Things That Go Bump in the Night: A review of Sleep Disorders
What do Robin Williams and sleep disorders have in common? Answer: Lewy bodies. According to recent news reports, Robin Williams was found to have diffuse Lewy body disease. Lewy bodies are abnormal clumps of microscopic proteins that can be discovered in the brain during an autopsy or biopsy. Their specific location in the brain often determines the presentation of symptoms that we might observe when a person is still living, such as unusual sleep activity, problems with balance, and the onset of hallucinations. Lewy bodies are typically associated with REM sleep behavior disorder, Parkinson's disease, and a host of other unpleasant diagnoses and symptoms. However, my goal today is not to give you a lesson about Lewy bodies. Rather, I'm illustrating one of the many reasons why talking about sleep is so important.
During my interview with prospective patients, I tend to ask quite a few questions about sleep. These questions relate to both quantity and quality of sleep, as well as any noteworthy behaviors. It is often helpful to have a partner or spouse present during this interview, since most of us are unaware of the things that we do while we are asleep! I might ask, "Does (s)he ever yell out, thrash around, or even fall out of bed while (s)he's sleeping?" When a partner says something like, "Yes! Half the time, it looks like (s)he's fighting someone!" then my interview questions tend to meander down another path... A path that is usually more concerning and aimed towards identifying additional symptoms that could suggest one of the conditions that I listed above. Yet having a problem with sleep isn't unique to neurological disorders. Sleep disruption can also be linked to general health issues, dietary habits, the side effects of medications, alcohol consumption, the use of illicit substances, various mental health diagnoses, and even run-of-the-mill stress.
At this point, you might be skeptical that I'll be able to address all of the sleep disorders and the possible reasons for them in one blog post... And you'd be absolutely right! So instead of a comprehensive review, I'll whet your appetite with a list of some sleep-related symptoms and syndromes that I attempt to screen for during an evaluation: REM sleep disorders, circadian rhythm disorders, insomnia, hypersomnia (i.e. excessive sleepiness), chronic fatigue syndrome, narcolepsy, night terrors, nightmares, sleep paralysis, Restless Leg Syndrome, somnambulism (i.e. sleepwalking), hypnopompic and hypnogogic hallucinations, teeth clenching and grinding (i.e. sleep bruxism), snoring, and sleep apnea. While some of these syndromes are relatively easy to treat with medication, a medical device, psychotherapy, and/or behavioral modification, some of them are signs of a more insidious problem.
So how do you know whether you have a sleep disorder or whether you are simply stressed out? Well, knowing your age and the length of time that you've been bothered by these symptoms would likely be helpful. Then I would want to know whether there have been any changes in your medication regimen, whether you have experienced any recent major life events (e.g. death of a loved one, divorce, job change), and a little bit more about your medical history. If you are relatively young and in otherwise decent health, there is a high probability that your sleeping patterns are merely a reflection of your current emotional state combined with a handful of bad habits. But don't write this off just yet! Sleep is critical when it comes to your body's ability to function properly. While your body is sleeping, your brain remains extremely active. In addition to the basic sleep cycles, your brain also goes through a recycling process to cleanse itself of toxins that have built up throughout the day. Even one night of sleep deprivation can reduce your learning and memory abilities and cause your mood to plummet. So can you imagine what the cumulative effects of poor sleeping habits can have on your health?! Since this topic is worthy of further discussion, I plan on returning to it next month. As promised in my newsletter, however, I will first take a detour for the week of Halloween in order to focus briefly on Z O M B I E S.