Sleep Disorder

Treatment for Sleep Disorder

According to numerous studies, irregular durations and poor-quality sleep can have significant impacts on both mental and physical health. Over 80 distinct types of sleep disorders have been documented, all of which can adversely influence different aspects of your sleep cycle. Predominant causes include sleep apnea, narcolepsy, insomnia, and restless legs syndrome – each one posing its own set of challenges to achieving good-quality sleep.  

More than mere nocturnal annoyances, these issues can potentially inflict severe damage to your physical and emotional well-being. The aftermath often surfaces as problems such as daytime fatigue, difficulty performing routine tasks, and persistent difficulties in initiating and maintaining sleep. While everyone occasionally struggles with sleep, chronic or persistent disturbances necessitate medical attention, especially if you regularly have trouble falling asleep, struggle with day-to-day activities, or feel persistently tired during the day despite having supposedly sufficient sleep at night.  

Fortunately, numerous treatment approaches are available, with specialized neurology centers for sleep disorders offering some of the best options. These centers can provide professional assistance in treating your sleep disturbances, contributing to improved overall health and sleep quality. Treatment could involve medicinal therapy, behavioral interventions, or a combination of strategies. 

DIAGNOSTIC EVALUATION

Diagnostic Evaluation

The diagnosis of various sleep disorders typically involves several steps:  

  • Sleep History and Physical Examination: For initial diagnosis, physicians conduct a comprehensive sleep history and physical examination to check for any underlying causes of sleep disturbances. This examination includes a discussion about sleep schedule, sleep environment, bedtime behaviors, and daytime symptoms. 
     
  • Questionnaires or Scales: The use of several validated questionnaires and scales can be instrumental in diagnosing sleep disorders. Tools such as the Epworth Sleepiness Scale and the Pittsburgh Sleep Quality Index are used to assess daytime sleepiness and sleep quality over time. 
     
  • Sleep Study or Polysomnography: This is the gold standard for diagnosing many sleep disorders, including obstructive sleep apnea, restless leg syndrome, and narcolepsy. It involves overnight monitoring of the patient’s sleep, including brain waves, eye movements, breathing patterns, heart rhythms, and body movements. 
     
  • Multiple Sleep Latency Test (MSLT): The MSLT, which measures how quickly a person falls asleep in a quiet environment during the day, is often used to diagnose narcolepsy and idiopathic hypersomnia. 
     
  • Actigraphy: This technique involves the use of a device, typically worn on the wrist, to measure periods of activity and rest over several days or weeks. It can be especially useful for diagnosing circadian rhythm sleep disorders and insomnia. 
     
  • Blood Tests: These tests may also be ordered to rule out other conditions that can interfere with sleep, such as thyroid problems.
    Professional consultation is always advised to obtain an accurate diagnosis and treatment plan. 
MULTIDISCIPLINARY CARE TEAMS

Multidisciplinary Care Teams

The treatment of sleep disorders typically necessitates a collaborative approach involving several medical specialists. Neurologists, sleep specialists, psychologists, and respiratory therapists often work together in multidisciplinary care teams to address the diverse factors contributing to sleep disturbances. This comprehensive approach recognizes that sleep issues frequently stem from a combination of behavioral, psychological, and physiological factors. 

Behavioral Therapies

Addressing sleep disorders using cognitive-behavioral therapy for insomnia (CBT-I) is a common approach. CBT-I, a widely adopted strategy, aims to modify cognitive and behavioral patterns that cause difficulties in initiating sleep. By incorporating these evidence-based techniques into treatment plans, therapists acknowledge the significant impact of behavioral and psychological factors on sleep. CBT-I is a critical component of our commitment to providing effective and personalized behavioral therapy. This approach assists those seeking to improve their overall well-being and sleep quality, by addressing root causes and promoting healthy sleep habits. 

Pharmacological Interventions

The decision to use medication instead of, or in conjunction with, Cognitive Behavioral Therapy for Insomnia (CBT-I) depends on several factors including the severity of the patient’s insomnia, the existence of other health conditions, and the patient’s response to previous treatments. Some patients might benefit from a combination of both approaches.  
 In cases where CBT-I doesn’t provide sufficient relief, or when severe insomnia is causing serious disruption in a person’s life and they need quick relief, medication might be considered. Similarly, medication might also be recommended when a patient has another condition (such as severe anxiety, depression or chronic pain) contributing to their insomnia.  

The American College of Physicians (ACP), in its latest clinical practice guideline, recommends that all adult patients receive CBT-I as the initial treatment for chronic insomnia disorder. The ACP notes that while medications for insomnia have risks—dependency and side effects—they may be considered for a select group of patients who are unable to participate in CBT-I, are not responding adequately, or are in need of a short-term intervention.  

Any insomnia medication should be used under the guidance of a health professional, and patients should be informed about the potential risks and benefits of insomnia medications.

PHARMACOLOGICAL INTERVENTIONS

Continuous Positive Airway Pressure (CPAP) Therapy

Continuous Positive Airway Pressure (CPAP) and Bilevel Positive Airway Pressure (BiPAP) are the most commonly used in the treatment of Obstructive Sleep Apnea (OSA), a condition characterized by interruptions in breathing during sleep due to airway obstruction. 

CPAP remains the first-line treatment for moderate to severe OSA and for those with mild OSA who experience symptoms such as daytime sleepiness or cardiovascular disease. CPAP provides a constant and steady air pressure to keep the airways open during sleep.  

BiPAP, which provides two levels of pressure (higher during inhalation and lower during exhalation), is typically used when patients do not tolerate CPAP or in cases of severe OSA with co-existing conditions such as heart failure or lung disorders. It’s also sometimes used in the management of other respiratory diseases or conditions that cause hypoventilation, such as chronic obstructive pulmonary disease (COPD) or obesity hypoventilation syndrome.  

However, the application of CPAP or BiPAP should always be under the direction of a healthcare provider.  

HOME SLEEP TESTING

Home Sleep Testing

Home sleep testing is becoming more prevalent as a convenient and cost-effective method of diagnosing sleep disorders, particularly obstructive sleep apnea. These tests vary in complexity and what they measure. Some common types include:  

  • Type II Monitors: These portable multi-channel systems monitor brain waves (EEG), eye movement (EOG), muscle activity, heart rhythm (EKG), breathing, and blood oxygen levels using sensors placed on the body, closely replicating what is measured during in-lab polysomnography. 
     
  • Type III Monitors: These are more simplified devices than the Type II monitors, and usually record respiratory effort, airflow, and blood oxygen level. 
     
  • Type IV Monitors: These are single or dual-channel systems that typically record only one or two parameters, such as blood oxygen level or airflow.  
     
  • Sleep Apps and Wearable Devices: These technologies record movement during sleep or use sonar technology to detect respiratory rate and body movement. While these options are less precise, they can still provide helpful information and encourage good sleep habits. 

While home testing provides added convenience, it’s important to note that these tests are not suited to diagnosing all types of sleep disorders. Recommendations for home sleep tests should always be made by a healthcare provider. 

Sleep Profile Home Sleep Testing

The Sleep Profiler is a type of head-mounted device that is designed for home-based sleep studies. It provides high resolution frontal EEG (Electroencephalogram) data – similar to full polysomnography – but in a less intrusive manner suitable for home use. 

Frontal EEG patterns are used to determine sleep stage, while additional integrated sensors detect heart rate variability, snoring intensity, and head position. The Sleep Profiler also includes an accelerometer to record body movement. Collectively, these data can be used to diagnose sleep disorders such as insomnia or sleep apnea and to evaluate the effectiveness of various treatments.  

The data are then wirelessly transmitted to a secure web portal for interpretation by physicians, offering a more convenient method for patients and physicians to diagnose sleep disorders compared to traditional in-lab studies. 

Telemedicine Services

Yes, sleep disorders can be managed via telemedicine, according to recent studies and recommendations. Telemedicine involves using digital platforms and technology to offer remote patient care, including diagnosis and treatment.  

  • Cognitive Behavioral Therapy for Insomnia (CBT-I), which is typically the first line of treatment for insomnia, can be delivered effectively via telemedicine, with comparable outcomes to face-to-face therapy. 
     
  • For sleep disorders like Obstructive Sleep Apnea (OSA), telemedicine can be used for initial screening, diagnosis (via home sleep tests), treatment initiation (with CPAP or other therapies), monitoring, and follow-up care. 
     
  • Telemedicine has been found to be acceptable to patients and can lead to improved access to care, more timely treatment, cost savings, and reduced travel. 
     
  • During the COVID-19 pandemic, many sleep medicine practices have adapted to provide care through telemedicine successfully, this has highlighted the feasibility and potential benefits of this approach.  

However, while telemedicine offers many potential advantages, it may not be suitable for everyone and every situation. In-person care may be necessary in some cases, and some individuals may not have access to the necessary technology or prefer not to use it. 

TELEMEDICINE SERVICES

Reference links:

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https://www.ncbi.nlm.nih.gov/books/NBK19961/ 
 
https://pubmed.ncbi.nlm.nih.gov/15951083/ 
 
https://www.aafp.org/pubs/afp/issues/2022/0400/p397.html