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.

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.

How do you know if you have insomnia? Insomnia is a condition which is specifically defined in  the DSMIV (the list of rules used to diagnose psychological illnesses). The current DSM version required the following conditions be met:

• For at least a month, the patient’s main complaint has been trouble going to sleep, trouble staying asleep, or feeling unrested.
• The insomnia causes daytime fatigue or impairs daytime functioning.
• The insomnia (or its daytime results) causes clinically important distress or impairs work, social, or personal functioning.
• Although it is serious enough to warrant clinical attention, the clinician believes that another Axis I or II disorder (such as Generalized Anxiety Disorder, Major Depressive Disorder, or Adjustment Disorder) causes it.
• Another sleep disorder (such as a parasomnia, Narcolepsy, or Breathing-Related Sleep Disorder) does not explain the symptoms better.
• The insomnia is not directly caused by a general medical condition or by the use of substances, including medications.