A host of neurologic, metabolic, and psychiatric conditions may cause a disruption in the usual sleeping patterns. Among the disorders that most commonly cause sleep disturbance are Parkinson's disease, Alzheimer's dementia, arthritis, nocturnal chest pain, gastrointestinal disorders, anxiety with or without panic attacks, and depression.
1. Parkinson's Disease
Sleep fragmentation with frequent awakenings each night, lighter sleep, and diminished REM and total sleep time are commonly seen in Parkinson's disease. In addition, a Parkinsonian tremor, rigidity, and abnormal complex motion may occur during sleep in some individuals with the disease. The result of these abnormalities is a customary daytime sleepiness.
2. Alzheimer's Dementia
Nighttime arousal and agitation that includes pacing the floor and verbal aggressiveness among persons with various types of dementia is referred to as "sundowning", a nocturnal abnormality that occurs in as many as 40% of persons with Alzheimer's and other dementias.
3. Arthritis
A significant percentage of persons, probably 80% or more at one time in their lives or another, have back pain or other joint problems that are severe enough to affect sleep. For some with joint or back pain, sleep deprivation is a chronic problem. For them, taking pain medicine has become a nightly ritual to allow sleep.
4. Nocturnal Chest Pain
Chest pain at rest, typically during the night, is a variant of angina pectoris (chest pressure pain due to insufficient blood flow to the heart) that occasionally disrupts the sleep of cardiac patients. Heart arrhythmias, some causing a sensation of rapid heart beats (palpitations), can also disturb sleep comfort and, in the extreme, can be dangerous.
5. Gastrointestinal Discomfort At Night
Gastro-esophageal reflux associated with heartburn can occur at night as partly
digested food backs up into the esophagus when a person reclines. Duodenal ulcer acid secretion is frequently greatest in the first few hours after sleep onset, representing a mechanism for ulcer pain at night that can interfere with sleep.
6. Anxiety Disorders
Persons who cannot stop thinking about their problems at night and are chronically anxious will often have a chronic insomnia with problems both initiating and maintaining sleep. Short-term episodes of anxiety and fright that include hysterical behavior, rapid heartbeat, and pain--known as panic attacks--may occur at night and disturb sleep.
7. Depression
Persons with major depression commonly experience insomnia. Sometimes insomnia is the main presenting symptom to a doctor when the depressed person is unaware that depression is the underlying cause. The insomnia associated with depression often requires a higher dosage of sleeping medication and concomitant treatment of the depression for restoration of better sleep.
It is always necessary to have information about a person's medical history in order to fully evaluate a sleep problem. Such problems may require a collaboration between the primary care physician and the sleep medicine specialist for most successful treatment of the disordered sleep. For the most thorough evaluation of your sleep disorder, arrange for a referral to a local sleep medicine specialist.
