Sleep Disorders

Restless Leg Syndrome
Restless Leg Syndrome (RLS) or Willis-Ekbom Disease is a neurological disorder characterized by an irresistible urge to move ones’ body to stop uncomfortable sensations. It most commonly affects the legs, but it can affect the arms, legs, or torso, and even phantom limbs or odd sensations. Moving the affected body part offers temporary relief. As with many diseases with diffuse symptoms, there is controversy among physicians as to whether RLS is a distinct syndrome.

Restless Leg Syndrome may start at any age, including childhood, and is a progressive disease for some, while the symptoms may cease in others.

Risk Factors
Restless leg syndrome (RLS) may affect 3 - 15% of the general population. It is more common in women than in men, and its frequency increases with age. The disorder affects an estimated 10 - 28% of adults older than age 65. In about 40% of patients, RLS begins in adolescence.

In most cases, the cause of RLS is unknown. However, it may have a genetic component; RLS is often found in families where the onset of symptoms is before age 40. Specific gene variants have been associated with RLS. Evidence indicates that low levels of iron in the brain also may be responsible for RLS.

Considerable evidence suggests that RLS is related to a dysfunction in the brain’s basal ganglia circuits that use the neurotransmitter dopamine, which is needed to produce smooth, purposeful muscle activity and movement. Disruption of these pathways frequently results in involuntary movements. Individuals with Parkinson’s Disease, another disorder of the basal ganglias dopamine pathways, often have RLS as well.

RLS also appears to be related to the following factors or conditions, although researchers do not yet know if these factors actually cause RLS:

Alcohol and sleep deprivation also may aggravate or trigger symptoms in some individuals. Reducing or completely eliminating these factors may relieve symptoms, but it is unclear if this can prevent RLS symptoms from occurring at all.

Tests and Diagnosis
There is no specific test for RLS. The four basic criteria for diagnosing the disorder are:

Physicians should focus largely on the individual’s descriptions of symptoms, their triggers and relieving factors, as well as the presence or absence of symptoms throughout the day. A neurological and physical exam, plus information from the individual’s medical and family history and list of current medications, may be helpful. Individuals may be asked about frequency, duration, and intensity of symptoms as well as their tendency toward daytime sleep patterns and sleepiness, disturbance of sleep, or daytime function.

Laboratory tests may be performed to rule out other conditions. Blood tests can identify iron and vitamin deficiencies as well as other medical disorders associated with RLS. In some cases, sleep studies such as polysomnography (a test that records the individual’s brain waves, heartbeat, breathing, and leg movements during an entire night) may identify the presence of other causes of sleep disruption (e.g., sleep apnea), which may impact management of the disorder.

Diagnosing RLS in children may be especially difficult, since it may be hard for a child to describe where it hurts, when and how often the symptoms occur, and how long symptoms last. Pediatric RLS can sometimes be misdiagnosed as "growing pains" or attention deficit disorder.

Treatment For Restless Leg Syndrome (RLS)
RLS can be treated, with care directed toward relieving symptoms. Moving the affected limb(s) may provide temporary relief. Sometimes RLS symptoms can be controlled by finding and treating an associated medical condition, such as peripheral neuropathy or diabetes.

Certain lifestyle changes and activities that may reduce symptoms in persons with mild to moderate symptoms include decreased use of caffeine, alcohol, and tobacco; supplements to correct deficiencies in iron, folate, and magnesium; changing or maintaining a regular sleep pattern; a program of moderate exercise; and massaging the legs, taking a hot bath, or using a heating pad or ice pack. A trial of iron supplements is recommended only for individuals with low iron levels. Although many people find some relief with such measures, rarely do these efforts completely eliminate symptoms.
Medications are usually helpful but no single medication effectively manages RLS for all individuals. Trials of different drugs may be necessary. In addition, medications taken regularly may lose their effect over time, making it necessary to change medications periodically.

Causes: Restless Leg Syndrome
In many cases, no known cause for restless leg syndrome exists. Researchers suspect the condition may be due to an imbalance of the brain chemical dopamine. This chemical sends messages to control muscle movement.

RLS runs in families in at least half the people with RLS, especially if the condition started at an early age. Researchers have identified sites on the chromosomes where genes for RLS may be present.

Pregnancy or hormonal changes may temporarily worsen RLS signs and symptoms. Some women experience RLS for the first time during pregnancy, especially during their last trimester. However, for most of these women, signs and symptoms usually disappear quickly after delivery.

Related Conditions
For the most part, restless leg syndrome isn't related to a serious underlying medical problem. However, RLS sometimes accompanies other conditions, such as:
1. Peripheral neuropathy. This damage to the nerves in your hands and feet is sometimes due to chronic diseases such as diabetes and alcoholism.
2. Iron deficiency. Even without anemia, iron deficiency can cause or worsen RLS. If you have a history of bleeding from your stomach or
bowels, experience heavy menstrual periods, or repeatedly donate blood, you may have iron deficiency.
3. Kidney failure. If you have kidney failure, you may also have iron deficiency, often with anemia. When kidneys fail to function properly, iron stored in your blood can decrease. This, with other changes in body chemistry, may cause or worsen RLS.

The symptoms of restless leg syndrome (RLS) can range from mildly annoying to severely disabling. You may experience the symptoms only once in a while, such as when you are under a lot of stress, or restless legs may plague you every night.

Jet lag
Jet lag, medically referred to as desynchronosis is a physiological condition which results from transmeridian (east–west or west–east) travel on a jet aircraft. It is classified as one of the circadian rhythm sleep disorders. The condition of jet lag may last several days until one is fully adjusted to the new time zone, and a recovery rate of one day per time zone crosses is the suggested recovery timeline. The issue of jet lag is especially pronounced for airline pilots, crew, and frequent travelers. Airlines have regulations aimed at combating pilot fatigue caused by jet lag.

The symptoms of jet lag can be quite varied, depending on the amount of time zone alteration, time of day and the susceptibility of individual differences. Sleep disturbance manifests itself with poor sleep upon arrival, sleep disruption including trouble falling asleep (if flying east), early awakening (if flying west) and interrupted sleep with multiple awakenings and trouble remaining asleep. Other symptoms are:

Jet lag has been measured with simple analogue scales but a study has shown that these are relatively blunt for assessing all the problems associated with jet lag. The Liverpool Jet lag Questionnaire was developed to measure all the symptoms of jet lag at several times of day, and this dedicated measurement tool has been used to assess jet lag in athletes.

Jet lag usually doesn't require treatment. However, if you're a frequent traveler continually bothered by jet lag, your doctor may prescribe medications or light therapy.

Disruption to your circadian rhythms
Jet lag can occur anytime you cross two or more time zones. Jet lag occurs because crossing multiple time zones puts your internal clock or circadian rhythms, which regulate your sleep-wake cycle, out of sync with the time in your new locale. Some research shows that the changes in cabin pressure associated with air travel may also contribute to some symptoms of jet lag, regardless of travel across time zones.

A key influence on your internal clock is sunlight. That's because the pineal gland, a part of the brain that influences circadian rhythms, responds to darkness and light. Certain cells in your retina — the tissue at the back of your eye — transmit the signal of light to an area of your hypothalamus, a part of your brain. The signal is then sent to your pineal gland. At night, the pineal gland releases the sleep-promoting hormone melatonin. During the day, melatonin production is very low. So you may be able to ease your adjustment to your new time zone by exposing yourself to daylight in that new time zone.

Risk Factors
Factors that increase the likelihood you'll experience jet lag include:

Prepare your body for the change in time zones.
Every week, push your schedule one hour back or forward, depending on where you're going. The more time zones you're flying across, the earlier you'll need to start. This will give your body a chance to gradually adjust to your new time zone.

If the time difference is several hours, however, it may prove inconvenient to spend your final week before leaving 3 or 4 or more hours ahead or behind everyone else. Alternatively, you can shift your eating and sleeping schedule by an hour a day.

Stay hydrated. On the day of your flight, drink plenty of fluids. Dehydration is one of the symptoms of jet lag, and the dry, cabin air on the plane doesn't help. Stay away from any beverages with alcohol or caffeine in them, as the side effects of dehydration can do more harm than good.

Sleepwalking is also known as somnambulism and is classified as a parasomnia, an undesirable behavior during sleep. It involves getting up and walking while the individual is still asleep.

Sleepwalking is less common in adults and has a higher chance of being confused with or coexisting with other sleep disorders. Sleepwalking in adults also carries a higher risk of endangering others. Sleep Solution Doctors has the knowledge and tools to sort through multiple sleep issues and accurately diagnose the cause of a patient's sleep problems.


Risk Factors
The most common risk factor for sleep walking is that it is hereditary. An individual is more likely to develop this disorder if it runs in the family.

Many factors can contribute to sleepwalking, including:

The following underlying conditions may also contribute to sleepwalking:

Generally, there is no treatment necessary for sleepwalking. In children, they must be gently redirected back to bed and its best not to wake the child. In adults sometimes hypnosis is used, and in severe cases medications may be prescribed.


Night terrors or sleep terrors
Night terrors or sleep terrors are episodes of screaming with fear while still sleeping. It is more common in children than adults; nevertheless adults may experience it as well. A small percentage of children experience night terrors, usually between the ages of 4 and 12.


Risk Factors
Usually hereditary and may occur in adults with history of anxiety and depression.

Causes Night Terror

Treatments: Night terrors
Treatment for night terrors isn't usually necessary. If your child has a night terror, it’s best to wait it out. Gently restrain your child to ensure his or her safety and try to get him or her back into bed. Speak softly and calmly. Shaking or shouting usually tends to make it worse.

If the sleep terrors are associated with an underlying medical or mental health condition or another sleep disorder, treatment is aimed at the underlying problem. If stress or anxiety seems to be contributing to the sleep terrors, your doctor may suggest meeting with a therapist or counselor. Cognitive behavior therapy such as hypnosis, biofeedback and relaxation therapy may help.

Medication is rarely used to treat sleep terrors, particularly for children. If necessary, however, use of benzodiazepines or some antidepressants may help reduce sleep terrors.

Tests and Diagnosis
Night terrors are usually self-diagnosed.

Nightmares are dreams that are often related to feelings of anxiety or fear. Some children experience nightmares in early childhood until about age 10 when they tend to decrease, however they can continue into their teens or even adulthood. At around age13, nightmares become more prevalent in girls than boys.

Nightmares are associated with stress and anxiety. Watching a scary movie or reading scary books may also cause nightmares. Other possible causes are eating late, fever, certain medications and/or substance abuse. Traumatic events can also trigger nightmares.

Imagery Rehearsal Therapy is the most common therapy for nightmares. This involves changing the ending to the patients’ nightmare to a positive ending while he or she is awake. The patient is then asked to rehearse the new ending in his or her mind. This approach tends to reduce the frequency of the nightmares.

Treatment is not usually necessary for nightmares. If the nightmares are caused by stress, stress reduction techniques, counseling or therapy may be recommended. If an underlying condition is causing the nightmare, treatment will be targeted to the underlying condition.

Tests and Diagnosis
There are no specific diagnostic tests for nightmares. If the patient reports significantly disturbed sleep, the doctor may recommend a sleep study to determine whether the nightmares are caused by another underlying sleep disorder.

Bruxism is the chronic involuntary clenching or grinding of teeth usually during sleep but may also occur while awake.

Risk Factors

The exact cause of bruxism is unknown, but it is believed to be related to:

Methods of treatment include:

This method focuses on changing behavior through various techniques, such as:

Orthodontic Treatment
Your dentist may recommend a protective mouth appliance, such as a night guard, that can absorb the pressure of constant night grinding.

Medication is only recommended for short-term use. Medications may include:

Bruxism that is not treated may result in gum damage, loss of natural teeth, and jaw-related disorders.

The same methods used to treat bruxism can be used to prevent the condition.

Night Leg Cramps
Night time leg cramps are usually sudden spasms, or tightening, of muscles in the calf. These cramps can sometimes happen in the thigh or the foot. They often occur just as you are falling asleep or waking up. The risk of having night leg cramps increases with age. Pregnant women also have a higher likelihood of experiencing night leg cramps.

Risk Factors

The cramp, or “charley horse”, is due to the muscle contracting (shortening and tightening) in a sudden and violent way. These nocturnal leg cramps usually occur in the calf muscle. But foot and leg cramps do happen at night also. Cramps in the thighs are less common.
One main reason for the pain is because blood flow to the muscle is restricted. Waste products also build up within the muscle tissue.

Talk with your doctor about the best plan for you. If no specific cause can be found, treatment options include the following:

None of these medications have earned full approval for either safety or efficacy. Quinine, while often effective for reducing the frequency and intensity of cramps, has a significant risk of major allergic reactions. The other prescription medications carry risks as well so they are not generally recommended. They are most often used in only severe cases.

To reduce your chance of getting nocturnal leg cramps, take the following steps:

Face a wall and put your hands on the wall and keep them there. Step backward. Keep your knees locked. Keep your heels on the floor until you feel a strong pull in your calves. Hold that position for 10 seconds. Repeat two or three times.