Restless Legs Syndrome
Restless legs syndrome (RLS) is a common yet under-diagnosed movement disorder that is characterized by unpleasant limb sensations occurring at rest and is associated with an irresistible urge to move.
Periodic limb movements (PLM) may accompany these sensations and often interfere with sleep onset or sleep quality. Discomfort, sleep disturbances, and fatigue are direct results of RLS and may have a negative impact on a person's quality of life.
Although RLS was first recognized several centuries ago, it was not until recently that progress began in defining the clinical features of RLS. Specifically, an International RLS Study Group, (the IRLSSG), has organized and has started to define the characteristic symptoms of RLS.
Criteria for the diagnosis of RLS, as described by the IRLSSG, include four features:
An urge to move the legs usually accompanied or caused by uncomfortable and unpleasant sensations in the legs. (Sometimes the urge to move is present without the uncomfortable sensations and sometimes the arms or other body parts are involved in addition to the legs.)
The urge to move or unpleasant sensations begin or worsen during periods of rest or inactivity such as lying or sitting.
The urge to move or unpleasant sensations are partially or totally relieved by movements, such as walking or stretching, at least as long as the activity continues.
The urge to move or unpleasant sensations are worse in the evening or night than during the day or only occur in the evening or night. (When symptoms are very severe, the worsening at night may not be noticeable but must have been previously present.)
Epidemiologic studies have indicated that 5% to 15% of the adult population may experience RLS symptoms.
RLS is easily diagnosed by Actigraphy and PSG studies. No single therapy has been globally approved for the treatment of RLS. Germany and Switzerland are the only countries with an approved treatment available specifically for RLS. A number of treatments have been used off label in the UK, including levodopa, dopamine agonists, benzodiazepines, opioids, and anticonvulsants.
RLS may also occur as part of another disease or illness and may be the first sign of these. This type of RLS is called secondary RLS and occurs in people with Diabetes, Parkinson's disease, Rheumatoid Arthritis, Iron Deficiency Anaemia, in Pregnancy, Neurological diseases and some drugs may cause RLS.
The Sleep Medicine group of sleep centres is actively involved in Research in RLS
Monday, January 18, 2010
Insomnia
Insomnia
Insomnia is an experience of inadequate or poor quality sleep characterized by one or more of the following:
difficulty falling asleep
difficulty maintaining sleep
waking up too early in the morning
nonrefreshing sleep
Insomnia also involves daytime consequences such as:
tiredness
lack of energy
difficulty concentrating
irritability
As many as one-third of patients seen in the primary care setting may experience occasional difficulties in sleeping, and 10 percent of those may have chronic sleep problems.
About 30 to 40 percent of adults indicate some level of insomnia within any given year, and about 10 percent to 15 percent indicate that the insomnia is chronic and/or severe. The prevalence of insomnia increases with age and is more common in women.
Types of Insomnia
Acute Insomnia: Periods of sleep difficulty lasting between one night and a few weeks are referred to as acute insomnia. Acute insomnia is often caused by emotional or physical discomfort. Some common examples include significant life stress; acute illness; and environmental disturbances such as noise, light, and temperature. Sleeping at a time inconsistent with the daily biological rhythm, such as occurs with jet lag, also can cause acute insomnia.
Chronic insomnia refers to sleep difficulty at least three nights per week for one month or more. Chronic insomnia can be caused by many different factors acting singly or in combination, and often occurs in conjunction with other health problems. In other cases sleep disturbance is the major or sole complaint, and involves abnormal sleep-wake regulation or physiology during sleep.
Insomnia associated with psychiatric, medical and neurological disorders. Although psychiatric disorders are a common source of chronic insomnia, they account for less than 50 percent of cases. Mood and anxiety disorders are the most common psychiatric diagnoses associated with insomnia. Insomnia can also be associated with a wide variety of medical and neurological disorders. Factors that cause problems throughout the day such as pain, immobility, difficulty breathing, dementia, and hormonal changes associated with pregnancy, peri-menopause, and menopause can also cause insomnia. Many medical disorders worsen at night, either from sleep per se, circadian influence (e.g., asthma), or lying down (e.g. gastro-oesophageal reflux).
Insomnia associated with medication and substance use. A variety of prescription drugs, non-prescription drugs, and drugs of abuse can lead to increased wakefulness and poor-quality sleep. The likelihood of any given drug contributing to insomnia is unpredictable and may be related to dose, lipid solubility, individual genomic differences, and other factors. Some drugs commonly related to insomnia are stimulating antidepressants, steroids, decongestants, beta blockers, caffeine, alcohol, nicotine, and recreational drugs such as Ecstasy.
At the Sleep Medicine group of sleep centres we offer a specialised treatment service for patients who have insomina associated with substance abuse please contact us for further information.
Insomnia associated with specific sleep disorders. Insomnia can be associated with specific sleep disorders, including restless legs syndrome (RLS), periodic limb movement disorder (PLMD), sleep apnoea, and circadian rhythm sleep disorders.
Primary Insomnia: When other causes of insomnia are ruled out or treated, remaining difficulty with sleep may be classified as primary insomnia. Factors such as chronic stress, hyper-arousal, poor sleep hygiene, and behavioural conditioning may contribute to Primary Insomnia.
Insomnia is an experience of inadequate or poor quality sleep characterized by one or more of the following:
difficulty falling asleep
difficulty maintaining sleep
waking up too early in the morning
nonrefreshing sleep
Insomnia also involves daytime consequences such as:
tiredness
lack of energy
difficulty concentrating
irritability
As many as one-third of patients seen in the primary care setting may experience occasional difficulties in sleeping, and 10 percent of those may have chronic sleep problems.
About 30 to 40 percent of adults indicate some level of insomnia within any given year, and about 10 percent to 15 percent indicate that the insomnia is chronic and/or severe. The prevalence of insomnia increases with age and is more common in women.
Types of Insomnia
Acute Insomnia: Periods of sleep difficulty lasting between one night and a few weeks are referred to as acute insomnia. Acute insomnia is often caused by emotional or physical discomfort. Some common examples include significant life stress; acute illness; and environmental disturbances such as noise, light, and temperature. Sleeping at a time inconsistent with the daily biological rhythm, such as occurs with jet lag, also can cause acute insomnia.
Chronic insomnia refers to sleep difficulty at least three nights per week for one month or more. Chronic insomnia can be caused by many different factors acting singly or in combination, and often occurs in conjunction with other health problems. In other cases sleep disturbance is the major or sole complaint, and involves abnormal sleep-wake regulation or physiology during sleep.
Insomnia associated with psychiatric, medical and neurological disorders. Although psychiatric disorders are a common source of chronic insomnia, they account for less than 50 percent of cases. Mood and anxiety disorders are the most common psychiatric diagnoses associated with insomnia. Insomnia can also be associated with a wide variety of medical and neurological disorders. Factors that cause problems throughout the day such as pain, immobility, difficulty breathing, dementia, and hormonal changes associated with pregnancy, peri-menopause, and menopause can also cause insomnia. Many medical disorders worsen at night, either from sleep per se, circadian influence (e.g., asthma), or lying down (e.g. gastro-oesophageal reflux).
Insomnia associated with medication and substance use. A variety of prescription drugs, non-prescription drugs, and drugs of abuse can lead to increased wakefulness and poor-quality sleep. The likelihood of any given drug contributing to insomnia is unpredictable and may be related to dose, lipid solubility, individual genomic differences, and other factors. Some drugs commonly related to insomnia are stimulating antidepressants, steroids, decongestants, beta blockers, caffeine, alcohol, nicotine, and recreational drugs such as Ecstasy.
At the Sleep Medicine group of sleep centres we offer a specialised treatment service for patients who have insomina associated with substance abuse please contact us for further information.
Insomnia associated with specific sleep disorders. Insomnia can be associated with specific sleep disorders, including restless legs syndrome (RLS), periodic limb movement disorder (PLMD), sleep apnoea, and circadian rhythm sleep disorders.
Primary Insomnia: When other causes of insomnia are ruled out or treated, remaining difficulty with sleep may be classified as primary insomnia. Factors such as chronic stress, hyper-arousal, poor sleep hygiene, and behavioural conditioning may contribute to Primary Insomnia.
Sleep disorders
Sleep accounts for approximately one third of our lives, and a growing number of physicians believe that it should receive more attention from the medical community. Researchers have linked sleep-related illnesses to hypertension, stroke, congestive heart failure, depression, and an overall decreased quality of life.
At the Sleep Medicine group of sleep centres our expertise lies in the Diagnosis and Treatment of the following Sleep and Sleep Related Disorders:
Insomnia
Narcolepsy and Excessive Daytime Sleepiness
Obstructive Sleep Apnoea (OSA)
Restless Legs Syndrome
REM Sleep Behaviour Disorder
Sleep Walking and Sleep Terrors
Circadian Rhythm Disorders
Sleep and Activity Disorders of Childhood including ADHD
Chronic Fatigue Syndrome
Medical and Psychiatric Sleep Disorders
Anxiety Disorders
Panic Disorder
Depression
Dementia and Memory Disorders
Stress and Occupational Related Sleep Disorders
Menstrual Associated Sleep Disorder
Sleep Disorders in Pregnancy and the Postpartum Period
Monday, December 7, 2009
Effects of Obstructive Sleep Apnoea
Obstructive Sleep Apnoea is a significant cause of Excessive Daytime Sleepiness.
The following are effects of OSA: Metabolic Effects
Sympathetic overload; Supra Renal effects; Nocturia; Frontal Symptoms
The following are effects of OSA: Metabolic Effects
Sympathetic overload; Supra Renal effects; Nocturia; Frontal Symptoms
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