Treatment and Management of Sleep Disorders
Good management of a sleep disorder depends on the sleep disorder and may include: learning more about your sleep disorder; practicing good sleeping habits; using and understanding devices to help you sleep; and, using and understanding medicines.
How are sleep disorders diagnosed?
What is a sleep study?
Other Tests To Diagnose Sleep Disorders May Include
How are sleep disorders managed?
How are sleep disorders diagnosed?
If a sleep disorder is suspected, your healthcare provider may refer you to our sleep clinic for an evaluation by our sleep specialists . Our doctors will perform a medical examination, carefully review your medical history, and may order other tests to determine any physical problems that may be causing a sleep disorder. You may also be asked to keep a sleep diary .
What is a sleep study?
Your physician, or our sleep specialists may recommend that you have an overnight Sleep Study to determine if you have a sleep disorder. A Sleep Study, also called a Polysomnogram, is a painless, non-invasive test that records your physical state during various stages of sleep. It provides essential data to evaluate sleep and sleep-related complaints and problems, such as: identifying sleep stages, body position, blood oxygen levels, respiratory events, muscle tone, heart rate, eye movement, brain waves, amount of snoring, and general sleep behavior.
If you are being tested for sleep apnea , you may undergo a “split-night” test, in which half the night will be used to diagnose your sleep problem, and the other half will be used to determine the best way to treat the problem. Or you may be asked to return for another sleep study to help us determine the best treatment for you.
Sleep studies are performed in a Sleep Lab that is specially equipped with computerized monitoring equipment. Studies are performed at our main health campus, at our Broomfield location and at the Denver Tech Center Sleep Lab.
Other Tests To Diagnose Sleep Disorders May Include:
Multiple Sleep Latency Test (MSLT)
This test, performed in our Sleep Lab, objectively determines your degree of sleepiness . On the day following an overnight Sleep Study, you will be asked to take four or five naps over an eight to ten hour period. Each nap period lasts about twenty minutes. During these nap periods, you will be closely monitored, as you were during your Sleep Study.
Maintenance of Wakefulness Test (MWT)
This test measures your ability to stay awake. It consists of four nap opportunities, each lasting forty minutes. During the nap period, you will be asked to try to stay awake. Most people without excessive sleepiness remain awake during these nap periods.
Performance and Vigilance Testing
This is a test of your ability to perform certain tasks. Driving simulators measure how you perform. They also measure alertness.
Actigraphy
For this test, a device called an actigraph is worn over the wrist like a watch. Signals are recorded when movement is detected. There are no signals recorded during sleep or inactivity. This can provide information about periods of rest / sleep activity. The device may be worn for several days to weeks, if needed.
Lab Tests
Your doctor may order lab tests. These may include drug screening for stimulants, opiates, and anti-anxiety medicines. These medicines are known to affect the level of alertness.
How are sleep disorders managed?
Practice Good Sleep Hygiene!
Once a sleep disorder is diagnosed, the first step in managing a sleep disorder is to practice good sleep hygiene (good sleep habits).
If practicing good sleep hygiene alone is not enough to manage your sleep disorder, there are other treatments and management strategies for:
Sleep Apnea
There are several options for managing sleep apnea. They include:
Maintaining An Ideal Weight
People who are overweight are more likely to develop sleep apnea. Therefore, maintaining an ideal weight is important in managing sleep apnea. Before starting a diet or exercise program, talk with your doctor about your plan to make sure it is safe.
Sleeping Position
Some people breathe better and snore less loudly when sleeping on their sides or stomach. There are simple techniques to keep you from sleeping on your back, including sewing a tennis ball to the back of your pajama top, wearing a soft backpack at night, or placing a pillow under your shoulder.
CPAP (Continuous Positive Airway Pressure)
More severe cases of sleep apnea may require CPAP. This common and effective treatment provides pressure to the person’s airway through a machine that blows air. The airflow from the CPAP machine is delivered through a mask that fits on the face and covers the nose, or the nose and mouth. This air acts as a splint to keep the airway open during sleep, allowing breathing to become more regular. Snoring stops and restful sleep is restored. Risk factors associated with untreated sleep apnea are greatly reduced when CPAP is used as prescribed by the doctor.
Dental Devices
Dental devices are designed to push the jaw forward. Worn at night, they widen the throat and increase the size of the airway.
Surgery
Surgery may help improve sleep apnea, depending on the cause. A deviated nasal septum can be fixed, or enlarged adenoids or tonsils can be removed. More extensive surgery can also be performed, e.g., remodeling the air passages in the throat (uvulopalatopharyngoplasty). Other surgical options include making an opening in the throat to bypass the upper airway (tracheotomy), or reconstruction of the jaw. Your doctor will help you decide if surgery is an option for you.
Learn more about treating and managing sleep apnea.
Restless Legs Syndrome and Periodic Limb Movement
People with restless legs syndrome or periodic limb movement disorder without symptoms often do not need treatment. Medicines are available for people with symptoms. Ask your doctor what medicines would be best for you.
Low blood levels of iron can also cause these disorders. If an iron deficiency is present, medicines to increase iron may be given. Caffeine, nicotine, alcohol or heavy meals can make these disorders worse.
Narcolepsy
Medicines may be prescribed for people with narcolepsy, and may be needed for life. Some people find brief naps helpful.
Circadian Sleep Disorders
Disturbances of the rhythm of our internal clock can be managed with light therapy to readjust the timing of sleep and wakefulness. People with a delayed sleep-phase should have exposure to light in the early morning. Light exposure in the late evening is used for people with an advanced sleep-phase. A medical eye exam should be performed before light therapy is started.
Parasomnias
Parasomnias, including sleepwalking and sleep terrors, are more common in children. They usually resolve as the child grows, and do not often require treatment. Other parasomnias, such as REM sleep behavior disorder, can cause major safety risks, and often require treatment. To help identify this and see if treatment is needed, ask your doctor.
Insomnia
Behavioral Management of Insomnia
Medicines to Treat Insomnia
Behavioral Management of Insomnia
Behavior therapy can help reduce the factors that disrupt sleep. Behavior programs that may help insomnia include stimulus control therapy, relaxation techniques, temporal control therapy and sleep restriction therapy. It is common to combine several approaches.
Stimulus control therapy helps to strengthen the connection of the bedroom with sleeping rather than with insomnia.
- The bedroom is to be used only for sleep and sexual activity. Eating, working, playing, and watching television are not allowed in bed.
- Go to bed only when sleepy. If unable to sleep after 15 to 20 minutes in bed, leave the bedroom. Return only when drowsy. Until drowsy, engage in restful activities such as reading with a dim light.
Relaxation techniques target issues that may cause insomnia.
- Exercises that tense and relax each muscle group help the muscles relax.
- Stressors may be decreased by meditation, in which thoughts are redirected towards pleasant topics.
Temporal control therapy promotes the routine of the sleep-wake schedule.
- Get out of bed at the same time each day.
- Avoid daytime naps.
Sleep restriction therapy seeks to increase the quality of sleep by limiting time spent in bed to sleeping only.
- Do not spend too much time in bed awake. For example, the amount of time spent in bed may be kept to 6 to 6.5 hours per night if your total sleep time is 6 hours nightly. The mild sleep deprivation that is allowed to develop is expected to increase your ability to sleep. Your time in bed is increased slowly by going to bed earlier until you are sleeping the amount of time that leaves you feeling rested.
Medicines to Treat Insomnia
Hypnotic or sedating medicines may be used to treat sleep problems and may be helpful for short sleep problems caused by jet lag or acute stress. These medicines may also be prescribed for chronic insomnia.
Barbiturates, chloral hydrate, antihistamines and some antidepressants, were all prescribed in the past. They have been replaced with newer and safer medicines. Antihistamines (many over-the-counter) are helpful for mild insomnia. Talk with your doctor before taking over the counter medicines for insomnia.
Some sedating medicines may be used to treat insomnia. Short acting medicines are used for people who have trouble falling asleep. For people who can’t fall asleep quickly and wake up often, intermediate action medicines may be helpful. Long acting medicines are used for people who wake up early and have daytime anxiety.
Sedating medicines can cause side affects and should be used with caution.
- Long acting medicines may cause sleepiness the next day. This may be more noticeable among the elderly, and may contribute to accidents and falls.
- Caution must be used when operating motor vehicles or when performing tasks that require alertness.
- Insomnia may develop again if medicines are stopped quickly.
- Tolerance may develop with long-term use of medicines.
- Pregnant women and breast-feeding mothers should not take sedating medicines. People with liver or kidney problems may need to have their dosage adjusted. And, those with sleep apnea and chronic lung disorders should use caution, as sedating medicines may suppress breathing.
Might you, or someone you care about, be suffering from a sleep disorder? National Jewish can help.
Are you a healthcare professional looking for more information? .
This information has been approved by Teofilo Lee-Chiong Jr., MD (December 2006).
