorders based on symptoms, how they affect a person (pathophysiology), and the body system they affect. According to the latest revision, `ICSD-3R`, there are several main categories:

• Insomnia: You have difficulty falling asleep and staying asleep.
• Sleep-related breathing disorders: Your breathing pattern changes while you sleep. An example is snoring and shortness of breath.
• Central nervous system disorders that cause excessive daytime sleepiness (Central disorders of hypersomnolence): Difficulty staying awake during the day, feeling sleepy all the time.
• Circadian rhythm sleep-wake disorders: A problem with your body's natural clock (internal clock) that causes you to not fall asleep at the right time or wake up in the morning. Consider that some people don't fall asleep until the early hours of the morning and can't wake up in the morning.
• Parasomnias: Unconscious behaviors during sleep, such as sleepwalking, talking, and eating.
• Sleep-related movement disorders: Physical movements or a strong urge to move that make it difficult to fall asleep and/or stay asleep.

This ``(ICSD)`` classification is constantly being updated, to include the latest information about sleep disorders and their subcategories.

What are the most common sleep disorders?

Although there are more than 80 types of sleep disorders, some of the most common are:

• Chronic Insomnia: Difficulty falling asleep or staying asleep most nights for at least three months, resulting in daytime fatigue and irritability.
• Obstructive Sleep Apnea: Snoring and brief pauses in breathing during sleep, which disrupts sleep.
• Restless Legs Syndrome (RLS): A strong urge to move or shake the legs while at rest.
• Narcolepsy: You can't control when you fall asleep or how long you stay awake. You may fall asleep suddenly.
• Shift Work Sleep Disorder: Your shift work (e.g., night shift) makes it difficult to fall asleep and stay asleep. You may feel sleepy at inappropriate times.
• Delayed Sleep Phase Syndrome: You fall asleep at least two hours later than you should. It can be difficult to wake up on time for school or work.
• REM Sleep Behavior Disorder: During the ``REM - Rapid Eye Movement`` stage of sleep, people actually act out their dreams. They may scream or flail their arms.

How much sleep do we really need?

We all need sleep. It is essential for our bodies to function properly. You may need more or less sleep than others. But experts say that an adult should get between seven and nine hours of sleep a day . This sleep requirement varies with age. For example, young children and adolescents may need more sleep than adults.

How common are sleep disorders?

It is estimated that over 50 million people in the United States have some form of sleep disorder. In addition, it is reported that over 100 million Americans of all ages do not get enough sleep. This situation can be seen to some extent in Sri Lanka as well.

What are the symptoms of sleep disorders?

The symptoms of sleep disorders vary depending on the type, but here are some common symptoms:

• Difficulty falling asleep, or often taking more than 30 minutes to fall asleep.
• Difficulty staying asleep throughout the night, or waking up frequently in the middle of the night and not being able to go back to sleep.
• You snore while sleeping, feel suffocated, or have difficulty breathing.
• When you are at rest, you feel like moving your legs, and doing so reduces the feeling (this is a symptom most often seen in Restless Legs Syndrome).
• When you wake up in the morning, you feel like you can't move (Sleep Paralysis).

In addition to these symptoms, lack of sleep can also cause you to have other problems during the day. Some of them include:

• Excessive daytime sleepiness, frequent need to sleep during the day, or falling asleep even while doing normal tasks.
• Behavioral changes, such as difficulty concentrating and concentrating.
• Mental changes, such as becoming easily angry and having difficulty controlling emotions.
• Not being able to do schoolwork or office work properly, not being able to perform to the expected level.
• Frequent accidents or falls.

If you feel like you're not getting enough sleep, or if you have symptoms that are interfering with your daily activities, be sure to see a doctor.

What are the causes of sleep disorders?

Sleep disorders occur when your body's sleep-wake cycle is disrupted. There can be specific causes for this, and the causes vary depending on the type of sleep disorder you have. Some common causes include:

• Being a symptom of a medical condition, such as heart disease, asthma, pain, or neurological disease.
• Being a symptom of a mental health condition such as depression or anxiety disorder.
• Genetic factors, that is, a mutation that comes from heredity.
• Being a side effect of some medications.
• Working the night shift.
• Consumption of caffeine (tea, coffee) or alcohol before bed.
• Decreased levels of certain chemicals or minerals in the brain.
• Sometimes it may not be possible to find a reason.

Who is at higher risk of developing sleep disorders?

You may be at increased risk of developing sleep disorders if you:

• If you have any other chronic medical conditions.
• If you are suffering from severe stress.
• If you work late shifts.
• If anyone in your family (biological family) has had sleep disorders.

Research has shown that women are more likely to suffer from sleep disorders than men . It is also estimated that about half of adults over the age of 65 have some form of sleep disorder .

What happens if you don't sleep well?

If your body doesn't get the amount or quality of sleep it needs, it can have effects that go beyond just feeling tired during the day. Not getting enough sleep can cause things like:

• Difficulty learning, remembering things, and making decisions.
• Personality changes, such as becoming easily angry.
• Reduced reaction time (this increases the risk of accidents).

Sleep deprivation can also contribute to health conditions such as:

• Depression
• Obesity
• Type 2 Diabetes
• Heart Disease
• Dementia

Although rare, some sleep disorders can be life-threatening, so this is not something to take lightly.

How to diagnose sleep disorders?

A doctor will diagnose a sleep disorder by reviewing your symptoms, performing a physical exam, and possibly doing other tests. Blood tests or other imaging tests may help determine the cause of your symptoms.

Your doctor may tell you to keep a sleep diary . This is to record your sleep patterns. You should write down the time you go to bed, the time you fall asleep, and the time you wake up each day. If you take a nap during the day, you should also write down how you feel before you go to bed and after you wake up.

It's a good idea to keep a pen and paper by your bed so you don't forget. It's hard to know exactly when you fell asleep, so try to estimate the time and write it down. You might also want to use a ``smartwatch'' or an ``actigraph'' that records your rest and activity cycles.

Your primary care provider may refer you to a sleep specialist, who may perform a test called a polysomnogram . This involves electronically recording certain activities of your body and brain while you sleep. This data is analyzed to determine whether you have a sleep disorder.

What questions would a doctor ask you?

A doctor may ask questions like these to learn about your sleep patterns:

• How many hours do you sleep at night?
• Do you toss and turn in your sleep?
• Do you sleep during the day?
• How long does it take to fall asleep?
• Do you wake up in the middle of the night?
• Do you work the night shift?
• How sleepy do you feel during the day?
• Are you snoring?

How are sleep disorders treated?

There are several treatments for various sleep disorders. Some of them are:

• Change your sleep patterns to establish a regular sleep schedule and good sleep hygiene.
• Psychotherapy methods such as Cognitive Behavioral Therapy (CBT).
• Taking medications (sleeping pills or drugs that increase wakefulness) or supplements (e.g., melatonin).
• Changing or changing the dosage of medications that cause excessive drowsiness (do not stop any medication without your doctor's approval).
• Using a CPAP (Continuous Positive Airway Pressure) machine or surgically implanting a neurostimulator for sleep apnea.
• Using light therapy.

Your doctor will recommend the treatment that is right for your condition. Your doctor will also discuss possible side effects with you before starting treatment.

Some medications for sleep disorders

The doctor may recommend medications or supplements such as:

• For insomnia: Sleep aids such as `(Melatonin)`, `(Zolpidem)`, `(Zaleplon)`, `(Eszopiclone)`, `(Ramelteon)`, `(Suvorexant)`, `(Lemborexant)` or `(Doxepin)`.
• Restless Legs Syndrome: Medications such as `(Gabapentin)`, `(Gabapentin enacarbil)` or `(Pregabalin)`.
• Sleep disorder (Narcolepsy): Stimulants or drugs that increase wakefulness such as `(Modafinil)`, `(Armodafinil)`, `(Pitolisant)`, `(Solriamfetol)`.

All of these medications should be taken only on medical advice.

What can we do to get good sleep? (Sleep Hygiene)

Your doctor may advise you to practice good sleep hygiene . This means changing your sleeping habits to create a good environment for good sleep. You can also get a good night's sleep by doing these things:

• Create a comfortable sleep environment: Make your bedroom cool, quiet, and dark. If noise keeps you awake, use background noise, such as ``white noise,'' or wear ``earplugs.'' If light disrupts your sleep, use a ``sleep mask'' or ``blackout curtains.''
• Reduce stress: Try to reduce the stress you feel before going to bed. You can do something like making a ``to-do list`` for the evening. This is helpful for those who find themselves thinking in bed at night. Go to bed with a positive attitude, without negative thoughts like, "If I don't get a good night's sleep tonight, how will I get through tomorrow?"
• Use the bed only for sleep and sexual intercourse: Do not watch TV, watch videos on your phone, eat, or work in the bedroom.
• Establish a regular bedtime routine: Take a warm bath, listen to soothing music, or read a book before going to bed every night. Practice relaxation exercises or meditation. Wake up at the same time every day, including on weekends.
• Don't stare at the clock: Turn your watch upside down, or turn your phone's screen upside down. Use only the alarm to wake you up. If you can't fall asleep after 20 minutes, leave the bedroom. Go to another room and read a book or do something relaxing that doesn't involve screen time.
• Exercise regularly: Exercise can help you sleep better. But if you have trouble falling asleep, avoid exercising within four hours of bedtime. Also, avoid strenuous exercise close to bedtime.

What should we avoid doing for good sleep?

If you want to improve your sleep, avoid these things three to four hours before bed :

• Caffeinated drinks (like soda, tea, coffee).
• Tobacco (like cigarettes).
• Alcohol.
• Taking a nap after 3 pm.
• Chocolate.
• Heavy meals.

What can you expect if you have a sleep disorder?

Sleep disorders can affect your overall health. You may not have enough energy to do the things you want to do, or even complete some of your daily tasks. You may also miss out on special occasions because of your sleep disorder. What’s more, if you drive a car or operate heavy machinery, you could be putting yourself and others at risk because you’re not getting enough rest.

If you're having trouble getting a good night's sleep so you can wake up refreshed, talk to your doctor. There are treatments that can help manage many sleep disorders and get you back on track.

How long will these conditions last?

There is no set time frame for when a sleep disorder will stop affecting you. You may find that you feel better within a few weeks or months. Others may have to manage the condition for the rest of their lives. Talk to your doctor about your specific situation.

When should you see a doctor?

If you have trouble falling asleep, staying asleep, staying awake, getting a good night's sleep, or have unexplained daytime sleepiness or fatigue, talk to a doctor. Don't put it off.

What are the important questions to ask the doctor?

• What kind of sleep disorder do I have?
• How serious is my sleep disorder?
• What kind of treatment do you recommend?
• Are there any side effects of the treatment?
• How can I improve my sleep habits (sleep hygiene)?
• Should I see a sleep specialist?
• Do I need a ``(referral)`` to see a specialist?
• Are there any medications you recommend to help with my sleep disorder?
• How often do I need to see you?
• Are there any medications I should stop taking?

Finally, I have to tell you... (Take-Home Message)

Sleep disorders can have a major impact on your quality of life. They can interfere with your ability to think, your performance at school or work, your mental health, and your physical health. Common sleep disorders can prevent you from getting the restful, deep sleep you need to function at your best.

If you are having trouble sleeping, don't hesitate to see a doctor. Your health, and even your happiness in life, depends on good sleep.

Practice good sleep hygiene and follow your doctor's instructions. You will feel better soon.

` Sleep, sleep disorders, insomnia, snoring, good sleep, mental health, medical advice