There are many classified sleep related disorders but experiencing symptoms does not mean you have one! When you consistently show signs of disorder, night after night, and it’s beginning to have an effect on your life, that is when you should consider visiting a medical professional. Many sleep disorders can be fixed with small adjustments to your daily schedules and life choices.

Sleep Apnea
Persons with sleep apnea stop breathing several times during each night’s sleep. Each episode ends with a sudden snore. The cause may be a central nervous system problem or an upper airway obstruction. In rare cases, both causes may exist. Symptoms include excessive daytime sleepiness and complaints of poor sleep. In some people, this can be life-threatening and may require a respiratory aid or surgery.

Narcolepsy
This disorder of excessive sleepiness has four main characteristic symptoms: cataplexy, excessive daytime sleepiness, hypnagogic hallucinations, and sleep paralysis. Symptoms do not appear in any typical order, sometimes appear years apart, and may vary widely in severity. There is a genetic predisposition to inheriting the disorder.

Myoclonus – Periodic Limb Movements (PLM)
This disorder is diagnosed when highly stereotyped leg twitches repeat every 20 to 40 seconds. Episodes generally last from five minutes to two hours and alternate with periods of normal sleep. It is not the same as “hypnic jerks” which startle many of us as we fall asleep. The victim of myoclonus is usually unaware of leg movements, but complains of fragmented and unrefreshing sleep.

Insomnia
Insomnia is a disorder of initiating and maintaining sleep. The insomniac may be totally relaxed and still sleep poorly because of a weakness in the sleep system. This can be manifested as difficulties falling asleep, frequent nocturnal arousals, or earl morning awakenings. Transient insomnia lasts less than three weeks and usually has an emotional cause. Persistent psychophysiological insomnia usually starts with a prolonged episode of stress in a person who slept adequately, but not well, before the stress. Insomnia is often caused by drugs and alcohol. It may also accompany myoclonus (periodic limb movements).

Parasomnias
These are dysfunctions associated with sleep or partial arousals and may be associated with a specific stage of sleep or related to the transition between sleeping and waking. Patients may not know if they are awake or asleep and thus confuse activities, demonstrating such symptoms as sleepwalking, bedwetting, etc., or suffering sleep-relatyed headaches, abnormal swallowing, painful erection, or head-banging.

Disorders of the Sleep/Wake Schedule
People whose sleep time is shifted every few weeks may find their daily rhythms cannot adapt and may experience disrupted sleep. Even when circumstances later permit a regular schedule, it may be difficult to re-establish a good sleep schedule. Such people may develop mood changes, cognitive difficulties, and a tendency for peptic ulcers. Insomnia is common.

High doses of vitamin B₁₂ have been reported to relieve a few cases of DSPS and non-24-hour sleep-wake syndrome. Vitamin B₁₂ neither helps you wake up nor fall asleep in the short term, and it is not yet clear why vitamin B₁₂ would have an effect on circadian rhythms.

Reportedly, the dose needed for a significant effect in treating these circadian disorders is 2-3 mg per day, which is about 1000 times the ordinary recommended daily allowance. There have been no reported side effects from such large doses of vitamin B₁₂. Vitamin B₁₂ tablets are available from many drugstores and health food stores. The vitamin is also available in injectable form, but that is only for people who cannot absorb it at all from food.

Melatonin is a treatment for sleep/wake timing disturbances. It is a hormone whose concentration in the blood rises as the body prepares for sleep. It has been synthesized and can be taken orally, as a pill, at night to induce sleepiness and a seemingly natural sleep.

Melatonin has two effects which are of interest to individuals with DSPS. For many people, it advances the timing of sleep in the short-term, making them feel sleepy soon after they take it. Melatonin is also believed to have a chronobiotic effect – it actually helps reset circadian rhythms. Melatonin is the only known drug which resets circadian rhythms at safe doses. Ordinary sleeping pills, such as benzodiazepines (Flurazepam, Valium, and others), do not have this chronobiotic effect. Although in the popular press melatonin has received more attention than light therapy as a chronobiotic treatment for jet lag, recent research has indicated that bright light is a more powerful circadian phase-resetter than melatonin.

Advantages of Melatonin

• It is easy to take melatonin. Sleep deprivation isn’t necessary, although if you take too much you will feel tired or hung-over the next day.
• Big help for jet-lag.
• Is available over the counter.

Disadvantages of Melatonin

• Most people, if they could, would rather sleep without taking sleeping pills. It is possible for people with even severe DSPS to sleep at night without using melatonin at all. Ask yourself whether you are willing to take melatonin every night for many years. Would use of a sleeping pill make you lose the skill of falling asleep without medication?
• Buying, selling, or importing melatonin is restricted in some countries. If you do not know how to obtain melatonin, or whether you can legally bring it into your country, ask your local authorities.
• Some melatonin users have reported:
  • increase in vivid dreaming and nightmares
  • tiredness the following day
  • restlessness instead of sleepiness after taking melatonin
  • mood changes
• Melatonin has been shown to affect reproductive cycles and inhibit sexual development in animals. Its effects on humans are not known. Do not take melatonin if you are:
  • a child or adolescent
  • pregnant or breastfeeding
• There is some evidence to suggest that melatonin may have cardiovascular effects, and therefore might be detrimental in patients with cardiovascular disorders.
• Consult your doctor before taking melatonin if you:
  • are depressed
  • have an autoimmune disease, diabetes, leukemia, or a lymphoproliferative disorder
  • are taking MAO inhibitor drugs or corticosteroids

Dosage and Timing of Melatonin

If you decide to take melatonin for DSPS, take it at least 30 minutes before you want to fall asleep. Individuals vary widely in how much melatonin they need to take to bring about sleep. Start with a low dose of about 100 or 200 mcg (pronounced “micrograms”; 1000 mcg = 1 mg = 0.001 g), and if necessary work up to higher doses gradually.

Light therapy (phototherapy) is more widely used to treat Seasonal Affective Disorder, but it is also an effective method of adjusting sleep/wake timing. The principle behind it is that exposure to light in the morning advances the sleep phase, whereas light in the evening delays it.

For light therapy, you need a source of very bright light. Room lighting is not bright enough. Sunlight is good, if you have lots of windows or if you can get outside. You should never look directly at the sun, of course. Most convenient is an electric light box or light visor, available from some medical supply stores or by mail-order. A good light source will have the UV radiation filtered out. Remember that the intensity of light drops off exponentially with distance from the source. For example, if you double the distance between the light source and your eyes, the dose you receive is reduced by 75%. Treatment effectiveness also increases (up to a point) with the length of exposure – 30 minutes to two hours is often recommended.

Advantages of Light Therapy

• The light levels in commercial light therapy equipment are believed to be safe for eyes, at least in the short term and for people who do not already have eye disease.
• Does not require taking time off work or school.
• Light therapy daily or a few times a week is a simple way to maintain your sleep schedule once you have moved it to an earlier time.

Disadvantages of Light Therapy

• Certain medical conditions and medications are incompatible with light therapy. Check with your doctor if you are taking any kind of medication, or have any skin or eye disease.
• Headache is a possible side effect. It may help to avoid reading or having to focus your eyes during the light exposure. and to decrease the intensity of the light.
• Overdosage can make you feel “wired” and overstimulated – if this happens, decrease the time or intensity of the light treatment.
• The long-term effects of bright light treatment are not yet known.
• You can do other things in your morning routine while under exposure to light, but you may still need to wake up earlier than you normally would, so you can get enough light before leaving the house in the morning. You don’t have to get out of bed for light therapy, as long as you keep your eyes open.
• Equipment for light therapy can cost several hundred dollars (Canadian or US). If you have a doctor’s prescription for light therapy, and extended medical insurance, your insurance plan may cover it.
• Requires some time – a few days to two weeks – to take full effect. During this period, you will probably feel sleep-deprived.

Timing of Light Therapy and Sleep

Light exposure timed just before the middle of the night is most effective in delaying the sleep phase, and light timed just afterwards is most effective in advancing it. In this case, “night” refers to your night, so if you are used to sleeping between 4 am and noon, the middle of the night is around 8 am (give or take about an hour). The general rule is that light therapy for DSPS should begin as soon as you can get up in the morning. Minimizing your exposure to light in the evening may also be helpful.

There are different ways you can reschedule your sleep with the help of light treatment

1. Cold-turkey phase advance. That is, if you want to be getting up at 7 am, you force yourself up at 7 am, and don’t take naps, every day until (you hope) you get used to it. Light therapy upon waking should accelerate the adjustment.
2. Gradual phase advance. This means getting up a little earlier, e.g. by 15 minutes, every day or every other day, until you reach your desired wakeup time. It can take a long time if you are more than two hours away from the schedule you want.
3. Sleep deprivation-phase advance (SDPA) consists of staying up all night then moving bedtime one or 1.5 hours earlier the next night. If you are more than 1.5 hours away from your desired schedule, you can do this once a week on the weekends until you’re there. SDPA doesn’t always work – some DSP individuals cannot fall asleep until their normal bedtime even after staying up all night.
4. Cold-turkey phase advance with a nap. This involves getting up early for light therapy and going back to bed for a nap after the light treatment is over. You will probably find it easier psychologically to wake up early if you know you can go back to sleep again soon.