Saturday, September 11, 2010

Research Paper on Sleep Disorders

Research Paper on Sleep Disorders

All of us, at one time or another, have had a restless night sleep. We have tossed and turned and woke up the next morning feeling tired and restless. You may ask yourself if this means that you have a sleeping disorder? What kinds of sleeping disorders exist and what causes them? I went on vacation this summer and my friend mentioned that she was an insomniac. She told us that she had been involved in a sleep study in Oakland, California, at California Center for Sleep Disorders. She was in a drug trial for a sleeping pill for people who suffer from insomnia. The pill allowed her to sleep for up to 4 hours and when she woke up she felt refreshed and alert. The good thing was the pill worked on her, but because it had not been approved, she could not be prescribed the pill. I was fascinated by her story and it made me wonder what happens with people who have sleep disorders. Some of us have heard terms like, insomnia, narcolepsy, sleep apnea, nightmares, and night terror, but how do these sleep disorders effect an individual?

Sleep Cycles

To understand some sleep disorders we must first understand the cycle of sleep. Most of us believe that sleep is what occurs at night when we close our eyes. This is true, but sleep is actually 5 different patterns or stages of activity in the brain. When we first lay down and close our eyes, this is the beginning of stage one sleep. In this stage you are no longer completely aware of your external environment. A slight noise or light touch could wake you. You become relaxed, your breathing becomes regular, and you have disconnected thoughts. After about 10 minutes you enter stage two of sleep.


Stage two is a transitional stage, just like stage one, but on an EEG (electroencephalogram), which measures the electrical output of the brain, the brain activity is different. This stage takes a louder noise or heavier touch to wake a person from sleep. It is also at this stage when sudden jerks in your arms or legs cause you to wake suddenly. Stage one and two together usually last about thirty minutes and then you enter stage three sleep.

Stage three and four are considered deep sleep. These stages are when you get your most fulfilling and restful sleep. We have very little body movement in these stages and our heart rate and blood pressure slow down and become regular. The activity of the brain shows that there is a definite slowing of electrical activity. It would take a pretty strong stimulus to cause someone to wake up. If you are awakened during these stages you are disoriented and confused. Deep sleep is necessary for both physical and mental restoration. At these stages growth hormones are produced and that is why these stages are considered to be the most restorative part of sleep. Both stages together last 20 to 40 minutes and then you progress backwards toward stage one sleep. Most times, when you get back to stage one sleep you roll over or reposition yourself. Then you transcend through the four stages again and in about 15 minutes you enter the fifth stage of sleep, also known as REM (rapid eye movement) sleep.

REM sleep is the stage in which dreams take place. When you enter into REM sleep the electrical activity of the brain is very similar to the activity of the brain when awake. We can see rapid movement of the eyes under the eyelids and you are considered paralysis, but only temporally. Temporary paralysis happens to our body so we do not act out our dreams. Our heart rate and rate of breathing can increase, according to the action in the dream. If we awaken during this stage our mind functions well and we are not confused. A total cycle from stage one to stage four, then back to stage one, and finally through REM sleep, takes about 90 to 100 minutes. Most adults have three to five sleep cycles in one night (Caldwell, 1997). Now that we know about the sleep cycles lets take a look at sleep disorders.


The California Center for Sleep Disorders (2000) says that there are three kinds of insomnia transient or temporary, chronic, and due to medical reasons. Insomnia is the persistent difficulty of falling asleep, staying asleep, or waking too early. Huffman (2002) states “Many people think they have insomnia if they cannot sleep before an exciting event (this is normal) or because they have wrongly assume that everyone must sleep 8 hours a night” (p. 172). If you are excited before an event or don’t sleep well for a couple of nights, you are not considered to have insomnia. What we consider temporary insomnia lasts for a couple of weeks and then it disappears. It usually results from psychological stress or when facing problems such as a family crisis, death of a loved one, or loss of a job social stress. This is actually a very normal response to stress and treatment is not required. Chronic insomnia persists for at least a month or more and it causes the person significant distress. With chronic insomnia people feel tired all the time, they lack motivation, and have poor concentration. There are others who experience pain due to a medical condition, like arthritis, or who take drugs (prescription or street) and this too can cause a person to experience transient or chronic insomnia.

Who gets insomnia? According to Bayer (2001) “Approximately 36 out of every 100 Americans have reported experiencing this symptom [insomnia]. However, only 5 out of every 100 Americans consider the problem severe enough to seek medical help” (p. 22). It is said that all ages can be effect with insomnia. Young adults usually have more problems falling asleep, while the elderly has difficulty staying asleep.

To diagnosis insomnia a patient is evaluated according to their medical history and sleep history. Specialists may talk to the bed partner or ask the patient to fill out a sleep diary. Sometimes specialized sleep studies are recommended, if they suspect other causes, such as narcolepsy or sleep apnea.

Treatment for insomnia can come in many varying forms. For temporary insomnia sleeping pills may be prescribed. For chronic insomnia first they diagnosis and rule out an under lying medical or psychological problems. They also look at behaviors that may increase insomnia and have the patient discontinue these habits. Sometimes sleeping pills are given, but they can cause side effects and do not solve the long-term problem. Relaxation therapy, sleep restriction therapy, and reconditioning are all techniques to help people with chronic insomnia. Relaxation therapy helps the muscles to relax and the mind to stop racing. Sleep restriction therapy is where the patient is only allowed to sleep a couple hours of night and as time passes more normal nights sleep is achieved. Reconditioning can sometimes help by conditioning the person to associate the bed and bedtime with sleep (SIRS Knowledge Source, 1995).

Sleep Apnea

Sleep apnea defined by Huffman (2002) is “A temporary cessation of breathing during sleep” (p. 173). People with sleep apnea fail to breathe for a minute or longer and wake up usually gasping for air. Sleep apnea can be a serious and life threatening disease. In a nights sleep the number of involuntary breathing pauses can be as many as 20 to 30 per hour. These pauses are almost always accompanied by snoring, but this does not mean that everyone that snores has sleep apnea. Sleep apnea usually interrupts stage three or four sleep, the deep, restorative sleep, and cause the patient to have excessive daytime sleepiness and fatigue. It is very important to recognize sleep apnea because it can be associated with high blood pressure, stokes, or heart attacks.

Sleep apnea is seen in both males and females and in people of all ages. SIRS knowledge source (1995) estimates that “as many as 18 million Americans have sleep apnea” (p. 1). Individual who are most likely to get sleep apnea are overweight, can have high blood pressure, or have some abnormality to the nose, throat, or other parts of the upper airway.

What causes sleep apnea? When a person reaches deep sleep their muscles and tissues begin to relax. In the mouth and throat the muscles in the upper airway relax. Their soft palate, in the upper back of your mouth, begins to sag as well as their uvula. Their jaw muscles relax which allows the tongue to droop backwards. All of this causes the airway to narrow and evenly close off. When this happen a person’s brain send a signal to the diaphragm to contract, which causes negative pressure in the chest cavity. If this does not open the airway and let air in, the level of oxygen in a person’s blood would decrease. Their blood pressure would rise and so would their heart rate. At some point the brain causes the body to move, so air can enter the lungs. You can see that the lack of oxygen in the blood and the constant waking from deep sleep would cause a person to feel tired the next day. Most patients are unaware that any of this is happening to them and think that they have been asleep for the whole night.

Sleep apnea can affect a patient in many ways. Coren (1996) says sleep apnea “show[s] excessive daytime fatigue and sleepiness, as well as loss of motivation, inability to concentrate, poor stamina, inefficient problem-solving abilities, depression, and a higher risk of accidental injures” (p. 143). It also causes some to be impotent and have incontinence of urine. They can experience acid reflux due to the diaphragm creating negative pressure to move air into the upper airway. Since these patients are sleep deprived they tend to fall asleep easily while watching TV or any time there is minimal stimulation.

Sleep apnea is diagnosis is a sleep laboratory. If a person has a few episodes of apnea, during their sleep study, they are not diagnosis with sleep apnea. A person must have 5 to 10 apnea episodes an hour to be diagnosed with sleep apnea, and they have to last at least twenty seconds or more.

There are a couple of different treatments for sleep apnea. Some patients can be helped with surgery. In this situation they may remove the adenoids and tonsils, or part of the soft palate. If the person is overweight, the doctor suggests that the patient loses weight. They are also told not to take any kind of sleeping pills or any kind of depressant that will cause the muscles to relax more than normal. The most effective procedure is to have the patient wear a mask over their nose at night. Pressure from an air blower blows a constant amount of air through the mask and into the nasal cavity to prevent the airway from collapsing. In the most serious cases a tracheotomy is done. This is where a small hole is made in the windpipe and a tube is inserted into the opening. The hole is covered during the day and is opened at night to allow air to flow into the lungs freely.


Narcolepsy is an unusual sleep disorder classified by uncontrollable and irresistible episodes of excessive sleepiness. Even though the patient sleep 8 to 12 hours a night, they still tend to be tired and fall asleep during the day. The interesting thing about narcolepsy is that a person falls asleep at the most unusual times. It might be in the middle of eating, while driving their car, or in the middle of a conversation. Coleman (1986) states “Its not surprising that people with these symptoms would believe themselves mentally ill or that physicians would diagnose them as having a psychiatric disorder” (p. 157). When this happens to a person some believe they have mental disorder. These patients might also have cataplexy (sudden loss of muscle tone) that can make them fall down. They can have sleep paralysis, which cause the person to not be able to move their limbs immediately after waking up or just before they fall asleep.

Narcolepsy occurs both in men and women and at any age. There is strong evidence that narcolepsy runs in families, with 8 to 12 percent of them having a close relative who also has it. SIRS (1995) says “Although it is estimated that narcolepsy afflicts as many as 200,000 Americans, fewer than 50,000 are diagnosis. It is as wide spread as Parkinson’s disease or multiple sclerosis…but it is less well known” (p. 1).

Though narcolepsy is not completely understood, it is said that it is an abnormality of REM sleep. In narcolepsy REM sleep or dream sleep intrudes into the waking hours. Caldwell (1997) explains that REM sleep is the main problem with this disorder:

REM sleep is associated not only with vivid dreams, but also with paralysis of most of the major muscle groups of the body. This understanding of the inappropriate intrusion of REM sleep into wakefulness explains much of the clinical manifestations of the disease. It seems as though the brain of a patient with narcolepsy harbors an intense desire for REM sleep, lurking just beneath the surface and waiting for any opportunity to capture the function of the brain (p. 145)

Narcolepsy is diagnosed by two tests, the polysomnogram and the multiple sleep latency test. The polysomnogram is a continuous recording of the brain waves, as well as a number of nerves and muscle functions, during normal nighttime sleep. When a person has narcolepsy they generally fall asleep fast and enter REM sleep early. This can be seen on the polysomnogram. In the multiple sleep latency test the subject is told to fall asleep every two hours during the day. The sleep specialist measures how long it takes for the subject to fall asleep and how long until they enter REM sleep. If the person can easily fall asleep during the day and enters REM sleep early they are considered to have narcolepsy.

There is no cure for narcolepsy, but medicine can be prescribed for some patients. The patients are given central nervous system stimulants to help their daytime sleepiness. Some are also prescribed antidepressant medication to help suppress REM sleep and also help with cataplexy. They are also told to schedule short naps before meeting or times of low stimulus.


Nightmares are usually frightening dreams with traumatic experiences. Dreams most often involve physical danger, being chased, or injury and can be extremely frightening to the person dreaming. We understand that nightmares occur during REM or dreaming sleep. This is why a person may experience an increased heart rate, sweating, and rapid breathing, but they are immobile. Children’s nightmares usually begin around three to six years old and most of them outgrow them. There are some people however, that continue to experience nightmares for the rest of their lives. Others experience nightmares when a life change or a traumatic event happens. When a woman becomes pregnant sometimes she has nightmares that the baby will be deformed.

Bayer (2001) notes “According to the DSM-IV, between 10 to 50 percent of youngsters three to five years of age have nightmares frightening enough to disturb their parents” (p. 39). Among adults, about 50 percent experience nightmares from time to time. Just because a person has a nightmare does not mean they have a disorder. Bayer (2001) concludes, “According to the DSM-IV, nightmares must be recurrent and greatly distressing for this diagnosis to be made” (p.36). Sometimes behavioral therapy can help a person overcome nightmares.

Night Terrors

Night terrors are a practically dramatic form of partial waking during deep sleep or Non-REM sleep. Deep sleep is not usually a stage when dreaming occurs, but it is a stage where physical mobility is. This would explain why the sleeper sometimes screams, sits up in bed, or runs around. The person may become flushed, contorted with fear, and even seem like they are trying to get away from someone or something. Most times when night terrors occur, the person cannot be woken up.

Night terrors usually happen about an hour or two after sleep and usually happen at the same time every night. According to the American Psychological Association (1980) “It is estimated that 1% to 4% of children at some time have the disorder. A much greater portion of children experience isolated episodes” (p. 85). Night terrors are most common in children ages three to five and they usually disappear over time. Generally, a child has only one night terror during the course of the night. When the child wakes the following morning, they generally won’t be able to remember anything about the episode. Bayer (2001) shows us one theory for night terrors:

It is believed, however, that night terrors are primarily the results of an immature developing brain that is struggling with the problem of moving from deep to light sleep. Caught in this sort of twilight zone of partial wakefulness and deep slumber, the child panics and responds with automatic defensive measures, such as screaming, crying, and thrashing around. According to this view, the child cannot recall a nightmare upon awakening, because no nightmare occurred. This theory would explain why the child who experiences a night terror can usually return to peaceful sleep, without every fully awakening, and has no memory of the frightening experience the following morning. It would also explain why most children outgrow night terrors by about age eight or nine, when the brain has developed the ability to switch between sleep stages and to regulate the various states of dreaming and sleeping (p. 42)

Night terrors can be very upsetting to parents, but they usually don’t affect children. Night terrors are not unusual and they are not psychologically damaging to the child.

Most of us don’t realize that sleep disorders are more than just a restless night’s sleep. We now see that sleep disorders can be life threatening for some and a constant irritation for others. Bayer (2001) claims “Each year, sleep-related errors and accidents cost U.S. businesses an estimated $56 billion, cause nearly 25,000 deaths, and result in 2.5 million disabling injuries” (p. 17). Sleep is necessary for our physical and mental well being and when a sleep disorder occurs it can effect a great percentage of someone life. Sleep allows our bodies to rest and our brains to recharge. In writing this paper, I now understand how sleep disorders affect a person and understand that a good nights sleep is essential.

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