Sleep disorder centers are healthcare facilities aimed at improving individuals’ sleep quality and overall health. Sleep loss has harmful effects on individuals’ quality of life and nearly all organ systems. These centers diagnose and treat various sleep disorders faced by individuals of all ages. Expert evaluations for common sleep problems such as insomnia, sleep apnea, restless legs syndrome, and narcolepsy are conducted in sleep laboratories. Polysomnography, used to monitor and analyze patients’ sleep patterns, is one of the fundamental tests widely utilized in the sleep industry. At sleep disorder centers, doctors from various specialties including neurology, psychiatry, and pulmonology create tailored treatment plans for patients. Additionally, non-invasive treatment methods such as behavioral therapy and lifestyle changes are among the services offered at these centers.
What Are the Symptoms of Sleep Disorders?
Symptoms of sleep disorders can vary depending on their type and severity. Common symptoms of sleep disorders may include:
- Difficulties falling asleep
- Difficulties maintaining sleep
- Waking up early
- Fatigue and low energy
- Loud snoring
- Breath cessation
- Feeling of choking
- Night sweats
- Sudden need for sleep
- Sleep paralysis
- Constant need to move in individuals with restless legs syndrome
Types of Sleep Disorders:
- Difficulties in obtaining sufficient sleep (Dysomnia)
- Physiological events occurring during sleep (Parasomnia): Manifested with symptoms such as nightmares and sleepwalking.
Difficulties in obtaining sufficient sleep (Dysomnia):
- Insomnia: One of the most common sleep disorders. It can be referred to in individuals who have difficulty falling asleep at night, frequently awaken from sleep, wake up too early and cannot fall back asleep, or feel unrested despite getting sufficient sleep.
- Hypersomnia: Characterized by excessive sleep. In hypersomnia, individuals complain of extreme sleepiness. Additionally, daytime drowsiness is observed in these individuals. This excessive sleepiness causes significant distress and impairment in social, occupational, and other areas.
- Narcolepsy: This genetically-rooted sleep disorder is characterized by irresistible refreshing sleep attacks that occur daily for at least three months, along with loss of short-term muscle tone control. The most notable feature of narcolepsy is the sudden occurrence of excessive sleepiness, regardless of the amount of sleep obtained the previous night.
- Respiratory-related sleep disorder: Sleep-related breathing disorders are a medical issue. A range of breathing disorders can be observed during sleep, ranging from simple snoring to cessation of airflow (sleep apnea). Those who experience breathing problems during sleep may wake up numerous times throughout the night and may not feel rested even after 8-9 hours of sleep. Some patients may temporarily stop breathing (10-30 seconds), a condition known as apnea. The affected individual is often only slightly aware of their breathing difficulties and does not link the sleep problem to it. However, their sleeping partner may often notice loud snoring (a sign of this issue) or alarming instances of breath cessation. Other signs indicating that a person has difficulty breathing during sleep include:
- Excessive sweating at night,
- Waking up with a headache in the morning,
- Sleep attacks during the day that do not provide adequate rest.
Circadian (Daily) Rhythm Sleep Disorder / Sleep-Wake Cycle Disorder: There are various types of circadian rhythm sleep disorders. One of the most well-known is the condition caused by traveling across different time zones, referred to as jet lag. When there is a sudden change in the sleep-wake schedule according to the body clock, the individual struggles to adjust their sleep pattern. Many people complain of discomfort, fatigue, and disturbed sleep after transcontinental or oceanic flights.
Movement Disorders Related to Sleep:
Restless Legs Syndrome: Can be described as a deep, uncomfortable feeling in the legs during periods of prolonged immobility or while falling asleep. Because it affects sleep quality, it can also be categorized as a type of sleep disorder. This uncomfortable feeling is not a form of pain; it typically manifests as itching, tingling in the legs, rarely in the arms, a crawling sensation in the legs, burning, pulling, stretching, and tingling. An irresistible urge to move the legs arises to relieve this feeling, and movement reduces this sensation. This feeling often occurs during long bus and airplane journeys when sitting still for an extended period, frequently appearing before falling asleep at night. Restless legs syndrome occurs in about 3 to 10% of the population, equally among men and women. It generally appears in middle and older age but can also be observed in childhood.
Physiological Events Occurring During Sleep (Parasomnia)
Sleep Anxiety Disorder/Nightmare Disorder: Typically occurs during the second half of the sleep period. In this sleep disorder, individuals often experience long and extremely frightening dreams involving threats to their life security. Immediately after these frightening dreams, the individual wakes up and vividly remembers the dream. Most commonly, these nightmares occur during the second half of the night. About 50% of children aged 3-5 years experience nightmares.
Sleep Terror Disorder: This sleep disorder typically occurs at the beginning of sleep and starts with a panic scream. Seen in children aged 5 to 7 years, the individual often wakes up suddenly. During sleep terror, severe automatic and motor symptoms, including loud and piercing screams, are observed in the individual.
Sleepwalking Disorder: Characterized by getting out of bed and wandering around while asleep. Sleepwalking is common in children aged 5 to 12 years. Sometimes it continues into adulthood or can start rarely in adulthood. The duration of sleepwalking is usually less than 10 minutes. Individuals with a family history of sleepwalking have a higher likelihood of experiencing it. During sleepwalking, injuries and incidents of violence have been reported; however, individuals can usually navigate their surroundings. The most important intervention for a sleepwalking person is to ensure they do not trip over objects and injure themselves.
All these conditions must be diagnosed through a sleep test (polysomnography).
Sleep Test (Polysomnography)
A sleep test (polysomnography) is a sleep study. It involves the monitoring of normal and abnormal conditions experienced during sleep and helps in the clinical evaluation of the patient’s diagnosis by tracking parameters such as airflow from the mouth and nose, blood pressure, EKG activity, blood oxygen levels, brain wave movements, eye movements, respiration, muscle activity, and leg movements.
How is a Sleep Test Conducted?
Patients must arrive at the hospital at least 2 hours before their normal sleep time. Since the patient will spend the entire night in the sleep room, they should bring necessary personal items such as pajamas, slippers, toothbrush, and towel. Electrodes are placed on the chin, scalp, and the outer edge of the eyelids. These must remain in place during sleep. Signals from the electrodes are recorded while awake (with eyes closed) and during sleep. Monitors will be attached to the chest to record heart rate and respiration. The number and duration of breathing cessation will be measured. The amount of oxygenation during the night, shallow and deep sleep periods, sleep depth, snoring, and many other parameters will be measured. The data recorded throughout the night will be evaluated and concluded by a sleep specialist.
In our center;
- All Night Polysomnography (PSG) + Respiratory Records + PLM
- All Night Polysomnography + CPAP/BiPAP Titration
- PSG + Nocturnal Penile Tumescence Test (NPT)
- PSG + Sleep Activation EEG
- MSLT (Multiple Sleep Latency Test) is performed.
How is the Diagnosis of Sleep Disorders Made?
The diagnosis of sleep disorders can be made through a combination of detailed medical history, physical examination, and certain diagnostic tests. Following the physical examination, the doctor may request diagnostic tests to assist in the diagnosis. Some tests and procedures used in the diagnosis of sleep disorders include:
- Sleep diary: Patients are usually asked to keep sleep diaries for a period. In these diaries, patients record their sleep and wake times, awakenings experienced during the night, and other sleep-related events.
- Polysomnography (Sleep study): Polysomnography is considered the gold standard in diagnosing sleep disorders. This test involves overnight monitoring in a sleep laboratory and records numerous parameters such as brain waves, eye movements, muscle activity, heart rhythm, and respiration during sleep.
- Home sleep tests: In some cases, doctors may recommend home sleep tests. Although less comprehensive, these tests can be used for preliminary diagnosis of disorders like sleep apnea. Home sleep tests typically monitor breathing and oxygen levels.
- Actigraphy: Actigraphy monitors sleep-wake cycles using a small device worn on the wrist. This method is particularly useful in diagnosing sleep-wake rhythm disorders. The device helps assess sleep duration and quality by recording the patient’s movements.
- Blood tests and other laboratory tests: Some sleep disorders may stem from other underlying medical conditions. Therefore, doctors evaluate health indicators such as thyroid function and iron levels through various blood tests and other laboratory tests.
- Psychological assessment: Sleep disorders are often associated with psychological conditions such as stress, anxiety, and depression. Therefore, psychological evaluations may also be part of the diagnostic process. Doctors investigate the psychological roots of sleep disorders by assessing patients’ mental health.
- Electroencephalography (EEG): EEG is a test that measures the brain’s electrical activity and plays a vital role in diagnosing sleep disorders. This test is particularly used in diagnosing and evaluating neurological conditions like epilepsy.
- Multiple Sleep Latency Test (MSLT): The Multiple Sleep Latency Test (MSLT) is used to evaluate daytime sleep tendencies. This test is used to diagnose narcolepsy and other excessive daytime sleepiness disorders. MSLT is conducted by providing the patient with short sleep opportunities at specific intervals in a sleep laboratory. During each nap, the duration it takes for the patient to fall asleep and which sleep stage they enter is recorded.
What Are the Treatment Methods for Sleep Disorders?
Treatment methods are planned by specialist doctors based on the underlying causes and symptoms of sleep disorders. Various treatment options that may include the following can be utilized for sleep disorders:
- Medication therapy
- Cognitive Behavioral Therapy (CBT)
- Improvements in sleep hygiene
- Lifestyle changes such as regular exercise, healthy eating, and stress management
- CPAP (Continuous Positive Airway Pressure) device
- Uvulopalatopharyngoplasty (UPPP)
- Light therapy
How is the Treatment of Sleep Disorders Done?
The goals of treating sleep disorders are to alleviate symptoms and improve quality of life. Treatments are planned by specialist doctors based on the specific type and severity of the disorder. Some of the treatment methods may include:
- Cognitive Behavioral Therapy (CBT): CBT is an effective approach, particularly in treating chronic insomnia. This therapy aims to change negative thoughts and behaviors related to sleep. It includes strategies such as sleep restriction, stimulus control, and relaxation techniques. CBT addresses worries and misconceptions that make it difficult to fall asleep, improving sleep quality. In the long term, CBT has the potential to provide lasting improvements in sleep without medication.
- Medication therapy: Medications are used in the treatment of sleep disorders, particularly as a short-term solution under medical supervision. Sleep medications such as benzodiazepines and non-benzodiazepines may be prescribed for insomnia. In cases such as sleep apnea, medications that help keep the airways open are preferred. Dopaminergic medications can be effective in treating restless legs syndrome (RLS), while stimulants like modafinil and methylphenidate are used to reduce excessive daytime sleepiness caused by narcolepsy. However, long-term use may lead to dependence, so caution is advised.
- Improvements in sleep hygiene: Sleep hygiene refers to healthy sleep habits and improvements in the sleep environment. Avoiding electronic screens before bedtime and establishing regular sleep schedules can be beneficial. Additionally, avoiding caffeine and heavy meals is also important factors in sleep hygiene. Improvements in sleep hygiene, implemented under medical supervision, can be effective in managing insomnia and other sleep disorders.
- Lifestyle changes: Regular exercise under medical supervision, practicing stress management techniques, and maintaining a balanced diet can enhance sleep quality. Avoiding stimulants such as alcohol, caffeine, and nicotine can be effective in regulating sleep. These changes can contribute to the natural and side-effect-free management of sleep disorders in the long term.
- CPAP (Continuous Positive Airway Pressure) device: The CPAP device is an effective method recommended by doctors, particularly for treating sleep apnea. It continuously applies positive pressure to keep the airways open during sleep. CPAP improves sleep quality by preventing breathing cessation, providing uninterrupted sleep. This method can significantly reduce sleep apnea symptoms and improve the patient’s quality of life.
- Uvulopalatopharyngoplasty (UPPP): Uvulopalatopharyngoplasty (UPPP) is a surgical method used in the treatment of sleep apnea. This procedure involves removing part of the soft palate, uvula, and tonsils. The surgery improves airflow by widening the airway and reduces breathing cessation during sleep.
- Light therapy: Light therapy is a type of therapy designed to treat certain health conditions by exposing individuals to artificial light. During a light therapy session, the individual is indirectly exposed to artificial light that emits bright light similar to natural sunlight, known as a light therapy box. Light therapy can be recommended by doctors for treating circadian rhythm disorders and seasonal affective disorder (SAD). This treatment can help regulate the biological clock. Light therapy is especially effective for those working night shifts or experiencing jet lag.
Frequently Asked Questions
Sleep disorders are typically evaluated by specialists in neurology, psychiatry, and pulmonary diseases. The neurology department examines sleep disorders related to the nervous system, while psychiatry addresses those related to psychological causes such as stress, anxiety, or depression. Additionally, the pulmonary diseases department can plan necessary treatment methods for respiratory-related sleep disorders like sleep apnea.
Individuals with complaints of sleep disorders can initially consult the neurology or psychiatry departments. The neurology department evaluates sleep disorders related to the nervous system, while the psychiatry department addresses sleep issues related to psychological causes. Additionally, the pulmonary diseases department can be consulted for respiratory-related sleep disorders like sleep apnea.
Inability to sleep at night is typically a symptom of a sleep disorder known as insomnia. Insomnia can arise from various factors such as stress, anxiety, depression, or chronic pain. Additionally, respiratory disorders like sleep apnea or neurological conditions such as restless legs syndrome can also lead to difficulties sleeping at night.
Sleep problems are often caused by a deficiency in the hormone melatonin. Melatonin is a hormone that regulates the sleep-wake cycle. Additionally, deficiencies in vitamin D or iron can also affect sleep quality and lead to sleep disorders such as restless legs syndrome.
Sleep disorders can especially arise from a deficiency of vitamin D, as vitamin D has effects on the central nervous system and stress hormone levels. A deficiency in vitamin B12 can also affect nervous system functions, leading to fatigue and sleep issues. Additionally, iron deficiency can cause restless legs syndrome, which can negatively impact sleep quality.
Vitamin B12 deficiency can lead to sleep disorders. Vitamin B12 is critical for nerve system health and energy metabolism, and its deficiency can cause fatigue, weakness, and sleep irregularities.
Magnesium deficiency can lead to various sleep problems, including insomnia. Magnesium is an important mineral that plays a role in over 300 biochemical reactions in the body. It is vital for regulating nervous system and muscle functions. Its deficiency can make it difficult to fall asleep and transition into deep sleep.
A deficiency in vitamin D levels can be effective in the occurrence of sleep disorders. Vitamin D receptors are present throughout the body, including the central nervous system. These receptors control the sleep cycle and help achieve deep sleep. However, due to vitamin D deficiency, these receptors may not function properly. Additionally, vitamin D deficiency can lead to elevated levels of cortisol, known as the stress hormone, which can make sleeping difficult.
Individuals’ sleep quality can be impaired due to factors such as underlying disorders, poor lifestyle habits, or genetic predisposition. This situation can pose significant challenges in daily life. Individuals with sleep disorders can start treatment by making an appointment at sleep disorder health centers for quality sleep hygiene.
