Sleep Medicine

Bed wetting, also known as nighttime incontinence or nocturnal enuresis, is not a sign of toilet training gone bad. It is often just a developmental stage. Bed wetting is by far, most common in children, but has also been seen in adults, especially the elderly.

Children who have never been dry at night are considered to have primary enuresis. Children who begin to wet the bed after at least six months of dry nights are considered to have secondary enuresis.

Generally, bed wetting before age six or seven isn't cause for concern. At this age, nighttime bladder control simply may not be established. If bed wetting continues, treat the problem with patience and understanding. Bladder training, moisture alarms or medication may help.

What causes bed wetting?

No one knows for sure what causes bed-wetting, but various factors may play a role:

• A small bladder
• Inability to recognize a full bladder
• A hormone imbalance
• Stress
• Urinary tract infection
• Sleep apnea
• Diabetes
• Chronic constipation
• Anatomical defect

Although bed wetting is common with children, if you are concerned about this disorder contact the SSM Center for Sleep Disorders and we will evaluate the circumstances, diagnose the cause and recommend treatment, if needed.

Insomnia is a sleeping disorder characterized by persistent difficulty falling asleep or staying asleep despite the opportunity. According to the U.S. Department of Health and Human Services, approximately 64 million Americans regularly suffer from insomnia each year, and it is more common in women than in men.

What causes insomnia?

Insomnia can be caused by other problems, such as a medical condition that causes pain or use of substances that interfere with sleep. Common causes of insomnia include:

• Stress
• Anxiety
• Depression
• Medications
• Caffeine, nicotine, or alcohol
• Medical conditions
• Change in your environment or work schedule
• Eating too much late in the evening

Insomnia becomes more prevalent with age. As you get older, changes can occur that may affect your sleep. You may experience a change in sleep patterns, activity or in your health. In addition, the increased use of medications increase the chance of insomnia caused by a medication.

How is insomnia treated?

Insomnia can be treated with medications or by taking steps that promote sleep. Prompt diagnosis and treatment of the condition can greatly improve your quality of life and overall health, so don’t delay asking for help if you struggle with sleep. We understand the impact the condition can have on your life and will work with you to create a treatment plan that leaves you feeling rested and ready for your day.

Narcolepsy is a sleep disorder characterized by uncontrollable daytime sleepiness. If you have narcolepsy, you may experience the sudden onset of sleep at inappropriate times such as while working or driving, having a conversation, or being in any sedentary or non-stimulating situation.

What are the signs and symptoms of narcolepsy?

The signs and symptoms of narcolepsy include:

• Excessive daytime sleepiness
• Sudden loss of muscle tone. This condition, called cataplexy, can cause a range of physical changes, from slurred speech to complete weakness of most muscles, and may last for a few seconds to a few minutes. Cataplexy is uncontrollable and is often triggered by intense emotions, usually positive ones such as laughter or excitement, but sometimes fear, surprise or anger. For example, your head may droop uncontrollably or your knees may suddenly buckle when you laugh. Some people with narcolepsy experience only one or two episodes of cataplexy a year, while others have numerous episodes each day. About 70 percent of people with narcolepsy experience cataplexy.
• Sleep paralysis. People with narcolepsy often experience a temporary inability to move or speak while falling asleep or upon waking. These episodes are usually brief — lasting one or two minutes — but they can be frightening. You may be aware of the condition and have no difficulty recalling it afterward, even if you had no control over what was happening to you.
• Hallucinations. These hallucinations, called hypnagogic hallucinations, may take place when a person with narcolepsy falls quickly into REM sleep, as he or she does at sleep onset at night and periodically during the day, or upon waking. Because you may be semi-awake when you begin dreaming, you experience your dreams as reality, and they may be particularly vivid and frightening.
• Automatic Behavior. During episodes of automatic behavior, you continue to function during sleep episodes — even talking and putting things away, for example — but you awaken with no memory of performing such activities, and you generally do not perform these tasks well. As many as 40 percent of people with narcolepsy experience automatic behavior. People with narcolepsy may also act out their dreams at night by flailing their arms or kicking and screaming.

The signs and symptoms of narcolepsy can begin anytime up to your 50s, but they most commonly begin between the ages of 10 and 25. Narcolepsy is chronic, which means signs and symptoms may vary in severity, but they never go away entirely.

How is narcolepsy treated?

If your doctor thinks you have narcolepsy, you may be referred for a sleep study. In many cases, narcolepsy can be treated with medications and modifying your sleep habits. Prompt diagnosis and treatment of the condition can greatly improve your quality of life and overall health, so don’t delay asking for help if you struggle with sleep. We understand the impact the condition can have on your life and will work with you to create a treatment plan that leaves you feeling rested and ready for your day.

Night terrors are a type of disruptive sleep disorder that occur during the deepest phase of sleep. During an episode of night terrors, a person wakes in a terrified state. Although they are asleep, their eyes may be open. They feel unable to fully awake and can be difficult to comfort.  Once awake, they have no memory of the event but may have a sense of fear. Night terrors can last from 5 to 20 minutes.

Night terrors are not nightmares. Nightmares occur during REM sleep like most dreams. After awakening, most people can recall the nightmare like a long, movie-like dream.

Night terrors are common in children, but can also occur in adulthood. If you or your child experiences night terrors, schedule an appointment with your SSM Health provider to discuss your concerns and determine the steps you can take to get better sleep.

Periodic Limb Movement Disorder (PLMD) is a sleep disorder characterized by rhythmic movements of the limbs while you are asleep, typically resulting in fragmented and unrefreshed sleep.

What are the signs and symptoms of PLMD?

The movements associated with PLMD usually involve the legs, but upper extremity movements may also occur. Movements occur periodically throughout the night and can fluctuate in severity from one night to the next. They tend to cluster in episodes that last anywhere from a few minutes to several hours. These movements are very different from the normal spasms that we often experience initially while trying to fall asleep.

The causes of PLMD are unknown. However recent research has shown that people with a variety of medical problems, including Parkinson's disease and narcolepsy, may have frequent periodic limb movements in sleep. PLMD may be induced by certain medications, most notably, antidepressants.

A patient may occasionally have both Periodic Limb Movement Disorder and Restless Leg Syndrome.

How is PLMD treated?

If you’ve been diagnosed with PLMD, medications can help minimize your symptoms, including those that minimize movements and those that help you sleep through movements should they occur. If you experience the symptoms of PLMD, schedule an appointment with your SMS Health primary care provider to discuss your concerns. Our team will perform a thorough evaluation to determine the cause of your sleep problem and provide the support and follow-up care you need to finally get a good night’s sleep.

Restless leg syndrome (RLS) is a disorder that involves sensations in the lower legs that make a person uncomfortable unless the legs are moved. If you have RLS, you may experience an irresistible urge to walk or move your legs to relieve the discomfort. This can result in periodic episodes of leg movement during the early sleep stages. RLS symptoms may last for one hour or longer and are worsened by stress.

Restless leg syndrome can result in fragmented sleep and insomnia and occurs most often in occurs most often in middle-aged and older adults.

What are the signs and symptoms of restless leg syndrome?

• Difficulty sleeping
• Persistent leg movements during sleep hours
• Irresistible urge to move the legs
• Abnormal sensation in the legs (occasionally in feet, thighs, arms)
  • Creeping sensations or discomfort (not pain, not cramps) relieved by movement of the legs
  • The sensations usually occur shortly after going to bed, but may also occur during the daytime.
  • The sensations are worse when lying down

How is RLS is treated?

Restless leg syndrome can be treated with medication and lifestyle changes like exercise, massage, and stress reduction. If you experience the symptoms of restless leg syndrome, schedule an appointment with your SMS Health primary care provider to discuss your concerns. Our team will perform a thorough evaluation to determine the cause of your sleep problem and provide the support and follow-up care you need to finally get a good night’s sleep.

Sleep apnea is very common condition that affects more than 12 million Americans according to the National Institutes of Health. People with untreated sleep apnea stop breathing repeatedly during their sleep, sometimes hundreds of times a night and often for a minute or longer. These periods when breathing stops, called apneas, are followed by sudden attempts to breathe. The result is fragmented sleep that leads to insomnia and excessive daytime sleepiness.

What are the risk factors and complications of sleep apnea?

Sleep apnea can strike anyone at any age - even children - but certain risk factors make the condition more likely, including being male, overweight, and over the age of 40.

Because of the lack of awareness by the public and healthcare professionals, the vast majority of sleep apnea patients remain undiagnosed and untreated, despite the fact that this serious disorder can have significant consequences, including putting you at an increased risk for:

• High blood pressure and heart problems
• Types II diabetes and metabolic syndrome
• Liver problems
• Depression

What are the different types of sleep apnea?

There are three types of sleep apnea: obstructive, central, and mixed.

Obstructive Sleep Apnea: Obstructive sleep apnea is the most common type of sleep apnea. The condition is caused by a blockage of the airway, usually when the soft tissue in the back of the throat collapses and closes the airway during sleep.

Central Sleep Apnea: In central sleep apnea, the airway is not blocked, but the brain fails to signal the lungs to breathe.

Mixed Sleep Apnea: Mixed apnea, as the name implies, is a combination of obstructive and central sleep apnea.

What are the signs and symptoms of sleep apnea?

If you experience the following signs and symptoms, talk to your SSM Health physician about whether you may have sleep apnea:

• Loud snoring
• Witnessed periods of not breathing
• Awakening not rested in the morning
• Abnormal daytime sleepiness, including falling asleep at inappropriate times
• Morning headaches
• Recent weight gain
• Limited attention
• Memory loss
• Poor judgment
• Personality changes
• High blood pressure

After a discussion of your health history and symptoms, your doctor may refer you to an SSM Health Sleep Center for an evaluation. You may also undergo a sleep study, which is a specialized test used to diagnose sleep disorders.

How is sleep apnea treated?

If you are diagnosed with sleep apnea, your doctor will create an individualized treatment plan designed to improve your sleep. The most common treatments for sleep apnea include lifestyle changes, such as quitting smoking and losing weight, and continuous positive air pressure (CPAP), a device that sends air through your mouth and nose to keep your airway open while you sleep.

The sleep specialists at SSM Health are experts at diagnosing sleep apnea. Prompt diagnosis and treatment of the condition can greatly improve your quality of life and overall health, so don’t delay asking for help if you struggle with sleep. We understand the impact the condition can have on your life and will work with you to create a treatment plan that leaves you feeling rested and ready for your day.

Sleepwalking is a sleep disorder that causes people to get up and walk during their sleep. While sleepwalking usually occurs in childhood, adults can do it, too.

If you experience episodes of sleepwalking, schedule an appointment with your SSM Health primary care provider about whether an underlying medical condition is causing your sleepwalking and the steps you can take to help it stop.

What are the signs and symptoms of sleepwalking?

Sleepwalking typically occurs when a person is in the deep stages of sleep during the early portion of the night’s sleep. The sleepwalker is unable to respond during the event and does not remember sleepwalking. In some cases, sleepwalking is associated with incoherent talking. Sleepwalking occurs most commonly in childhood, but can last into adulthood.

Episodes of sleepwalking can range from quiet walking about the room to agitated running. Typically, the eyes are open with a glassy, staring appearance as the person quietly roams the house. On questioning, responses are slow or absent. If the person is returned to bed without awakening, the person usually does not remember the event. Older children, who may awaken more easily at the end of an episode, often are embarrassed by the behavior (especially if it was inappropriate).

What are the causes of sleepwalking?

Several different factors may be involved in the development of sleepwalking:

• Genetics
• Poor sleep habits
• Stress
• Alcohol consumption
• Certain medications
• An underlying health condition, such as asthma or seizures
• A sleep disorder, like restless leg syndrome or sleep apnea

How is sleepwalking treated?

While there is no specific treatment for sleepwalking, establishing good sleep habits can help.

It’s also important to create a safe sleep environment to minimize the risk of injury in the event you sleepwalk. Remove any sharp or harmful objects from your sleep environment, install locks on your doors and windows, and add gates to your stairs.

Finally, make an appointment with your doctor to discuss your symptoms. Together, you can determine whether a medication or underlying health condition is causing you to sleepwalk. Often times, treating the underlying illness can put an end to sleepwalking.

The polysomnogram, or overnight sleep study, is the most common test utilized to analyze your sleep. The polysomnogram consists of at least 13 sensors that monitor different aspects of your sleep.

During the overnight sleep study, the sleep technician will count the number of times you stop breathing or demonstrate shallow breathing during your sleep. If that number is five events per hour or more, you may have sleep apnea. If you demonstrate moderate to severe sleep apnea during the initial part of the study, the technician will come into your room and start nasal Continuous Positive Airway Pressure (CPAP) therapy. During the remaining portion of the study, the technician will adjust the air pressure setting on the CPAP until the sleep apnea is treated.

The Multiple Sleep Latency Test (MSLT) is used to measure the time it takes from the start of a daytime nap period to the first signs of sleep. The test is based on the idea that the sleepier people are, the faster they will fall asleep.

It can be used to test for narcolepsy, to distinguish between physical tiredness and true excessive daytime sleepiness, or to see if sleep disorder treatments are effective. Its main purpose is to serve as an objective measure of sleepiness.

The test consists of four or five, 20-minute nap opportunities that are scheduled about two hours apart. The test is often done following an overnight sleep study and is performed in the same room as the overnight study. During the test, things such as brain waves, EEG, muscle activity and eye movements are monitored and recorded. Between naps, you are allowed to walk around the sleep lab, or watch TV in the room. The entire test typically takes about 7 hours.

The Maintenance of Wakefulness Test (MWT) is used to measure how alert you are during the day. It shows whether or not you are able to stay awake for a defined period of time. This is an indicator of how well you are able to function and remain alert in quiet times of inactivity. The test consists of four 40-minute sessions in one of the sleep center bedrooms. You are asked to stay awake while the lights are very dim.

The MWT is used to see how well a sleep disorder patient is able to stay awake after starting treatment. It can also be used to help judge whether a patient is too tired to drive or perform other daily tasks. Sometimes the Federal Aviation Administration or Department of Transportation will require passing this test before a specialized license can be issued.