Snoring and Sleep

Polysomnography is a method for the diagnosis of sleep disorders in which brain waves (electroencephalography), muscle movements (EMG), heart and breathing functions are measured and recorded. Patients who are referred by an expert doctor who listened to their complaints are directed to sleep laboratory and their appointments are made. When patient come for the appointment in sleep laboratory, preparations for sleep test are done and patient is informed.

Sleep technician inserts the necessary electrodes. In order to record brain activity and waves electrodes are inserted on the scalp, for eye movements two electrodes next to each eye, for muscle movements on the chin and legs, and for heart functions electrodes are inserted around breasts. For measuring the oxygen level in the blood, a sensor is inserted on the finger, and for breathing functions a sensor is inserted on the nose, belts are used for position evaluation. Patient is taken to bed when preparations are made and test begins. Patient is not given any drugs for sleeping and recordings are taken when he or she sleeps as usual. Patient is prepared in a way to feel comfortable with these electrode and sensors all night. Patient can sleep in any position with comfort. Patient can get up from the bed whenever he or she wants to. Recordings are watched by a technician all night and patient room is watched from the camera. Patient can communicate with the technician via the pager phone next to their bed. Patient who has been sleeping all night is expected to wake up spontaneously. Test ends when he or she wants to get up and electrode and sensors are taken out. Recordings are analyzed by expert doctors the other day and reports are given to patient.

Insomnia

Difficulty in falling asleep and staying asleep (is called insomnia) is a common problem which can be seen in one out of 3 persons. IF you have a complaint about it, you know how it affects your night and days. It makes you feel tired all the day. It makes it harder for you to focus on your jobs.
In order to treat insomnia, find the reasons and effects, you need to keep tracks of what is good for you. In most cases, sleeplessness is a result of a few factors. Among these factors, there are what you think about sleeping, your choices on life conditions and where you sleep. In some occasions medical and psychiatric problems are causes of sleeplessness.

What can cause insomnia?

Psychological Factors

Some people who are disposed to sleeplessness suffer from it easier than others in stressed periods. Others respond to this stress with headache or stomachache. If a person knows that he/she is disposed to being sleepless and that won’t take long, it will be better for him to deal with it when needed.

Permanent stress family problems, a son with serious diseases or an unsatisfactory job may cause sleep problems. Learning how to handle stres may help you treat your sleeplessness.

Environmental Factors

Sound: Keep your bedroom as quite as possible. Close traffic, planes, tv and other sounds will affect your sleep without any other reasons.
Lights: Use window shades and thick curtains to keep your bedroom dark. Light reaches your eyes even if your eyes are closed. Lights will affect your sleep. If you feel tired even though when you think you have slept all night, all these factors must be considered.

When should I get help?

If your sleep is impaired for more than a month and if it affects your daily routine, it is time to seek help. Consult your doctor and ask for a meeting with sleep diseases expert. Your medical history, physical examination and some blood tests will be helpful for finding the causes. Your partner and family members may have valuable information about your sleep. Ask them if you snore or be restless while sleeping. Your health expert will want to know if sleeplessness make you tired sleepy or depressive during they and affect your life in other ways.

Questionnairre

– Have you ever been told that you snored, you had irregular breathing or your breathing stopped for some time during sleeping?
– Do you commonly feel sleepy or sleep after eating?
– Do you feel sleepy while driving or working?
– Do you feel restless when you wake up in the morning?
– Do you complain about being forgetful, having lack of attention and concentration?
– Do you have troubles falling asleep?
– Do you wake up commonly in the night when you sleep?
– Have you ever been told that you had muscle contractions on your legs and/or arms while you were sleeping?
– Do you feel restlessness on your legs while you are falling asleep or when you wake up? DO you feel the need to get up from the bed and walked because of it?
– Do you have sleep attacks that you cannot resist during the day?
– Do you have nightmares commonly?
– Have you ever been told that you walk, talk or gnash the teeth when you sleep?

If you answer yes to any of these we suggest that you consult your doctor. Restless leg syndrome

What is Restless Leg Syndrome?

Restless Leg Syndrome (RLS) is a movement disorder. Patients feel an unbearable need to move their legs at nights. Symptoms differ on every patient. Most of the patients have difficulties while telling the uncomfortable feelings on their legs. They commonly define ‘numbness’ or ‘prickling’. These feelings are different than cramps. This feeling is most commonly in shanks. Sitting idly or laying down increases these feelings. Moving the legs or stretching them lowers these complaints for a short time.

Some patients define similar feelings in arms too. While complaints of some RLS patients are not permanent, some of them may show up every night. Therefore sleep qualities of many patients are low. They can be very tired during the day because of low sleep quality. With the same reason, their Professional and social lives may be impaired. Sleepy condition during the day is only one of the problems that RLS causes. These patients commonly have troubles while travelling by car or planes. Similarly, they have troubles in cinemas, theatres and business meetings, in which they have to sit idly for long time. RLS may cause anxiety and depression because of low quality of sleep and sleep interruptions.

Most of the patients who have RLS also have ‘periodic limb movement disorder’. Patients commonly have a flexural position in their toes while sleeping. This may be accompanied by a joint move like twitching of ankles, knee and hips. Sometimes these movements are defined like myoclonus or kicking by their partners. Periodic limb movements have a leaning towards being periodic. Their intervals are usually 20-40 seconds. They appear more commonly in the first half of the night. Just like RLS, these movements may appear in arms too.

As a difference from RLS, ‘Periodic Limb Movements Disorder’ always occurs in sleep. Patients are not aware of the situation; therefore it is not possible for them to take it under control. In contrast, RLS shows symptoms during the day and legs are moved due to unpleasant feelings.

‘Periodic Limb Movement Disorder’ may impair sleep quality just like RLS does. It may cause brief awake moments during sleep. These brief awake moments are told ‘microarousal’. Therefore interrupted sleeps appear which do not let the patients rest. Patients become sleepy all the day. They feel sleepy while reading newspaper, watching TV or driving. ‘Periodic Limb Movements Disorder’ do not just impair the sleep of patients but also their partners. These partners may tell that they got kicked all the night. Their blankets which they cover themselves while sleeping may fall of during the night.

Is RLS a common disease?

Most of the RLS patients do not have any other major diseases. IT is seen both in men and women. In our country, this disease is seen in three persons out of 100. In western countries, higher rates have been reported. Spontaneous recovery is very rare apart from some special occasions such as pregnancy. It follows the same severity for years without any specific cause. It is seen more commonly in women. Although some studies have reported it being higher amongst older people, in the society based study which was made in our country there were no significant differences between young and old people. Children who have RLS in their family have a higher risk. Sometimes these complaints are wrongfully evaluated as pains due to growth. Some kids are wrongfully diagnosed with lack of attention-hyperactivity syndromes. However these kids are not hyperactive but they feel the need to move their legs due to RLS. RLS may appear in pregnancy or become worse. It may become more visible in especially the last 6 months of pregnancy.%80 percent of RLS patients also have ‘periodic limb movement disorder’ but the opposite is not common. Most of the ‘periodic limb movement disorder’ patients do not have RLS.

What causes RLS?

RLS patients have difficulties defining their complaints. These conditions may wrongfully be interpreted as a psychological symptom. RLS is not a psychological disease though. The causes of this disease are not certain. ‘Dopamine’ which is a substance that works as a mediator in brain, is pointed at. Because dopamine increasing drugs of nervous system are effective in treatment.
In some diseases, RLS incidence is high. In other words, we can say that these
diseases provide a basis for RLS. These diseases are;

• Iron deficiency anemia
• Blood flow disorders of the leg
• Hernia or leg nerve impairments
• Kidney diseases
• Muscle diseases
• Alcoholism
• Some vitamin and mineral deficiencies

RLS may be a genetic disease. The possibility of having this disease for one of the relatives of a RLS patient, who do not have any of these disease above, is %50. This situation points towards heredity. This hereditary form may appear in young ages, even in childhood, and it is more difficult to treat than non-hereditary forms.
Some depression drugs, allergy drugs and painkillers may aggravate RLS symptoms or make them be visible. Caffein, alcohol and tobacco use also aggravates its symptoms.

How is RLS diagnosed?

Neurology experts or expert doctors who are interested in sleep disorders can make a diagnosis. There is no blood test or imaging method to diagnose RLS yet. Diagnosis is made by a detailed medical history and physical examination. RLS symptoms are very typical and no additional tests are required. If there is a doubt or there is an existing disease that may aggravate RLS, blood tests, EMG or sleep test may be required for diagnosis.

If you have all of these complaints below you have RLS:

1- Restless feeling in both of your legs and the need to move them because of it.
2- This feeling fading away when you move your legs for a brief moment.
3- These complaints showing up or becoming more visible when you are motionless or at night.

How is RLS treated?

First step is to define other diseases that may aggravate or cause RLS. Amongst these diseases, there are iron deficiency anemia, diabetes and arthritis. Some drugs may also aggravate RLS.
Treatment of these diseases or quitting these drugs sometimes lowers the complaints or rarely makes them disappear. However most of the time RLS complaints keep on even if these diseases are treated. Besides, more than half of the patients do not have any other diseases or drug use.
In light forms of RLS, some precautions such as hot bath, leg massage, hot towel, ice application, painkillers, regular exercise and avoiding caffeine, which the patients discover themselves, might be helpful. Some exercises for the brain in the evenings which requires intense mental activity such as solving puzzles might also help. However in intermediate or severe forms, these precautions are insufficient and the patients need to take RLS drugs. The efficiency of these drugs differ from patient to patient. While choosing the drugs, factors such as additional diseases, age, and severity of the disease must be taken into consideration. All of the drugs have side effects. Therefore, close follow-up is required especially in first months of the treatment.

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